Mayor Adams on the subway (photo: Ed Reed/Mayoral Photography office)

In the first 11 months of the year, the NYPD removed 1,300 people suffering symptoms of mental illness from the city's transit system, often against their will. The city is unable or unwilling to say what happened to them next.

"Dealing with people who have mental health illnesses must be a focus of any plan moving forward," Mayor Eric Adams said at an October 22 announcement of a new subway safety campaign with Governor Kathy Hochul, dubbed Cops, Cameras, and Care – a plan to flood the subways with officers, surveillance cameras, and outreach workers.

"The New York City Police Department has had to remove 1,500 emotionally disturbed persons from the system this year — 1,500 — to prevent some form of incident from taking place," the mayor said.

A month later, in a directive to law enforcement, now clocking 1,200 additional hours in the transit system, Adams instructed officers to remove any individual who appears to have a mental illness that prevents them from meeting their own basic needs.

"Let me be clear," he said at the November 29 press conference announcing the directive, "we will continue to do all we can to persuade those in need of help to accept services voluntarily, but we will not abandon them if those efforts cannot overcome the person's unawareness of their own illness."

Even before that announcement, the NYPD Transit Bureau had already made contact with 1,600 "emotionally disturbed persons" between January 1 and November 22, and removed four out of five of them from subways and buses, according to Alfred Baker, a police department spokesperson.

None of them were charged with a crime, Baker said. Instead, they were handed over to EMS teams who delivered them to the nearest available hospital. It is unclear how many went voluntarily and how many met the clinical and legal criteria for a psychiatric admission. 

Spokespeople for the Mayor's Office, NYPD, and city’s Department of Homeless Services either referred Gotham Gazette to another city agency or stopped responding to inquiries about the outcomes of these cases. A spokesperson for the FDNY, which includes EMS, told Gotham Gazette to file a request for the hospital destinations of the 1,300 individuals under the Freedom of Information Law, which the department estimates will receive a response around April 2023.

The removal of individuals with untreated mental illness has been a central component of the controversial subway safety agendas of Adams and Hochul. As he outlined plans to step up the removals, Adams called it a "moral obligation" to help those suffering symptoms and to make the city safer.

"We can tell New Yorkers all the time that we have decreased crimes in certain areas, but if New Yorkers don't feel safe, we are failing," the first-year Democratic mayor said at the October 22 announcement, flanked by Hochul and top law enforcement, transit, and mental health officials. "And that's why the omnipresence of police officers and the removal of those who are dealing with mental health issues is crucial to our second phase of this important plan."

The focus on crime and disorder in the transit system has become a top political issue amid a period of increased crime rates and several instances of random violence committed by people with untreated mental illness.

Adams is now facing some backlash for that "second phase" from civil rights lawyers and advocates for homeless and disabled individuals. The new guidance, which was sent to NYPD, EMS, and Department of Health and Mental Hygiene mobile crisis teams, is based on an interpretation of existing state law from New York State Mental Health Commissioner Ann Marie Sullivan of what constitutes a danger to oneself and others – the failure to meet "basic living needs."

"It explicitly states that it is appropriate to use this process when a person refuses voluntary assistance and it appears that they are suffering from mental illness and are a danger to themselves due to an inability to meet their basic needs," Adams said on November 29 when he announced the push to increase involuntary hospitalization.

"We believe this is the first time that a mayoral administration has given this direction on the basic needs standard and official guidance," he said, referring to Sullivan's directive, which she issued to localities in February.

The people who fit that profile are predominantly unhoused people of color who have fallen through the cracks of the social safety net and live in the public spaces of the transit system.

It is unclear how effective the strategy is in getting people the help they need or improving safety underground. The Adams administration has been unable to provide information about the outcomes for the 1,300 detainments, including whether any of the individuals were admitted to a hospital, and how many ended up back on the street or in a shelter.

"The mayor didn’t 'tout' stats about those suffering from severe mental illness in the subways, but gave the simple stat where there is an overlap between mental illness and crime — not that the two are always tied because they are not," wrote Adams' press secretary, Fabien Levy, in an email responding to an inquiry about the efficacy of involuntary removals.

He did not provide any information about the 1,300 individuals removed from public transit by the NYPD or what City Hall is doing to track outcomes for those removed from the subways for mental health reasons. The city agencies Gotham Gazette was referred to by Levy or another agency were also unable or unwilling to provide any information about what happened to those individuals.

The NYPD initially referred Gotham Gazette inquiries to the Department of Homeless Services before referring inquiries to FDNY. DHS did not respond to inquiries about how many of the individuals were referred to its shelters, or how many people enter the shelter system after being released from a psychiatric commitment. FDNY said only that all patients are brought to the "closest appropriate hospital" when EMS is called.

While the city has seen multiple high-profile subway killings committed by people with reported psychosis, the mayor has drawn a tenuous connection between the majority of homeless individuals with mental health issues and violent crime in the subways. He has also made a point to say that not all people with mental illness are violent and the presence of apparently homeless and mentally ill individuals is as much a problem of disorder and unease among the broader riding public.

At the October “Cops, Cameras, and Care” announcement, Adams said the focus on mental health is in part a response to those few violent incidents. "Of the nine homicides that we've had on the subway system, this is why we're zeroing in today on mental health, 40% of those homicides came from people with a mental health history," he said, referring to four homicides, according to his office (a spokesperson for the mayor would not elaborate on what those alleged mental health histories consisted of, or whether the individuals were untreated at the time of the incident, but some have been reported by news outlets).

Adams went on to discuss the thousand-plus individuals removed from the system "to prevent some form of incident from taking place."

“Governor Hochul's top priority is the safety and well-being of New Yorkers, and we have been working collaboratively with the city on solutions to provide unhoused New Yorkers living with severe mental illness the help they need," wrote Justin Mason, a spokesperson for the governor, when asked to respond to the lack of clarity around outcomes for the 1,300 individuals removed from the transit system by the NYPD.

The governor controls the MTA and thus the subways, but, as she often notes, the city and the mayor are largely responsible for policing the transit system.

"This plan builds on our ongoing efforts together, including outreach teams in the subway system, training first responders, increasing capacity at psychiatric hospitals and residential programs, strengthening state laws, and issuing mental health guidance to ensure vulnerable populations get the care they need, and the Governor will continue working with elected colleagues, law enforcement, and medical professionals to enhance safety, support and resources," Mason wrote.

Disability and housing advocates criticized the removal regime, which they say violates individuals' civil rights and dangerously gives untrained police an invasive pseudo-clinical role in dealing with people with mental illness. Critics, including Public Advocate Jumaane Williams and members of the City Council, have raised questions about officers' ability to assess removal criteria among the vast and subtle web of experiences that fall into the category of mental illness.

"The NYPD has been illegally removing people from New York’s transit system for decades in violation of the Americans with Disabilities Act and the United States Constitution," wrote Marinda van Dalen, a senior staff attorney in the Disability Justice Program at New York Lawyers for the Public Interest, in an email. NYLPI and lawyers on behalf of a coalition of organizations filed a motion in federal court Thursday to block the new policy.

"The new involuntary removal policy is a dangerous departure from the already illegal 'EDP' policy," van Dalen said, using the acronym for emotionally disturbed person. "As set forth in our request for emergency relief, it now allows police officers to detain someone who they perceive as merely acting unusual."

Police and crisis intervention teams will receive enhanced training and the city will set up a hotline of clinicians that officers can call for guidance, according to the mayor.

City Council Speaker Adrienne Adams said the policy lacked enough detail to be evaluated by the Council.

“We are still waiting for a full, comprehensive plan when it comes to the rollout,” she said Wednesday at an unrelated press conference. “What we see in the Council is an idea. What we’d like to see is a plan. We have not seen that yet.” The speaker mentioned unanswered questions about how the NYPD will make removal assessments and how the directive will interplay with the larger continuum of care that the mayor has acknowledged is a deficient work in progress.

"New Yorkers deserve transparency on the effectiveness of the approaches the Administration is taking, particularly when it has announced an intent to expand its use," wrote a Council spokesperson in response to a Gotham Gazette inquiry about the lack of information from the administration about the outcomes of 1,300 removals.

The detainments may coincide with an increase of court-ordered outpatient treatment under a statute known as Kendra's Law, which the mayor and governor have repeatedly cited as a central plank to their mental health and public safety plans. The orders are sought by city health department officials under similar dangerousness criteria as the involuntary transit removals, though it is unclear what drove the uptick in those outpatient orders.

A separate state outreach program, known as Safe Option Support, made contact with 2,700 homeless individuals in the transit system and connected 410 individuals with services, Hochul said on October 22. The state has not provided data to show whether the program has been successful in achieving its goal of getting people into permanent housing. (It is unclear how many of these individuals, if any, are counted among the 1,300 people removed by the NYPD this year.)

Another piece of the puzzle is whether hospitals have the capacity to meet demand. The low availability of psychiatric beds has been a long-time issue for psychiatrists, social workers, and more recently, Adams and Hochul, who have centered it in their public safety plans. People often wait for days to be admitted to a hospital and the lack of continuity between inpatient and outpatient services – another element Adams said he wants to address – can leave people not far from where they started when they get out of a hospital stay.

Hochul has made it a point to restore over 1,000 psychiatric beds taken offline during the pandemic, which would increase the state's capacity by roughly 17%. But the state so far has restored only about 200, a pace that has slowed to a halt in the last five months. In New York City, 415 beds remain offline, though a spokesperson for the state Office of Mental Health told Gotham Gazette last month that 200 more would come online "in the coming months.”

New York City Health + Hospitals, the city's public hospital system and its largest behavioral health provider, would not provide details about its psychiatric bed capacity, including how many beds came offline during the pandemic and how many are currently available.

"The state should be able to provide granular detail for all the health systems in NYC. We're one piece of the puzzle," wrote Christopher Miller, a Health + Hospitals spokesperson, in response to repeated Gotham Gazette inquiries.