THE BAJA POST
SOURCE: PR MEDIA
Humans, our experiences, and the conditions that shape us are beautifully and painfully complex. The experiences we have, including our mental health needs, should be treated with care, respect, inclusiveness, thoughtfulness, and dignity. Above all, we must approach human needs through a lens of racial and social justice to ensure that we center cultural humility and health equity. – Dr. Claire Green-Forde
The National Association of Social Workers-New York City Chapter (NASW-NYC) is following developing announcements from several sources, including the New York Times (NYT) who released an article titled «New York City to Remove Mentally Ill People from Streets Against their Will» on November 29th, 2022. Like the organizations, agencies, and people who have been voicing concerns across social media and reaching out to NASW-NYC in light of the announcement, we too learned of the Mayor’s plan to involuntarily hospitalize people, when it was announced. NASW-NYC will continue to monitor these unfolding developments, seek to work collaboratively with our partners to evaluate the implications, and mount a more comprehensive response as we learn more.
The referenced NYT article opens:
«Acting to address ‘a crisis we see all around us’ toward the end of a year that has seen a string of high-profile crimes involving homeless people, Mayor Eric Adams announced a major push on Tuesday to remove people with severe, untreated mental illness from the city’s streets and subways». Mr. Adams, who has made clearing homeless encampments a priority since taking office in January, said the effort would require involuntarily hospitalizing people who were a danger to themselves, even if they posed no risk of harm to others, arguing the city had a ‘moral obligation’ to help them.»
Based on the article, it appears that the task of determining whether someone has a serious mental illness (SMI), is experiencing a psychiatric emergency, or is a danger to themselves, will be left to the New York City Police Department (NYPD), Emergency Medical Service (EMS) professionals, and other first responders. If this is indeed the intention, it is unconscionable and places an unfair and undue burden on NYPD and other first responders. This approach also puts the personal and professional well-being of first responders at risk if they are expected to operate outside of their scope of training and practice. Social workers and other mental health practitioners are highly trained behavioral health specialists and require years of specialized education, training/clinical internship hours, extensive experience, and successfully passing national licensure exams, to be credentialed. Expecting police officers to recognize, assess, and make decisions about SMI when they don’t have the experience and training to do so, is dangerous and places communities at risk. There have been many incidences of people experiencing serious mental illness or a psychiatric crisis being killed when police respond to calls.
The needs of New Yorkers are complex and require thoughtful, holistic responses; we all have a fundamental right to be safe. New York City continues to grapple with several crises related to immigration, humanitarian needs, economic hardships, poverty, housing, criminal justice, and mental health. There has been mounting political and social pressure to respond to the increase in crimes, encampments on the streets, and the financial hardships impacting countless families and businesses. NASW-NYC understands that people are demanding changes and we agree that changes need to be made. NASW-NYC calls for changes that center equity, racial and social justice, the right to self-determination, and the dignity and worth of all individuals. Social workers are among the largest providers of mental health services in the country, including New York. Plans that will undoubtedly impact those already at risk, while minimizing or ignoring the specialization and training required to adequately address NYC’s mental health needs, adds to NASW-NYC’s growing concern. Further adding to our concerns is the ongoing rhetoric that people who live with a mental illness are inherently violent —this false rhetoric must stop! Are there people who live with a mental illness who may also happen to commit acts of violence? Absolutely! However; there are vastly more people who are not living with a serious mental illness (SMI), who commit violent crimes. We must stop conflating mental illness with violence. There are countless academic articles and stories calling out the tendency to scapegoat mental illness; these stories highlight the fact that people who are mentally ill are typically the victims of crime, rather than the perpetrators. In order to positively move towards a path of understanding and comprehensive response, NYC leaders and residents must be properly educated about mental health. It is dangerous to conflate people who are living with mental health needs, people who are having a psychiatric emergency, people who are committing crimes, and people who are being targeted, scapegoated, and criminalized because of poverty. These are not the same and should not be treated as such.
It would be hasty of NASW-NYC to take a firm position on a newly developing story; we acknowledge that having not been invited to participate in this plan, there are many elements related to its development that we are not privy to. That said, having reviewed Mayor Adams’ Psychiatric Crisis Care Legislative Agenda, we understand that this is a difficult process yet, there were several areas for concern, including that the plan does not appear to be as comprehensive as would be expected. Additionally, the plan does not appear to have a lens of true inclusivity; it is critically important to include the perspectives and voices of people with direct lived and professional experiences when developing plans to address mental health. Social workers who directly engage with, assess, and treat people living with mental health needs, do not appear to have been included at all or substantially in the development of this plan. The plan contains several gaps, including ones that may potentially place social workers and other mental health service providers in ethical dilemmas or create conflicts with their professional values and established code of ethics. Highly specialized and trained voices, including the social work lens, are necessary and should always be included when developing plans with such deep implications. The social work lens is critical – these issues are equally related to racial and social justice, as they are to access to quality care and health equity.
NASW-NYC, social workers, and other trained mental health practitioners, seek to support initiatives that are comprehensive, inclusive, culturally respectful, and designed with the interest(s) of those in need. We are keenly aware that adequately supporting the mental health needs of NYC is a huge undertaking. Doing so would require significant financial investment, truly assessing the current mental health infrastructure and making substantial changes, and necessitates a commitment from NYC leaders and community stakeholders to include those best positioned to address those needs in the decision making process.
We would be remiss if we did not acknowledge the deeply fractured and bifurcated system of care in New York City’s mental health system. As an example, a recent article re-published by the Brooklyn Daily Eagle titled «Public Schools are NYC’s main Youth Mental Health System. Where Kids land Often Depends on what Their Parents Can Pay» squarely highlights the bifurcation in mental health service provision as well as the inadequacies, impacting NYC youth. The Mayor’s plan failed to acknowledge the significant backlog and challenges with the courts and Kendra’s Law/ Assisted Outpatient Treatment (AOT) programs in New York. It did not deeply acknowledge that our hospitals, community based organizations and clinics are woefully underfunded and understaffed, nor did it recognize that clients are forced to navigate the impact of pervasive underfunding and structural inequalities in the social and health care sectors. The plan didn’t acknowledge that clinicians are leaving the industry because of a lack of support, the ongoing refusal to fairly compensate social workers for their skills, training and education, high caseloads, and burnout.
If there is a plan to involuntarily admit people «even if they posed no risk of harm to others«, our questions to the Mayor and the administration are as follows:
- What are your immediate plans to adequately staff and fund the hospitals and systems of care?
- How and when will you staff the courts, revamp the AOT process, and thoroughly educate that system around mental health?
- What is the plan to support discharge planning in hospitals and fund the community based organizations receiving referrals?
- What is the plan to staff and fund the housing service networks who are a significant part of the aftercare network?
- What plans have you created to increase the behavioral health provider pipeline and what incentives will you provide to encourage pipeline growth? Will loan forgiveness and fair compensation be incentives you consider?
- What is the plan to support uninsured and insured clients as insurance companies will more than likely deny lengthy inpatient stays as well as evaluations and treatment that they deem unnecessary?
- How will you ensure racial and social justice, root out biases in these processes, and hold the system and people accountable to be anti-racist and anti-oppressive?
- Are you asking providers to fabricate diagnoses and provide treatment against people’s will? If yes, is the intention simply to move people who are unhoused off the street so that they don’t highlight the inequities that exist, particularly as it relates to housing, poverty, social, and racial discrimination in NYC?
Until these questions can be answered truthfully and comprehensively by the current mayoral administration, NASW-NYC cannot in good faith, support this plan in its current form as it goes against the core values of the social work profession. NASW-NYC continues to express our willingness and readiness to partner with the current Mayoral administration to thoughtfully address many of the bio-psycho-social needs impacting NYC. Most of the concerns noted for NYC – mental health crisis, housing crisis, immigration and humanitarian needs, substance misuse etc. are all areas that social workers are highly trained and skilled to address. We remain hopeful that the Adams administration, elected officials, and other stakeholders will be willing to extend the offer of partnership to NASW-NYC and the social work community, in better service to New York City.