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Mental Health in the Big Apple

Mental disorders and their treatment (or non-treatment) are related to issues of crime and incarceration, so C&C readers might be interested in this article by Stephen Eide in the City Journal.

Since the 1960s, America has faced an epidemic of serious mental illness that represents a shameful chapter in social policymaking. Hundreds of billions spent on "mental health" programs have left many untreated, fated to eke out a pitiful existence on the institutional circuit of jails, homeless shelters, and psychiatric hospitals. We often take for granted that modern times are gentler than the dark days of the thumbscrew, lynchings, and public executions. Yet we have allowed scores of tormented men and women to suffer and die on city streets every year.
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New York mayor Bill de Blasio has made improving New Yorkers' mental health a priority of his administration, but his ThriveNYC program repeats too many of the mistakes of the past and will deliver too little assistance to those in greatest need. Promising a "comprehensive solution to a pervasive problem," ThriveNYC relies on an overly expansive definition of mental health and lacks focus. While de Blasio claims that public confusion about the nature of mental health makes matters worse, his plan will increase that confusion by blurring the lines between mental illness in its serious and mild forms, making too much out of "stigma," and emphasizing prevention over treatment. De Blasio has committed more than $800 million to ThriveNYC, but these resources are spread too thin, across too many priorities. A better approach would focus more on helping the seriously mentally ill and less on ideological and political concerns.
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New York would be better served by a mental illness policy that focused more on addressing untreated serious mental illness. To reverse course from ThriveNYC, city government should make three changes. First, it should restore the original purpose of government-funded supportive housing to addressing the intersection of homelessness and serious mental illness. To the extent that other homeless populations need rental assistance beyond basic shelter, this should be provided via affordable- or transitional-housing programs.

Second, the city should advocate for state-level changes, such as revising New York's civil-commitment law to allow for institutionalization in the case of "grave disability," a more lenient standard than the "dangerous to self or others" now codified in state law. The city should also call for an end to the state Office of Mental Health's plan to reduce psychiatric beds. Though Governor Cuomo has touted bed reductions as a money-saver, the move will likely just shift costs to jails and homeless shelters.

Third, city policymakers should stop trying to be "comprehensive." As D. J. Jaffe, advocate and author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill, puts it: "100 percent of adults can have their mental health improved" in some way, but that doesn't mean that suboptimal mental health should rise to the level of a policy priority. For city government, a piecemeal approach that targeted efforts to where the seriously mentally ill slip through the cracks--such as jails and homeless shelters--would do more good than the current attempt to be everything to everyone. This would require curtailing talk of prevention and accepting the less glamorous--but far more daunting--task of treating serious mental illness where it already exists. Doing that comprehensively and well would be challenge enough.

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