N.Y. Picks Up, Commits Its Mentally Ill Street People

NEW YORK —  In action that could have profound implications for other cities and the nation’s health care system, Mayor Edward I. Koch announced Thursday that police and psychiatrists in New York City have begun to pick up from the streets and involuntarily hospitalize gravely mentally ill homeless people.

Eight street people, including one in handcuffs, were taken by vans to a new 28-bed psychiatric unit at Bellevue Hospital where they will be evaluated, medicated and eventually placed in state long-term care facilities or supervised housing. City officials estimated 480 people are candidates for the program this year.

The city invoked a broadened definition of its mental health law, allowing involuntary hospitalization of people unable to care for themselves who are at risk of harming themselves or others in the foreseeable future. Previously, the law had been more strictly interpreted, stressing situations where there was immediate danger.

“This precedent-setting initiative by the mayor will be shown (to signal) the change in which this society views the gravely disabled mentally ill,” said Dr. Sara L. Kellermann, New York’s commissioner of the Department of Mental Health, Mental Retardation and Alcoholism Services. “ . . . The aim is no one returns to the street.”

The program stresses the need for asylums or other forms of supervised shelter and seeks to reverse the trend toward freer discharge of mental patients. It immediately drew protests from the New York Civil Liberties Union. The group sent workers and volunteers into the streets and to places where the homeless congregate to inform them of their legal rights.

“Whenever government proposes to remove citizens from the streets and confine them involuntarily in a mental hospital,” said Norman Siegel, executive director of the New York Civil Liberties Union, “fundamental civil liberties are implicated . . . . There are hundreds of people out there who are frightened they will be picked up.”

“I am mad at myself,” countered Koch at a City Hall news conference. “I am sorry I didn’t have the energy and courage to do this five years ago. I just surrendered to the opponents . . . . We think there are eight people who are getting care who were not getting care before.”

Other city officials said they hoped the program would serve as a model for mental health systems elsewhere.

In New York and other major cities, the disturbed homeless have become a prevalent and persistent phenomenon. The tragedy can be seen in the case history released Thursday of one of the eight people brought to Bellevue under the new program. The man in his 40s lived alongside a highway near the garage of the United Nations headquarters in midtown Manhattan.

“He often sits on the highway with his feet hanging into traffic,” the history furnished by New York’s Health and Hospitals Corp. said. “He has been observed crossing lanes of traffic erratically and apparently unaware of the danger. He is often shirtless despite the rain and very cold weather.

Poor Physical Health

“He talks to himself and moves in a ritualized rocking and bowing. He is extremely avoidant. His physical condition is poor, very thin and malnourished . . . (he) has no awareness of illness. His judgment is extremely poor. His tentative diagnosis is chronic undifferentiated schizophrenia. He is in need of hospitalization. His inability to care for himself places him at serious risk.”

Advocates for the homeless estimate there are 70,000 to 80,000 street people in New York, but only perhaps 1,500 are so seriously mentally ill to qualify for the new program, labeled “Project Help.”

Four vans staffed by police, a psychiatrist and a social worker are used to transport the gravely mentally ill to the hospital, where they are bathed, given clean clothing and advised of their legal rights.

They undergo psychiatric evaluation, and can be held for 48 hours involuntarily, if two psychiatrists agree. Patients who are admitted are entitled to a court hearing within five days if they request the legal action.

Hospital officials estimate patients may spend three weeks in the special ward, before being placed in group homes, community residences or state psychiatric hospitals.

However, New York’s Partnership for the Homeless, a coalition of almost 400 churches and synagogues providing services to the homeless, said after-care facilities are inadequate and already burdened. While endorsing the mayor’s program, the partnership urged implementation be delayed until additional facilities are completed.

‘Do It Right’

“Our position is you should do it right from the beginning,” Peter Smith, the Partnership’s president, urged the mayor Thursday. “If you waited five years, a few more months wouldn’t hurt.”

Frustration over how to deal with the homeless mentally ill is not limited to New York. Federal studies estimate the homeless population of Los Angeles to be between 31,000 and 33,000 people, with at least one third severely and chronically mentally ill.

While California law allows mental health professionals to involuntarily detain people who are “gravely disabled,” the term is applied strictly. People judged to be an immediate danger to themselves in California can be hospitalized for up to 72 hours before a determination is made on the need for further care or hospitalization.

“The gravely disabled” criterion in Los Angeles is “used only in the strictest sense,” said Jill Halverson, director of the Downtown Women’s Center, explaining that large numbers of people who cannot feed, clothe or shelter themselves are ignored.

“Hundreds” each year in Los Angeles County are hospitalized “based on grave disability, but only in the most extreme circumstances,” added Elaine Lomas, director of the Los Angeles County’s Skid Row Mental Health Service and the Crisis Mobile Response Team. “If they’re mentally ill and violent, if they’re suicidal, or at the risk of dying. We never do it just because they’re in a poor state.”

Use Persuasion

Frances Griffith, homeless coordinator for the Los Angeles County Department of Mental Health, said about a dozen outreach teams of psychiatrists, social workers and paraprofessionals try to persuade the mentally ill to receive treatment.

“It is a very difficult process because people have to take these services voluntarily,” she said. “We have to work for months with patients sometimes before we even have eye contact.”

“There is a move here to expand the meaning of gravely disabled in the way New York is doing it,” Griffith added, “so we can pull more people off the street legally.”

John J. Goldman reported from New York and Penelope McMillan from Los Angeles.