Emergency medical service workers and advocacy leaders fear the Adams administration's new policy to forcibly take people believed to have mental illness to hospitals will increase an already significant number of assaults on first responders — and not meet the needs of homeless people in crisis.

Nearly 200 EMS workers have been assaulted on the job in New York City since May 2020, when the Emergency Medical Service Public Advocacy Council first started counting. Leaders of the 1,200-member organization say the actual number is much larger because their figures are based only on what their advocates report. They said an assault occurs on a mental health call at least once a week.

The mayor’s new directive, implemented on Tuesday, requires the city’s first responders and health contractors providing care in a “psychiatric crisis” to forcibly take people to the hospital if they appear unable to meet their basic needs.

Once admitted, psychiatric patients who are homeless often “get a sandwich, and a quick psychiatric evaluation before they are back on the street again,” said Ashley Lurie, who has been an EMS worker for more than a decade. She said she has been assaulted about five times and most of them were psychiatric calls: “The policy won’t change things. We need a significant influx of funding and getting trained people into the system.”

In the Bronx, where Lurie works, she said that out of more than a dozen hospitals, there are fewer than five facilities equipped to take psychiatric patients.

While the new directive is meant to get help for unhoused people with mental health conditions, EMSPAC Chief Advocacy Officer Walter Adler said it ignores logistical issues, such as severe staffing shortages among emergency medical workforces, limited hospital occupancy for psychiatric patients and a lack of training handling these matters.

As Gothamist reported earlier this autumn, New York City is “planning to be short about 235 EMTs per month on average throughout this fiscal year” and expects shortfalls with paramedic staff, too, due in part to low wages and burnout. EMS workers are also concerned that enforcement of the new directive could erode the fragile relationship between them and the communities they serve.

“Violence happens [to EMS workers] when civilians don't want to go to hospitals,” said Adler, who has served as an EMT or paramedic over an 18-year career at city hospitals. He said he has been assaulted five times on the job.

The biggest concerns center around safety. EMS workers are unarmed, and unless the patient is under arrest, they don’t ride with a police officer. They also don’t receive de-escalation training, even though they are sent into situations where there is a “high probability of violence,” Adler said. The hazards are increased by working in confined spaces — like ambulances and subways — which can turn dangerous very quickly and unpredictably.

“Our members get routinely assaulted as it stands now,” Oren Barzilay, president of FDNY EMS union Local 2507, said via email to Gothamist. “We know that forcing people with mental health issues to unwillingly comply with the policy can place our members in harm's way as they may physically fight our medics.”

This year, New York City has logged about 2,700 emergency medical calls per day, and EMSPAC says, typically, about half of those are due to mental health or substance abuse. The volume of daily 911 calls has been increasing, Adler said. Before the pandemic, the numbers hovered just over 4,000. The advocacy group feels confident that the mayor’s policy will lead to a spike in emergency calls and could also deter some people who need help from seeking it.

Adler and Lurie didn’t think the new policy would result in the intended outcome of providing more consistent care for the most vulnerable New Yorkers because of limited hospital capacity and gaps in staffing.

According to the New York State Nurses Association, New York City has experienced a persistent decline in inpatient psychiatric care while its population has continued to grow, and the need for these services has ballooned. About half of New York City’s 2,781 certified inpatient psychiatric beds were concentrated in public hospitals in 2018. The greatest decline in capacity has occurred in independent facilities. Overall, beds for mental health services dropped about 14% between 2000 and 2018. Gotham Gazette reported this week that a state-led effort to bring roughly 1,050 psychiatric beds back online this year had only yielded about 200 so far.

Lurie also pointed to the lack of coordination between agencies. In Westchester, where she also works as a paramedic, Lurie can call ahead to the hospital and inform them of any preparations needed. This is not the case in New York City, where the emergency response system is fractured between employees of different private hospitals, FDNY and public hospitals. Adler said there are nearly 40 EMS systems, independent of each other.

“The city needs to provide more resources right away if they’re going to do this, and not let the burden fall on EMS,” Lurie said. “You’re asking people who are making $17-$18 an hour to put their life on the line.”