Many New Yorkers facing serious behavioral health challenges are discharged from the hospital without the necessary support they desperately need, which leads to cycles of hospitalization, shelter stays, or homelessness. Governor Kathy Hochul’s proposed mental health reforms offer real solutions. While involuntary hospitalization is a controversial topic not to be taken lightly because it impinges on people’s rights, I have seen it save lives when done in a mindful way for a narrow subset of the population at the highest risk. However, it is only effective when paired with a robust continuum of trauma-informed and person-centered services.
As a licensed clinical social worker and Chief Operating Officer at the Institute for Community Living (ICL), I have spent nearly 30 years working within the behavioral health system. A couple of years ago, a woman in one of ICL’s programs was highly symptomatic. She had lost 40 pounds in just a few weeks because she had stopped eating. Our team made the difficult decision to have her hospitalized involuntarily, where she received the psychological and medical care she needed. When she was discharged into community-based support services, she regained stability and thrived. She later thanked us for saving her life.
Her case underscores how involuntary hospitalization – done as a last resort—can have a real impact on setting someone up on a new path to recovery. It also highlights the importance of individuals being connected to a comprehensive continuum of care, including housing and supportive services, to ensure long-term well-being after discharge from the hospital.
The Governor’s proposals will help more people access this level of support. Hospitals will be required to consider a person’s full behavioral health history—including input from clinicians who know them—rather than making decisions based only on how they present in the emergency department at that moment. The inclusion of psychiatric nurse practitioners in these evaluations is also a practical step toward improving care coordination and access to treatment. Care coordination is the key to ensuring New Yorkers don’t fall through the cracks. When someone is admitted to a hospital, their community outreach team—who knows them best and understands their unique needs—should be involved.
The Governor has made an unprecedented $1 billion investment in outpatient behavioral health services, outreach teams, peer support, and supportive housing. We also have strong partners at the Office of Mental Health dedicated to improving the system. However, there is still more work to be done.
Fortunately, we understand what works. To address critical gaps in care and to prevent crises before they occur, we must continue investing in community-based services that focus on a person’s overall well-being. Expanding programs like Assertive Community Treatment (ACT) and Intensive Mobile Treatment (IMT) is a compassionate, evidence-based approach to address the needs of New Yorkers experiencing serious mental health challenges, especially those who are the hardest to reach and treat.
In the last six months, 83% of ICL’s IMT clients were housed, 93% were not hospitalized, and 98% did not have a criminal justice incident. Despite serving some of the hardest-to-reach individuals who have been suffering on the streets for decades, 92% of IMT participants met regularly with our teams. However, over 1,000 people are currently on ACT waitlists, and 300 are waiting for IMT services. Without increased capacity, too many people in crisis remain in shelters, hospitals, and on the streets without the care they need.
The reforms being considered by lawmakers in Albany will help more people access these life-saving services. There is no time to waste; we must act now.
Troy Boyle is Chief Operating Officer at Institute for Community Living, an organization that provides services for New Yorkers living with serious mental illness.
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