Mental health advocates, lawmakers debate involuntary commitment expansion

New York has made it easier to involuntarily hospitalize people with severe mental illness as part of the state budget signed at the Capitol in early May by Gov. Kathy Hochul. 

“For too long, those who are suffering from mental illness, severe mental illness, they languish on our streets and our subways. People who pose a risk to themselves or others but also those who are too sick to secure proper health and shelter and food without help,” Hochul said in the spring. “This will allow us to connect people in the throes of severe mental illness with the life-saving care that they need and deserve.”    

State law previously allowed people with severe mental illness to be involuntarily hospitalized if two physicians determined they pose a threat to themselves or others. The updated law sets a standard to include people who are deemed unwilling or unable to support their basic needs, including food, shelter and medical care, due to their mental illness.

However, opponents of the updated law say it could be misused to involuntarily commit unhoused individuals without mental illness and argue lawmakers should invest more in voluntary community-based mental health services.  

During a February budget hearing at the Capitol, state Mental Health Commissioner Ann Sullivan told state lawmakers there are nearly 1,400 available inpatient psychiatric beds that can accommodate the expansion, which she said accounted for 15% of the state’s 9,200 inpatient psychiatric beds.

Citing high-profile violent incidents in New York City’s subway system, Hochul and Sullivan argued the new involuntary commitment standard promotes public safety while providing necessary care for people in need. 

“I’m talking about people who are physically ill who don’t understand their physical illness because of their mental illness,” Sullivan said. “[It’s] not going to overwhelm any number of hospital beds – it’s not an issue. It’s just to make sure that this small group gets the compassionate, ultimate care they need and you don’t want to leave them at this high risk in the community.”     

Sullivan added that 43 other states have enacted similar standards to involuntarily commit people with severe mental illness who can’t support their basic needs.

The state budget also commits an additional $16.5 million for counties to implement Kendra’s Law, which allows court-ordered outpatient treatment for mentally ill individuals with histories of hospitalization or violent actions. Additionally, the budget allocates $2 million to hire more state staff to oversee these outpatient treatment programs.  

Alex, a Long Island-based EMT who requested to only use his first name to discuss personal matters, said he was involuntarily committed in 2022 after attempting suicide. 

Alex, who was diagnosed with depression and PTSD in middle school, said he was forced to stay in a psychiatric ward for a week after being involuntarily hospitalized. He described the experience as dehumanizing because he felt his mental health had largely stabilized following his suicide attempt.  

“I had put a lot of thought and energy into just doing it the first time that afterwards, I was like, ‘I just don’t really feel like doing that again,’” he said. “And I expressed this to them, however, at the time, I wasn’t as composed as I would be now, so I might have been a little bit more aggressive with them. I never threatened anyone, never threatened myself again or anything like that, but I definitely was a bit agitated, and I probably could have gone about it a little bit better had I been a little bit more in control of myself.”

Although Alex enjoyed certain aspects of living in the ward, including communal activities like painting and lunch, he said the experience did nothing to improve his mental health after being discharged.  

“They put me on two different medications, which ended up not working out for me at all. I ended up going back on the exact same medication I started on,” he said. “In terms of my providers, I kept the same psychiatrist and therapist that I had prior too. In terms of home environment, I didn’t change anything. Yeah, nothing of note came out of it.”

Alex is part of a coalition of mental health and housing rights advocates who oppose the expansion and argue the state should instead invest more in voluntary community-based mental health services.

Luke Sikinyi, vice president of public policy at the Alliance for Rights and Recovery, which advocates for people with mental illness, said expanding the use of involuntary commitment could scare people from seeking help.   

“The folks who are going to be taking people off the street are almost always going to be police officers and for folks who are already really hesitant to be part of the system, seeing a police officer come to take you off the street involuntarily looks and often feels like an arrest,” Sikinyi said. “And for a lot of folks, that’s very traumatizing to them and it really pushes people away from the system in the first place, rather than towards the system that can provide that support and provide that long term housing and food security and nutritional support, but also that shelter and clothing for long periods of time.” 

Harvey Rosenthal, the alliance’s CEO, argued that expanding involuntary mental health services will target people of color as Black and Hispanic individuals disproportionately receive court-ordered outpatient treatment, according to data released by the state. Studies have shown white individuals have an easier time accessing healthcare than people of color largely due to the cost of care.       

However, Rosenthal called the governor a “historic leader” for her $1 billion multi-year investment in the state’s mental health care system since taking office, including funding for more housing units designed for people with mental illness.

The new state budget includes nearly $200 million for mental health services, with the majority of funds going toward 100 new inpatient psychiatric beds in New York City for individuals who have been charged with crimes. The budget also funds voluntary programs championed by mental health advocates including community support clubhouses, peer-led Intensive and Sustained Engagement teams that support people throughout their recovery journey, and a new program to help hospitalized individuals transition back into society. 

Additionally, the budget includes $8 million to create unarmed response teams across the state to address crises involving mental illness or substance abuse. This comes amid calls for state lawmakers to pass Daniel’s Law, which was named after a man who died in Rochester Police custody during a mental health crisis.   

Assembly Mental Health Committee Chair Jo Anne Simon, a Brooklyn Democrat, said she worries the new involuntary commitment standard will lead to unhoused individuals being falsely accused of crimes or being mentally ill.

“The reality is that people with disabilities with mental illness are 11 times more likely to be victims than perpetrators, and so we need as a society to get away from this criminalization of homelessness and mental illness,” Simon said. 

More than 30 mayors and town supervisors across the state wrote a letter in March urging state lawmakers to codify the expansion. Among the officials was Albany Mayor Kathy Sheehan, who said the Albany Medical Center Hospital makes the city a focal point for people experiencing mental health issues.

“When they are not able to be placed in a bed there because they refuse, they are put right back out onto the sidewalk,” Sheehan said. “They’re not returned to their home. They are oftentimes placed out on the sidewalk in the city of Albany, in distress, in need of care. And so we are very disproportionately impacted by what is a national crisis.”

J.T. Stone is a graduate of the University at Albany. He previously interned with WAMC Northeast Public Radio and Spotlight News covering New York’s capital region.