Testimony of Jason Hansman Regarding Mental Health Involuntary Removals and Mayor Adams’ Recently Announced Plan
Before the New York City Council
- Committee on Mental Health, Disabilities and Addictions
- Committee on Hospitals
- Committee on Public Safety
- Committee on Fire and Emergency Management
February 6, 2023
Good morning, Chairperson Hanks, Chairperson Lee, Chairperson Ariola and Chairperson Narcisse and members of the Committees on Public Safety; Mental Health, Disabilities, and Addiction; Fire and Emergency Management; and Hospitals. My name is Jason Hansman, and I am the Deputy Director of Mental Health Initiatives, Crisis Response and Community Capacity at the Mayor’s Office of Community Mental Health (OCMH).
I’m joined this morning by my colleagues Dr. Omar Fattal, System Chief for Behavioral Health and Co- Deputy Chief Medical Officer at NYC Health + Hospitals (Health + Hospitals); Chief Michael Fields, Chief of Emergency Medical Services at the Fire Department; Chief Theresa Tobin, Chief of Interagency Operations, Chief Juanita Holmes, Chief of Training and Michael Clarke, Director of the Legislative Affairs Unit, all from the Police Department; and Jamie Neckles, Assistant Commissioner of the Bureau of Mental Health at the Health Department.
OCMH coordinates and develops citywide policies and strategies to facilitate critical mental healthcare so every New Yorker, in every neighborhood, has the support they need.
In November 2022, Mayor Adams announced a plan to create a culture of engagement for New Yorkers with untreated serious mental illness (SMI). It is clear that we have a responsibility as a city to lead with compassion and care, and that there is more we can do to help New Yorkers experiencing a mental health crisis, especially when their mental illness is so severe that they lack the ability to recognize and care for their own needs. The plan that Mayor Adams announced is an important step to delivering essential care to our most vulnerable fellow New Yorkers.
Our office had a significant role in crafting the administration’s mental health involuntary removal policy and has an ongoing role in coordination across these agencies. I’m happy to testify before you today to discuss Mayor Adams’ recently announced plan, including his policy regarding involuntary removals.
Mental Hygiene Law – 9.41 Removals and 9.58 Removals
New York State Mental Hygiene Law allows for individuals to be removed from the community to a hospital for evaluation by medical and psychiatric professionals who can assess the need for admission and treatment. The policy the Mayor announced in November draws on two of the Mental Hygiene Law’s provisions that grant this authority: Sections 9.58 and 9.41.
Section 9.41 authorizes a police or peace officer to remove an individual who appears to be mentally ill and is conducting themselves in a manner likely to result in serious harm to self or others from the community to a hospital to receive a psychiatric evaluation.
Similarly, Section 9.58 authorizes Designated Clinicians on mobile crisis outreach teams – which can include licensed psychologists, registered professional nurses and certain social workers – to direct the same kind of removal for evaluation at a hospital.
Importantly, these Sections (9.41 and 9.58) only authorize a removal to a hospital, where a physician then conducts an evaluation to determine if the individual should be hospitalized. They do not allow for Designated Clinicians or police or peace officers to order the involuntary hospital admission of any individual.
New York State Guidance
In February of 2022, the New York State Office of Mental Health (OMH) issued interpretative guidance stating that both Sections 9.41 and 9.58 authorize the removal of an individual who appears to be mentally ill and displays an inability to meet basic living needs, even when no recent dangerous act has been observed. Their guidance was intended to help clinicians and other community providers make thoughtful, clinically appropriate determinations relating to involuntary removals, while at the same time respecting an individual’s due process and civil rights. The City concurs with OMH on their interpretation.
Mayor Adams’ Plan
Before this plan, these removals were done without a coordinated approach across agencies – first responders and clinicians often followed their own protocols, that were usually unknown to one another. With the Mayor’s new policy, everyone is working off the same playbook, ensuring our most vulnerable individuals have an opportunity to be connected to life-changing and saving care.
As the Mayor said in November – “Job One” is as follows: New York State Law allows us to intervene when it appears that mental illness is preventing an individual from meeting their basic human needs. We must make this universally understood by outreach workers, hospital personnel, and police officers.
To that end, the Mayor’s new DOHMH, FDNY-EMS, and NYPD Directive does two things:
- Creates an expedited step-by-step process for involuntary transportation for individuals in crisis; and
- States explicitly that, in concurrence with OMH, it is appropriate to use this process when individuals appear to be mentally ill and unable to meet their basic needs
Second, the Mayor also announced enhanced training for outreach workers. This training led by the New York City Health Department – in consultation with OMH – emphasizes the need for “basic needs” interventions and includes engagement strategies to try before resorting to a removal – as voluntary transport is always the goal. Training is already underway.
Third, the Mayor announced establishing specialized intervention teams. He announced a special cadre of clinicians and officers to ensure safe transport of those in need of hospitalization. These specialized teams will have training, expertise, and sensitivity to handle these complex cases.
Fourth, the Mayor announced creating a new support line staffed by clinicians from Health + Hospitals to provide support and advice to police officers in real-time, as they consider potential response to individuals with mental health needs. This hotline became operational last week.
Fifth, the Mayor announced that the City’s legislative agenda includes working with State partners to amend the law to make clear that serious harm includes the harm that comes from an inability to meet basic needs because of a mental illness. This would codify court precedent to make this principle widely understood across the State. Additional legislative needs he announced were: (1) requiring hospital evaluators to consider all relevant factors, such as treatment history and recent behavior, not just how a person presents at that moment; (2) allowing a broader range of mental health professionals to perform hospital evaluations and serve on mobile crisis teams; and (3) requiring Kendra’s Law eligibility screening in hospitals to help our most vulnerable New Yorkers stay engaged in treatment.
Importantly, the Mayor’s plan does not call for “sweeps” of people living with mental illness from public spaces. It does not expand the powers of city personnel to transport individuals for hospital evaluation. It does not increase the reliance on police to address untreated serious mental illness. It does not allow 9.58 Designated Clinicians or police officers to involuntarily admit individuals to the hospital. And it does not represent the sole answer to fix our public mental health system. The City will be releasing a Behavioral Health Agenda in early 2023 that covers serious mental illness, youth and family mental health, and preventing overdoses.
To ensure that we are doing all we can for our fellow New Yorkers, this work requires an interagency approach to maximize connections to mental health services.
All of this work starts with high quality training.
For 9.58 Designated Clinicians, DOHMH conducts a two-day virtual Section 9.58 training. Trainers include a variety of experts in mental health crisis intervention and risk assessment. At the end of this training, DOHMH confirms the trainee’s credentials (licensure and employment on an approved mobile crisis outreach team) and issues a DOHMH identification with photo and letter signed by the Executive Deputy Commissioner of the Division of Mental Hygiene designating a person as authorized to direct 9.58 removals. These credentials expire every two years and can be renewed by recertifying licensure and employment. DOHMH also conducted refresher training in November focused on clinicians doing outreach on the street and subway to ensure that clinicians doing 9.58 removals understood the guidance from OMH. This included composite vignettes from real situations involving people in experiencing street and subway homelessness. This refresher training content will be folded into the regular ongoing 9.58 designation training curriculum for all eligible clinicians working in mobile outreach teams for housed, sheltered and unsheltered individuals.
The NYPD trains officers on how to interact with people suffering from a mental health crisis starting in the academy. There, the NYPD has dedicated modules that provide officers with the skills that they need to make determinations on whether a person needs to be removed to a hospital pursuant to Mental Hygiene Law Section 9.41. This training is reinforced throughout an officer’s career, through command-level training, videos, and training at the academy, including during training whenever an officer is promoted to sergeant, lieutenant or captain. Additionally, the NYPD is currently working to provide all officers with a four-day crisis intervention training, which provides an officer with more in-depth skills when responding to mental health calls. When the Mayor announced his directive, the NYPD added new training that builds upon and reinforces the training officers already receive. This training, developed in consultation with OCMH and DOHMH, ensures that officers understand the guidance from OMH. To help reinforce this training, the NYPD has also produced a training video that all officers must watch. Moving forward, the OMH guidance will be incorporated into existing training. The training for all outreach workers, hospital personnel, and police officers emphasizes the importance of using best efforts to encourage the individual to be transported to the hospital voluntarily.
To that end, when a 9.58 Designated Clinician believes that an individual may need to be evaluated at a hospital, their first responsibility is to use their clinical skills (where safe and appropriate) to work collaboratively with the individual to secure their voluntary agreement to be taken to the hospital for further evaluation. In the less common cases where an involuntary removal is necessary, the clinician will call for NYPD to assist with this process. In all of these cases, NYPD’s role is to aid the individual in getting to the care they need. Working with the clinician, EMS and NYPD will effectuate a transport to the hospital. In the case of a Section 9.58 removal, the decision to remove is solely the clinician’s– NYPD and FDNY follow the clinician’s lead.
In the case of a 9.41 removal, once again, the NYPD’s role is to aid an individual in getting to the care that they need. When officers determine that an individual is suffering from mental illness and is engaging in behavior that is likely to cause harm to themselves or others – consistent with Section 9.41 – they will work with EMS to bring the individual to a hospital, where a physician can do a comprehensive evaluation. To provide additional support to officers in the field, Health + Hospitals is providing a dedicated support line for NYPD officers as they encounter potential 9.41 situations. This support line is staffed 24/7 by behavioral health clinicians from Health + Hospitals’ Virtual ExpressCare service, who can answer questions and advise officers as they determine whether circumstances truly call for the last resort of an involuntary removal. Critically, Health + Hospitals staff also provides NYPD officers with information on other appropriate community and social service resources to consider for those individuals who do not meet the criteria for involuntary removal or who might otherwise be better served in the community.
Importantly, if the individual’s future location is predictable and they appear at no risk of imminent harm, Health + Hospitals might advise sending out a clinician the next day.
Importantly, the 9.58 Designated Clinician and the police officer or peace officer, in the case of 9.41 removals, can only have an individual taken to the hospital for evaluation. They cannot have an individual involuntarily admitted – that is at the sole discretion of the physician at the hospital.
Once an individual arrives at the hospital the 9.58 Designated Clinician or police officer assists them in registering and provides information about the reason for the removal to the hospital staff. At that point, the role of the 9.58 Designated Clinician, NYPD and EMS is complete. Ideally, the hospital will obtain additional relevant information on the individual by contacting family members, community providers, and outreach teams, and conduct a thorough psychiatric evaluation. If necessary, they will admit the patient following Mental Hygiene Law admission criteria. If not, they will be discharged with a discharge plan that includes follow up care and community resources.
All of this work is about ensuring that New Yorkers in psychiatric crisis get the highest level of care that the City can provide. This is truly a health-driven approach and one that is grounded in trying to connect everyone to the care that they deserve.
I thank your committees for your attention to this important topic and we are happy to answer any questions you may have.