“Mr. Friar, good morning. My name is Lachlan, and I’m a medical student with psychiatry. Did you know we were consulted?”
Mr. Friar had been cycling in and out of our ER for the past month, with recurrent pneumonia and dementia with psychotic features. At first, our hospital discharged him to the Salvation Army with a course of antibiotics. Within a week he had lost his antibiotics, his driver’s license, and his car and returned to our ED with a passive suicide wish. He was stranded in Tampa, and our hopes for a resolution to his problems were declining at the same rate as his memory. Still, we discharged Mr. Friar later that day, with a Lyft voucher to a location of his choosing. Unfortunately, uncomplicated community-acquired pneumonia and dementia are not ‘hospital’ problems. While his 30-day readmission rate remained high, the care he needed couldn’t be provided at a hospital.
Mr. Friar’s case isn’t an anomaly. There are numerous people who are homeless and lack the ability to care for themselves. The creation of large ‘tent’ communities that dot the sidewalks of major cities is indicative of a societal failing to care for these individuals. This is based on a rational assumption that people would choose the comfort of electricity and running water over the shelter of a fabric tent. This brings me to the order by Eric Adams, New York City’s mayor, to involuntarily remove and hospitalize all homeless individuals who are deemed unfit to take care of themselves. His ‘mental hygiene law’ is intentionally broad and essentially gives authority to police to hospitalize anyone living on the streets. His decision comes after a man with schizophrenia pushed a woman into the path of a moving subway in January of this year. Rates of homelessness in New York soared during the pandemic, and housed New Yorkers want them off the streets. Mr. Adams was bowing to public opinion.
People with mental illness shouldn’t be forcibly detained and placed into hospital systems poorly equipped to care for them. The mental health system continues to fail those most mentally ill, and the issue is just getting worse. Instead of reforming the system, New York City has closed 50% of their care centers for patients in a mental health crisis. By issuing this decree, Mr. Adams takes away the rights of thousands of New Yorkers while failing to address the real issue.
“People who are homeless are not social inadequates. They are people without homes.” – Sheila McKechnie
Instead of forcing more people like Mr. Friar into hospital beds, we need to tackle the key issue at hand. Build more homes. Restrict the building of multimillion dollar condos, and force developers to build apartment buildings with a greater number of units. Start converting the city’s unused hotel rooms into livable units before it’s too late. Find a way to house the unfortunate, and then find a way to reform the mental health system. Stop criminalizing homelessness.
Image by Bryan Ledgard; Credit below