March 31, 2025
NYS COUNCIL ADVOCACY
1) Please work with us this week to call out members of the NYS Congressional Delegation to address the federal grant terminations that were announced last week. According to the Governor’s Press Release (last week) OASAS has lost $40M (total), while OMH has lost $27M. Therefore, the request for immediate assistance from the delegation should be $67M. The NYS Council VoterVoice system is ready to assist you with sending letters to your representative/s here: https://nyscouncil.org/advocacy-action-center/
2) At the state level we are calling on the Governor and legislative leaders to come together to close the funding gaps that threaten to eliminate critical programs and services across the SUD and OMH systems of care. Considering the NY state budget is still in play, it makes complete sense for us to be calling on lawmakers to appropriate the funds we need to close the gap in entirety, allowing providers the time and space to mitigate the cuts and (where necessary) try to absorb impacted staff. The NYS Council is calling on Governor Hochul and state lawmakers to establish (during ongoing state budget negotiations process) a Contingency Fund account in each of the two state agency budgets (OASAS and OMH) to include adequate funds to permit the Offices to help providers preserve continuity of care. Our letter generator page includes communications you can send to state leaders to request full restoration of grant funds for impacted OASAS & OMH providers. https://nyscouncil.org/advocacy-action-center/
3) While visiting our online NYS Council Advocacy Action Center please PLEASE continue to send letters pushing for OMIG Reform (you will find the link to generate letters on this topic on the same page as the others, at the bottom). https://nyscouncil.org/advocacy-action-center/
4) Please continue to make calls to press for a 7.8& Targeted Inflationary Increase using the information here:
MAKE THREE CALLS TODAY TO SUPPORT 7.8% TARGETED INFLATIONARY INCREASE FOR MENTAL HEALTH/SUBSTANCE USE DISORDER SERVICES IN SFY 26 STATE BUDGET
As state budget negotiations continue we urge all members to continue to call the Governor Hochul’s office, Senate Majority Leader Andrea Stewart-Cousins, and Assembly Speaker Carl Heastie to urge the final budget include a flexible 7.8% targeted inflationary increase (TII) for mental health and substance use disorder services. Budget negotiations continue around the clock so it is imperative we make our voices heard.
ACTION NEEDED
- Call Governor Hochul’s Office at (518) 474-8390.
- Call Senate Majority Leader Andrea Stewart-Cousins at (518) 455-2585.
- Call Assembly Speaker Heastie at (518) 455-3791.
SCRIPT
Good Morning/Afternoon. I am calling to urge the final budget includes a 7.8% targeted inflationary increase for community-based behavioral health not-for-profits providing critical services and supports. This increase is needed to support rising inflationary costs for programs and to support the workforce.
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FEDERAL BUDGET UPDATE
Republicans in the House and Senate are aiming to adopt a negotiated budget blueprint before they leave town for a two-week Easter recess on April 11th. The budget blueprint is the first step towards crafting a bill that contains Trump’s tax, border, energy, and defense policies, but both Chambers must pass the same budget measure to begin drafting legislation. That could prove difficult as the Senate has already made clear they have concerns with the proposed House blueprint.
Senate Republican leaders will move as soon as Wednesday to begin advancing a budget plan and may have a resolution adopted before the weekend. But there’s still one critical piece needed to make it work.
But the Senate parliamentarian needs to sign off on Republicans’ plan to use the current policy baseline, which would allow them to pursue trillions of dollars in tax cut extensions while claiming it doesn’t cost anything. Republicans need this ruling — they believe it could come as soon as Tuesday or Wednesday — before finalizing their revised budget resolution.
The Senate’s budget resolution guidelines are expected to instruct committees to cut as little as at least $1 billion when lawmakers begin to draft legislation through the budget reconciliation process. That strategy would give senators a spending cut floor as low as $3 billion compared to the House GOP’s savings floor of $1.5 trillion. The Senate won’t alter the House’s instructions to its own committees, including leaving untouched the House GOP plans for the Energy and Commerce Committee to slash $880 billion from its jurisdiction — which has sparked worries among a segment of Republicans in both chambers that it will force deep cuts to Medicaid.
The Senate Finance Committee also isn’t expected to mirror the House Ways & Means Committee $4.5 trillion guidelines. The Senate wants to make the extension of Trump’s tax cuts permanent — but where lawmakers end up on their ceiling for the tax portion of the reconciliation bill will depend on the parliamentarian’s ruling this week. The Senate is also expected to include a higher defense number — $150 billion for its committee compared to the House’s $100 billion — and is eyeing a $5 trillion debt hike to get the party past the midterms without having to pursue a politically difficult fight with Democrats to avoid a default.
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STATE BUDGET
According to Politico, over the weekend, Liz Krueger, Chair of the Senate Finance Committee, said, “If we lose federal dollars in various categories, we are going to have to completely re-evaluate sections of the budget or perhaps the whole budget. We think it’s better to move forward and know that we will have to come back and do our work again.” Hochul has said her team has begun gaming out how certain federal cuts would trickle down to the state level, but put the onus on Republicans in New York’s Congressional Delegation to push back on anything that would impact New Yorkers. Hochul said, “We also have a responsibility to put them on the spot and say, ‘What are you doing to make sure your home state of New York is not hurt?’” In the Capitol, whispers abound that September is the time most likely to see a Special Session to revisit any potential economic recalibration.
NYS budget will be late as leaders continue talks on tax cuts, cellphones in schools ban
By Michael Gormley, Newsday, 3.29.25
ALBANY — Gov. Kathy Hochul and legislative leaders this week will negotiate a late state budget that will increase spending despite the threatened loss of billions of dollars in federal aid, provide a $3 billion tax cut for most New Yorkers and include several significant policies, including a “bell-to-bell” ban on student cellphones in schools.
The budget is constitutionally due by Tuesday, which is the start of the 2025-26 fiscal year. But that deadline, as in most years, will be missed. Closed-door talks won’t resume until Tuesday after the Monday observance of the Muslim holiday Eid al-Adha.
Legislative leaders are planning to pass an “extender” that will maintain spending under the lapsing state budget through this week, but more extenders can be approved until a new spending plan is passed.
Of all the major issues being negotiated behind closed doors, the student cellphone ban appears most likely to gain approval in a $252 billion budget deal, according to legislative leaders.
WHAT NEWSDAY FOUND
- Gov. Kathy Hochul and legislative leaders this week will negotiate a late state budget that will increase spending despite the threatened loss of billions of dollars in federal aid.
- The budget is constitutionally due by Tuesday, which is the start of the 2025-26 fiscal year. But that deadline, as in most years, will be missed.
- Legislative leaders are planning to pass an “extender” that will maintain spending under the lapsing state budget through this week. More extenders can be approved until a new spending plan is passed.
Hochul has proposed a “bell-to-bell” ban on student cellphones in schools to reduce distraction in the classroom and improve instruction. Senate Majority Leader Andrea Stewart-Cousins (D-Yonkers) and Assembly Speaker Carl Heastie (D-Bronx) said their Democratic conferences favored the concept, but there was pushback.
Some parents feared loss of contact from their children in emergencies while some school officials bristled at another mandated policy from Albany. These critics called for local control — a touchy political issue for state officials dependent on local support — and to leave the policy up to school boards which already have the authority to set such policies.
“I think the majority of members are more comfortable with ‘bell-to-bell,’” Heastie told reporters last week.
Stewart-Cousins in a separate news conference said her majority conference also is “comfortable with a ‘bell-to-bell’ ban.” She said a provision is likely to allow school districts to continue their own policies if they are effective.
But just when that budget deal will be made is uncertain.
Also dominating the closed-door talks are Hochul’s proposals to send tax rebate checks of up to $500 to families making less than $300,000 a year and $300 to single filers making less than $150,000 a year; $3 billion in additional tax breaks for families making less than $323,000 a year; an increase in school aid of nearly $1 billion to $2.7 billion above current spending at $34 billion; and paying for all of it partly by extending a temporary income tax surcharge on New Yorkers making more than $2.1 million a year to raise $5 billion in revenue.
While there is broad agreement on those concepts, the details are in dispute.
“We don’t have a lot nailed down,” Heastie said.
Hochul said Wednesday she is pushing “a common-sense agenda that delivers real relief and lifts up middle-class families.” She calls the budget proposal an “affordability agenda.”
Hochul’s $252 billion budget proposal would increase state operating funds spending by $10.5 billion, or 7.9%, according to a February analysis by state Comptroller Thomas DiNapoli.
The independent Citizens Budget Commission said counterproposals by the Democratic majorities of the Senate and Assembly would bring that total increase to as much as 13.8%.
“Although the stated theme is affordability, the proposals add billions of dollars in spending to an already inflated spending plan and layer additional tax increases onto New York’s chart-topping taxes,” said the CBC’s analysis released Tuesday.
And there may be another wild card.
Legislative leaders said they and Hochul are seeking more revenue for the Metropolitan Transportation Authority to fund operations and renovations needed for mass transit, including the Long Island Rail Road. That could include a higher tax likely aimed at the largest corporations in New York City, legislators said.
The need for new state revenue is compounded by President Donald Trump’s threats to reduce federal aid that has gone to the MTA.
“We bounced around a bunch of ideas,” Heastie said. “But we all decided we know we are going to have to come up with funding.”
Legislative leaders and Hochul won’t disclose what options are being considered, which has drawn rebukes.
“Albany Democrats’ complete lack of fiscal responsibility is staggering,” said Assemb. Alec Brook-Krasny (R-Brooklyn). He said an independent audit of the MTA is needed to root out what he considers massive waste and improve efficiency.
“The notion that taxpayers should foot the bill for [the MTA] is laughable,” the Republican said in a statement.
But whatever the final budget includes, that may not be the end of the story.
“The process is tedious because of what we see on the horizon coming from our Republican colleagues in Washington,” Stewart-Cousins said. “It really is difficult and deeply disturbing.”
Hochul, Heastie and Stewart-Cousin have embraced a strategy under which they will adopt a standard state budget, making no concessions or plans to address the threatened cuts from Washington.
“One-third of New York State’s budget, $90.8 billion, comes from the federal government,” said Patrick Orecki of the Citizens Budget Commission. “The state should reserve at least $2 billion of the fiscal year 2025 surplus as a contingency fund to mitigate the initial impact of federal cuts. The state will not be able to backfill federal aid reductions dollar-for-dollar, which is why lawmakers need to restrain spending growth now.”
Trump and Congress pledge to cut billions of dollars in aid to the state, claiming without proof there is massive waste. If approved by Congress and the courts, the cuts would force the State Legislature into special session in the fall to cut spending, while blaming the pain on Trump and the narrow Republican majority in Congress.
“We do have seven Republicans in the majority that, if they had the strength, they could actually assure that New Yorkers are protected,” Stewart-Cousins said Wednesday.
Pressure is now building to pass a late budget before Trump details his promised cuts. Heastie estimated federal cuts would cost New York $5 billion in Medicaid health care coverage and aid for hospitals as well as $4 billion for schools.
“Like Yogi Berra said,” Heastie said, paraphrasing the baseball philosopher, “It’s getting late early.”
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NY mental health commissioner faces no-confidence vote following attacks
Planned June 12 vote follows a series of assaults on staff me
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The New York State Office of Mental Health has issued a Request for Proposals for the Youth Safe Spaces Program. This initiative will fund three to five pilot programs throughout New York State to create voluntary, youth-led, community-based, non-clinical mental wellness spaces for youth and young adults ages 12 to 24. Programs may establish new Safe Spaces or designate existing community settings — such as libraries, youth recovery clubhouses, and recreation centers — as Safe Spaces. Applicants do not need to be licensed OMH providers.
Funded Youth Safe Spaces will:
- Offer peer-led, culturally responsive, and supportive environments;
- Increase access to wellness resources;
- Facilitate individual and community youth mental wellness training; and
- Provide opportunities to empower young people to advocate for change.
Priority will be given to communities impacted by trauma, youth homelessness, transportation barriers, or limited behavioral health access.
The full RFP is available on the OMH website: https://omh.ny.gov/omhweb/rfp/2025/yssp/index.html.
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HHS Announces Department Restructuring
On 3/27/25 HHS announced a broad department restructuring initiative that will ultimately eliminate 10,000 full-time employees. According to HHS estimates, these actions will cut the federal workforce and save taxpayers $1.8 billion per year. Together with previous layoffs and voluntary departures, the total HHS workforce will drop from 82,000 to 62,000, over a 20% reduction.
Specific details of the restructuring include:
- Consolidating Agencies: HHS is planning to consolidate its current 28 divisions into 15, including:
- Creating the Administration for a Healthy America (AHA) through the combination of multiple agencies, including the Health Resources and Services Administration (HRSA) and Substance Abuse and Mental Health Services Administration (SAMHSA), among others;
- Absorbing ASPR into the CDC;
- Establishing a new Assistant Secretary for Enforcement to oversee the Office of Civil Rights, among others;
- Combining Assistant Secretary for Planning and Evaluation (ASPE) with the Agency for Healthcare Research and Quality (AHRQ) into an Office of Strategy; and
- Move programs within the Administration for Community Living (ACL) into other agencies.
- Regional Offices: Regional offices will be cut in half, from 10 to 5.
Secretary Kennedy claims that with the streamlining of duplicative functions and personnel across agencies, HHS will be better poised to execute their “priority of ending America’s epidemic of chronic illness.”
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New York has debated forced psychiatric treatment for decades
Half a century after the state tightened the criteria for involuntary commitment, Gov. Kathy Hochul wants to make it easier to hospitalize mentally ill people against their will.
City & State, 3/31/25
On Jan. 3, 1999, Andrew Goldstein pushed Kendra Webdale in front of a subway train, killing her. Goldstein suffered from untreated schizophrenia, and the shocking incident galvanized a movement for a new law allowing judges to order mentally ill people to comply with treatment plans drawn up by physicians, also known as “assisted outpatient treatment.” Within months, Kendra’s Law, named in honor of Webdale, passed the state Legislature and was signed into law. It became a model for other states. Kendra’s Law was enacted nearly three decades after New York reorganized its mental hygiene law, which created a new standard for “involuntary commitment” to allow psychiatrists to hospitalize mentally ill patients against their will.
This year, New York is poised to change its laws around involuntary commitment once again. Concerns over the presence of mentally ill people on the streets and shocking incidents of violence in the subway system prompted Gov. Kathy Hochul to propose amending the state’s mental hygiene law to expand the criteria for involuntary commitment. State lawmakers have not supported the proposed changes, which are supported by psychiatric groups but opposed by some civil liberties organizations and community-based clinicians.
It’s just the latest development in the larger debate over the necessity of forced psychiatric treatment that has played out over the past 50 years.
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The first state-run mental health asylum in New York opened in 1843 in Utica. Over the next century, the number of people in asylums continued to grow – reaching a peak of over 90,000 people in 1955. By the late 1950s, though, the asylum model was falling out of favor. Journalistic investigations by Nellie Bly, Geraldo Rivera and others into the abuses at mental institutions, the development of the first antipsychotic drugs and a growing belief among psychiatrists to “deinstitutionalize” psychiatric treatment and replace large, state-run asylums with community-based treatment centers.
In 1963, President John F. Kennedy signed into law the Community Mental Health Act, which funded the construction and staffing of 1,500 community mental health centers across the country. Kennedy’s vision was never fully realized; only about half of the planned community mental centers were ever built, and those that did operate were chronically underfunded.
Though the community-based treatment model was never fully scaled up, the asylums were emptied. Steve Rosenheck, an assistant professor of psychiatry at Columbia University who has studied the history of psychiatric treatment in New York, said the number of people held in state-run mental health facilities in New York declined by about 2,000 people per year between 1964 and 1968 and then by about 7,000 people per year between 1968 and 1974. Today, Rosenheck said, the state-run mental facilities that held 90,000 people in the 1950s now hold fewer than 6,000 people – mostly mentally ill people who face criminal charges but have been determined incompetent to stand trial.
New York state passed its involuntary commitment law in 1964. It laid out the criteria for involuntary commitment: Two psychiatrists had to certify that someone was “dangerous” before they could be confined. The law also created the Mental Health Information Service (later renamed to the Mental Hygiene Legal Service), a kind of public defender’s office that represents people facing involuntary commitment. The idea was to make determinations about involuntary commitment into an adversarial legal proceeding, akin to a criminal trial, complete with strong protections for the patient “defendant.” The involuntary commitment law was tightened in 1972, replacing the “dangerousness” standard with a requirement that the person has a mental illness that is “likely to result in serious harm” to themselves or others – the standard that is used to this day.
Not all psychiatrists were happy with this new state of affairs. In a 1973 article titled “Dying with Their Rights On,” Wisconsin psychiatrist Darold Treffert argued that the increasing obsession with patients’ rights had led to people with mental illness being denied the treatment that they needed. Courts were respecting people’s rights to refuse hospitalization and treatment, and the result was that they were suffering and dying. Other psychiatrists took this argument even further, suggesting that people with serious mental illness suffered from a form of “anosognosia” – a neurological condition in which a patient is unable to recognize that they have an illness or disability.
One of the most influential proponents of this school of thought was Edwin Fuller Torrey, a psychiatrist and schizophrenia researcher who founded the Treatment Advocacy Center to push for the adoption of state laws allowing involuntary treatment. For decades, Torrey has argued that people’s refusal to accept necessary treatment is itself a symptom of serious mental illness – rather than a reasoned rejection of treatment that the law must respect. In turn, those clinicians opposed to involuntary commitment have argued that it is paternalistic and dangerous for doctors to deny the validity of patients’ explicit refusals of treatment.
Torrey and the Treatment Advocacy Center were instrumental in the passage of Kendra’s Law, working alongside politicians who viewed the issue of mental illness primarily through the lens of public safety. The law, passed in 1999, allows judges to order mentally ill people to follow a specific treatment plan drawn up by a psychiatrist. If the person does not comply with the treatment plan, then they can be picked up by police officers and taken to a hospital for a psychiatric evaluation.
It wasn’t that anybody needed to push him into outpatient treatment. They needed to push the people who do outpatient treatment into opening their door to him.
Kendra’s Law was supported by a coalition of groups and politicians, including the National Alliance on Mental Illness, then-Gov. George Pataki and then-state Attorney General Eliot Spitzer. The law was drafted by Brian Stettin, then an assistant attorney general in Spitzer’s office who went on to join the Treatment Advocacy Center and currently serves as New York City Mayor Eric Adams’ chief adviser on serious mental illness. The law was bitterly opposed by civil liberties groups like the New York Civil Liberties Union and psychiatrists who were against the idea of forcing people into treatment. But it ultimately passed with overwhelming support in the state Legislature.
Former Assembly Member Richard Gottfried, the longtime chair of the Assembly Health Committee, was one of 142 Assembly members to vote in favor of the bill. He told City & State that he voted for the legislation reluctantly and had several concerns with it. “I don’t think it actually had anything to do with the death of Kendra Webdale because the man who pushed her onto the subway tracks had, in fact, been going from one hospital to another seeking mental health treatment and (was) being turned away,” he said. “So it wasn’t that anybody needed to push him into outpatient treatment. They needed to push the people who do outpatient treatment into opening their door to him, and of course the bill doesn’t deal with that.”
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In January, Gov. Kathy Hochul proposed amending the state’s mental hygiene law to expand the criteria for involuntary commitment. It would be the first substantive change to the involuntary commitment standard since 1972, according to Rosenheck.
Under the current law, someone may only be subject to involuntary admission to a hospital if a psychiatrist certifies that they suffer from a mental illness that is “likely to result in serious harm to himself or others.” In turn, the law defines “likely to result in serious harm” as a substantial risk of physical harm due to either “threats of or attempts at suicide or serious bodily harm or other conduct demonstrating that the person is dangerous to himself” or “homicidal or other violent behavior by which others are placed in reasonable fear of serious physical harm.”
The governor’s proposal would expand that definition to also include “a substantial risk of physical harm to the person due to an inability or refusal, as a result of their mental illness, to provide for their own essential needs such as food, clothing, medical care, safety, or shelter.” This means that people with a mental illness who cannot safely provide for themselves could be hospitalized against their will, even if they are not suicidal or homicidal.
The state Legislature has opposed the governor’s proposal to expand the criteria for involuntary commitment; both the Assembly and the state Senate omitted the proposal from their one-house budget proposals. Civil liberties groups are also against the proposed changes to the law. At a time when homelessness in New York City is increasing and City Hall has been aggressively clearing homeless encampments, treating the inability to meet one’s needs as a sign of mental illness could lead to homeless people being forced into mental health facilities just to get them off the streets.
Just as when Kendra’s Law was being debated in the 1990s, much of the discourse around the governor’s proposal, especially in conservative tabloids, has focused on strengthening involuntary commitment laws in order to get mentally ill people out of the subways where they could pose a threat to other people. Take the conclusion of a recent New York Post editorial criticizing the state Legislature for opposing the governor’s plan: “Next time you’re maneuvering around a dangerous-seeming loon, above or below ground, remember: The Democrats who run the Legislature think we need more such folks running free – guaranteeing even more maimings, killings and avoidable tragedies to come.”
The state Office of Mental Health, which helped draft the governor’s proposal, insists that is not the point of the law. Dr. Ann Marie Sullivan, the commissioner of the Office of Mental Health, told City & State that the law is targeting a very small, very specific population of people who desperately need treatment. She gave the example of a person living on the street who had cellulitis in their leg, a serious infection that if left untreated could require the leg to be amputated, but who refused to go to the emergency room because they insisted that there was nothing wrong.
She gave another example from her own experience working as a community psychiatrist. “I used to see him on the streets and then suddenly I go to see him and he’s panting, he’s barely breathing. But he said, ‘There’s nothing wrong with me, I don’t want to go to the hospital, I don’t want to go with you,’” she recalled. “He wasn’t causing any disruption on the street, he wasn’t scaring anybody, he wasn’t threatening anybody, but he was clearly getting sicker and sicker. And I took him to the hospital. That’s the kind of person you’re talking about.”
Sullivan said she thought most unsheltered homeless people with a mental illness would still not be subject to involuntary commitment, even under the newly expanded criteria. “Someone who has been stably sitting on the subway bench for six months, really knows how to live outside, unsheltered, kind of has a lot of bags around them and maybe talks to themselves – that’s not going to affect (them) at all,” she said.
The commissioner specifically rejected the idea that the law could be abused to involuntarily hospitalize large numbers of unsheltered homeless people. “The reality is that it would be illegal for a psychiatrist to do that, and believe me, they’re not going to do it,” she said.
One reason to suspect that the governor’s proposal won’t lead to a flood of new involuntary commitments is that her proposed language is already the de facto standard. The current form that a psychiatrist must fill out when certifying that someone is in need of involuntary commitment explicitly defines harm to one’s self as “the person’s refusal or inability to meet his or her essential need for food, shelter, clothing or health care.”
This isn’t a new development; it has been built on decades of court decisions interpreting the state’s involuntary commitment law.
I used to see him on the streets and then suddenly I go to see him and he’s panting, he’s barely breathing. But he said, ‘There’s nothing wrong with me, I don’t want to go to the hospital, I don’t want to go with you.’
One of the most famous cases involved a homeless woman named Joyce Brown, also known as “Billie Boggs,” who was taken to Bellevue against her will in 1987. After Boggs objected to her hospitalization, a state court held a hearing to consider whether to release her. Legendary civil rights attorney Norman Siegel, then the executive director of the New York Civil Liberties Union, agreed to take her case. Four psychiatrists testified on behalf of Bellevue that Boggs was seriously mentally ill and posed a danger to herself because she was unable to fulfill her needs. They cited the fact that Boggs was urinating and defecating on herself, wearing inadequate clothing in winter, ripping up money that passersby gave her and running into traffic. But three psychiatrists recruited by Siegel and the NYCLU to testify on Boggs’ behalf told the court that Boggs’ strange behavior, while inappropriate, did not necessarily indicate that she was mentally ill or a danger to herself.
The judge overseeing the case was frustrated by the fact that the different psychiatrists had reached diametrically opposite opinions as to Boggs’ mental health and safety. “It is evident that psychiatry is not a science amenable to the exactness of mathematics or the predictability of physical laws,” he complained in his ruling – and decided to release her, largely because he thought she seemed sane when she testified before him in court. An appellate court later reversed that decision, finding that the Bellevue psychiatrists had clearly shown Boggs was unable to safely care for herself, thus meeting the criteria for involuntary commitment.
Given that the inability to care for one’s needs has already been part of the de facto standard for involuntary commitment and has been for decades, why try to amend the statute?
Sullivan believes that codifying the standard would make clinicians more likely to use it when evaluating whether someone can be involuntarily committed. “It is in the case law, but when you talk to individuals who are making these clinical decisions, case law carries a certain weight for them, but something actually being in the law itself can carry a different level of weight,” she said.
In recent years, both the state Office of Mental Health and the New York City Department of Health and Mental Hygiene have issued guidance documents for clinicians and others who interact with mentally ill people reminding them that they can involuntarily commit people who are not violent.
“There is often a misconception amongst both police as well as front-line mental health crisis intervention workers that a person with mental illness must present as ‘imminently dangerous’ in order to be removed from the community to a hospital. … This is not the case,” reads a 2022 guidance memo issued by the state Office of Mental Health, which goes on to cite the appellate court’s ruling in the Boggs case.
The governor’s proposal also includes changes to Kendra’s Law. The primary change is a relatively minor one; it would allow people who have previously been issued an assisted outpatient treatment order to be immediately put on a new order if they are hospitalized or incarcerated within six months of the old order expiring.
In addition, the proposed change to the definition of “likely to result in serious harm,” while only intended to expand the statutory standard for involuntary commitment, would also technically change the criteria for assisted outpatient treatment as well (since Kendra’s Law specifically cites that definition), though this appears to be an oversight by the state Office of Mental Health rather than a deliberate expansion of Kendra’s Law. The office told City & State that it does not expect that the governor’s proposal will have any effect on the number of people subject to assisted outpatient treatment.
Though less controversial than involuntary commitment, assisted outpatient treatment has still been criticized by some civil liberties groups and community-based treatment organizations that objected to the idea of forcing people into treatment that they do not want.
“Just being coerced is itself very traumatizing and can really drive people further away from care, because then the system is viewed in particular ways, it’s not viewed as helpful but can be seen as harmful,” said Cal Hedigan, the CEO of Community Access, a nonprofit founded in 1974 that provides supportive housing and social services to people with mental illness.
Community psychiatrists and advocates like Hedigan said the state should invest more in a variety of voluntary treatment options. “We need a system where people can access more kinds of support – outpatient counseling, family counseling, programs like clubhouses, places where people would be asked ‘What kind of help do you want?’ Not like, ‘We have this idea of the help that you want and that’s all we’re going to give you,’” Hedigan said.
The clubhouse model that Hedigan supports is in many ways the opposite of assisted outpatient treatment. Pioneered by Fountain House – a nonprofit founded in the 1940s in by former patients of a mental hospital – the model takes a broad view of treatment, emphasizing community and peer support, and connecting people with serious mental illness to housing, employment, education and crisis services. The clubhouse model has been widely praised, even by psychiatrists like Torrey who continue to support involuntary commitment in other contexts.
We need a system where…people would be asked ‘What kind of help do you want?’ Not like, ‘We have this idea of the help that you want and that’s all we’re going to give you.’
Assembly Member Jenifer Rajkumar, whose senior adviser Arvind Sooknanan is a board member of Fountain House, recently introduced an ambitious piece of legislation called the Empire State of Mind Act that would provide a right to voluntary treatment for all people with serious mental illness.
Under the bill, any person experiencing a mental health crisis who is admitted to an emergency room would have the right to ongoing treatment (if they want it) and could sue hospitals for discharging them prematurely. When they do choose to leave the hospital, they would be provided with wraparound services, including access to supportive housing, clubhouses and employment opportunities – and a peer advocate to coordinate their care. The bill would also provide mental health screenings to all people entering correctional facilities and homeless shelters to ensure that they receive care.
“We need a Marshall Plan to provide thousands of our fellow New Yorkers the mental health care and housing they need to thrive,” Rajkumar said in a statement announcing the bill. “I have listened to the stories of those caught in the revolving door of hospitals, navigating Byzantine application processes and enduring endless waitlists. When we pass the Empire State of Mind Act, we will ensure that every New Yorker has a dignified pathway to recovery.”
The circumstances of Kendra Webdale’s death have little relationship with the law that bears her name. The man who pushed her in front of a subway had repeatedly sought help, only to be discharged from hospitals with little support. The system failed him – and Webdale – due to a lack of resources, not a lack of forced treatment.
The general public tends to show the most interest in the mental health crisis in the wake of violent incidents. “Every time there is some tragic or horrific act, the immediate impulse, it seems like, out in the world is to say, ‘Yes, and that’s why we need more involuntary and coercive services’ rather than, ‘Yes, that’s terrible and that’s why we need a mental health system that is more welcoming and more responsive to individual needs,’” Hedigan said.
There may be a greater political appetite these days for forcing mentally ill people to accept treatment, in this “Era of Punitive Excess.”
Gottfried said: “In many aspects of our society, Americans are more willing to provide resources if they think they’re punishing somebody than if they’re providing service to somebody. That’s just how we seem to be.”