Eric Adams’ Plan to Hospitalize the Homeless Without Affordable Housing and Services, the Mentally Ill will End Up Back on the Streets

by DEBORAH DE SANTIS

Communities across America are struggling with how best to respond to unsheltered homelessness, especially those who battle mental illness. Some states and cities are responding by passing bills that make sleeping on the streets or parks a criminal offense. Others are clearing encampments in the interest of public safety or are directing funding for “sanctioned encampments.” In New York City (NYC), Mayor Eric Adams and Commissioner of the NYC Department of Health and Mental Hygiene, Dr. Ashwin Vasan, recently released the city’s action plan for mental health. The plan followed up the mayor’s announcement last fall that described how the city would take steps to involuntarily institutionalize New Yorkers experiencing homelessness and exhibiting symptoms of a mental illness even if they posed no active threat of violence or harm to themselves or others.

New York City has tried similar approaches in the past without success. Homelessness soared in the city during the 1980s, mainly due to the deinstitutionalization of severely mentally ill individuals from psychiatric hospitals. Many of these individuals ended up homeless or in jail without the city making the necessary investments in housing and behavioral health services. States and cities around the country passed similar deinstitutionalization policies. Now, 40 years later, policymakers are swinging back to the 1980s despite knowing that there are better alternatives.

People experiencing homelessness in NYC accounted for 37%, nearly 47,000, of those who cycle through the emergency mental health programs. This included emergency rooms, inpatient psychiatric stays, and mobile crisis referrals.1 These crisis response services are expensive and inefficient at providing the necessary support to address long-term housing and health needs. Individuals without housing who are placed into involuntary psychiatric holds or arrested are frequently discharged back into homelessness. With no connection to services or housing, these individuals will cycle through these systems repeatedly.

Recent research conducted in Denver, Colorado, found that this cycle costs approximately $15,100 annually per person.2 If we apply this cost to the 47,000 unsheltered homeless involved in NYC’s emergency mental health program, the taxpayers will foot a $710 million bill annually. This estimate is likely conservative since NYC services costs are predictably higher.

As the decades since the 1980s have shown, investing in and scaling short-term interventions will not reduce homelessness and certainly will not help those individuals living with severe mental illness become healthier. Funding for crisis-based responses only perpetuates the cycle of homelessness and generates high public costs.

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1) See Care, Community, Action: A Mental Health Plan for New York City. Pg. 34: https://www.nyc.gov/assets/doh/downloads/ pdf/mh/care-community-action-mental-health-plan.pdf

2) See Cost and Offsets of Providing Supportive Housing to Break the Homelessness-Jail Cycle. Findings from the Denver Supportive Housing Social Impact Bond Initiative, pg. 23: https:// www.urban.org/sites/default/files/publication/104499/costs-andoffsets-of-providing-supportive-housing-to- break-the-homelessness-jail-cycle_0.pdf