January 15, 2022. The New York subway line R platform in Times Square is frozen. And for good reason, this hive usually teeming with tourists and locals has turned into a crime scene. A little before 10 a.m., Michelle Go, a 40-year-old New Yorker, volunteer in an association for the homeless, was pushed in front of a train entering the station. The author of the fatal gesture suffered from schizophrenia.
The tragedy aroused great emotion in New York, where such incidents were numerous in the 1980s and 1990s, a dark period in the history of this city marked by high crime. Above all, it revealed the mental health crisis that has been eating away at the Big Apple for years – and which the Covid has amplified.
In the streets, train stations or transport: difficult to move these days without meeting men and women suffering from psychiatric disorders, sometimes severe (bipolarity, schizophrenia, psychosis…). “I pay much more attention to my surroundings than before. In the stations, I no longer put on the edge of the platform to avoid being pushed onto the tracks”says Art Harvey, a long-time resident.
Feeling of insecurity
Last November, New York Democratic Mayor Eric Adams announced a controversial directive to address the sense of insecurity that has spread amid mounting incidents. The former police officer, elected in 2021 in a context of rising crimes in the wake of the pandemic, evokes the ” obligation morale to help the most vulnerable. He authorized law enforcement and emergency medical personnel to ” to withdraw » from the street and the metro the mentally ill whom they consider incapable of treating themselves, in order to place them in hospitals. And this, even if they do not represent a danger to others.
It would suffice, for example, for the authorities to consider that an individual is unable to meet his basic needs (to eat, to dress, etc.) due to psychiatric problems for him to be taken away. A particularly light regulation in view of that which is current in Europe, and in particular in France, where hospitalizations without consent, very framed, can only take place at the request of a relative, a doctor or justice .
A policy considered retrograde and ineffective
Mayor Adams’ directive, which specifies the conditions for applying a law adopted in 2021 at the New York State level, has therefore caused a stir. Several associations took her to court last December. In vain. For Phyllis Vine, an author specializing in mental health across the Atlantic, the mayor’s policy is not only retrograde but ineffective. ” Voluntary participation in care is a more durable solution than when it is coerced “, she observes. She is particularly concerned to see the police tasked with assessing the mental health of individuals.
According to a database compiled by the daily The Washington Post, people with psychiatric conditions accounted for almost a quarter of those killed by officers in 2018 nationwide. Non-white populations are disproportionately affected by this reality.
A decision against the grain
After the murder of African-American George Floyd in 2020, several municipalities (San Francisco, New York, Portland, etc.), under pressure to reduce police violence, launched initiatives to replace police forces during certain interventions. order by mental health professionals trained to manage potentially volatile individuals. Objective: to reduce the number of dangerous interactions while lightening the workload of the police in a context of exodus of officers. Eric Adams’ decision bucks that trend.
In New York, the most populous city in the United States with eight million inhabitants, the assistance of individuals suffering from untreated mental illnesses, delivered to the streets, is a sensitive and old subject. In 1999, New York State passed “Kendra’s Law” which allows the courts to impose psychiatric treatment on an individual considered a danger to themselves or others because of their mental state.
The text resulted from the murder of Kendra Webdale, a New Yorker pushed in front of a subway train by a schizophrenic man. A few days after it came into effect, a woman was bricked on the street by an unbalanced person, for no apparent reason. The episode led the local tabloid, The New York Daily News, to call on the mayor at the time, Republican Rudy Giuliani, to rid the sidewalks of ” violent lunatics ».
Lack of infrastructure
For Lisa Dailey, director of the Treatment Advocacy Center (TAC), an association that campaigns for the development of care solutions for people affected by “severe” illnesses (bipolarity, schizophrenia, acute depression, etc.), this reality illustrates the lack of infrastructure to help patients. ” The situation has worsened since the 1950s and 1960s when hospitals, rightly considered to be abusive, found themselves under pressure to close beds. Today, we lack structures and health professionals. The system is unable to provide a continuum of care. Result: the condition of the patients worsens. The pandemic has accentuated these challenges.she explains.
TAC founder Dr. Fuller Torrey has long been an advocate for the forced placement of people with severe disorders. This position, forged by his experience alongside his schizophrenic sister, earned him a long marginalization from the scientific community.
The octogenarian is pleased today to see his ideas taken up by left-wing bastions such as New York, but also California, whose Democratic governor, Gavin Newsom, recently ratified a law authorizing justice to force certain mental patients to follow. a treatment plan, at the request of their relatives or doctors. ” Many sufferers do not know they are. It’s inhumane to leave people on the street when they don’t even know they have a problem.explique Fuller Torrey. Progressive municipalities can no longer ignore the subject. The numbers have become too large. Public opinion is tired. »
Strengthen police training
He recognizes it: recourse to the police “ is not an ideal solution”. « Interventions should be led by social workers “, he says, pleading in particular for the development of rehabilitation programs. Keith Ross, a former police officer who teaches at John Jay College of Criminology in New York, agrees. ” Historically, when a city agency can’t fix a problem, the police pick it up. In this case, officers receive training on mental health, but it lasts only a few weeks. However, those in the field sometimes find themselves in situations where they have to make decisions in a fraction of a second. ».
Eric Adams promised to strengthen police training in this area, while calling for increased resources to take care of individuals taken from the street (additional beds, treatment plan before leaving hospital, etc.). But according to Phyllis Vine, forced placement risks having a traumatic effect on the sick. And this, while a number of non-coercive solutions and initiatives exist to build bonds of trust between the institutions and the patient. ” As soon as we start from the principle that we can force people to seek treatment because they would not be aware of what is happening to them, we open the door to a world where isolation, coercion and medication by force become acceptable. »
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Psychiatry in need of resources
The number of beds in psychiatric units fell by 12% between 2000 and 2018 across New York State. There were 5,419 in 2018.
72% of bed cuts between 2000 and 2019 concentrated in New York City, a loss of 459 beds.
280,000 New York adults have a severe psychiatric disorder (schizophrenia, acute depression, etc.), i.e. 3% of the population.
17% of New Yorkers are homeless suffered from severe mental illness in 2020.
A quarter (26%) of homeless shelter users with serious mental illness, such as schizophrenia, are not placed in specialized accommodation structures.
In 2022, more than 1,300 people were evacuated from the New York subway by the police because they showed signs of emotional distress.
Sources : Ville de New York ; Coalition for the Homeless ; HUD, New York State Nurses Association