NEW YORK CITY — Mayor Bill de Blasio's $22 million program to reduce violence by the city's mentally ill plans to draw on court ordered psychological exams after a DNAinfo investigation revealed shortcomings in identifying candidates.
The Mayor’s Office of Criminal Justice launched NYC Safe last August as an effort to reach a population that had historically refused medical treatment. The goal was to tap into resources and data from various city agencies to connect the mentally ill to services.
But seven months after it was launched, the city has yet to draft an outline for NYC Safe — as they’ve done with other programs — because they said they wanted to move quickly. However, the Mayor’s Office did hold several meetings with experts and various agencies to develop the plan, said a source with direct knowledge of the program.
Currently, the only city agency that refers people to NYC Safe if the Department of Homeless Services and privacy laws keep the city from accessing crucial medical records.
Trish Marsik, executive director of the Mayor's Task Force on Behavioral Health and the Criminal Justice, said that they are figuring out how to work with obstacles presented by laws surrounding medical records.
“Given privacy law, we need to think creatively about how to identify early those individuals whose mental illness may be untreated and how to get services to these individuals before crisis or violence,” Marsik said.
“To do this, the next step we are taking in NYC Safe is working with various agencies to identify the observable, objective characteristics and behaviors that would create a red flag.”
The program plans to tap into the city’s court system to track people who are ordered to undergo medical evaluations. The Mayor’s Office also wants to sit down with agencies, find out how they identify people with special needs, and then codify those methods to create a more thorough set of criteria.
Last week, after a man murdered his girlfriend and her two daughters in a shelter, Comptroller Scott Stringer blasted the De Blasio administration for increasing spending on homeless services by 46 percent since the mayor took office without seen substantial results.
But even with the help of the court system and increased involvement from agencies, the city cannot force anyone to undergo treatment if they don’t want to, said Dr. Gary Belkin the Executive Commissioner of Mental Hygiene for the Health Department.
While some people think of Kendra’s Law or Civil Confinement as a way to force treatment on people who meet a strict threshold, people are not physically forced to comply, he said.
The law lets judges issue orders for people to undergo evaluation and treatment. Failure to comply could result in commitment for three days but it does not require patients be forced to take medication.
“It’s not an order to tie you down and force you medication, no one can do that,” Gelkin said.
NYC Safe is attempting to increase the likelihood of reaching people earlier by identifying those who pose risk and making a dedicated effort to monitor them and follow up with those who refuse care, he said.
The doctor added that most people who are mentally ill are not prone to violence and vice versa. They are dealing with a small population, he said.
Trying to help people who have a history of refusing help also presents a unique set of challenges, Marsik said.
“People in crisis can sometimes alienate their families and alienate the other support systems in their lives — they can seem or appear difficult or scary,” Marsik said. “And people who look or act intimidating are less likely to get services and treatment.”
"They end up in the shelter system that is compelled to admit them or in the jail system — but we want to intervene earlier, to make sure these people have a chance at the care that could stabilize them and help them avoid crisis sooner. I feel very strongly about this.”
Another issue NYC Safe is still trying to figure out is how to balance protecting the privacy of the 76 people in the program and protecting people who are at risk of violent outbursts.
People who run the program have yet to decide how to relay information to neighborhoods or create some sort of feedback loop. They are currently erring on the side of caution to avoid people in NYC Safe any stigmatization, a city official said.
