The death of Jordan Neely, a homeless man diagnosed schizophrenic, has prompted forceful calls for accountability.
Neely deserved to be helped before it was too late. The public deserve to feel safe.
These are not separate ends, and accountability is the solution for both.
We need a public mental-health system obligated to prioritize individuals with serious mental illness in crisis.
The tragedy reflects a grim saga all too familiar to the seriously mentally ill, their families and society.
Police received calls about an emotionally disturbed person. Reportedly five passengers called 911 before and while Neely was held in a chokehold by Marine veteran Daniel Penny on a subway train.
Callers said Neely was “harassing people,” “attacking people,” making threats and (incorrectly) that he had a weapon. Neely was also reportedly asking for help: food, shelter, a job.
The NYPD received more than 166,000 EDP calls in 2021.
Families call police when their loved ones are in crisis but are often told that nothing can be done until the person is a danger to himself or others.
Those with serious mental illness, like schizophrenia or bipolar disorder, are often victims of violence and, when untreated, may be offenders of violence.
In 2018, mentally ill Saheed Vassell was shot to death by police while waving a pipe appearing to be a gun.
In January 2022, Martial Simon shoved Michelle Go in front of a subway train to her death. Neely, Vassell and Simon all had serious mental illnesses — and were not being treated.
No treatment turns into a dangerous cycle. Neely had been arrested at least 42 times in 10 years — at least twice since 2019 for subway attacks.
Mentally ill Alexander Wright, who punched a woman unconscious at random in May 2021, had more than 40 arrests.
City outreach staff know these frequent fliers well — in fact, Neely was on the Department of Homeless Services’ “Top 50” list of those most urgently in need of services and treatment.
Still, he was continuously shuffled between jail for committing random violence and hospitalizations without stabilization.
Neely’s aunt told The Post that she “pleaded with judges and doctors to help get the proper care” — to no success.
The pattern persists. Simon had 24 hospitalizations in 20 years for schizophrenia.
Anthonia Egegbara, who was 29 years old in 2021 when she pushed a passenger into a subway train, had been hospitalized more than 50 times, for schizophrenia and other diagnoses.
What’s lacking is a continuum of care for seriously mentally ill individuals before, during and after crisis.
Above all, this requires beds — in general hospitals and standalone psychiatric hospitals, as well as residential beds.
For those like Neely who can’t stay stable nor avoid violence without intensive care and oversight, longer-term inpatient care is likely the most appropriate and humane setting.
Without it, Neely was institutionalized in a punitive, cross-system setting of jails and streets.
City and county mental-health authorities should operate programs and services, including a spectrum of beds, in this continuum-of-care system in partnership with the state providing funding and oversight.
New York must also maintain appropriate bed capacity in state-run psychiatric hospitals.
The federal government should support efforts through repeal of the Institutions for Mental Diseases (IMD) Exclusion, which disincentivizes states from investing in beds dedicated to psychiatric care.
A real, effective system has yet to emerge because the movement to deinstitutionalize psychiatric patients from hospitals to the community occurred alongside a shift in mental-health funding that deprioritized treatment for the mentally ill in favor of preventing mental illness among the masses.
This despite that we don’t know what causes mental illness (so we can’t prevent it).
And serious mental illness will never develop in the overwhelming majority of the “worried well”: prevalence rates of schizophrenia are around 1% to 2%.
Mayor Eric Adams has taken constructive steps. He has implemented plans aiming to facilitate access to care and psychiatric hospitalization: by clarifying when police and other frontline workers can initiate involuntary treatment, by proposing reforms for commitment evaluations and by directing health-care providers to consider patients’ history when determining if discharge is appropriate.
Adams also added intensive outreach teams helping maintain service continuity at all points where mentally ill individuals may drop out of providers’ view.
Importantly, Adams’ focus on mental illness is complemented by Gov. Kathy Hochul, whose recent budget includes funding to add more than 1,000 psychiatric beds in hospitals across New York.
Hochul’s support is needed because some of Adams’ initiatives, like discharge planning, fall under state jurisdiction.
Ramping up inpatient capacity has not been easy. Already hospitals have missed a deadline Hochul’s administration set to get pandemic-shuttered psychiatric beds back online. Beds are key to the city’s and state’s success.
Original Article: https://nypost.com/2023/05/09/how-to-build-a-mental-health-system-that-saves-people-like-jordan-neely/
