New York, NY—GMHC has several concerns about the mayoral mental health plan for involuntary hospitalization of homeless individuals in distress. As an organization with decades of experience working with people living with and affected by HIV and AIDS who have mental health needs, as well as a need for stable and supportive housing, we recommend that the city instead create a pilot program that can help a smaller group of people in need. Following this group of people in mental health crises, while tracking each step of meeting basic needs, would allow for assessment of how New York City can evaluate the program for expansion.
Presently, there are not enough hospital beds available in New York City, along with a substantial lack of affordable housing, followed by not enough services for mentally ill people. If a mentally ill person is forcibly brought to a hospital only to find out there is not access to group or individual housing after they leave, what happens next? They could be discharged without a treatment plan and end up back in the shelter system, which is already overloaded, or on the streets. Thus, the deficient cycle of lack of treatment and care comes full circle—again and again. People are not homeless solely because they do not want mental health treatment.
A pilot program must allow for assessment by mental health specialists, followed by creating a coordinated care plan for when individuals are discharged from an inpatient program. Then, community providers—such as GMHC—could help with assessment if supportive housing is needed, as well as linkages to care. This support can include guidance on how to live in their own home, what tools they will need to maintain the home, linkages to individual and group counseling, medication adherence, preparing for job training, addressing other life challenges—and more.
The process of working with people in mental health crisis—whether they are considered in an extreme or moderate state—takes time and consistent care, perhaps a full year from assessment to independent or group living. Moreover, a second stage of planning, which would not be punitive, needs to be created for people who are not able to comply with a program.
Community providers must be brought to the table for planning as well as mental health specialists, law enforcers, and most importantly, people living with mental health issues. Those with lived experience can tell us what is or is not working.
This kind of planning and evaluation could also support increased funding opportunities for community-based organizations and health centers providing care and psychosocial support services.