A New Push to Improve Mental Health Care for Homeless New Yorkers

The Manhattan borough president on Tuesday is expected to announce a plan that he said will help expand access to psychiatric care and housing for severely mentally ill homeless people in New York City.

The proposal by the borough president, Mark Levine, was designed to address gaps in New York City’s social safety net in the wake of several high-profile incidents involving random attacks by homeless people with mental illness.

It calls for the creation of 240 long-term psychiatric beds in the public hospital system’s extended care units, where patients can be stabilized rather than discharged onto the streets, and the addition of intensive mobile treatment teams to care for those patients outside the hospital setting. Mr. Levine wants the city to double the number of those teams to 62, which would allow them to serve about 1,500 people. As of August, nearly 480 people were waiting to be assigned to such a team, records show.

“We have not invested in the kinds of interventions that put people back on the right path,” said Mr. Levine, a former city councilman who took office as borough president last year. “I am optimistic if we have the will we can get this right.”

Mr. Levine unveiled his plan in the wake of a New York Times investigation that identified breakdowns in the city’s mental health care system — homeless shelters, hospitals, specialized treatment teams and other organizations. The lapses preceded nearly 100 acts of violence over the past decade, The Times found, sometimes by a matter of days or hours.

Mr. Levine said the killing of a financial consultant early last year by a homeless man with schizophrenia and a history of erratic behavior prompted him to take a hard look at the gaps in mental health care, and what he described as a “crisis playing out on the streets of New York City.”

General hospitals have slashed hundreds of psychiatric beds in recent years, leading to the discharge of patients who were not yet stable. Once released, some of the patients have spent months on wait-lists for assignment to specialized treatment teams. Others have filled homeless shelters or landed on the streets and in the city’s subway system. Some have gone on to unravel in preventable and violent ways.

The Times found that the city had not placed mentally ill homeless people in dedicated mental health shelters where they could get psychiatric services. Hospitals frequently discharged patients before they were stable. Workers on specialized treatment teams were frequently overwhelmed, undertrained and underpaid, and they sometimes failed to help homeless people who were showing signs that they were deteriorating.

Many of the failures stemmed from poor communication among the various agencies responsible for treating mentally ill homeless people, The Times found.

So often, Mr. Levine said, we only learn about the kinds of failures documented in the Times investigation “after a horrible act.” He added: “No one was connecting the dots.”

To understand the ways in which the city’s social safety net worked and the ways it did not, Mr. Levine said he has toured the different parts of the system. He visited psychiatric facilities and mental health housing units on Randall’s Island and tagged along with outpatient teams as they treated people in the streets.

What he found, he said, were a number of underfunded programs that worked for a small subset of people, but were not able to meet the full need.

As borough president, Mr. Levine does not have the power to pass legislation or enforce laws, but he can introduce bills through the City Council in partnership with a council member and push for the changes he has proposed.

Mr. Levine’s plan calls for the state to create 400 new beds in the Transition to Home program at the Manhattan Psychiatric Center, a new inpatient treatment program for homeless people with severe mental illnesses. The program currently has 50 beds, Mr. Levine said.

He also urged city officials to ensure that supportive housing projects, including three being developed in Manhattan, are completed despite community opposition.

As another part of his plan, Mr. Levine urged the city to strengthen opioid treatment for people with serious mental illness and address staffing shortages in the behavioral health care industry through expanding student loan forgiveness programs, among other initiatives.