We Know How to Solve the Mental Health Crisis. Will We Actually Do it?
It happens like clockwork. A person suffering from serious mental health problems is accused of a heinous and tragic crime committed against a stranger. Then the calls come from law enforcement, politicians, and right-wing tabloids to lock more people up. Rinse and repeat. This all happens despite the fact that people living with mental health challenges are 11 times more likely to be the victims of crime and violence than to commit an act of violence.
It is undeniably true that the status quo for how we address issues like homelessness and serious mental health challenges is untenable. But the response must not be to simply lock more people away. That doesn’t make us safer, and it doesn’t solve the root problems that lead to these devastating events.
Everyone deserves to have safe and stable housing, and we should all be able to get the health care we need when we need it. But for this to happen, we need meaningful, comprehensive, and paradigm-shifting new investments in affordable housing and our mental health care system.
If we don’t see these types of commitments from our state leaders soon, we are headed for incredibly dark days, especially with President Trump in office who promised to disappear homeless people into ill-defined “tent cities.”
On this episode, we talk about why our current approach to dealing with homelessness and serious mental health issues doesn’t work and what needs to be done to truly fix these problems with Harvey Rosenthal, Chief Executive Officer of the Alliance for Rights and Recovery and Beth Haroules, NYCLU Senior Staff Attorney.
Please, download, rate, review, and subscribe to Rights This Way. It will help more people find this podcast.
Resources:
The Alliance for Rights and Recovery
The Status Quo on Homelessness and Mental Health Care is Untenable
Links to definitions of key terms mentioned in the podcast:
Intensive and Sustained Engagement Team (INSET) program
Transcript:
Simon: [00:00:00] It happens like clockwork. A person suffering from serious mental health problems is accused of a heinous and tragic crime committed against a stranger. Then the calls come from law enforcement, politicians, and right wing tabloids to lock more people up. Rinse and repeat. This all happens despite the fact that people living with mental health challenges are 11 times more likely to be the victims of crime and violence than to commit an act of violence.
News: The mayor’s been pushing Albany to endorse involuntary commitment. Governor Hochul now says she’ll include new legislation in the executive budget to change New York’s involuntary commitment standards. They found 88% of respondents are in favor of involuntary commitment laws to take mentally ill people off of the subway.
Simon: It is undeniably true that the status quo for how we address issues like homelessness and people with serious mental health issues is [00:01:00] untenable. But the response must not be to simply lock more people away. That doesn’t make us safer, and it doesn’t solve the root problems that lead to these devastating events.
Everyone deserves to have safe and stable housing, and we should all be able to get the healthcare we need, when we need it. But for this to happen, we need meaningful, comprehensive, and paradigm shifting new investments in affordable housing and our mental health care system. If we don’t see these types of commitments from our state leaders soon, we are headed for an incredibly dark day, especially with President Trump in office, who promised to disappear homeless people into ill defined tent cities. On this episode, we’ll talk about why our current approach to dealing with homelessness and serious mental health issues doesn’t work, and what needs to be done to truly fix these problems. We’ll get to this in a moment, but first I’d like to ask you to please download, rate, review, and subscribe to Rights This Way. [00:02:00] It will help more people find this podcast.
Simon: Welcome to Rights This Way, a podcast from the New York Civil Liberties Union, the ACLU of New York State. I’m Simon McCormack, senior staff writer at the NYCLU and your host for this podcast, which is focused on the civil rights and liberties issues that impact New Yorkers most.
Simon: And now I’m joined by two guests. Harvey Rosenthal is the Chief Executive Officer of the Alliance for Rights and Recovery, and Beth Haroules is a NYCLU Senior Staff Attorney. Harvey, Beth, thank you for coming on Rights This Way.
Harvey: My pleasure.
Beth: Thanks for having us.
Simon: Of course. So, Harvey, I want to start with you. Can you start off by talking about why this issue is important to you and also what the Alliance for Rights and Recovery is and what it does?
Harvey: Sure, Simon, I’m happy to. [00:03:00] So, my career in this field begins as a patient in a mental hospital on Long Island, in 1969, and I was there for six weeks for a very severe depression. As a matter of fact, if I had stayed longer, they were going to give me shock therapy. So thank God that didn’t happen.
But it took me a while to get back on my feet. And eventually I wound up coming to Albany from Long Island. And eventually I wanted to work, I wanted to help people not go through what I went through. This idea of losing, you fell off the world. You were no longer on a straight line going somewhere.
You didn’t know what was going to happen to you. You relied on other people to, you know, almost answer that. And they looked at you like you were really sick. I felt the need to take control of that a little bit, so I went up to Albany, and I wound up working in the state hospital here in Albany.
And I wanted to see, I wanted to be there, and I wanted to help the people not go through what I did. And back then, my hospitalization in a local hospital was nothing as bad as a state hospital, where [00:04:00] people really had no control, no power, no hope for them. And people like me were being told, there’s nothing you can do about them. They have schizophrenia. They can’t make relationships. They’re gonna relapse.
You know, this is the nature of, they’re going to resist. They’re going to be not compliant, and all this sort of thing. I was once told actually, please don’t use the word recovery. It’ll give people false hope. So, I go back to that period. Eventually, I wind up working as an outpatient staff person, and what I remember there is, when people didn’t show up, they would say, we’ll put down patient not compliant, review in three months. We didn’t say as we do now, I got to get out of the office and find these folks. I have to maintain a relationship. I have to be there and prove my, you know, my trust. That was the kind of, it was passive. It was blaming the person and prescribing essentially a form of coercion, which we do to this day.
We blame people for not responding as if it’s their fault. And then we impose this sort of [00:05:00] coercion on people. Anyway, back to the story. So I wind up eventually working in a psychosocial club or a clubhouse program here in Albany, which I was director of for ten years. And during that period, I was exposed to what we call the movement.
And that’s the human rights movement that so many of us really are ruled by, are led by. And it really has to do with human rights and choice and self determination and freedom. And so that really, between working in a clubhouse where it really normalizes the relationships, which I wanted, and where the focus was on people’s humanity, you know, not their patient hood, and then being a part of the movement, really joining in that fully. It led me right to wanting to become a rights advocate, which is at my heart. I do a lot of advocating, but this is always ground zero for me. So my organization, my club program was part of a statewide association, which eventually became the Alliance. The Alliance is now, began in 1981. [00:06:00] And it’s been around ever since then. And in recent years, I’d say 20 years, it has really become a big tent for people who believe in recovery, who value rights, who believe people should live real full lives in the community, and believe that people get to decide, you know, what that means to them.
So, what we do is we really advance recovery, rehabilitation, rights, community inclusion, very involved in criminal justice reform, in racial equity. Those are the big sort of pieces. We do it by advocacy, grassroots advocacy, both. You know, I always say on the outside of the Capitol, we’re marching around the Capitol, but we’re also in the seats inside, really talking to, behind closed doors with the, with government.
So advocacy is a big part. We do a lot with media, as Beth does as well. And we do a lot of training of providers, retraining really of providers, not to be about illness and depersonalization. We created some peer models, the Peer Bridger model, which now been replicated around [00:07:00] the country is, you know, we created that back in ’94.
And more recently, we’ve created a model called INSET, which is an alternative to outpatient commitment. We can maybe talk more about that. So those are the main things I would say about me and the Alliance.
Simon: Yes, thank you, Harvey. That, and we will definitely circle back to some of those models in a bit. But first, I kind of wanna set the scene here as I did in the intro a bit as well. But it seems like what happens is there is a violent incident that gets, captures headlines and gets splashed across local news.
The suspect in the case is someone who has struggled with serious health issues, usually for years. And then the calls from politicians and law enforcement and prosecutors et cetera, you know. They come to say we should increase the number of people who are either imprisoned or involuntarily committed to psychiatric facilities.
And just broadly now Beth, if [00:08:00] you could talk about what’s wrong with this cycle.
Beth: Well, you know, unfortunately there’s so many things wrong with the cycle, right? I mean, this is a sort of sad, but periodically disturbing event that takes place. I think at bottom what it exposes the cycle that we see an event, a cry for really restrictive interventions to take people away from participating in society, living their lives, and lock them up.
You know, there’s a serious issue here because there is not in fact a system that provides mental health services to people. It needs to be a comprehensive system that’s in place. You know, we talk about, and we hear about people who are repeatedly admitted to a quick emergency room visit in the city. They’re called CPEPs, Comprehensive Psychiatric Emergency Programs, where a person is stabilized, which basically [00:09:00] means they’re medicated, and then put back outside on the street again without connecting them to services, not giving them a navigator who can help them find their way to the very sparse services that are out there. In the city, in particular, we don’t have culturally competent services. We don’t have services that are based in the community, that reflect the makeup of the community, communities of color with generational trauma, with all the social determinants of health that just cascade and make day to day existence extraordinarily difficult. So, you know, we look at what has happened with respect to the mental health service system since the period of the Great Deinstitutionalization. Back, you know, to Harvey’s point about, the movement was a civil rights movement to ensure that people could live in community, live their lives, recover, succeed. And what happened with the mental health side of the equation [00:10:00] is that we ended up not actually taking the dollars that were recovered from closing big institutional settings, lots of state staff were unionized. That was not plugged into community based services, into housing, supportive housing that was no barrier.
We ended up looking to places like Rikers to become a substitute institutional setting. So, you know, there is a problem because things will happen. People will, in fact, get into a situation where they’re brought into the criminal justice system. Or people will be victimized themselves. Ms. Kawam, the woman who was burned to death, was the victim of someone who actually didn’t have a mental health service issue.
You know, it was a person who committed a criminal act against her. Most people with mental health issues are going to be victims of crime as opposed to perpetrators. But when it comes to perpetrators, right, who are not actually criminally liable, [00:11:00] our politicians say lock them up, get them out of the public domain, take them out of the subway, take them out of the street, put them away someplace. And then, that’s the end of the discussion. Our politicians fail us because there is a way to create a service delivery system that meets people where they are, that helped them recover and succeed, that protect them from harm and protect all of us from harm. And every single time, lock them up.
That’s the end of the discussion. And then people forget about it, you know, the New York Post doesn’t cover it on the front page anymore. But people’s lives go on. People are still unable to connect with appropriate services. They’re not given the dignity of housing that is safe, that’s over their heads.
People are not given culturally competent, linguistically competent access to services. People cannot participate in recovery if they don’t have a therapeutic alliance. They don’t have a trust with the [00:12:00] folks who are providing talk therapy or suggesting they get into a medication regime, anger management classes.
If those services don’t exist in a way that the person is engaged and wants to participate, then, you know, you failed the person. And so, again, I go back to politicians really fail us because they have one trick in their playbook. The playbook has been written since the 70s, for better or worse, and they never move past this one limited band aid response of getting everybody out of public sight.
Harvey: You know, Beth, I want to jump on that word fail because we view a court order, a Kendra’s Law court order, as system fair. There are those that want to see the sign of a good system as more orders. We feel the exact opposite. But that doesn’t mean that we want to, you know, leave people on the street suffering and struggling.
It’s not like we’re defending people’s rights to [00:13:00] suffer. We’re defending their rights, frankly, to get a right, to have the right to get good care, good services and supports. That’s our responsibility, and too often we blame people. But we know how to help people, even now. We know how to help people in the worst shape, with the greatest sort of crisis.
We’ve learned so much in this field, and a lot of it has to do with peer support. Folks like me who’ve been there helping other people that are sort of trying to get there. And I could talk a lot more about that. But that’s really a key to Beth’s point about trust, it’s critical that a peer is. And another problem is funding in the system, because the relationships are always changing because the staff have to leave to get a better job.
Then we can’t do either one. We have the wrong staff person, or we have the right person who’s cycling through at times. So there’s a lot there with that. You know, we can talk a little bit more about how to help people who are in the street in the worst way. We’ve learned, can tell you more about how we do that.
Simon: And I just want to make the point as well that for the [00:14:00] calls to lock them up, it doesn’t like, even that is not being done and that is not a solution that any of us on this podcast are advocating to be sure. But it’s also not something that, correct me if I’m wrong, you two are the experts, but it seems like someone gets involuntarily committed, they get given some drugs, and then they get taken out onto the street again. And so they’re not even accomplishing their draconian goal of completely eliminating people with mental health challenges. They’re just, you know, putting a bandaid.
Beth: Yeah, I mean, that’s the hypocrisy of the system, right? That politicians are supposed to administer the public fisc. They’re supposed to administer public safety. They’re also, under our state constitution, obligated to aid the needy, right? That manifests both in a state constitutional mandate to provide people with housing and shelter, and it also provides for aid to people with mental health disabilities. And, you [00:15:00] know, from a historical perspective, a lot of that comes out of our 1938 state constitution, where there were amendments to the state constitution specifically to introduce a mandate to provide housing and a mandate to provide social services and specifically mental health services in the wake of the Great Depression, where you had Wall Street folks losing their entire portfolio and losing portfolios they administered for other people, committing suicide, leaving families destitute. We turned from that stock crash into the Great Depression, where we had Hooverville’s tent houses up and down the West Side Highway and the Hudson River.
So, we have state constitutional mandates. And again, you know, I go back to hypocrisy of elected officials here. Because putting somebody on a temporary basis into chemical restraint, to Harvey’s point of a Kendra’s order as a failure. You know, to qualify for a Kendra’s [00:16:00] order, a person has to either have committed an act of violence within a four year period or had two involuntary commitments based on treatment noncompliance in a three year period. And you know, people are triaged when they come into a psychiatric center. And the order is reserved effectively for people that are deemed to be most at risk of ending up on the front page of a newspaper. And it jumps them to the head of the line for, again, you know, services that aren’t necessarily the right services at the right time for this person, you know.
There’s like a social work saying that you meet a person where they are and you work with them. That’s why state constitution that sort of takes that provision. We have Olmstead, which is a Supreme Court case that speaks to every human being has the right, particularly people with disabilities, to be in the least restrictive setting most appropriate to their needs.
That is the balancing [00:17:00] test here in terms of who requires more restrictions on their sort of individual liberty because their disability manifests in a way that requires restrictions to be placed on them. And, you know, it’s a sliding scale. People graduate or move on that scale, so that, do you need some restrictions?
Do you need inpatient commitment? Do you need involuntary treatment while you’re in an inpatient setting? Do you need involuntary outpatient commitment, which is AOT, assisted outpatient under Kendra’s law? Because that allows you to be in the community with guardrails. Do you need an order? Do you just need access to services that bring with them oversight and accountability?
We don’t have that right now. I know Harvey wants to jump in.
Harvey: Yeah, thank you Beth. Well, it’s a question of are you getting the right services by the right person at the right time in the right way? [00:18:00] And peer support, I think, has a lot to do with that. Again, we’re not trying to leave people on the street or coerce them. I think, by the way, there’s a false sort of comparison here, a statement which is we feel like right now we either have to reduce people’s rights or sacrifice public safety.
And we don’t have to do either one. We can actually fix both with the right kinds of services that we’re about to talk about. So if people are on the street, we have a whole continuum now. We have outreach programs that are run by peers. I had a contract, my organization, with the biggest managed care provider here.
We were out on the street. That was our people. That’s people we work with. They’re not going to come in necessarily. They have fear. They have chaos. Staff, you know, help is not attractive. It’s not rewarding. It’s not effective. So we don’t blame the person because they’re not coming in or because they’re not accepting care.
We’re taking it on. What is going on here? Let’s find out. And let’s offer people what they do want instead of sending a staff [00:19:00] person out that they don’t like, offering something that they don’t want, and then calling them non compliant. So in that program, we went out, we went all over the city, you know?
And, you know, in the projects, on the homeless shelters, out of hospital, and we found that we could engage people. Not everybody, you know, but a lot of people who thought were the unengageable.
Matter of fact that in, I’ll skip to that INSET program which is the program that we created really to see if we could prove that peer services, voluntary peer services could work with people who had real difficult times.
The same profile is what Beth talked about. People who met the, all the criteria for Kendra’s Law. And we wanted to test out whether we could, if we engage them with peers and a different way and offering different services, whether they would engage. And 83 percent of the unengageable were engaged by the INSET program in its first six months in Westchester County.
And now that program has been adopted by the governor. [00:20:00] It wound up in the State of the State. You know, there are now going to be, by the time we’re done between the legislation and the governor, we’re going to double the number of INSET programs. That’s the way to go. That’s the right way to go. And by the way, it’s so much cheaper than 1, 300 a day in a community hospital in New York City.
These programs really are very effective and cost effective.
Beth: And, you know, the sort of flip side to that is that we have an existing provision in the mental hygiene law that permits critical incident reviews that sort of fills in the blanks, right? You know, programs shouldn’t have to go out and test and then come in, hat in hand, to say, look we know how to do this, right?
The government, under 31.37 of the mental hygiene law, and that is the state and the office of mental health, should be convening critical incident review panels when there is a public safety issue that arises. And you know, it has not been used. It has been on the books [00:21:00] since 2013, 2014. It came out of a joint task force convened by the state and New York City in 2008.
And we see in the current proposal from the governor, you know sort of, nothing looking at that, but the one house bill in the assembly is proposing that there be some mandate built into that, to have the Office of Mental Health convene a panel. But only when a local governmental unit requests it. You know, it should be a mandate.
Anytime something happens, the parties who should be accountable should be at the table to assess what happened here. Was it a lack of services? Was it nobody watching? Was it no services? Were the services that were, you know, provided to the person something that they didn’t want, offered by a staff person that they didn’t like?
Was there some dropping off of that person [00:22:00] because non compliant, can’t find them? It sounds like that clearly is what happened with a couple of the folks who have made the front page of newspapers, right? Including Jordan Neely, who a lot of reports he was over served. But nothing stuck, nothing reached him, nothing worked for him, and there was no effort to determine what was happening here.
What do we have that could reach him and make him commit to recovery? What would make him somebody who didn’t have to live on the street?
Harvey: You know, I would say that this is one of our main points as advocates this session is to say the legislature you want to keep the peace, you want to be tough on crime, you want to eradicate violence. Well, the incident review, you know, subcommittee, every time that there’s an episode of violence, if the people who should most be involved, providers, government, et cetera, really got to the basics of what happened and fix that. I mean, I was going to say Jordan [00:23:00] Neely as well. There are people, Daniel Prude, who was killed by the police in Rochester. And to go into why that happened, what could have happened. And so often, there’s so many things that could have happened upstream. Instead, we leave people out there until terrible things happen to them as well as others.
Simon: And I do want to get to something called Daniel’s Law in a bit. But can we talk about what Governor Hochul and state legislatures have proposed with regard to increasing the reasons, the reasons for and the number of people who can be involuntarily committed? And I just, I know we’ve mentioned Kendra’s Law on this episode.
Can you quickly just describe what that is as well?
Beth: Let me work with Kendra’s Law first, because that’s a little bit easier to explain. Under New York state law, we have a particular chapter of the state mental hygiene law, Article 9. That is the chapter of state law that deals with involuntary commitments, involuntary [00:24:00] treatment. Kendra’s Law is a form of involuntary treatment that was adopted back in the late 90s, that was intended to provide mandated treatment in a community based setting.
The rest of Article 9 deals with inpatient, so either emergency room, or short term inpatient acute care, or ultimately longer term care in a state’s psychiatric center. So Kendra’s Law was intended to address what pejoratively is called like frequent flyers, people who commit, you know, as they say, one act of violence or something that’s criminally adjacent in a four year period. That was at the time called Larry Hogue provision, the wild man of 96th Street.
There was a gentleman who was engaging in property destruction on the Upper West Side and causing a lot of extreme distress in the people who lived in that [00:25:00] neighborhood. The rest of Kendra’s Law was intended to get at actually the situation of Andrew Goldstein, who was the man who pushed Kendra Webdale in front of a subway train.
He had been asking for services. He was deemed to be treatment non compliant because he wasn’t able to access services. And so Kendra’s Law is intended to get to people who have a mental illness and are treatment non compliant such that they have had involuntary admission to a psychiatric center.
Now the rest of Article 9, which is where Governor Hochul in this budget time frame, as well as previously two years ago she tried this, is resuscitating some old legislation that has been introduced and struck down and just not adopted in New York State. It comes from a national organization, the Treatment Advocacy Center, which is aligned with the New York City based Manhattan Institute.
It is very both [00:26:00] conservative and also very stigmatizing in terms of trying to force people with mental illness into involuntary treatment on an ill founded assumption that the person lacks insight. So it’s a very paternalistic approach to, you know, we will give you the treatment we think is appropriate.
That comes out of long standing institutionalization treatment modalities, right? That the psychiatrist in the white coat behind a desk knows what’s best for you, and doesn’t really need to know where you’re coming from, what are your triggers, what’s your path in life that’s led you to this situation where you’ve got a psych person who is putting you under a treatment regime.
So, Governor Hochul wants to basically change the standard by which a person can be involuntarily taken in, retained, and treated to capture people who are homeless, who are quote unquote [00:27:00] unable to provide for themselves, whether it’s shelter, food, treatment, money, you name it. The intent is to provide sort of this very large net to remove people who are unhoused from particularly in this city’s central business district.
Harvey: And basically, right now, the standard previously was you could be involuntarily committed to a hospital if you were a danger to self or others. Danger to others is fairly straightforward. Danger to self is being redefined here, is not trying to harm yourself in some violent way, for example. But that you’ve had difficulties with food, shelter, and clothing. Somehow that’s supposed to be tied to your mental illness or what have you. And the police then is given the right to take you off the street to an inpatient facility involuntarily, but they don’t give out food, shelter, and clothing in hospitals. So how is that the fix? I mean, it’s basically, I see it as we’re trying to hide people, not help them.
The real help is not going to be [00:28:00] in a medical facility if you have trouble with food, shelter, and clothing. As Beth says sometimes, it’s criminalizing poverty if people were not able to have access to that. So, and in Kendra’s Law again, they’re making it easier. Kendra’s Law increasingly has become a hospital discharge sort of mechanism to force you in a discharge plan to take this kind of medication and do this kind of service.
Again, I want to talk about discharge planning later, because it really disproves the idea more hospital beds are going to do anything when the discharge plans are as bad as they are. But Kendra’s Law is often included in discharge plans now, because they’re saying well, we want them to leave hospital and force them on medication because that’s going to be the solution.
Simon: I wonder if, you know, cause it’s not just the governor’s plan. I don’t want to unfairly single her out, but it seems like there’s not a plan on offer, at least that I’m aware of, from politicians in Albany that’s likely to change the status quo for dealing with homelessness and [00:29:00] people who are dealing with serious mental health concerns.
And I think something you said, Harvey, and I know Beth you’ve said it as well, it seems like by changing the standard to is unable to care for themself, that could be anyone who doesn’t have a home, right? Or anyone who doesn’t have enough money for adequate food. You know, that does seem to put the onus, it’s a very individualized look at the problems people are facing.
So, sorry with that tangent.
Beth: You know, I mean, I think we’ve just seen reports coming out that one in four New Yorkers are unable to provide for their basic needs. That means one in four New Yorkers in a city of eight million. I know we just had some census numbers talking about resurgence of growth in the city, but let’s use 8 million.
One in four of those folks cannot afford housing, food, clothing, and the like. So you have this sort of construct in the city where a person is perceived as [00:30:00] they must be mentally ill because they’re out there on the street and they don’t have a place to live. Well, I’m sorry, the socioeconomic conditions in the city make it more likely than not that people will lose shelter.
Families with children will lose shelter. And again, I go back to we have a state constitutional mandate that should never happen. But affordable housing is an issue in New York City. Affordable, supportive housing for people with disabilities is another issue.
Harvey: I want to expand upon that. So I think you were asking, Simon, what could the legislature or the governor do that would solve the problem in the most effective way? And the governor has done some things. She’s spending towards a billion dollars, and she’s putting things on the street that are really critical. The legislature puts up some things, but it’s in miniature. Both of them are in miniature to what the need is. The focus shouldn’t be on public safety, but public health and expanding. So we have a continuum I’d like to talk about a little bit to help people in the [00:31:00] greatest need. The first one would be if people are on the street and they’re suffering and struggling, we have INSET. We have SOS team, safe option support team,
I think it is. We have crisis mobile crisis teams. All of them are expanding out of this billion dollars. Help is on the way. Help is here in many instances. Instead of going to an emergency room, we have something called Peer Crisis Respite. It’s a home like setting where people can stay for as long as they need, or at least, you know, a week or two anyway, in that program to really bring the stress down, to feel comfort from their peers, to de medicalize.
Not to go to a fluorescent light emergency room where you’re going to be brought upstairs and shot with a needle, but to have a place that really is soothing and supportive. We have crisis stabilization programs which are multidisciplinary places where people can go whether it’s medical needs or addiction related needs, mental health needs.
And then if people are hospitalized, we have Peer Bridger, a model we created, that starts at admission, during the trauma of [00:32:00] admission and offers a peer to help folks get ready for and leave in a discharge plan of their choosing. And then, the next thing is to go to a housing first program, which would be the supported apartment with an act team, you know, like a multidisciplinary team. And then they have a place like a clubhouse, so a person to walk alongside you as you leave, a place to live, and a place to go.
All of that. Those are answers. Just those are not what we’re investing in but in miniature. The governor is in miniature, the legislature in miniature, but the focus is more on public safety than really ramping up the real answers to this.
Simon: And sorry, just real quick. What is a clubhouse?
Harvey: Clubhouse is a program created in, the legend goes, in 1948, five people that had been in Rockland State Hospital, again and again, sat on the steps of the New York City Library and said we do not want to go back. They formed a support group that eventually became a model. A clubhouse model, which again started in [00:33:00] New York City, and it’s all over the world. And it basically is a place to go where it’s not medical, you’re not feeling like a patient, you’re a member of a club. In many instances, the staff are not allowed to have offices. It’s meant to be not hierarchical. Everybody works together for the work of the club. There’s a lot of social activities from evenings and what have you.
It’s a place to go to get that food, you know, to have shelter. And they also run some housing programs. But I think the most important thing is, it’s a family. Many people have lost their families, or vice versa. Well, they lost a person. They burned their bridges. And a clubhouse is a family.
And I was the director of the club. People go, you know, were married there. We had all the holidays there. It was a place where you could go and get the things that you would get from a family.
Beth: It’s basically, you know, for people who think about institutional models, it’s almost like a day program without walls type thing. But, you know, there are navigators. There are social workers, whatever you might [00:34:00] need or might not know exists can help you, right? If you are looking for a place to live, if you’re looking for a place just to sit back and share your experience and get input and insight. In the city, for example, Fountain House is one of the biggest sort of clubhouse models adjacent to Times Square.
So there’s a lot of interaction between Fountain House and the Times Square Alliance, you know, because obviously a lot of people are given bus tickets to come into New York City because local places can’t provide supports and services to them. So a lot of people come down to the city and they do come in unhoused and they do come in unconnected, burned bridges with family members. And clubhouses become a circle of support for people. You know, the crisis stabilization centers are sort of based on that less restrictive, less medicalized kind of situation. Because, you know, we litigated Kings County where there were [00:35:00] hundreds of people in the emergency room, fluorescent lights, no place to sleep, people coming in at all hours, no place to shower. Just really inhumane conditions.
Harvey: If you were in a mental health crisis, do you think you’re gonna get better in that kind of a setting? Would you take me to a place where some lights, where the security guard is looking at me funny, where I’m waiting a long time, where the only treatment I’m gonna get is medication?
And I’m going to lose my hope. Who would construct, as they call that, and call it a treatment plan or a service?
Beth: Well, and that’s why our state law, right, has these markers. You know, 6 hours, 12 hours, 18 hours, 24 hours, 72 hours. Because there is an understanding in the psychiatric profession that people deteriorate. The less time they’re in a high stress situation where they may need some sort of treatment intervention, the quicker they get access to something like that, the better off everybody [00:36:00] is.
So keeping people out of these high trauma, high stress settings is critical. And again, you know, to Harvey’s point, little bits and pieces.
Oh, let’s have a pilot project here. No, everyone knows it works. There’s literature, I know it’s being struck off the CDC website and the NIH websites, but there is literature. There is actual, peer reviewed materials that demonstrate that these are all tried and true and successful programs.
We know what works. We don’t have time.
Harvey: Here’s an example of where government is working. Now I disagree with Mayor Adams on almost every single thing, but he did spend 30 million dollars to expand the number of clubhouses in New York City. And Governor Hochul is putting money in the budget to bring clubhouses back upstate. At one point there were 30 of them, that’s why association began as a clubhouse association.
And she’s putting back seven. We don’t have to agree with everything a politician does when they can sometimes do something, you know, we [00:37:00] do agree with. And back to the governor, she’s put a lot of these things on the street. I actually feel like, and you see this throughout the country, public fear and the narrative of public safety. We have to control violence and then conflating that with mental illness and then cracking down on the dangerous mentally ill is what may be where the governor’s attention gets. But she was also in Fountain House eight months ago and left there saying we’re going to bring clubhouses back upstate, we are going to put more SOS outreach teams in the street, we are going to have more INSET. So to your point, there are things that government can do.
And to Beth’s point, not just in pilot format, but as a major policy. We spent the money on these kinds of things so you would save lives and you would save dollars for sure.
Beth: Yeah. And, you know, even with Mayor Adams, I’m intrigued by one of his proposals to create this Bridge to Home, which is basically a step down unit. A supportive housing setting [00:38:00] that is a little bit more adjacent to psychiatric center and to clinical services than I would like to see. But the model is that for a person who does not require long term shipment out of the city to a state psych center away from family or supports in the community or friends in a clubhouse, but they don’t require staying in the hospital, but there may not be necessarily the safest place for them to go. It’s like a step down place. Now, like so many things with this administration, there’s a lot of talk and there’s not an awful lot of transparency and there’s not a lot of demonstrated success and movement towards implementation.
Because I know that Adams wants to bring on clubhouses again in New York City, but he has taken a lot of the smaller clubhouses offline. Anyway, you know, we can dispute whether it’s good or not, but it remains to be seen if this will be successful. But again, it is another piece of the puzzle.
We had this with Kings County with [00:39:00] discharge planning, which is a bugaboo that both Harvey and I have lots of issues with and lots of things to talk about, is that’s critical to ensuring safety for people and society.
Harvey: Maybe you’ll circle back to Daniel’s Law, but that’s just what we’re talking about is a health response, not a public safety response.
Simon: So now I kind of want to move into the solutions. We have talked about some of them, but I do want to get into Daniel’s Law and then to how the treatment plans can work once someone is out of hospital.
But first I actually realize I kind of want to make sure that we’re aware the status quo is unsustainable, as I’ve said. But the right or the far right or however you want to characterize them, the MAGA right, and then the president Trump has put out what I think pretty clearly his solution and their ideas for what to do. And Beth, you and I wrote a blog on this, where we mentioned this, but he put out a document titled ending the [00:40:00] nightmare of the homeless drug addicts and dangerously deranged, you can kind of see where he’s going, where he proposed making it illegal for people to sleep on the streets.
And then he then urges states and local governments to force unhoused people to live in federally created tent cities. So basically, it is exactly as you kind of said, Beth, like out of sight, out of mind. We unperson these people and we never have to think about them. And you just pray that you never are someone who has a mental health issue or struggles to find a home. But for the time being, you just think okay, you know great, I don’t have to think about this. Beth and then Harvey, I’m just curious what your reaction is to this kind of plan.
Beth: Well, you know, I mean, again, it’s sort of back to the days of people being seen as criminally insane and needing to be removed from society and the world. There’s a lot of eugenics tied up with all of this as well. I think we see this sort of recognition in a way of the [00:41:00] failure of the psychiatric establishment.
There was a promise at one point that psychotropic medications would restore everybody to capacity. The whole Prozac thing, right? Don’t worry, be happy. None of that has borne fruit in terms of actually being a chemical crutch to full quote recovery. You know, there’s a lot involved with a person’s psyche, how they see the world, how they navigate through the world.
So I think we’re going way back in terms of just get them out of sight. Who cares about rights? Who cares about conditions under which people will exist? The tent city phenomenon is just again hearkening back to the hoovervilles where West Side Highway just put people out in those tents and hopefully we won’t see them.
The problem is, of course, the West Side Highway is, you know, highly desirable for high cost residential development, including Donald Trump himself. His Trump Towers on the West Side [00:42:00] Highway are built right on the prior land that the hoovervilles were on. We saw tent cities in Central Park, for example, during COVID at the very beginning where they needed to have surge medical tents.
I don’t think that’s anything that most people want to see in their faces. Now what we saw with the sort of surge of new arrivals to the city, people seeking asylum, immigration folks, we had that same sort of knee jerk reaction with the big tents. Tent city over on Randall’s Island where there’s one bus every hour and a half that goes over there. Tent city out in Creedmoor’s parking lot. Tent city out on a former air base out in the Rockaways.
So, we have models, and we’ve seen why those don’t work, why they are not hospitable to decent, sort of standards of human habitation. When you think about putting somebody into a setting like that, that just enhances the trauma and creates [00:43:00] just enormous burdens. It’s back to institutional asylums. We are so far from that.
We are so much better than that in terms of recognizing that people have challenges. Again, you know, New York City is a tough place to live. Rural areas in New York State are tough places to live. If you don’t drive or if you’ve got issues around getting to places, we have deserts for treatment. Telehealth is fine, but if you live in a rural setting, you can’t even get telehealth counseling because you might not have broadband.
So you can’t access this sort of video connection. So we need to figure out how to effectuate our constitutional mandates in New York state to recognize every person as a human being, and then to address what makes their lives the best those lives can be, because that’s where you end up solving issues around violence, around safety which really [00:44:00] dominate the discussion.
We lose track of the site that, you know, back to the 8 million people in New York City. One out of every four New Yorkers, according to New York City DOHMH, live with a mental health challenge. So we’re talking about very small numbers of people who drive the stigmatizing discussion that is had around the violence of people who live with mental health challenges. It dominates the conversation and it really eliminates solutions here.
So we really need to move back to humanity. I know empathy is not a trait apparently that this particular administration thinks is a characteristic that the American population, New York State population should have. But New York is not like that, and we’ve got constitutional mandates that we have to, in fact, demonstrate empathy because we are supposed to ensure everyone has housing, people who are mentally ill have [00:45:00] treatment services, assistance.
Simon: Yeah, and I also realize that Beth, you had talked about Kings County. We’ll put a link to that case in the show notes. But that’s a case that Beth litigated, Kings County Hospital in Brooklyn. But yeah, so, okay, that’s a perfect segue. Beth, because you’ve both talked about we know what works.
We know that tent cities don’t work. We know that little drips and drabs of effective programs are not going to change things to the extent that they need to be changed. So, let’s talk about some of the solutions. I want to make sure we hit on Daniel’s Law, and also the treatments you both have been talking about, like once you’re out of a sort of inpatient setting.
Harvey: I’d like to talk about that, but let’s talk about Daniel’s Law. I think Beth is the expert here, so.
Beth: Okay, well I promise I won’t keep going on and on. Daniel’s Law is an effort to touch one piece of the mental health service system, and it’s the moment of crisis, right? So, a functioning system that provides mental health [00:46:00] services has a continuum of things, right? You have early intervention, early identification. You have crisis. You have post crisis stabilization. You have wraparound services.
Ideally, crisis doesn’t happen very often, right, if you had a functioning system. We don’t have a functioning system. So, more often than not, crisis occurs. And what is crisis? Crisis is a person asking for help. Crisis is a family asking for help for their family member. Crisis is somebody in the community saying I see something where a person needs something. Crisis is law enforcement coming across somebody who appears to be mentally ill and having a moment where they are a danger to themselves or to others. And it’s one thing, okay, fine, somebody’s out there allegedly with, you know, a knife or a firearm, somebody is standing at the edge of the highway threatening to jump off a bridge.
Okay, but for those [00:47:00] folks who are in a more subtle or nuanced situation, Daniel’s Law is intended to remove the police from being the responders, the deciders, the folks who do what is called a mental hygiene arrest, even though New York City, NYPD doesn’t like to call it that. You do not want law enforcement being the responder to a person who is identified in crisis, self identified, family identified, by community.
You want ideally a peer, a person with lived experience. You want somebody who might be a medical professional because sometimes people are having a diabetic crisis. Sometimes somebody is having an allergic reaction to a medication. Sometimes somebody has had a mini stroke, a TIA. You want a medical person as well as a peer being the response team to try to work with the person, de-escalate, figure out where that person should go if they should go [00:48:00] someplace.
Do they go home? Do they go to a stabilization center? Do they go to a clubhouse? Do they want to go to a psychiatric center? The police under Daniel’s Law would be able to be activated by the responders if the responders felt that there was an immediate need that their safety was being compromised.
The theory is with Daniel’s Law that if you embrace that construct, that you are having a non policing response, a health informed, peer informed response to a person in crisis, you will lower the numbers of use of force, death, grievous harm, and trauma and you’ll continue to maintain that person in the community with their family, with their community members, and the like.
The theory at the end of the day with Daniel’s Law is that you roll out a series of councils, community-based councils, comprised of peers and service providers in the community. It’s modeled on the [00:49:00] New York State Ambulance Law that provides, you know, for how does a location, a community ensure that you have the ability to respond to people’s medical needs in a very quick fashion.
And folks are on these councils intended to submit plans to a statewide council that the State Office of Mental Health and OASAS, which is the substance abuse group, ultimately have the ability to accept or reject. That opens up funding to communities that have a model that does not rely on a policing response to people in crisis.
So, Daniel’s Law, you know, has been a piece of legislation that has been worked on, we’re coming up on five years. It is tied to, named after Daniel Prude, who was a gentleman visiting family in Rochester who ended up confronted by the police at a moment in crisis. He was half naked, on the street, in a [00:50:00] snowstorm. The police circled him, put him in a spit hood, and ultimately caused him to die.
And the community, his family very much up in arms. It was a George Floyd moment in terms of abuse and overreach by police. And it has become sort of a rallying point or a north star for the movement in New York State, which is very similar to movements across the country and in Canada and in other countries, to take the police out of the equation.
Police say they do not want to do this. They are not trained. They don’t have empathy. Their job is not empathy. Their job is command and control and enforcing criminal statutes. Their job is not responding to people who are having a health crisis or a mental health crisis. Other than being sort of the Uber, right?
You need a ride someplace? We’re here. We can do that. But in terms of actual response, determining what’s going on, the intent is to try to get this [00:51:00] across the state as the default model for responding to people in crisis. But again, it’s one piece of a non functional mental health system. The crisis piece is the piece that captures media attention, that drives the story about danger.
You know, we had to take this person down. Win Rosario, right, we saw the videotapes in New York City where his mother and brother were also at risk of use of force by the police. So we don’t want that, and it needs to be rolled out, but we’re five years down the line. It has finally been introduced in the Senate One House Budget Bill.
It’s a policy thing, but it does require funding. It requires significant amounts of funding. So that’s Daniel’s law.
Harvey: Well, it’s in both houses.
Beth: A little piece of it.
Harvey: Well, twenty, very close. One house is giving twenty million. One house is giving twenty two million to also pay for a technical assistance center. I want to credit the coalition [00:52:00] for getting that in actually that way. It’s very, it was a disparaged sort of remedy and now it’s in both houses. And there’s a lot of strength behind it. I will say, because a lot of crime is inflicted upon people who have mental illnesses, who are people of color. Daniel Prude being an example. It’s going to be really important. I think the caucus for Black, Hispanic, Puerto Ricans, Asians are really in support of that for that reason.
So there’s a lot of constituencies that are in support of Daniel’s Law and I hope it’s time has really come.
Simon: And Harvey, I want to get to the other paths forward in just one sec, but you bring up a great point about the racial disparities that exist not only with regard to Daniel’s Law, throughout what we’ve been talking about, right, in terms of who is most likely to be involuntarily committed, who has been most likely to be subject to Kendra’s Law orders. They’re disproportionately people of color, disproportionately black.
Is that correct?
Harvey: Well, absolutely. I’d say two things. First of all, in terms of the orders themselves, they’re weighted heavily [00:53:00] towards people color. A Kendra’s Law order in New York City, four out of five of them are people of color, of that group Black, Hispanic, and Asian. Upstate New York, the rest of New York is three out of five orders.
A lot of our people wind up in jails and prisons, people of color. A lot of our people wind up in solitary confinement, people of color. A lot of people are the homeless. So, it’s a lot of factors, but one of them is, it’s fair to engage. When we go back to about relationship and how starting with the person is, we don’t do well with people of color, for any number of reasons, not just racism.
It’s just a lack of cultural understanding that enough people who work in the field that look like and talk like the people we’re trying to help.
Beth: It’s very unfortunate, but the racial disparity is very much present here.
It has been identified with Kendra’s orders in particular, which are compulsion of treatment, in the community, directed at people who are seen as most likely [00:54:00] to engage in acts of public disorder or danger. And you know, that ties up with it everybody who’s in the criminal justice system, everyone who can’t access services. And again, you know, the workforce, it is not tailored towards, it has not created opportunities for people to enter that workforce because their licensure. You have to have academic credentials. You know, part of Daniel’s Law, one of the discussions we’ve had there is ensuring that there is a career pathway established with lived experience, which would take the place of and substitute for academic credentials. That is so important in terms of making sure your workforce actually is hospitable to people who might need to seek help from that person. So.
Harvey: You know, I want to mention something quickly about this. The research, if you look at the demographic of people who are on Kendra’s Law, in many instances, [00:55:00] the average for many years was a black man in his 30s or 40s. It turns out that the original study on Housing First, which is a program that takes people whether they’re drinking or drugging, whether they’re taking their medicine or not, engage that same population, and 93 percent of the time, they took housing with that ACT team, that multi disciplinary team. So here’s a group of people of color who normally wind up in forced treatment, but when you offered housing first, we’re high achievers in that area, so this is another example of the data that we have to. One other thing on Kendra’s Law is that the law was passed in 99. In the law were two options.
There were the Kendra’s Law order and the voluntary enhanced services. What was supposed to happen is the county directors, who for many years were the ones who doled out the orders, had the option to offer people the same package but voluntarily. And too often they failed to do so. They did not do, you know, in a first [00:56:00] resort, last resort. Kendra’s Law was the first resort instead of a last resort.
They did not offer the people, some of the systems had those services, not as many as they should. But at some point, over since 99, there was about 24 or 5 thousand court orders. But almost 24 or 25 thousand in AVS, Enhanced Voluntary Service Arrangements, voluntary agreements. So what we’re pushing for, there’s about 16.5 million in the budget that we’re trying to get our hands on and keep it in services. And we’re fighting others that want to put it in staff who will process the court orders. We don’t need to hire more staff. We need to offer people more services. The enhanced package will prove that people will want it.
So that’s another big piece of our advocacy is to get that money, put it where it belongs.
Simon: So, Harvey, just to be clear, if I’m understanding this correctly, you’re saying that there is evidence that people voluntarily will take services, but that we need to increase the [00:57:00] availability of those services. Is that right?
Harvey: When Kendra’s Law first came out in New York City, it was a force first, you know, city. Nobody was offered an enhanced voluntary. The law was passed. I called the city council. I said, this is great. You have this money, you can use it alternatively. He said, we’re never gonna do that. We don’t want liability, force first. But upstate New York, it was not that way. So in Syracuse, in Buffalo, in Rochester, they took that same money and they offered people a service agreement which was voluntarily, and lots, you know, thousands of people took that agreement, and more would if they were offered that.
Beth: Although I have to say Buffalo actually did have a high number of orders because Kendra Webdale was originally from Buffalo and so.
Harvey: Not in the beginning but right.
Beth: Not at beginning. Yeah. So Erie County started doing that. But Harvey’s exactly right. I mean, the workforce should be developed, but not in the administrative processing of orders compelling people into services or jumping them to the front of the line.
I mean, [00:58:00] it’s much easier to grow your workforce there. We need people who are actually up here working with people, finding them, making sure, you know, they didn’t come in for the appointment, let’s go find them. Those are the people you want as opposed to check, check, literally on a piece of paper.
Harvey: And it brings you back to the financing for the workforce. We need a strong, dedicated, stable workforce, but we’re not paying. We’re paying so little that people are going to work at Amazon or McDonald’s and it compromises our efficiency and our effectiveness.
Beth: Which gets into discharge planning.
Simon: Oh, yes, discharge planning. Thank you, Beth.
Beth: Let me just put a little pin in that one because what generally happens, okay, so a person comes in to a psychiatric setting, so emergency room, longer term inpatient. And then what’s in between inpatient and this sort of first touch. The state has always had a provision of law, 29.15, which mandates discharge planning. A [00:59:00] person needs a safe discharge. For people who are familiar with nursing home discharge, hospital discharge, it’s the same concept. If you are in a facility you cannot be just caught and released, put back out there.
You know, when we litigated in Kings County, we had a mandate that people could not be quote discharged to a shelter for housing. They had to have a real address, housing first, a place that would take them. Of course once our consent judgment went away, that fell off the side, but. I digress. What we see currently and what we’ve seen for a long time is that the state which controls these facilities and controls the application of discharge planning, has like three levels of discharge planning.
So it’s basically if a person comes in for evaluation and referral, they get nothing. They might get an appointment to an outpatient mental health clinic. They get nothing at all. These are the folks, and it’s that OMH mandate that leads [01:00:00] to this cycle of a person being brought in, medicated, and immediately put back out, right?
OMH says, don’t give them any discharge planning. For the people who go inpatient, okay, it’s full blown 29.15 discharge planning. Do we think that what is done is appropriate for people coming out of facilities? Not likely because, again, you have to work with what’s there. You have to work with what will accept someone.
You have to work with whether the person’s on Medicaid or not on Medicaid. You have to work with family support. Are they there? Is there barrier free housing? Does the person need something else? So the discharge planning is supposed to be much more robust. Again, I look to our Kings County case where we had a process that if a person’s discharge plan failed and they were readmitted, you know, on a three day basis, on a 30 day basis, on a 60 day basis, on a 90 day basis, it goes back to the [01:01:00] critical incident review analysis.
What happened? Why did that discharge plan fail? So discharge planning plus critical incident review, I think, having done this legal work for too long, I won’t say how long I’ve been doing it, you know, would go a far way towards addressing what we see routinely occurring here. You know, people who fall off the safety net.
And then suddenly result in a cry to lock them up and involuntarily admit them and treat them.
Harvey: I just want to comment on that too, in that we had this peer program in New York City working with people who were being discharged, who had been previously hospitalized 20 times that year. If hospitals worked, somebody shouldn’t be coming back 15 to 20 times. If hospitals work in the rare instances of violence that we’ve seen, too many of them in hospital a few weeks before that. So, you know, hospitalization is not the cure. It’s about getting people to off [01:02:00] and on the street, but also giving them a plan, a good plan. We know what works. It’s participatory. A peer at the beginning really de traumatizes the experience, offers people hope, makes sure people’s wishes are included in the plan.
A peer, a bridger, that’s what I’m talking about here, is by our model, stays with somebody all the way through. You know, the word warm handoff is very popular now. We don’t like warm handoffs. It’s just one more, one more handoff to another. It’s about relationship, stability. As a bridger, when you get admitted, I promise I’m going to be with you throughout as long as you need me. That’s really a rare and precious thing. And again, another part of a discharge plan is having a person to be with, but also a place to live and a place to go. If we’re not addressing those things and just making it about medicine. I take medicine. I’m not against medicine, but A, it’s a choice, and it’s only one of many things I do, and people deserve that choice and all the options that they should have.
Simon: And really quickly both of you have mentioned a couple of different terms, I just want to make sure [01:03:00] we define for the audience. One is a peer in this context and one is a bridger. What are those two?
Harvey: A peer is somebody who basically has the same experience as the person they’re trying to help. Maybe they’ve had a little more recovery, a little more experience, and it’s the kind of person, I know for me, when I was coming out of the hospital and people didn’t have that experience, they looked at me like I was from another planet, that I was a child. The feedback I got back from what happened to me and who I was, awful.
If a peer had come up to me saying, Hey man, I’ve been there. I know what that’s like. Let’s talk about that. I’ll be there with you. That’s what a peer is. And that’s what a peer bridger, it’s something we created in New York state, out of five state hospitals. We’re still there. Sending a peer into a state hospital, which in those days people have been there 10, 20 years.
Long time. Are we able to go and send a bridger and help people leave and want to stay out? It’s an effective model in that we worked with a managed care plan and lowered [01:04:00] the recidivism by 47 percent and the length of stay by four days and the Medicaid spend by 50%. So, this is a proven model that really has a lot of. What’s good is the governor, for the first time, has broken that out in the State of the State and in the budget.
A lot of these folks, the legislature too, are doing really good things here, but it’s not the majority. Too much focus on public safety and a few bridger programs.
Everyone should have access to a bridger.
Beth: And there should be peers in all of these settings. That was one other aspect of our Kings County litigation where we had peers in the emergency room so when a person was still, you know, being brought in and in a heightened state of crisis. And then we had people who were peers in the inpatient settings.
The peer is the reminder, you know, they wear multiple hats, the reminder to staff that this is a human being and this is the way they should look.
You’re having a problem [01:05:00] and they can look like this. They looked like this before and they will again. The peer bridger is also critically important for the person who comes out discharge, because there’s an awful lot of navigating that needs to be done at the other end as well, and that person becomes the person’s advocate and becomes a valued player in that person’s life.
Simon: Okay, I know I’ve already taken a lot of your time, but just very quickly, if you could give like a, just a final summation of what we need in a very generalized, you know, bullet pointy way what you think we need to, what we need.
Harvey: I think we’ve talked about it. We need a system that sees people as people, doesn’t medicalize or criminalize, you know, the distress, the poverty, the homelessness that people experience. The cure for homelessness is housing. The cure for poverty is employment or entitlements, you know. We know what it takes to help people.
I guess that’s my thing. We know, we’ve known for a while what it takes. [01:06:00] We haven’t had the will to put the money into enough housing, enough employment programs with enough peers to have a social sort of connection. Clubhouses and peers are a big part of that as well. But I think that’s the point of, you know, this, we know what to do.
We’ve learned a lot in these years, and there hasn’t been the investment and the focus too much. So now we’re talking about hospitals and police. That is so regressive to what we were, we’re doing. The conversation has been just really taken over by this issue about violence and public safety. And if it’s bad in New York, it’s hell in Washington.
And we’re very concerned about really being ready to fight that, most of all. And I hope that lawyers like Beth will be there to make sure that doesn’t happen.
Beth: And I just want to put in a plug for preventative and early intervention services because, you know, we have so many young people, so many children who we see in New York all the time being taken out by school safety officers and [01:07:00] put into psychiatric facilities. Kings County had that latency unit, which was for young children up to the age of 18.
We saw a lot of very young children in there. Again, you know, a lot of our conversation is around the lack of adult services, you know, what happens to people who effectively are pushed into the criminal justice system, but I think making sure that we’re focusing as well on what the continuum is of a person’s lifetime.
What is it that people need in terms of support, lack of trauma, intervention, identification? There are going to be first break, which just occur, psychiatric challenges that occur, you know, at about 19 or 21. But for the most part, there’s a large population of kids coming through who are going to be pushed into an adult service system that doesn’t have services that had they had services earlier, they wouldn’t be in the adult service system, or they would need a lesser level [01:08:00] of intervention and less assistance to succeed in life. So, focusing as well on the children’s side. I mean, there’s some lip service up in Albany, but it’s more towards, we need beds for these kids.
Those are inpatient, psychiatric, institutional beds that we’re talking about. They’re not community based services. There’s not a lot of focus on the younger side of the equation. And to me, that’s sort of a massive gap here because you see these young people aging and ending up in the criminal justice system, ending up in the path of violent, homeless, unhoused, substance abusing kind of person. So adult services, remembering that every adult came from a child and there’s trauma there that has to be addressed.
Simon: All right. And with that Beth and Harvey, thank you both so much for coming on Rights this Way,
Harvey: Very welcome.
Beth: Thanks for focusing on this. [01:09:00]
