Mayor Eric Adams on Tuesday issued a directive that would allow emergency responders to transport presumed mentally ill people to hospitals involuntarily.

The move could allow non-medical professionals, such as police officers, to request such removals from streets and subways based on their judgment of a person's inability to meet basic needs for health and safety, the mayor’s office said. This can happen whether or not the person poses an overt danger to themselves or others.

After removal and transportation to a city-run hospital, doctors can then decide if the person needs to be admitted.

The mayor’s announcement comes days after police arrested a woman for fatally stabbing her two children. The incident is one of a string of violent crime incidents committed by people who reportedly had a history of mental illness.

Adams also proposed an 11-point series of reforms in state law to govern the care of mentally ill New Yorkers.

“For too long there has been a gray area where policy, law and accountability have not been clear,” Adams said during an address at City Hall. “And this has allowed people in need to slip through the cracks.”

According to New York state’s Mental Hygiene Law, a police officer, peace officer, physician or mental health professional can order a person to be taken to a hospital or psychiatric facility for an evaluation "if such person appears to be mentally ill and is conducting himself or herself in a manner which is likely to result in serious harm to the person or others."

Adams described the need to determine the “overt” potential for harm as a myth that burdens emergency responders, leading to assistance only being provided in cases where they are “violent, suicidal or presenting a risk of imminent harm.” The policy states “waiting for EMS may increase that risk of danger.”

The new directive removes this misunderstanding, according to the mayor. It would allow involuntary removals and transport to a hospital, so long as the person cannot meet their “basic human needs,” as judged in the moment.

Deputy Mayor Anne Williams-Isom said ideally that this judgment would come from specialized teams composed of mental health professionals and first responders such as the police.

“We want the specialized teams to come to that site, and then do that work and wait for the EMS to come so that we can transport them to the hospital,” Williams-Isom said.

But the policy, as written, allows the police alone to call on EMS to make a removal, even if a mental health clinician isn’t present on the scene. The NYPD is not permitted to transport an individual.

The policy, which takes effect immediately, states that it permits these removals in order for the person in question to receive a mental evaluation.

But the mayor’s directive acknowledges that “case law does not provide extensive guidance regarding removals for mental health evaluations based on short interactions in the field.”

The reaction

At least one prominent civil liberty advocate opposes the mayor’s efforts. Norman Siegel, the former head of the New York Civil Liberties Union and an ally of the mayor, said the approach would open the door to numerous legal challenges involving the deprivation of individual liberty.

He argued that the new directive was “based on vague and overly broad terms” that could result in non-dangerous people being confined due to speculation over their future conduct. He added that the administration’s response raises questions about its intentions toward homelessness and the city’s mental health crisis.

Siegel was tapped to help the administration lead an outreach program to those living on the street.

He said responders who win over the trust of homeless individuals will typically find them willing to accept mental health treatment.

The problem, he said, is that the city could not accommodate the demand for mental health programs.

“Is it ‘out of sight, out of mind’ or is it to help people?” he said.

The Coalition for the Homeless also criticized the mayor’s strategy.

“Homeless people are more likely to be the victims of crimes than the perpetrators, but Mayor Adams has continually scapegoated homeless people and others with mental illness as violent,” read a statement from the group. “Further, his focus on involuntary transport and treatment ignores that many people cannot access psychiatric care even on a voluntary basis.”

But other stakeholders said they support the mayor’s move. Kathryn Wylde, head of the influential group the Partnership for New York City, which represents the business community, said, "I believe the mayor's announcement today is a very thoughtful approach to getting people the treatment and support they need, and that's something that the business community strongly supports."

In his remarks, Adams spoke of his partnership with Gov. Kathy Hochul on the issues of public safety and mental health.

Hochul on Tuesday signaled her backing of Adams’ proposed legislation. Reached for comment, Hazel Crampton-Hays, a spokesperson for the governor, said the mayor’s plan “builds on our ongoing efforts together” around mental illness, including outreach teams in the subways and increasing bed capacity at psychiatric hospitals.

Earlier this year, state lawmakers approved a five-year extension of Kendra’s Law, which allows the court to order a person to undergo mental health treatment under certain conditions.

But some advocates have argued that in the face of the pandemic, New York City has not done enough to address the ongoing mental health crisis.

Mental illness has been cited as an underlying factor in some of the city’s most high-profile crimes this year. In January, Michelle Go, 40, died after being pushed onto the subway tracks by a homeless man who had been in and out of hospitals for a behavioral condition. The next month, Christina Yuna Lee was killed allegedly by Assamad Nash, who had reportedly been suffering from mental illness.

It’s unclear if New York City hospitals can handle an influx of involuntary removals. A recent report by Public Advocate Jumaane Williams found that since 2019 the number of respite care centers — mental health facilities that offer an alternative to hospitalization — fell by half. And despite efforts to redirect mental health emergencies to trained specialists, the city is still mostly relying on police officers to respond to such 911 calls, according to the report.

Although Adams and Hochul said earlier this year they would seek to increase the number of psychiatric beds across the state, Gotham Gazette reported this week that only a small fraction have come online.

Adams said he would make his proposed reforms a key part of his agenda in the upcoming legislative session in Albany. After the announcement, the mayor appeared before reporters along with several state lawmakers, including Assemblymembers Ron Kim and Jenifer Rajkumar.

The Legal Aid Society and a group of public defender organizations released a joint statement praising the mayor for bringing attention to the city’s mental health crisis — but did not directly address the directive or the proposed reforms.

Instead, they urged the mayor to support legislation that would allow New Yorkers who are charged with crimes and also have substance use disorders or mental health conditions to be placed in treatment programs as opposed to jail.

Chau Lam and Jon Campbell contributed reporting.

This story has been updated to include details on the criteria police can use to remove someone and transport them to a hospital, according to the mayor’s office.

Correction: A previous version of this article misspelled Hazel Crampton-Hays’ name. It’s been updated.