COLUMBIA SOCIAL WORK REVIEW, VOL. XIX | 3 New York's Directive for Mental Health Involuntary Removals: The Intersectional Risk for Unhoused New Yorkers with a Serious Mental Illness LANYA SNYDER 4 | COLUMBIA SOCIAL WORK REVIEW, VOL. XXI NEW YORK’S DIRECTIVE FOR MENTAL HEALTH INVOLUNTARY REMOVALS ABSTRACT Behavioral health care, more commonly known as psychiatric care, has been a longstanding and complex issue, especially for marginalized New Yorkers. Healthcare policy addressing and caring for people diagnosed with a serious mental illness is fundamental to basic human rights; at the same time, it is a nuanced matter. Policies surrounding economic issues of poverty and housing instability are inextricably linked to social issues of mental and physical healthcare. Healthcare policy and the experience of homelessness are closely SPURLK�MVY�[^V�YLHZVUZ!�ÄYZ[��[OL�OPNO�JVZ[�VM�OLHS[OJHYL�JVU[YPI\[LZ�[V� poverty for many Americans; and second, the poor and the aging are [OL�TVZ[�SPRLS`�[V�Z\ɈLY�MYVT�PSSULZZ�HUK�OPNO�TLKPJHS�L_WLUZLZ��4HY[PU�� 2015). This paper will consider the intersectional risk for unhoused New York City residents with a serious mental illness in light of Mayor Eric Adams’ recent directive for Mental Health Involuntary Removals. This new directive enables authorities to forcibly transport unhoused New Yorkers to hospitals to remove them from public areas. Although the current mayoral administration frames this as a moral obligation to act on behalf of New Yorkers with a serious mental illness, it is far MYVT�HU�LɈVY[�[V�LUZ\YL�[OH[�L]LY`VUL�OHZ�OV\ZPUN�HUK�YLJLP]LZ�IHZPJ� healthcare. Adams’ misguided policy is a veiled attempt to make the city HWWLHY�ZHMLY�^OPSL�KVPUN�SP[[SL�[V�HZZPZ[�[OVZL�^OV�HYL�Z\ɈLYPUN�HUK�MHPSZ� [V�HKKYLZZ�PU[LY]LU[PVUZ�MVY�[OL�YLHS�PZZ\L�H[�OHUK!�OV\ZPUN� COLUMBIA SOCIAL WORK REVIEW, VOL. XXI | 5 LANYA SNYDER O n the morning of January 15, 2022, Michelle Go, a 40-year- old Chinese-American, was fatally pushed onto the subway [YHJRZ�H[�;PTLZ�:X\HYL��4HY[PHS�:PTVU��[OL�PUKP]PK\HS�^OV� committed this unprovoked act, emigrated to New York from Haiti in his teens and had been experiencing homelessness for the past 18 years. He also has a longstanding history of schizophrenia, including approximately 20 prior hospitalizations. Go’s death is sadly not [OL�ÄYZ[�VM�P[Z�RPUK��5L^�@VYR�OHZ�Z[Y\NNSLK�[V�LUHJ[�LɈLJ[P]L�SLNPZSH[PVU� governing the treatment of individuals with a chronic serious mental illness (SMI) and, as a result, thousands of New Yorkers like Simon elude [YLH[TLU[��+P]LU���������(�:40�PZ�KLÄULK�I`�[OL�5H[PVUHS�0UZ[P[\[L�MVY� Mental Health (NIMH) as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities (Mental Illness, n.d.). The timing of this violence impacted the political response. This tragedy occurred when hate crimes targeting Asian Americans were on the rise, and although police concluded that this particular incident was not racially motivated and there was no known prior connection between Go and Simon, the larger sociopolitical context may have fueled the HKTPUPZ[YH[PVU�Z�ULLK�[V�YLZWVUK��PU�VYKLY�[V�LUZ\YL�W\ISPJ�Z\WWVY[�� This particular incident happened following a slew of incidents in which people were pushed onto subway tracks, though none of the previous had been fatal. As of mid-March 2022, transit crime was up 80.3% compared with the same period in 2021, though this number may be ZRL^LK�ILJH\ZL�VM�KLJYLHZLK�Z\I^H`�YPKLYZOPW�K\YPUN�[OL�ÄYZ[�`LHY� of the Covid-19 pandemic (Gelinas, 2022). It also occurred during Eric (KHTZ»�ÄYZ[�^LLR�HZ�TH`VY��;OPZ�[PTPUN�HTWSPÄLK�PZZ\LZ�VM�YHJPHSS`� driven hate crimes, random acts of violence, and a perceived surge in subway crime, and it provided linkage to the deep-seated issues VM�\UOV\ZLK�5L^�@VYRLYZ�^P[O�TLU[HS�PSSULZZ��ZWLJPÄJHSS`�[OVZL�^P[O� persistent and often treatment-resistant SMI. 6 | COLUMBIA SOCIAL WORK REVIEW, VOL. XXI Leaders in the public and private sectors have worked for decades to propose policies for those who struggle with homelessness and mental illness. Hospitalization rates for New Yorkers living with a SMI are consistently higher than the national average (Heun-Johnson et al., 2018). While the percentage of people with a SMI is a much smaller subset than those living with any mental illness, New York City has a disproportionately higher number of its population diagnosed with a SMI compared to the national average and fewer resources to treat those needing inpatient psychiatric care. Go’s death garnered widespread media attention and was the catalyst for The Subway Safety Plan, a reaction outlined by the Adams administration the month after the incident. This was followed by the Mental Health Involuntary Removal (MHIR) policy directive, announced later in 2022. Multifaceted sociopolitical issues in which mental health is just one KPTLUZPVU�LUHISL�WVSP[PJPHUZ�[V�JP[L�TLU[HS�OLHS[O�HZ�HU�V]LYZPTWSPÄLK� Q\Z[PÄJH[PVU�^OPSL�VTP[[PUN�V[OLY�JVU[YPI\[PUN�MHJ[VYZ�[OH[�HYL�UV[�HZ� politically compelling. Adams’ MHIR response to the issues at the MVYLMYVU[��^OV�P[�HɈLJ[Z��HUK�OV^�P[�^PSS�IL�PTWSLTLU[LK�HTV\U[�[V� UV[OPUN�TVYL�[OHU�JVTWHZZPVUH[L�^PUKV^�KYLZZPUN�PU�HU�LɈVY[�[V� HWWLHY�[V\NO�VU�JYPTL��OH[�PZ�JVUZWPJ\V\Z� PZ�[OL�JP[`»Z�YH[PVUHSL�MVY�^O`�[OPZ�WVW\SH[PVU�PZ�H[�YPZR!�¸JOYVUPJHSS`� homeless individuals with SMI often have symptoms and cognitive KPɉJ\S[PLZ�[OH[�JVU[YPI\[L�[V�KPɉJ\S[PLZ�HJJLZZPUN�[YLH[TLU[�HUK�OV\ZPUN� resources” (OMH et al., 2022, p. 2). Furthermore, the alternative agenda OLYL�PZ�OPKPUN�PU�WSHPU�ZPNO[��(KHTZ�Q\Z[PÄLK�[OPZ�HNNYLZZP]L�SHUN\HNL� to augment existing sections of the MHL under the guise of a moral obligation to help unhoused New Yorkers in need of mental healthcare, ^OPSL�ZPT\S[HULV\ZS`�\ZPUN�P[�[V�X\LSS�W\ISPJ�ZHML[`�JVUJLYUZ�HIV\[�JYPTL� on the street and in the subway system. MHL SECTION 9.60, KNOWN AS KENDRA’S LAW After Go’s death, Adams pointed to New York MHL section 9.60, better known as Kendra’s Law, which assertively connects New Yorkers experiencing a mental health emergency to medical treatment. Section 9.60 was named after Kendra Webdale, who died in January 1999 when she was pushed in front of a NYC subway train by a person with untreated schizophrenia (Pataki et al., 2005). Similar to Go’s case, the man who pushed Webdale had just been released from a psychiatric hospital, and his actions resulted from medication non-compliance (Diven, 2022). Soon thereafter, in 1999, New York passed legislation to provide court-mandated Assisted Outpatient Treatment (AOT). This is a more humane and less restrictive alternative to inpatient commitment for LANYA SNYDER 10 | COLUMBIA SOCIAL WORK REVIEW, VOL. XXI those who are unlikely to survive safely in the community without court- mandated supervision (Pataki et al., 2005). Per the U.S. Department of Justice (2022), AOT programs are also responsible for the oversight and monitoring of service providers, including case management services or Assertive Community Treatment (ACT) team services. Case managers and ACT team members follow an AOT recipient’s level of compliance and delivery of services by other providers pursuant to the court order (U.S. Department of Justice [DOJ], 2020). ASSISTED OUTPATIENT TREATMENT (AOT) EVALUATION More than two decades have passed since the enactment of section 9.60 under New York’s MHL. Critics of AOT argue that court mandated medical compliance infringes on civil liberties and disproportionately targets people of color. Others have studied the results and praised P[Z�LɈLJ[P]LULZZ�PU�YLK\JPUN�OHYT�[V�PUKP]PK\HSZ�HUK�JVTT\UP[PLZ�� Appelbaum (2005) reviewed more than 10,000 New Yorkers who were YLMLYYLK�[V�(6;�K\YPUN�[OL�Ä]L�`LHY�ZWHU�HM[LY�P[�^HZ�ÄYZ[�LUHJ[LK�� Of the referrals, 93% of cases were granted court-ordered AOT. In evaluating participation, Appelbaum’s (2005) study examined the history of the individuals granted AOT for three years prior to their court-ordered AOT. It found that 97% had been previously hospitalized, 30% were arrested, 23% were incarcerated, and 19% were unhoused. Even more LUJV\YHNPUN�^LYL�V\[JVTLZ�HZZLZZLK�V]LY�Ä]L�`LHYZ�HM[LY�THUKH[LK� treatment, which showed a 44% decrease in general harmful behaviors, including a 47% decrease in physical harm to others (Appelbaum, 2005). Furthermore, arrests, incarceration, psychiatric hospitalization, and homelessness collectively dropped by 74 to 87% (Appelbaum, 2005). AOT CRITICISM Kaufman (2023) notes that when Simon left the hospital in July of 2021, social workers escorted him to a supportive housing apartment building in the Bronx, where he could live with on-site services. They left him with a 30-day supply of medication and a next-day appointment with a psychiatrist. Mr. Simon never showed up to his outpatient psychiatry NEW YORK’S DIRECTIVE FOR MENTAL HEALTH INVOLUNTARY REMOVALS COLUMBIA SOCIAL WORK REVIEW, VOL. XXI | 11 appointment and is believed to have spent no more than two hours in OPZ�UL^�OVTL�^OLYL�OL�SLM[�VUS`�H�[YHJL�VM�OPZ�WYLZLUJL!�H�IYV^U�WHWLY� IHN�Z[\ɈLK�^P[O�[OL�Z\WWS`�VM�TLKPJH[PVUZ��2H\MTHU���������(6;�PZ� not a life sentence; court orders can lapse after six months. The most MYLX\LU[S`�JP[LK�YLHZVU�MVY�UVU�YLUL^HS�VM�JV\Y[�VYKLYZ��HJJVYKPUN�[V�[OL� NYS-OMH, is that the individual has improved and is no longer in need of court-ordered services. The paradox is that people likely improved because they were mandated to comply with medication, as was the case for Simon. According to Simon’s sister, treatment and medicine kept him going, and once he no longer posed a threat to himself or V[OLYZ��[OL�JV\Y[�UV�SVUNLY�YLX\PYLK�OPT�[V�[HRL�OPZ�TLKPJPUL��+P]LU�� 2022). Left to his own devices, he stopped taking his medication and his delusions resumed. �9HJPHS�KPZWHYP[PLZ�WLY]HKL�5L^�@VYR�Z�(6;�WYVNYHT��^P[O�)SHJR�HUK� Hispanic people disproportionately subjected to its court orders. Because of this, AOT programs have arguably further marginalized and discriminated against New Yorkers of color (Rodríguez-Roldán, 2020). During Adams’ 2022 announcement, he called to make it easier to enforce Kendra’s Law as a means to improve ongoing mental health outpatient treatment compliance for those who cannot meet their needs V\[ZPKL�VM�PUZ[P[\[PVUZ��5L^�@VYR�4/3� �����V\[SPULK�I`�1HɈL����� ��� stipulates that once a patient meets the threshold for AOT eligibility, almost any person associated with that individual can petition for court- ordered treatment. While hospital providers can and do apply for AOT, (KHTZ��Z[H[LTLU[�PZ�TPZSLHKPUN��HZ�P[�Z\NNLZ[Z�2LUKYH»Z�3H^�JHU�VUS`� be mandated through hospitalization. In fact, the petition can be initiated by any mental health providers, directors of community programs, Z\WWVY[P]L�OV\ZPUN�KPYLJ[VYZ��WHYVSL�VY�WYVIH[PVU�VɉJLYZ��VY�HU`�ZVJPHS� service designee working with the individual. Furthermore, AOT is not an under-utilized resource as Adams also infers. According to Rascoe and Lewis (2022), as of October, there was an 800-person waiting list for those eligible for AOT. Without additional funding for this supportive service, forcing AOT creates a bottleneck for outpatient behavioral healthcare supportive services in the community. LANYA SNYDER 12 | COLUMBIA SOCIAL WORK REVIEW, VOL. XXI >OPSL�2LUKYH»Z�3H^�JHU�IL�ILULÄJPHS�MVY�[OVZL�^OV�KV�YLJLP]L�(6;�� Diven (2022) outlines its pitfalls. It fails to address the population at large, because it does not account for those who are not a threat to themselves or others. Furthermore, the legal statute for obtaining a court order is based on prior acts demonstrating dangerousness and treatment non-compliance, which imposes a high burden of proof. A widespread misconception is that people who are hospitalized for psychiatric stabilization are simply discharged to the streets without shelter, follow-up outpatient care, medications, or other supportive services. According to a study of psychiatric inpatient discharge practices and aftercare appointments in New York State, Smith et al. (2017) concluded that hospital providers, including social workers, reported having scheduled appointments for ongoing follow-up treatment for 85% of patients prior to discharge. The percentage of those found not to have psychiatric outpatient services were patients associated with having a co-occurring substance use disorder or other comorbid condition that took priority. This does not account for other social services secured for these patients in discharge planning. This study examined associations between routine discharge planning WYHJ[PJLZ�HUK�[PTL�[V�[YLH[TLU[�MVSSV^�\W�HM[LY�KPZJOHYNL��ÄUKPUN�[OH[� 45% of adults did not attend an initial aftercare appointment within 30 days of discharge (Smith et al., 2017). The data illustrates a void in the continuum of care needed for outpatient support, such as intensive case management and services through ACT teams, during the transition from the inpatient setting to supportive housing. STAKEHOLDERS For the MIHR directive, stakeholders include community members, SH^�LUMVYJLTLU[�VɉJPHSZ��OLHS[OJHYL�^VYRLYZ�HUK�HKTPUPZ[YH[VYZ�� lawmakers, and New York City residents. New Yorkers with a SMI are WYPTHY`�Z[HRLOVSKLYZ��JVUZPKLYPUN�[OPZ�WVSPJ`�KPYLJ[S`�HɈLJ[Z�[OLPY�ZVJPHS� welfare. At present, it is estimated that 250,000 adults have a SMI, or 3% of the total population in New York City. Among the unhoused population, which totals about 60,000 living in city shelters or on the NEW YORK’S DIRECTIVE FOR MENTAL HEALTH INVOLUNTARY REMOVALS COLUMBIA SOCIAL WORK REVIEW, VOL. XXI | 13 Z[YLL[Z��[OL�504/»Z�5L^�@VYR�JOHW[LY�LZ[PTH[LZ�[OH[�VUL�PU�Ä]L�[V�VUL� in six people live with a SMI (Kaufman, 2023). While the percentage of WLVWSL�^P[O�H�:40�PZ�ZPNUPÄJHU[S`�ZTHSSLY�[OHU�[OVZL�SP]PUN�^P[O�V[OLY� mental illnesses, New Yorkers with a SMI are disproportionately visible in the community given the longstanding systemic failures and lack of continuity in care. SOCIAL DETERMINANTS FOR PRIMARY STAKEHOLDERS In addition to the linkage between poverty and housing insecurities, it should also be noted that much of the population in need of urgent psychiatric care already face racial stigma, injustice, and other VWWYLZZP]L�Z`Z[LTPJ�MVYJLZ��;OPZ�WVW\SH[PVU�TH`�Z\ɈLY�MVY�`LHYZ�^P[OV\[� ILPUN�[YLH[LK��HUK�[OLU�VM[LU�KV�UV[�OH]L�HɈVYKHISL�MVSSV^�\W�JHYL�VY� access to costly prescriptions. Many unhoused patients with a SMI also Z\ɈLY�MYVT�JVTVYIPKP[PLZ�Z\JO�HZ�Z\IZ[HUJL�HI\ZL��^OPJO�PZ�[V�ZH`�[OH[� even if medication and therapeutic treatments are to stabilize the mental PSSULZZ��[OLZL�5L^�@VYRLYZ�Z[PSS�MHJL�HɊPJ[PUN�OLHK^PUKZ��3VUNZ[HUKPUN� failures to address oppressive social determinants are why people often end up back in the ED or CPEPs mere days after discharge from inpatient care. The lack of funding and resources for the continuum of care including housing—that is not predicated on drug testing, curfews, or a lapse in mental health care—exacerbates the syndemics of homelessness and mental illness. THE PROBLEM: NEW YORK CITY’S CURRENT MAYORAL STANCE New York City is facing a crisis as those in power are using people L_WLYPLUJPUN�OVTLSLZZULZZ��TVYL�ZWLJPÄJHSS`�[OVZL�^P[O�H�:40�VY�� now, even a perceived mental illness, as a means to ensure public safety. Politicians like Adams, a former NYPD Captain, turn to policing as a means to remove the unhoused from the streets. Friedman (2022) HYN\LZ�[OH[�WVSP[PJPHUZ�JVUÅH[L�PZZ\LZ�VM�OVTLSLZZULZZ�HUK�[OL�ULLK� for public safety, utilizing law enforcement to unfairly target people LANYA SNYDER 14 | COLUMBIA SOCIAL WORK REVIEW, VOL. XXI who are unhoused to ensure public safety. He points to how laws, particularly those in urban areas that wrest the “out of sight, out of mind” mantra, lessen public concerns for safety. There is an exhaustive list of legislation to keep those experiencing homelessness out of sight, including laws against living in public spaces, camping in cities, vagrancy and loitering, begging and panhandling, and sleeping in public. In the policy’s original version, Adams claimed people with mental illness were largely responsible for an increase in subway crime, despite data suggesting most crimes were not committed by unhoused or mentally ill New Yorkers (Fitzsimmons & Newman, 2022). The only X\HSPÄJH[PVU�MVY�YLTV]HS��HJJVYKPUN�[V�[OL�4/09�KPYLJ[P]L��PZ�[OH[�[OL� WLYZVU�PU�X\LZ[PVU�JHUUV[�TLL[�[OLPY�IHZPJ�ULLKZ��H�Q\KNTLU[�LU[PYLS`� subjective and in the hands of those tasked with the person’s removal. CRITIQUES AND CONSIDERATIONS The MHIR is an attempt to outstrip laws that already exist for people experiencing a psychiatric emergency in public, through its directive that police and emergency responders simply remove individuals from the streets and transport them to a hospital, whether or not the individual WVZLZ�H�KHUNLY�[V�[OLTZLS]LZ�VY�[V�V[OLYZ��:\WLYÄJPHSS �̀�[OPZ�PTWSPLZ� [OH[�HSS�WLVWSL�^P[OV\[�WLYTHULU[�OV\ZPUN�T\Z[�Z\ɈLY�MYVT�HU�\U[YLH[LK� TLU[HS�PSSULZZ�HUK�HYL�]PVSLU[�PUKP]PK\HSZ��0U�HKKP[PVU�[V�[OPZ�ÅH^LK� presumption, politicians such as Adams cite morality and responsibility to disguise policing as a means of confronting longstanding problems, instead of addressing the root causes of homelessness through substantive policy changes. The New York City Civil Liberties Union (NYCLU) has been a vocal critic of MHIR and believes this directive violates fundamental legal rights for people living with any mental illness. The National Alliance on Mental Health (NAMI) has been critical, too, suggesting involuntary detention does not solve the issue of supportive housing for those with any mental health crisis. Adams points to court ordered AOT as a successful law that should be enforced, yet is misleading regarding how this essential component of a functional NEW YORK’S DIRECTIVE FOR MENTAL HEALTH INVOLUNTARY REMOVALS COLUMBIA SOCIAL WORK REVIEW, VOL. XXI | 15 public mental health system can be implemented and to whom it applies (Subway Safety Plan, 2022). Admittedly, the 2019 NYS-OMH data for all inpatient New York *P[`�WZ`JOPH[YPJ�MHJPSP[PLZ�ZOV^�[OH[�VUL�PU�Ä]L�������WH[PLU[Z�^LYL� readmitted within 30 days, and nearly one in three (33%) were YLHKTP[[LK�^P[OPU� ��KH`Z��([�Ä]L�JP[`�OVZWP[HSZ��[OL� ��KH`�WZ`JOPH[YPJ� YLHKTPZZPVU�YH[LZ�^LYL�ZPNUPÄJHU[S`�OPNOLY��YHUNPUN�MYVT�����[V� 64%. Similar rates exist for those presenting to EDs departments for psychiatric symptoms soon after inpatient discharge. On the surface, P[�PZ�LHZ`�MVY�WVSP[PJPHUZ�[V�WVPU[�[OL�ÄUNLY�H[�OLHS[OJHYL�Z`Z[LTZ�� when in actuality the data points to a system that relies on short-term [YLH[TLU[�VM�WZ`JOPH[YPJ�Z`TW[VTZ�YH[OLY�[OHU�HKLX\H[LS`�HKKYLZZPUN� long-term supportive care and social determinants for people with a SMI (Nortz, 2021). There is no formal healthcare policy, much less detailed plans or proposed guidance for actual treatment in the MHIR other than a psychiatric evaluation. This policy does not acknowledge, let alone propose, solutions that largely contribute to why unhoused people do not have access to healthcare. And for those who do receive ZVTL�PUWH[PLU[�[YLH[TLU[�[OYV\NO�OVZWP[HSPaH[PVU��[OLYL�HYL�PUHKLX\H[L� resources for the post-discharge continuum of care, which is essential for sustaining remission from chronic illness. Opponents of the mayor’s MHIR policy say not enough attention is KPYLJ[LK�[V^HYKZ�HJJLZZPISL�HUK�HɈVYKHISL�OV\ZPUN�HUK�OLHS[OJHYL��-VY� decades, unhoused New Yorkers have been brought to EDs by NYPD and EMS every night. In response to Adams’ plan, many psychiatrists say this will not come close to solving the problem of untreated mental illness among those living on society’s margins (Goldstein, 2022). /VZWP[HSZ�HYL�UV[�H�WSHJL�[V�MVYJPIS`�[YHUZWVY[�HUK�VɊVHK�WLVWSL�ZPTWS`� to remove them from the streets. Adams fails to acknowledge the long- term resources needed to address the interconnected medical and housing issues this policy directive purports to solve. When treating someone with a SMI there is a disproportionate emphasis on symptom reduction using drug therapies and psychotherapy and not enough LANYA SNYDER 16 | COLUMBIA SOCIAL WORK REVIEW, VOL. XXI attention and resources for the continuum of care that is practical and HɈVYKHISL��;OL�TLU[HS�OLHS[O�JYPZPZ�JP[LK�I`�WVSP[PJPHUZ�PZ�UV[�Z[YPJ[S`� medical; the path to healing also involves interventions to address the social determinants. Without ongoing follow-up appointments, supportive care, and rehabilitative services including housing, several days or even a few weeks of psychiatric hospitalization do little to break the cycle of chronic homelessness and SMI. SOLUTION: HOUSING REFORM The solution to the issue at the core of this crisis is to reform housing policies. Social workers join other providers and advocates in lamenting the lack of service integration and the scarcity of resources available for adults who are experiencing comorbidities of homelessness and mental illness (Padgett et al., 2006). However, studies have consistently found that only about 25%–30% of unhoused people have a SMI (Padgett, 2020). In just a handful of days, if a person receives proper nutrition, sleep regulation, social support, and consistent medication, their behavior changes and psychiatric symptoms diminish. During the public announcement for the Subway Safety Plan, Adams said, “It is cruel and inhumane to allow unhoused people to live on the subway, and unfair to paying passengers and transit workers who deserve a clean, orderly, and safe environment” (2022, February 18). If the mayor believes this, then the administration should consider redirecting resources toward policies that connect people with community-based systems such as ACT teams and adopt Housing First (HF) policies. New York City relies on an overcrowded shelter system and a [YLH[TLU[�ÄYZ[�HWWYVHJO��^OPJO�YLX\PYLZ�\UOV\ZLK�PUKP]PK\HSZ�^P[O�H� :40�[V�JVTWSL[L�H�ZLX\LUJL�VM�Z[LWZ�[V�KLTVUZ[YH[L�YLHKPULZZ�MVY� supportive housing. HF is a departure from this linear continuum of care model by providing immediate access to housing in independent HWHY[TLU[Z��;OPZ�L]PKLUJL�IHZLK�OV\ZPUN�WVSPJ`�VɈLYZ�[LUHU[Z�HU� array of services through interdisciplinary ACT teams consisting of social workers, psychiatrists, vocational trainers, and substance NEW YORK’S DIRECTIVE FOR MENTAL HEALTH INVOLUNTARY REMOVALS COLUMBIA SOCIAL WORK REVIEW, VOL. XXI | 17 HI\ZL�JV\UZLSVYZ��7HKNL[[�L[�HS����������/-�KVLZ�UV[�YLX\PYL�WLVWSL� experiencing homelessness to address their behavioral health or substance use before providing housing. The policy is predicated on the philosophy that housing is the foundation on which people can recover. Additionally, studies have consistently shown access to housing generally results in cost savings for communities because housed people are less likely to use emergency services such as hospitals, jails, and emergency shelters (National Alliance to End Homelessness [NAEH], 2022). Waiting for individuals to receive and comply with medical treatment for a SMI, then rewarding them with housing, perpetuates the never-ending cycle of homelessness, institutionalization, and incarceration. In short, it solves neither the housing nor the mental health crisis. During his MHIR address, Adams said his administration had a moral obligation to help [New Yorkers] who “cycle in and out of hospitals and jails, and New Yorkers rightly expect our city to help them and help [OLT�^L�^PSS¹��(KHTZ���������!�����0YVUPJHSS �̀�H�TLYL�[OYLL�^LLRZ�ILMVYL� this speech, data was released showing that nearly 2,600 supportive housing apartments were vacant, which is enough to house the estimated 3,400 people living in streets or subways (Newman, 2022). According to Brand (2022), the city launched a new pilot program in early September of 2022, moving 80 formerly unhoused New Yorkers into vacant supportive housing units in single-room occupancy (SRO) buildings in Brooklyn and Manhattan. This pilot program, based on the HF model, enables residents to bypass the bureaucratic hurdles necessary to obtain supportive housing. While a start, the 80 units represent a paltry 3% of NYC’s empty units. Furthermore, the program PZ�ILPUN�Y\U�I`�[OL�UVUWYVÄ[�]VS\U[LLYZ��YH[OLY�[OHU�I`�[OL�JP[ �̀�0M� the Adams administration truly wanted to solve the issue of housing and provide compassionate care for those in need, it might consider adopting the evidence-based HF policies citywide in the other 97% of reportedly empty apartments. LANYA SNYDER 18 | COLUMBIA SOCIAL WORK REVIEW, VOL. XXI CONCLUSION Adams’ MHIR policy takes a page out of the political playbook that JVUÅH[LZ�PZZ\LZ�VM�W\ISPJ�ZHML[`�^P[O�[OVZL�VM�TLU[HS�OLHS[O��0M��HZ�[OL� 4/09�KPYLJ[P]L�Z[H[LZ��[OL�VUS`�X\HSPÄJH[PVU�MVY�YLTV]HS�MYVT�W\ISPJ� areas is that a person cannot meet their basic needs, then perhaps a TVYL�JVTWHZZPVUH[L�HUK�LɈLJ[P]L�^H`�[V�ZVS]L�[OL�WYVISLT�H[�OHUK� would be to pivot from “mental health” and reform current housing policies that enable individuals to meet these basic needs. Policing unhoused New Yorkers with a SMI and forcibly transporting them to overcrowded healthcare systems in NYC do little to reduce the intersectional risks for this population. Without reforming policies that address long-term care, namely social determinants and housing policies, forcibly hospitalizing unhoused New Yorkers in need of WZ`JOPH[YPJ�[YLH[TLU[�PZ�UV[�VUS`�PULɈLJ[P]L��I\[�WLYWL[\H[LZ�[OPZ� cycle. 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