A plan to institutionalize the homeless has little meaning in the ER. lisaxmiller reports from the front lines of Mayor Adams's forced-treatment mandate
, he seemed to overlook a basic point. People who are unhoused — whether mentally ill or medically ill or intoxicated or simply in need of a safe place to sleep — already use the city’s hospitals all the time. They come voluntarily and involuntarily, on foot, by ambulance and police van, and comprise 10 to 20 percent of patients in any city ER at any moment. Some come in so often the staff greet them by name on the subway; in the ER, they are referred to, mordantly, as “frequent fliers.
The legalistic guidance went largely ignored for nine months until Adams announced his own version, predicated on it, in November. Civil libertarians immediately took issue. “Hospital is not prison,” said Josh Goldfein, a staff attorney at the Legal Aid Society. “A person who has not been accused of a crime cannot be jailed. All the cops can do is take them to the hospital, and the hospital has to follow the same rules it always has.
Quietly and among themselves, though, some ER and psych doctors wonder whether the pendulum has swung too far in the direction of patient autonomy. It’s not that they agree with the Adams directive, which they see as a blunt instrument. Of the 3,400 people living on the street on any given night, about half have severe mental illness, a rough estimate by people who work with them. Of these, the overwhelming majority are not violent or dangerous, but a small fraction can be.
Beyond was the area for people with non-life-threatening illnesses, and here lay an older man. He had been living on the street for most of 27 years, he told me. He hated the shelters. “I’ve seen guys getting raped. I’ve seen guys getting killed in shelters,” he said. “No one in their right state of mind would turn down three meals a day and hot water to stay in the street” unless the shelters were worse.
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