What to do about people struggling with serious mental illness on trains and platforms
We are always trapped together, in urban life, but nowhere is that condition more obvious than on the subway.
Mostly this is a good thing, mind you. In addition to its obvious pragmatic benefits, the subway also fulfills an essential function of civic spaces. It brings everyone together. As a supporter of democracy as the least-bad system, I’m a fan of any shared social experiences, as they help us to expand our moral imagination to include people who are not like us.
Spend time on the subway and, I promise, you’ll observe people who are not like you. Certainly, there’s a layer of the city’s upper crust that wouldn’t deign to step foot below ground, content to be chauffeured around. Their loss. Everyone else takes the subway, at least some of the time, from the very poorest to the harried working class to the scrambling middle class to the competitively busy upper-middle class to those guys in wingtips who are bound for the corridors of Wall Street.
Of course, this habit of exposing New Yorkers to each other, in every variety, necessarily means that we sometimes come into contact with those we have collectively decided to forget. The homeless ride the subways, as do the severely mentally ill, and though these are distinct groups, the overlap is substantial. Those who live in that overlap typically occupy the dark cracks of our society, and though they are visible elsewhere, nowhere are they harder to ignore than in the subway. This is a necessary element of expanding our sympathy for them — only by coming into contact with the most desperate can we muster the compassion to help them effectively. I am very willing, though, to admit that these encounters are often unpleasant.
They’re unpleasant because mental illness is unpleasant, both to experience and to witness. That should be common sense, but since it apparently isn’t, I’ll tell you what I know from personal experience. I’ve spent more than two decades of my life wrestling with bipolar disorder, a condition which has repetitively ruined my life since I was 20 years old. And when I am in the full bloom of my disorder, I am at once a pathetic person and a dangerous one. It’s a sad state of affairs that I have to make this caveat before reflecting on the plain fact — the scientific fact — that people with severe mental illness can be very dangerous, but apparently I do. And given that using the subway entails squeezing into a narrow metal tube from which one generally can’t escape, such dangers are amplified there.
When I am in the full bloom of my disorder, I am at once a pathetic person and a dangerous one.
These dangers have gotten harder to ignore recently. A string of high-profile violent incidents, committed by assailants with long histories of mental illness, has made the problem of the disturbed and homeless difficult to ignore, even as New York City generally and its subway specifically have seen overall drops in crime. But particularly horrific crimes are particularly horrifying, and there has been a string of them on the subway since the pandemic began: two tourists shoved onto the subway tracks in August, a fatal subway-shoving this past March, a shooting that same month, a random assault and near-fatal subway-shoving in October 2023, a fatal shooting on the Q train in May of 2022, yet another subway-shoving in January 2022, this one fatal.
At some point, a sufficient number of anecdotes become data, and these data suggest that public fear of the mentally ill on the subways may well be rational.
Last year, the New York Times put together a compendium of more than 90 acts of terrible violence committed in the city in recent years, all by people with severe mental illnesses. The subway in particular is both distributed throughout the city and yet in another sense centrally located. Millions rely on it, and, as it functions as a shelter of last resort for many, it attracts some New Yorkers who are damaged and in need of help. All of this makes unhappy interactions inevitable. Police reformers and homeless activists are free to advocate for whatever policies they prefer, but they cannot pretend that fears of the mentally ill on the subway come from nowhere.
So what’s the solution? There are several elements of any successful approach. Unfortunately, much of what’s required is not easily achieved, requiring committed and long-term thinking in a system defined by the cyclicality of local and state politics. Fortunately, so many ugly incidents appear to have helped galvanize public support.
Any approach needs to involve:
- Expanding, and expanding access to, voluntary programs that provide mental health treatment; the activist class’s insistence that this would be sufficient is wrong, given how often severely mentally ill people refuse care, but more voluntary care is certainly necessary;
- Some sort of meaningful intervention into housing, ideally a society-wide commitment to building but more realistically expanded programs for the mentally ill specifically;
- A willingness actually to enforce fare evasion laws and other “nuisance crimes” on the subway, as doing so has been repeatedly shown to contribute to a broader atmosphere of public order and to allow cops to catch potentially dangerous people before they’re violent; and
- Some legal or practical approach to involuntary commitment of the severely mentally ill that makes the process easier and faster without provoking an effective legal challenge.
The first two of these would be very welcome for your average New York bleeding-heart liberal, while the latter two are likely to be represented as the worst kind of tough-on-crime conservatism. But real solutions to problems that are so deep are bound to piss off people from all over the political spectrum.
To some degree, there are already efforts in City government to address all of these bullet points. New York has long been one of the leading municipalities in the country when it comes to providing (or attempting to provide) mental health treatment for those who can’t afford it; the “Care, Community, Action” report from last year lays out a comprehensive program for how to do so more effectively.
The City has been on a major YIMBY kick in the last several years, and expansions to supportive housing specifically have been in the works since the beginning of the de Blasio administration. The NYPD appears actually to be enforcing fare evasion again after years of largely looking the other way, although, like much of what the NYPD does, this effort has been inconsistent. And the Eric Adams administration has garnered considerable controversy for its expanded interpretation of the already-existing Mental Hygiene Law of New York State, an interpretation that has resulted in more aggressive use of involuntary commitment — though, I would argue, not enough.
That last part is the most controversial and the most difficult to pull off, but ultimately the most important. The difficulty with expanding involuntary commitment is that the legal standard is a national one, handed down by the Supreme Court in the 1975 O’Connor v. Donaldson decision, which states that the government may only involuntarily commit those who pose an imminent risk to themselves or to others. As many have argued, the standard’s utter lack of reference to mental illness itself leads to many perverse consequences, forcing doctors to pretend to be fortune tellers rather than to assess someone’s actual level of mental impairment. It also has left the families of the severely mentally ill bereft of options, such as the family of Bailey Hamor, an Indiana man suffering from schizophrenia. Hamor’s family begged medical personnel to provide treatment, but were rebuffed until Hamor stabbed another man to death. At this point, the state became all too happy to provide him with care, in prison.
Because O’Connor was decided as a matter of constitutionality, the standard cannot be easily superseded by passing new laws. But there have long been advocates who believe that the standard is being interpreted incorrectly. According to this argument, the Supreme Court intended to define “danger” in broader terms, not just as imminent risk of physical damage but a broader sense of overall health. This point was made in a commentary from the Mental Illness Policy Org, a nonprofit founded by the late activist and author D.J. Jaffe:
Mental health law expert Paul Stavis, counsel to the New York Commission on Quality of Care, argues that the ACLU interpretation of the Donaldson decision is wrong. When it ruled by “surviving safely in freedom,” the Supreme Court did not have in mind rummaging in garbage cans for food or lying in the street in one’s own waste. Nowhere in the Donaldson decision did it say that the individual must be permitted to deteriorate to the point he is dangerous. Stavis is convinced a well crafted “need for treatment” statute will survive Supreme Court scrutiny.
New York is helping to push the envelope. Recently, the New York Times documented some encouraging developments in New York’s subway system. The City has been sending trained nurses down into the catacombs to look for those who appear to be in distress. Those appearing to suffer from serious mental illness are given information and access to voluntary services; those who appear to meet the criteria for involuntary commitment are taken into the hospital system to be assessed and, likely, to be committed. As the Times piece demonstrates, the initial returns provide reasons for optimism, as most who are approached accept some form of help.
These are indeed encouraging developments, and the policy of sending someone other than the police to assess the condition of the homeless is, if nothing else, politically savvy. Direct outreach, predicated on an ethic of compassion, is the best we can do; a willingness to invoke involuntary commitment in the face of public opprobrium is a necessity. Of course, it will take time, similar attempts in other cities and high-quality research to determine overall effectiveness. Initial research, though far too small to provide answers, suggests that the effort is worth pursuing.
I’m reserving long-term judgment. I have heard this kind of good news before, and it has a habit of evaporating. Consider the influence of the cycles of politics on this type of program: If a more conventional social justice-y mayoral administration takes power in New York, will this program survive? It’s hard to say.
The policy issues here are addressable, if not immediately resolvable. But to address them, we need to fundamentally reorient the conversation about mental illness, homelessness, and involuntary commitment from legalistic box-checking to a holistic effort to save the lives of the severely mentally ill. The trouble is that too many compassionate people adopt a personal policy of extreme libertarianism when it comes to the homeless, due to a general public perception that this is the “progressive” perspective — that is, people who ordinarily believe in the power of good government and the need for a muscular response to social problems become Republicans on this issue, fixating on individual liberty instead of the common good.
There is nothing progressive, nothing left-wing and nothing just about leaving people to die in filth in our subways.
I suspect that most people do not have strongly held feelings about this issue — it’s too far from their own experience — and so adopt the ones that they profess for fundamentally self-defensive reasons. Complaining about the NYPD is safer than suggesting that sometimes we need more aggressive public responses to severe mental illness; perpetuating the narrative of the mentally ill as nonconformist dreamers is safer than admitting that some are genuinely unpleasant or dangerous; doing nothing is safer than doing something. Who wants to risk saying the wrong thing about such an unpleasant topic at a cocktail party?
For this reason, a lot of liberals who lack any particular exposure to homelessness or mental illness default to a “leave it alone” attitude. And, given how voluble and aggressive the activist class tends to be, inevitably their interests fill the void. But we must be perfectly clear-eyed about this: There is nothing progressive, nothing left-wing and nothing just about leaving people to die in filth in our subways. The subway is one of New York’s crowning glories, one of the most powerful and tangible tools for equality in a city defined by spiraling inequality. It can only be what it is at its best, the carriage of the proletariat, if people feel safe enough to use it.