Eric Adams's Involuntary Commitment Plan for Mentally Ill has a Long, Cruel History (and Won't Help)

In December, a federal judge declined to block New York Mayor Eric Adams’s plan to allow police to involuntarily hospitalize unhoused people with mental illness pending a trial. Adams argues that overly strict interpretations of New York’s Mental Hygiene Law have left police, city workers and clinicians unsure if they are able to involuntarily hospitalize individuals with severe mental illness (unless they represent an imminent threat to themselves or others). As a result, most unhoused people with such conditions are left without structural support, suffering from starvation, freezing temperatures and untreated psychoses.

Adams asserts that by shifting the definition of “danger to oneself” to include a broader inability to care for one’s own basic needs, city workers can begin creating a pathway that leads from homelessness to mental health treatment. Adams’s plan calls for “intensive training” for first responders working with people with severe mental illness, enrolling homeless individuals in Medicaid and utilizing Kendra’s Law to mandate outpatient care for individuals who are forcibly hospitalized.

Adams sees himself as having a “moral obligation” to revamp the city’s mental health care system and help the several thousand people estimated to live on New York City’s streets and subways. Yet, however well intentioned, his proposed policy resurrects a historical practice with a long, dark past. In fact, Adams’s plan is a direct echo of 19th-century ideas about “curing” mental illness, even if through forced medical treatment. Examining the past implementation of these ideas shows that involuntary hospitalization ended up functioning more as a way of removing those with mental illness from society than as a way of offering them medical treatment. Adams’s policy threatens to do the same.

Beginning in the 1870s, state hospitals, colloquially known as “lunatic asylums” or “mental hospitals,” became the primary site of mental health care in the United States.

Contrary to popular depictions of mental hospitals (e.g., “The Snake Pit,” 1946; “The Bell Jar,” 1963; “Girl, Interrupted,” 1994; etc.), asylum patient populations were not primarily composed of middle-class Anglo-American women experiencing nervous breakdowns.

Instead, state hospitals became a place to merely warehouse society’s most marginalized. They were filled disproportionately with immigrants, members of the working class and ethnic minorities. In fact, in the early 20th century, New York state legislators vocally advocated for more stringent restrictions to bar immigrants with mental illness from even entering the country.