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NYC’s Mental Health Plan Sparks Controversy
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NYC’s Mental Health Plan Sparks Controversy

Mayor Eric Adams’ new strategy for addressing mental illness and homelessness includes the expansion of involuntary hospitalization.

A homeless woman moves her belongings from a New York City encampment. (Photo by Andrew Lichtenstein/Corbis via Getty Images)

Happy Friday! Indiana Jones is back! And so is Baby Yoda! And Star-Lord! What a day for movie and TV trailers.

Quick Hits: Today’s Top Stories

  • The Senate voted 80-15 on Thursday to pass a resolution implementing a labor agreement that was negotiated in September by freight rail companies, labor leaders, and the Biden administration, overriding four of twelve unions whose workers rejected the deal over demands for additional paid sick days. The measure—once signed into law by President Joe Biden—will avert a freight rail strike that was set to begin in the coming days. “I know that many in Congress shared my reluctance to override the union ratification procedures. But in this case, the consequences of a shutdown were just too great for working families all across the country,” Biden said in a statement. “Working together, we have spared this country a Christmas catastrophe in our grocery stores, in our workplaces, and in our communities.”
  • After days of anti-lockdown protests across the country, Chinese Vice Premier Sun Chunlan—largely responsible for China’s COVID-19 response—said Wednesday that China is entering a “new stage and mission” of its pandemic controls due to “the decreasing toxicity of the Omicron variant, the increasing vaccination rate, and the accumulating experience of outbreak control and prevention.” Reuters reported yesterday that, in the coming days, CCP officials are set to announce a reduction in the use of mass testing and allow some infected people (and close contacts) to quarantine at home rather than mass facilities. Several cities—including Guangzhou, Chongqing, and Zhengzho—have lifted lockdowns in recent days.
  • In response to North Korea’s recent barrage of missile testing, the U.S. Treasury Department announced Thursday it will impose additional sanctions on three North Korean officials over their support for the country’s development of weapons of mass destruction and ballistic missiles.
  • The Supreme Court announced Thursday it will take up a challenge to President Joe Biden’s student loan forgiveness program brought by several Republican-led states after a federal appeals court in Missouri temporarily blocked the program last month. The Supreme Court is set to hear oral arguments in the case in February, and the disbursement of loan forgiveness will remain on hold until at least that point.
  • In a scathing opinion released Thursday night, a three-judge panel of the 11th Circuit Court of Appeals unanimously concluded that District Court Judge Aileen Cannon erred in blocking the Justice Department’s access to material seized at Mar-a-Lago in August and in appointing a special master to review the seized material for documents that could be protected by executive privilege. “The law is clear. We cannot write a rule that allows any subject of a search warrant to block government investigations after the execution of the warrant,” wrote the three judges, two of whom were appointed by Trump. “Nor can we write a rule that allows only former presidents to do so. Either approach would be a radical reordering of our case law limiting the federal courts’ involvement in criminal investigations. And both would violate bedrock separation-of-powers limitations.” 
  • After looking into allegations that former President Donald Trump or a Trump appointee may have directed the Internal Revenue Service to conduct rare and invasive audits of former FBI officials James Comey and Andrew McCabe, the Treasury Department’s Inspector General for Tax Administration issued a report on Thursday noting the office “did not identify misconduct” in the audit selection process. “Our assessment of the original sample selection process concluded that the IRS randomly selected TYs 2017 and 2019 tax returns for NRP audits,” the report read.
  • The Federal Reserve’s preferred measure of inflation, the personal consumption expenditures (PCE) price index, increased 6.0 percent year-over-year in October, the Bureau of Economic Analysis (BEA) reported Thursday—down from a 6.3 percent annual rate in September. Core services inflation—a category Federal Reserve Chairman Jerome Powell said Wednesday might be the “most important” indicator of future inflation—rose 0.3 percent month-over-month, the smallest such increase in three months. The Bureau of Economic Analysis also reported Thursday that Americans’ personal savings rate fell to 2.3 percent in October—the lowest level since 2005—as higher prices and higher interest rates chip away at consumers’ disposable income.
  • The average cost of a gallon of regular gas in the United States fell to $3.47 on Thursday according to AAA, the lowest level since early February—before Russia’s invasion of Ukraine. Patrick De Haan—head of petroleum analysis for GasBuddy—projected recently the national average price could fall below $3.00 by Christmas.
  • The Labor Department reported Thursday that initial jobless claims—a proxy for layoffs—fell by 16,000 week-over-week to a seasonally adjusted 225,000 last week. The measure—still near historic lows—signals the labor market remains tight, but it comes as many major companies (Amazon, Meta, DoorDash, Salesforce, Redfin, Gap) have announced significant layoffs or hiring freezes.
  • The Food and Drug Administration announced Wednesday it was pulling the emergency use authorization of bebtelovimab—the Eli Lilly COVID-19 therapeutic—because the monoclonal antibody is not effective against the emerging Omicron BQ.1 and BQ.1.1 subvariants, which combined accounted for between 53 and 62 percent of new COVID-19 infections in the United States last week. The Department of Health and Human Services is putting any pending requests for the antiviral on hold until further notice, but encouraged healthcare providers to keep existing stock on hand in case future variants are more susceptible to the treatment.
  • The average number of weekly confirmed COVID-19 cases in the United States increased about 8 percent over the past two weeks according to CDC data, while the average number of weekly deaths attributed to the virus—a lagging indicator—fell 21 percent. About 28,000 Americans are currently hospitalized with COVID-19, up from about 21,600 two weeks ago.

Order or Overreach?

New York City Mayor Eric Adams on Tuesday announced a new plan intended to address the city’s crisis of untreated severe mental illness—a plan he said is the product of eleven months of work by his administration since he was sworn in this past January.

In his speech, Adams said that New Yorkers encounter people with serious but untreated mental illnesses—many of them homeless—on a daily basis.

“The man standing all day on the street across from the building he was evicted from 25 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 assistance from our mobile crisis team. … New Yorkers rightly expect our city to help them. And help them we will.”

Adams’ announcement was welcomed by some as a step towards greater public safety and health—but its expansion of the city’s standards for what sorts of situations warrant involuntarily institutionalizing mentally ill people has generated concerns from civil libertarians and progressives who argue the measure is an unconstitutional violation of personal liberty.

“Mayor Adams believes that involuntary hospitalization is not used often enough in New York City,” said Stephen Eide, a senior fellow at the conservative Manhattan Institute. “He’s trying to look for a way to expand the use of it and also make it more effective when it is used.”

Adams’ plan seeks to adjust the legal parameters around involuntary treatment through two main avenues: a directive to workers Eide described as “frontline public employees,” including mobile crisis response teams and police officers, as well as an 11-point agenda laying out Adams’ goals for the upcoming New York state legislative session in Albany.

The directive, meant to provide those frontline public employees with actionable guidance, explicitly cites a February memo from the state’s Office of Mental Health. The New York-based outlet Gothamist summarizes the key change in interpretation:

New York state’s Mental Hygiene Law outlines that a person can be
taken to a hospital or psychiatric facility for an evaluation “if such person appears
to be mentally ill and is conducting himself or herself in a manner which is likely
to result in serious harm to the person or others.”

But City Hall officials are relying on a state health department
memorandum issued in February that interprets the law as allowing “for the
removal of a person who appears to be mentally ill and also displays an inability
to meet basic living needs, even when no recent dangerous act has been
observed.”

In announcing the directive, Adams took pains to pre-empt claims that this shift marks a borderline-tyrannical expansion of government power, framing it instead as a compassionate response to a moral obligation.

“We will continue to do all we can to persuade those in need of help to accept services voluntarily,” he said. “But we will not abandon them if those efforts cannot overcome the person’s unawareness of their own illness. In short, we are confirming that a person’s ‘inability to meet basic needs,’ to the extent that it poses a risk of harm, is part of the standard for mental health interventions.”

While explaining the logic of the directive, Eide told The Dispatch that all mental health systems rely to some degree or another on involuntary hospitalization.

“Suicide has always been a justification for involuntary commitment,” he said. “Someone who’s mentally ill and trying to commit suicide as a result of their mental illness, they qualify for involuntary hospitalization. But it’s not humane, it would seem, to just wait until things reach that extreme. We know that people are deteriorating because of their mental illness in public all over New York City. Let’s try to get ahead of that. We need to broaden our concept of self-harm, so that we can intervene more proactively and stop operating in such a reactive mode.”

The second part of Adams’ announcement is the legislative agenda—what Eide characterized as “a wish list for Albany: these are the things we need from state government to build a better mental health system.” Several of the items on the list would involve explicitly codifying the new interpretation of the Mental Hygiene Law.

Whether Adams’ proposals will win the backing of state lawmakers in Albany remains to be seen. Since the 19th century, mental health policy in the United States has largely been a state issue rather than a federal or local one. (Adams did say that “there is a huge role for the federal government to play here,” mentioning that his team was “exploring ways to use Medicaid funding to provide services to people in shelter.”)

But the city will also need all the state-level support it can get, particularly in the face of looming legal battles. New York civil liberties groups—which Eide described as “aggressive and experienced”—have already stated their opposition to the plan and signaled their intent to challenge it in court. They will likely cite the 1975 Supreme Court decision in O’Connor v. Donaldson, which held that “if an individual is not posing a danger to self or others and is capable of living without state supervision, the state has no right to commit the individual to a facility against his or her will,” according to the legal information website Justia.

“There’s certainly a chance the mayor would lose,” Eide said. “There’s just so much uncertainty when courts get involved.”

Regardless of whether Adams succeeds or fails, other cities and states will be taking notes.

“Every jurisdiction I’m aware of has some degree of crisis with regard to untreated serious mental illness,” Eide said. “So it would really be extraordinary if New York could make some progress with this problem that many people have kind of given up on—not just in New York, but elsewhere.”

Worth Your Time

  • As we head into the winter, doctors and nurses are staring down a “tripledemic”—surges in COVID, flu, and respiratory virus infections—that will strain not only the American population, but the healthcare system itself. “We physically have 24 beds, but because of our staffing, we only have adequate staff for 20 or 21 occupied beds. Just because there are three more physical beds open doesn’t mean that we can safely staff them,” Hui-wen Sato—a pediatric ICU nurse in southern California—told Jonathan Lambert of Grid News. “Because of the respiratory surge, there’s so many who show up in the ED who need oxygen right now. And we take them, but I always have to think about the other things that can happen. There are still car accidents. There are still patients on the regular floors who suddenly have a medical crisis. Those kinds of things don’t stop just because this respiratory surge is happening. How do you plan when you don’t know when those emergencies are going to happen, and you don’t want to come up short, but you’re always short-staffed?”
  • As nationwide protests in China signal the end of public compliance with the government’s draconian zero-COVID policy, this piece in the Wall Street Journal looks at why the country is so unprepared for a major surge in infections. A recent study found that lifting the restrictions now could result in upwards of 2 million deaths in China—and the fault is Beijing’s own. In the time that lockdowns could’ve bought Chinese officials to bolster China’s healthcare system, investments in hospital capacity and medical treatments actually slowed. “While authorities were busy conducting mass tests and building quarantine centers, China’s vaccine drive also stalled. Fewer than 60 percent of Chinese have had a booster shot, government data shows, including 40 percent of those age 80 and older,” Liyan Qi and Raffaele Huang wrote. “Now, with virus outbreaks setting records and protesters taking to the streets to denounce Covid-19 controls, experts say China isn’t any better prepared for a serious healthcare emergency than it was three years ago.”

Presented Without Comment

Also Presented Without Comment

Toeing the Company Line

  • That “Kanye. Elon. Trump.” tweet from the House Judiciary Committee GOP official account was all Nick needed to launch into a characteristically witty Boiling Frogs (🔒). “It’ll remain a fascinating time capsule from the fall of 2022 about how three very different folk heroes to populist conservatives repeatedly” shot themselves in the foot professionally, he writes.
  • This week’s edition of The Current (🔒) focuses on the Federal Communications Commission’s decision to ban the import and sale of all communications equipment made by Chinese telecom companies Huawei and ZTE. “The wisdom of this action should be obvious,” Klon writes. But in case it isn’t, he’ll get you up to speed.
  • Jonah was in heaven on Thursday’s episode of The Remnant, talking to Barnard College professor Dr. Alexandra Horowitz about … dogs! Do dogs have a unique friendship with humans, or are they just social parasites? Why do dogs react in different ways to different people? And are dog shows a stain on mankind? Tune in to find out.
  • On today’s episode of The Dispatch Podcast, Sarah, David, Jonah, and Steve talk through whether and how the United States should support dissidents in China and Iran, discuss the infamous Trump-Kanye-Fuentes dinner, and lament the intractability of America’s gun debate. Plus: Why Team USA’s victory over Iran in the World Cup is a little bittersweet.
  • On the site today, Harvest has an explainer on the Supreme Court’s consideration of 303 Creative v. Elenis, a case that sets up a clash between the First Amendment and Colorado’s anti-discrimination law.

Let Us Know

Do you agree with the verdict in O’Connor v. Donaldson—that the state should only be able to detain mentally ill people if they are acting in a manner that is “likely to result in serious harm to themselves or others?” Or do you think Mayor Adams is right to try and push the boundaries of that decision?

Price St. Clair is a former reporter for The Dispatch.

Harvest Prude is a former reporter at The Dispatch.

Declan Garvey is the executive editor at the Dispatch and is based in Washington, D.C. Prior to joining the company in 2019, he worked in public affairs at Hamilton Place Strategies and market research at Echelon Insights. When Declan is not assigning and editing pieces, he is probably watching a Cubs game, listening to podcasts on 3x speed, or trying a new recipe with his wife.