Locking Up the Mentally Ill, Involuntarily, is Making A Comeback

Worst-case scenario under Gavin Newsom’s CARE Court: you wind up here for a little while.

New York City Mayor Eric Adams just announced his initiative to renew involuntary commitment. A “common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent,” said Adams, with the New York Times reporting. “Going forward, we will make every effort to assist those who are suffering from mental illness.” 

If you find “suffering” and “mental illness” ambiguous, there in part lies the concern. Adams’ wording conjures images of straitjackets, frontal lobotomies, One Flew Over the Cuckoo’s Nest. It’s no longer clear just who’s in control at any given point in a mental health crisis. Where is the line, and who gets to draw it? 

Since the Reagan administration dissolved state hospitals, has psychiatric care improved?

Whatever side someone finds themselves on may ultimately depend on their public perception. I can’t help but ask what kind of atmosphere the shift might foster. When we look out for people who might need hospitalization, are we helping or surveilling? Mayor Adams described those he hopes his approach will assist:

“The man standing all day on the street across from the building he was evicted from twenty-five years ago waiting to be let in. The shadow boxer on the street corner in Midtown, mumbling to himself as he jabs at an invisible adversary. The unresponsive man unable to get off the train at the end of the line without our mobile crisis team. These New Yorkers and hundreds of others like them are in urgent need of treatment and often refuse it when offered.”

Brendan McGuire, chief counsel to the mayor, told the Times on Tuesday hat “workers would assess people in public spaces ‘case by case.’”

Involuntary Commitment in California: The Ball is Already Rolling

City Councilwoman Tiffany Cabán called Mayor Adams’ plan “deeply problematic” on Twitter, adding that consent was key in responding. “Often the wrong responder and response is what creates a deadly situation, not the mental health crisis itself.”

“Continue to do what you’ve done and you get what you got. And look what we’ve got. It’s unacceptable,” said Governor Gavin Newsom in September (AP). Adams’ seemingly old-fashioned method follows the statewide passage of similar legislation in California. On September 14th, Governor Gavin Newsom signed into law the Community Assistance, Recovery, and Empowerment (CARE) Court Act. “This (law) has been architected completely differently than anything you’ve seen in the state of California, arguably in the last century.”

The idea is this:

“Family, close friends, first responders and behavioral health workers will be able to submit a petition to the court, signed under penalty of perjury, on behalf of a person with untreated schizophrenia spectrum or other psychotic disorders that shows why they qualify for CARE Court. To qualify, the person must be either unlikely to survive safely without supervision or be a threat to themselves or others without support. The petition must include either an affidavit from a licensed health care professional who examined them or tried to—or proof the person was recently detained under intensive treatment.” —CalMatters, Tobias and Wiener

Newsom’s CARE Court seems intent on plugging a legal loophole, one New York appears to have as well. “Frequently, homeless people with severe mental illness are brought to hospitals, only to be discharged a few days later when their conditions improve slightly.” (NY Times) This situation is not a far cry from California’s current guidelines on involuntary commitment, in place since the late sixties. Under code 5150, authorities can detain anyone they deem dangerous to themselves or others for up to seventy-two hours. Code 5250 extends the hold for fourteen days but no longer, after which a team of professionals must declare the patient fit for release.

Now vs. Then

Remember in “Girl, Interrupted” when Winona Ryder sang “Uptown Girl” to a panicking-in-solitary-confinement Elizabeth Moss? My song would be Peaches’ “F*ck The Pain Away.”

Treatment looks radically different under Newsom’s CARE Court. “The court would then order a clinical evaluation of the person—and review the evaluation to see if the person qualifies for CARE Court services. If they do, they’ll get legal counsel and a ‘supporter’—an advocate to walk them through the process, as well as a ‘Care Plan’ that can include recommended treatment, medication and housing. Medication can be court-ordered, but not forcibly administered. During twelve months,” or one year, “a participant will have to attend hearings to make sure they’re adhering to the plan—and counties are providing the court-ordered services.” (CalMatters)

“If you’re real good, next year I’ll take you to New York. Ok, buddy?” —Gavin Newsom, probably

People hold New York, “a city with money,” accountable for its homeless population the same way they do San Francisco. In the same vein, Mayor Adams argued that his city had a “moral obligation” to help its mentally ill community. Vocal opponent Chief Executive of the New York Association of Psychiatric Rehabilitation Services Harvey Rosenthal called Adams’ idea unsound. “The mayor talked about a ‘trauma-informed approach,’ but coercion is itself traumatic,” Rosenthal told the Times. The mayor’s resolution, he added, relied on the same failed, overburdened system that can’t assist the cases they already have.

What are the terms of our “moral obligation?”

When it comes to solving homelessness in San Francisco, at least for the mentally ill, is involuntary commitment a paradox? Arguments of credibility and consciousness fuel endless debates over agency and autonomy. To be clear, agency centers the control one has over their situation; who’s in the driver’s seat? Autonomy refers to the extent of control you have over your body; who is bound and gagged in the trunk?

Stepping away from this gruesome metaphor, the insularity of this argument becomes clear. The burden of choice shouldn’t rest with the sufferer. Social services should intervene where hospital services are not clearly required. New York and San Francisco have/will continue to receive and provide resources to which all should be entitled. For those who want to go off-grid of their own volition, the city should always be prepared for your return.