Should the Homeless Be Hospitalized?

You remember Phil Collins singing about “another day in paradise.”?


Here in Manhattan, mayor Eric Adams is under attack for his approach to what we’ve come to call homelessness. This week the mayor announced the city would begin hospitalizing more of the population that is in “psychiatric crisis.” In reading the new directive, I was surprised by how little of a policy shift it should represent.


Here’s the heart of it…


Section 9.41 authorizes a peace officer or police officer to take into custody, for the purpose of a psychiatric evaluation, an individual who appears to be mentally ill and is conducting themselves in a manner likely to result in serious harm to self or others.


Similarly, the written policy maps out a role for designated clinicians, who may remove or direct the removal of any person to a hospital for the purpose of evaluation for admission – if such person appears to be mentally ill and is conducting themselves in a manner likely to result in serious harm to the person or others.


That’s pretty much the law of the land, born of both progressive and libertarian thinking that doesn’t condone detaining an individual against their wishes. Which certainly makes sense when the person is mentally healthy. And this has been our approach in the decades since a shift toward de-institutionalization that has coincided with the rise of mass incarceration. Which leaves police in the untenable position of having little choice but to lock up those who are more in need of treatment.


I get that the causes are many and complicated. And the problem widespread– most common to big cities. I’ve witnessed homelessness here in New York, Washington, in Los Angeles, in the tenderloin section of California. You might remember my interview with the mom from Washington state who traveled to San Francisco in an unsuccessful effort to rescue her homeless, drug-addicted daughter.


California has a massive problem. Governor Gavin Newsom has pledged to make it a priority, and last month he paused one billion in state spending for local government’s homeless programs, saying plans submitted were simply unacceptable.


About a month ago, early on a Saturday morning, I stopped at a Wawa in center city Philadelphia to get coffee. Getting back in my car, I spied a man nearby on a vent. Prone. In an awkward position but nonetheless sleeping. On any other day, I would have kept moving. That day I stopped and watched, transfixed by the sadness of the situation.


What is it about me, about us, that has so easily enabled the desensitization to the plight of human beings? A tolerance that would never apply to a pet in distress? I don’t have it figured out, but I know the status quo is not working.


We are doing these people no favor by continuing with failed policy. Which is why I credit Eric Adams for trying. Just after he was sworn in last January, a woman was pushed to her death in front of a subway by a mentally ill man who’d been in hospitals, jails, and on the street for decades. That and other incidents have caused him to act. The policy for which Adams is now being criticized exists in theory all over – it’s just not being enforced.


The universal standard is to not intervene unless a person poses a risk to themselves or someone else. We know what it means to be a danger to another. That’s physicality. Or an act or threat of violence. Harder is defining a threat to someone themselves.


The New York City policy says this:
“Case law does not provide extensive guidance regarding removals for mental health evaluations based on short interactions in the field. But it does suggest that the following circumstances could be reasonable indicia of an inability to support basic needs due to mental illness that poses harm to the individual: serious untreated physical injury, unawareness or delusional misapprehension of surroundings, or unawareness or delusional misapprehension of physical condition or health.”


That’s the hard part. Defining “Harm to the individual themself.”


The guy I watched on the vent didn’t appear to have a physical injury. There’s no way of knowing if he has a delusional misapprehension of his surrounding or unawareness of his own condition or health without engaging and assessing him. But he’s clearly not thinking rationally. Probably due to mental illness and or substance abuse.


At its root, that’s what this is… underlying conditions that lead to loss of shelter. The lack of a roof is a manifestation, not the problem itself. Homelessness is the wrong descriptor. Housing alone won’t fix the addiction and illness that are the drivers. Which is not to say they don’t need shelter: they do. Adams will be fairly judged by how well he cares for those he removes from the streets. It would not be lawful for him to remove them, unless he can care for them.


Eric Adams says we have a “moral obligation” to try and help them. I’m hoping others follow his lead. This initiative is reminiscent of something presidential candidate Franklin Roosevelt said in 1932 amidst the great depression. Roosevelt called for “Bold, persistent experimentation.” Adams is doing that; let’s give him a chance and save our criticism for mayors not trying anything new.


Michael Smerconish

Using the perfect blend of analysis and humor, Michael Smerconish delivers engaging, thought-provoking, and balanced dialogue on today’s political arena and the long-term implications of the polarization in politics. In addition to his acclaimed work as nationally syndicated Sirius XM Radio talk show host, newspaper columnist, and New York Times best-selling author, Michael Smerconish hosts CNN’s Smerconish, which airs live on Saturday at 9:00 am ET.

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