Involuntary Treatment Makes People Less Likely to Engage Voluntarily
As officials in New York City move forward with their plan to have first responders involuntarily hospitalize anyone who “appears to be mentally ill” or “displays an inability to meet basic living needs,” psychologists are sounding the alarm on how this approach will never solve the problem.
There’s also a lot to say on how involuntary hospitalization of a marginalized group by police, untrained in psychiatry, is a massive restriction of rights and completely unethical even if it somehow worked.
For now, we will focus on how it’s doomed to fail.
Police Are Not Qualified for This Job
The process of deciding whether an individual’s situation warrants being involuntarily placed into treatment is one that fully trained psychologists with years of experience in precisely this area struggle to make. It’s a difficult balancing act between the risk of a person’s future harm due to their illness and the harm that’s inevitably done through involuntary treatment.
Police officers have little training, time, or context to make these decisions. Additionally, their new directive’s broad, vague language gives them enough leeway to bring practically anyone in for evaluation.
Juanita Holmes, the chief of the NYPD Training Bureau, says that training on how to interact with mentally ill individuals is being offered in the form of a 25-minute interactive lecture and a video which 87% of patrol officers have found the time to complete. Compare that to the multiple years of schooling, which 100% of psychiatrists require to make the same decisions.
NYC Mayor Eric Adams insists that this program is designed to be primarily carried out by mental health professionals, not cops. But if that’s the case, why are police involved at all? We already know that police and homeless people don’t mix well. Why introduce more opportunities for violent interactions to occur?
Influx Puts Strain on Hospitals, Providers, and Patients
From the time the policy was implemented in December to early February, at least 42 New Yorkers were brought in for this evaluation from mobile crisis teams alone. The total number from all sources was likely significantly higher.
Obviously, this sudden influx of people to emergency departments in New York City with no corresponding bump in funding or resources for those hospitals is putting a strain on things. It can even divert attention from patients who really need it to people who do not need treatment but were simply in the wrong place at the wrong time when a police officer decided to bring them in.
The evaluation process itself can also be grueling for both patient and provider. It involves a clinical interview, a review of past mental health records, and contact with third parties to confirm the patient’s level of functioning and any recent changes.
It can be traumatic for a person faced with losing their autonomy if they say the “wrong” thing. The sheer number of evaluations can also take a toll on providers. And a rushed, stressed-out doctor is probably the last person you want deciding the fate of your future freedom.
Involuntary Treatment Poisons the Well
Being forcibly brought in for involuntary treatment is the least optimal introduction to mental healthcare a person can have. In a discipline that relies on trust, vulnerability, and openness to be effective, a therapeutic relationship that begins with violently destroying a person’s autonomy is a difficult hurdle to overcome. If treatment does succeed, it would be against all odds.
Even if someone isn’t admitted to an involuntary care facility but “only” detained for evaluation, how likely do you think that person will be to reconnect with care providers when it’s most needed?
If it were me, I think I’d feel that I’d narrowly avoided being locked away against my will the first time, and I could never go back to seek treatment for fear of not being so lucky the second time around.
A recent study confirms this effect, noting that involuntary detainment like this leads to increased humiliation and loss of dignity- neither of which are conducive to a fruitful therapeutic relationship.
The Mask of Concern is Slipping
Why would a mayor choose to move forward with such a plan, even when experts in the field outline all the ways it’s bound to backfire? Are supporters of this plan just so self-assured that they think it can succeed despite all of the evidence to the contrary? Or is it more likely that they’re lying about their true motivations?
After all, if you genuinely wanted to help people improve their mental health and living conditions, it would give you pause to hear feedback that the way you want to do that will undoubtedly cause more harm than good. That would probably send you back to the drawing board to look for a different solution with a better chance of actually accomplishing your goal.
But if your true motivation was to just get unhoused people out of sight and out of mind, you probably wouldn’t care about that feedback. Because the plan is still accomplishing your real goal, and whether or not it actually helps the people it says it’s supposed to help is beside the point.
Improving homeless people’s lives isn’t the actual goal of the program. It was just the pretty packaging used to make an inhumane idea more palatable to the public. By the time it’s fully implemented and exposed as a scam, no one with the power to change anything will be paying attention anymore.
We can’t let that happen. We need to keep sounding the alarm, keep the pressure on politicians, and keep protecting the rights of our unhoused neighbors until this policy is reversed and until there are no more unhoused people to defend.