Expanding involuntary commitment won't solve our mental health crisis

Politicos, pundits and advocates across New York State are taking sides with regard to Gov. Kathy Hochul’s proposed expansion of involuntary commitment law, which would loosen the criteria for hospitalization to go beyond posing an immediate or substantial risk to one’s self or others, and include the inability to provide for essential needs. This debate pits the need for heightened public safety against potential violations of individual freedoms, a worthwhile conversation that, unfortunately, confuses essential aspects of mental health care.

In hospitalizing those unable to care for themselves, the law would send individuals suffering from chronic mental illness to facilities designed solely to help those experiencing acute episodes of mental illness. This mismatch would only accelerate the revolving door that cycles people in and out of our mental health care system. It would offer little help to those in need and yield no meaningful improvements in public safety, while making it more challenging for psychiatric departments to provide acute-level care to people who meet these criteria.

This discrepancy illustrates the extent to which we, as a society, continue to misunderstand the complexity of mental illness, looking for short-term solutions to meet long-term needs.

Individuals with serious mental health conditions such as schizophrenia and bipolar disorder require lifelong treatment, support and — crucially — the stability that only comes with long-term housing. Without this essential component of recovery, they can relapse, often as a direct result of the trauma, stress and isolation that accompanies homelessness. This materializes in the kind of behavior that returns them to hospitals or lands them in jail, before they’re again released to the streets, perpetuating the cycle that defines our broken mental health care system.

Safety advocates in favor of expanded criteria for hospitalization overlook this inescapable reality and the strong likelihood that individuals removed from subway stations and other public spaces will — without housing — return in short order. This is sure to draw the ire of citizens that demanded change in the first place.

That’s not to say that civil rights proponents fighting these reforms aren’t truly advocating in people’s best interests. But these groups often overlook the lack of insight that accompanies many serious mental health conditions, pushing for personal freedoms, autonomy and privacy at the expense of afflicted individuals’ safety and well-being.

Much of this emphasis on personal freedoms has also made it almost impossible for family members of individuals with mental health diagnoses to protect and support those they love. They’re prevented — often by HIPAA and state confidentiality laws — from accessing critical information and are excluded from clinical decision-making, leaving them desperate and hopeless about proposed solutions providing any meaningful help to their families.

We owe it to these individuals and families to think more deeply and expansively about how to help those who — through no fault of their own — are challenged by an often-debilitating, lifelong mental health condition. This starts with abandoning the idea that real help is possible without an expanded social safety net — supportive housing and community programs that are impactful and cost-effective compared with ongoing incarceration and emergency room visits — and laws that balance individual protection with the realities of mental health treatment.

New York State has long been a pioneer in its mental hygiene laws and regulations. It can continue this tradition of leadership, bringing together the different groups and voices that can, when working in partnership, shape reform efforts to drive real, positive change.

This guest essay reflects the views of Carolyn Reinach Wolf, executive partner at the Abrams Fensterman law firm and director of its mental health law practice.