It's Wise to Hospitalize Mentally Ill Homeless People, Even if Involuntarily: Ethicist

Arthur L. Caplan, PhD


February 16, 2023

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I run the Division of Medical Ethics at New York University's Grossman School of Medicine.

A large amount of controversy broke out recently in New York City about a plan to deal with the mentally ill who are out on the streets, homeless. The mayor of the city, Eric Adams, announced that he was going to permit and encourage the police to round up people who are out on the streets with mental illness, bring them into New York City hospitals, and ask for their evaluation as to whether they seem competent and able to make decisions about staying out on the streets.

The idea is to get people with severe mental illness off the streets and into care. The current laws don't permit retaining people with mental illness for more than 48 hours, unless they're deemed a threat to themselves or to others. Otherwise, they get kicked back out on the streets.

I really thought that Adams' idea was overdue and I applaud what he's trying to do. There were many critics who stepped forward and said that this is a violation of the civil rights of people, particularly homeless people who are vulnerable; they think that the police should not be involved and the mayor is wrong to do this.

Their objection primarily was that you can't force somebody against their will into a hospital for a psychiatric evaluation and potentially for inpatient treatment. That's providing care without permission or consent and using police power to drag somebody in against their will.

I think there's a confusion here. We're not trying to round up the homeless. Homeless people, I think, deserve homes. That's certainly a housing policy question, and it's one that many cities in America have not fixed, and that's deeply regrettable.

What the mayor focused on — and what I believe is correct — is a small percentage of those homeless people who are out there severely mentally ill and incompetent. We know who they are. When we go into cities, we see them talking to themselves, yelling, ill clothed, clearly in trouble, and not able to fend for themselves.

These are people who get preyed upon, who get attacked, robbed, and raped. They are people who often suffer health problems because they're out there sleeping without adequate protection. They don't know how to keep themselves warm in those parts of the country that have bitter winters.

I think it's overdue to go out there and find those people, get them to a hospital where psychiatric or psychological expertise can be applied, and ask if they are mentally ill to the point of incompetence. If they are, then I say pull them off the streets and get them some care. Don't let them stay out in the wild, out in the urban environment to be harmed and suffer from the elements.

No one likes the police dragging someone into a hospital against their will, but what the mayor was talking about, and what I believe is justified, is severely mentally ill people getting some help.

That strikes me as humane, appropriate, and doing the right thing for vulnerable people who aren't sitting around saying, "Well, I'd rather be out here than in a shelter" or "I'd rather be out here because I prefer to live the way I want to live." These are people with schizophrenia or other severe forms of mental illness that we're not paying attention to; we're just leaving them out there to fend as best they can. That strikes me as wrong.

I support what the mayor is doing in New York. I hope other cities follow and start to say that there are two kinds of people who are homeless: There is a group that, for one reason or another, finds themselves homeless, and cities aren't doing what they can to provide homes. They don't want to be out there, but there they are. The other group is the mentally ill who we de-institutionalized, didn't give proper follow-up care to, threw out onto the streets, and who are suffering greatly and probably have no idea where they are or whether they even want to be there because they're so severely mentally ill. They deserve better.

I'm Art Caplan at the Division of Medical Ethics at New York University's Grossman School of Medicine. Thank you for watching.

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