Involuntary Commitment

It took them some time to do it, but New York’s state government has just affirmed the right to institutionalize the mentally ill against their will. It’s called involuntary commitment, and it is based on the notion that the mentally ill are incapable of making such decisions independently.

The practice of emptying psychiatric hospitals and clinics dated to the last century. In principle, the advent of new classes of anti-psychotic and antidepressant medication made commitment unnecessary.

Besides, the medical treatments were far cheaper than institutionalization.

There was some validity to the concept, except that many patients stopped taking their medications. 

So, the new rights of the mentally ill caused some horrors. As we have noted in these pages on several occasions, some mass murderers were identified as dangerous by their psychiatrists before they acted out. Yet, these psychiatrists did not have any way to commit them against their will. 

Think Adam Lanza, Jared Loughner, James Holmes. In nearly all cases psychiatrists would have had the perpetrators committed if the law had allowed it. 

While it is true enough that the new classes of anti-depressants and anti-psychotics were significantly more effective than anything previously available, they also had some rather disturbing side-effects. Among them, tardive dyskinesia. 

Moreover, to state the obvious, when someone is suffering from severe mental illness, whyever would we trust his judgment regarding the need for treatment? Many paranoiacs consider themselves to be perfectly normal, in touch with higher truths.

As sensible politicians have noticed, when we cleared out the psychiatric hospitals and asylums, the mentally ill took up residence on our streets. It was the first version of the sanctuary city.

Now, New York’s Governor Kathy Hochul has prevailed in her fight to allow involuntary commitment.

Stephen Eide reports for the City Journal:

Governor Kathy Hochul insisted on adding language to state law that would make it easier to commit people to psychiatric hospitals, initially meeting resistance from the state assembly and senate. The fight was harder than it should have been—but Hochul persisted and won, marking a meaningful step toward mental-health reform in New York.

Eide points out that New York’s Mayor Eric Adams has also been pressing for involuntary commitment:

More than anyone, Mayor Eric Adams deserves credit for the changes to state commitment law, which authorize hospitals to provide involuntary treatment for people incapable of meeting basic living needs, not just those who are dangerous. Since taking office, Adams has prioritized untreated serious mental illness and sought to move the city’s approach to it from a culture of abandonment to one of intervention. 

Previously, people were only committed when they were shown to be a threat to themselves or others-- though it was hardly a scientific determination. Now, when they are incapable of functioning in society they can be committed to a psychiatric institution. It’s a new concept, one that was much needed.

Credit also to Eric Adams here.

For years, police and other frontline workers have believed that they couldn’t intervene—even when encountering a visibly psychotic individual on the subway—unless that person was suicidal or violent. But, as explained in a state Office of Mental Health guidance issued in February 2022, that notion of “imminent dangerousness” as a prerequisite to action was not rooted in state law. According to the OMH, “persons who appear to be mentally ill and who display an inability to meet basic living needs” are eligible to be involuntarily evaluated, “even when there is no recent dangerous act.”

Of course, the downside of the new policy is quite simply that New York State does not quite have the facilities to treat the new groups of mental defectives:

Effective implementation can’t be taken for granted. New York still lacks psychiatric hospital bed supply, which hasn’t recovered from cuts Governor Andrew Cuomo imposed through his devastating “Transformation Plan.”

Still, credit to Gov. Hochul and Mayor Adams for working to solve a mess that we brought on ourselves.