Who Is Being Targeted for Forced Medical Treatment in NYC? We Require Answers

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Editor’s Note: The piece below appears in the form of a letter, sent by the author to NYC Mayor Eric Adams today.

Dear NYC Mayor Eric Adams,

I’m Sarah Gorman, a philosopher living with schizophrenia. I write with deep concern for New Yorkers experiencing homelessness and mental illness under the Eric Adams mental health directive.

Painting by the author

I’m concerned for the real people who will be forcibly drugged by your policy. But also because New York City sets a national precedent. Kendra’s Law, piloted in Bellevue, exemplifies how well-intentioned policies born from tragedy can have unintended consequences. My own experience with forced medication under Kendra’s Law as a child informs my opposition to such practices.

Since its inception in 1999, laws like Kendra’s, supporting “Assisted Outpatient Treatment” (AOT), have sprung up in almost all states. The governor and the mayor talk about the “fewer than 100” persistently mentally ill homeless people this directive purportedly applies to but since the inception of Kendra’s Law in 1999, more than 20,000 people have been forcibly treated in New York State alone. Kendra’s Law is named after a woman, Kendra Webdale, who was pushed off a subway platform and into an oncoming train by a mentally ill man in 1999. This law is named after the victim (fondly, via her first name) to prey on your sympathy so you uncritically accept that forced medical treatment was necessary for the man who pushed Webdale into the train.

We can’t police things that haven’t happened yet.

What happened to Kendra was no doubt a tragedy, but the use of Kendra’s name was a red herring, distracting from the abuse this law codified. People who aren’t seeking medical treatment shouldn’t be forced to be medically treated. The law was superseded by another called the New York SAFE Act which was passed in 2013 that allowed for Assisted Outpatient Treatment for at minimum a year—an “improvement” on the six months that Kendra’s Law could originally mandate.

Understanding and Respect, Not Sanism and Saviorism

Sanism is the dehumanization of those deemed “insane,” and can lead to incarceration and forced medication. This directive enshrines sanist policy. Mentally ill people are worthy of the dignity they possess in virtue of being born sensate on this planet. Saviorism, well-intentioned but uninvited intervention, can be equally harmful. People with Serious Mental Illness (SMI) deserve respect regardless of their treatment choices. Even if they choose not to access treatment. Coercion does not and cannot cure mental health stuff. We legislate as though it can but usually that results in the quiet indignity of forced treatment in dark rooms with locks on the doors.

Real Solutions, Not Band-Aids

Treating homelessness and mental illness requires addressing root causes, not individual symptoms. Forced treatment is pissing on fires. A temporary fix, not a cure. We need systemic solutions. Some of these are outside of the mayor’s power but complicated problems require complicated solutions and coordinated efforts by multiple parties.

  • Universal Healthcare with Community Care: free, accessible, culturally sensitive care delivered by peers who are from the community and who understand the lived experience of SMI. This system would empower individuals to make informed treatment decisions in collaboration with trusted caregivers. It would be an open invitation to receive care for all.
  • Unionized Care Workers: A well-supported workforce provides better care for those it serves. This includes psychiatric peer workers. Yes, you have to pay them a livable wage. Corporations that exploit mostly intellectually disabled people for profit with the assistance of 14(c) certificates, which allow a corporation to pay someone with a disability subminimum wages, should not be supported by people with a conscience.
  • In-Home Support: Enabling people with disabilities to live independently. Housing is key, as is supportive in- home assistance, not just mental health outpatient treatment. People with mental health stuff might not be singly disabled. Just like some wheelchair users stand up. Your expectations have nothing to do with someone’s abilities and your surprise is usually unwelcome.
  • Expanded Libraries: Safe open spaces with essential resources like internet, information and restrooms.
  • Peer-Led Crisis Response: CAHOOTS-style programs provide a non-threatening peer-led (READ: nonpolice, nonarmed) response to mental health crises.
  • Peer-Led Safehouses: Peer-led safehouses, like Afiya House, offer temporary crisis respite with trained peers.
Transparency and Accountability

Adams must release demographic data to ensure historically marginalized communities aren’t disproportionately targeted. The NYC Bar raises valid concerns about potential bias. We need access to this data to ensure these programs aren’t re-entrenching unfreedom in Black disabled life in NYC.

Imagine a Different Future

Imagine expanding what Jackie Leach Scully, Ph.D. calls “permitted dependencies” like public transportation to include healthcare and housing. We can build new infrastructures that don’t rely on force and incarceration, but instead support the most vulnerable amongst us in achieving our own (self-defined) conceptions of wellness. Mental health “recovery,” like recovery from addiction, requires desire leading to action. The best approach is to build robust support systems that empower individuals on their wellness journeys, that will be waiting for them whenever they’re ready for it. This requires planning, imagination, patience, and a focus on trust and support.

Think Human, Not Force

We need systemic solutions, not a policing approach. Transparency and data-driven reviews are crucial to ensure the system doesn’t exacerbate existing inequities, particularly for Black disabled communities. Their freedom and survival depend on it.

In a recent NYT opinion piece it was said that: “Forcible restraints are routine events in American hospitals. One recent study, using 2017 data from the Centers for Medicare and Medicaid Services, estimated the number of restraints per year at more than 44,000.” The article continues to comment on the rarity of hearing a first-person account of restraint: “But it is rare to hear a first-person account of the experience, because it tends to happen to people who do not have a platform… Listening, rapt, to Mr. Tuleja was a roomful of psychiatrists. It was a younger crowd—people who had entered the field at the time of the Black Lives Matter protests. Many of them lined up to speak to him afterward. “I still can’t forget the first time I saw someone restrained,” one doctor told him. “You don’t forget that.”

They Also Don’t Forget Being Restrained

I don’t know if it requires mentioning, but: Neither does the restrained person forget about being restrained. And they remember viscerally, they can still feel fingerpads pressing into their bones. They know it like they know the pit in their stomach and the growl they were surprised to have released when they were handled so violently by people with more power than them.

One afternoon my mom, knowing she was going to lose custody of us kids, was apprehended by a police officer in our driveway after an unfriendly neighbor called the cops on her. She happened to be only intermittently taking her meds for schizophrenia at the time, keeping us inside the house, and peeking out the windows suspiciously.

They took my mother away that day, to hospitalize and medicate her. They called my uncle who took custody of us temporarily. We went to live with him until after her “stabilization,” an unwanted visit to the hospital, and a NYS signed court order for her to take her meds, which established that, conditionally, she could keep custody of us kids. She was abysmally overmedicated when she returned, but her custody was returned to her and our family was reunited.

The issue goes far beyond my personal story, though. Statistics demonstrate that disabled Black Americans are disproportionately targeted by law enforcement across the country. Therefore, the public needs access to the demographic data on just who is being forcibly treated by the mental health directive Mr. Adams championed.

Sandra Bland, Eric Garner, Tamir Rice, and many other Black American victims of police violence were also disabled and/or mentally ill people. This is where the rubber meets the road on why people talk about how important intersectionality is. Births and deaths tell us a lot about the “health” of a section of the population. But we need intersectional data. Demographics matter. Any single incidence of applying Adams’ mental health directive might be the next police brutality death to upend the country. I say this with profound sadness, but there will be a next one. Directives resulting in carceral “care” like Adams’ nearly guarantee it.

Black disability justice writer Vilissa Thompson, who argues for more responsible–multidimensional, comprehensive, and intersectional–data collection and reporting on policing, says that “In the United States, 50 percent of people killed by law enforcement are disabled, and more than half of disabled African Americans have been arrested by the time they turn 28—double the risk in comparison to their white disabled counterparts.”

I will therefore say again: we need the data to see if it adheres to similar white supremacist trends we observe on the whole in policing and incarceration.

How about we refocus on preventing “normative rape” against homeless women with mental illness instead? 

A report devastatingly states “Lifetime risk for violent victimization for homeless women with mental illness is 97%, making sexual and physical violence a normative experience for this population.” Sexual violence should never be describable as a ‘normative experience’ for a population. You should concern yourself with making NYC safe for these women, rather than with warehousing them, Mr. Adams. Address this problem and utilize the immense coffers of the NYC government for some good. Prevent normative rape and work towards housing and offering care to these women, rather than policing and warehousing them. Ask them, preferably directly, about what they need to be more secure and stable. Your city is systematically failing these women. They are the experts about what their needs are. Quit locking them up and arrange a focus group to hear their needs, the barriers they face, and what resources they lack.

And in the meantime, give us the demographic data about just who is getting locked up because of this directive. The transparency is important for the NYC Mayor’s office to espouse. We know who tends to be abused in such situations and we want to avoid things like the homicide by chokehold of Jordan Neely by a white former Marine that occurred without any interference by bystanders on your subway. We want to avoid systematic white violence against disabled Black and Brown people.

SMI people can’t even exist peacefully in public; we have to be warehoused, cared for, and profited upon, all thanks to what the late, disabled thinker, Marta Russell dubs handicapitalism: “the handicapitalists hold that in order for disabled people to be tolerated by our capitalist society, rights must be subsumed to the profit motive.” And they most certainly have been.

Mr. Adams, this policy will result in the quiet indignity of forced medical treatment, behind closed doors, against people with no one there to advocate for themselves but themselves. The double bind of their situation is that they are seen to be “incapable of caring for themselves” and so their pleas and advocacy in their own defense are discounted. They need mad kin. They need their peers.

Forced drugging is a regular practice in most of our carceral institutions: ICE facilities, psych wards, nursing homes, prisons. Medical treatment should be available to people with SMI, should they like it. But people shouldn’t be medicalized without their own prior and informed consent. This is a principle of health care. You could say it’s what makes it ‘healthy’ or ‘care’ at all. Forcibly administering drugs is a medical trauma; there is no reason why someone else should have the power to alter your consciousness with drugs. It’s a case of medical abuse.

My last plea lies here: Mr. Adams, release multidimensional, intersectional data on who is being targeted by your mental health directive. It is imperative that we do not reproduce the same violence that seems to be omnipresent in this white supremacist system of empire. Forget the policing tactics of your old job and try something new: expand your imagination about what dependencies we permit in our culture. Use the money of the government to expand infrastructure that supports healthy violence-free living in safe communities for all disabled people like libraries, community health centers, and peer-led safehouses or respite centers.

Sincerely,

Dr. Sarah Gorman

I want to thank you, Dr. Sabeen Ahmed, for your comments on an early version of this project. I’ve learned so much from thinking with you over the years. I cherish you. A note about language: I try to be expansive and say disabled/mad/mentally ill/sick because I think we need more disabled/mad/ill/sick solidarity. I recognize not wanting to pathologize states that can be transformative, helpful, extreme, religious, unusual, magical or powerful. So know: I’m not calling your experience anything. I defend your right to define wellness for yourself as well. I defer to letting you define the language preferences and if I’ve unintentionally excluded you through my speech or my actions, please let me know. [email protected]

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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8 COMMENTS

  1. I’m disappointed to have the only comment on this piece so far as it is excellent. The research and the links that click through to supporting articles are just so tight and expressive of the problem you are discussing. I’ve been looking at the situation in NY state for almost two decades now, and I activated there around the time that Kendra’s law was getting the upgrade you mention, with the Mental Patents’ Liberation Alliance of Upstate New York. I saw the “mental health ghettos” that existed at that time–low-income style, warehousing apartment buildings for people, some of whom had fairly “normal” lives before being forcibly hospitalized for several months to a year for various forms of “mental illness”. The pattern was get aprehended by the police, go to the emergency room, then to a psychiatric floor, and then, sometimes, to a longer-term type facility until anything such as a job or an apartment that was going okay stopped existing. Then, the “mental health housing” becomes the only option upon release. I’ve never forgotten one woman who told me she thought her worker called in a wellness check on her in order to steal her expensive purebred puppy. “We don’t force them to follow their treatment plans, we just remove their housing if they don’t” I was told by a caseworker servicing people living in this type of environment. New York is the most repressive state in the US (followed closely by Orange County CA, which has a very powerful NAMI) with regard to psychiatric incarceration and other atroicities.

    Unfortunately, Afiya Hous is not as safe as you think it is, and it could really use a union for the reasons you already mention in your piece. It is currently staffed like any other low-end social services non-profit staffs their “group homes”, offering low-paid, part-time positions to people who lack qualifications and training. They are competing with employers like Wal Mart. While it is not a terrrible thing that the staff are non-professionals, it is unfortunate that they are also untrained and hold most of the same prejudices as the general public about “mental illness” and those assaulted with its labels. This is the situation with a lot of “alternatives”. If we go back 30 years and look at the genesis of these programs, we can find the government intervening in what was once a dignified liberation movement, offering small payoffs for organizational models such as technical assistance centers that are known by large-systems analysts to fail, with the end-game being to make the social movements they are inserted into fail with them. I’d say that process has been completed at this time, with “peer” roles now mostly as prescribed and oppressed/oppressive as those of police and social workers.

    These were the things we talked about at MPLA, and brought to the public in various ways, such as the through Bastille Day Vigil held in front of the New York State Department of Mental Hygiene each July for 40+ years. The date is coming up, but most of the people who did this type of organization have died. I’m not sure how the idea of actually putting people in the street to protest the progressively Draconian legislation you write against here would fly these days. I know there are many “peers” who would see it as extreme, unnecessary, or even disrespectful to the systems that provide them a subsitance living.

    I’m surprised to see someone writing here who is actually well-read on the topic of psychiatric oppression in NY, and able to recognize that the increased policing of people experiencing homelessness is an outgrowth of a long-standing dynamic of disempowerment and discrimination, rooted in a narrative designed to gather public sympathy but not critical thought. Unfortunately, even some folks who oppose the increased policing of homeless communities don’t understand this history and continue to believe forced treatment is okay if it only impacts people labelled as “mental health” cases.

    Thanks for this great piece.

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  2. Hey, human being, human person, experiment of one: hear a human being talking with you, a real one like you, n=1. Step back and see what we are doing here. We are noticing and addressing a species of social injustice, social violence, and we are getting on our soap box about it and crying foul. But we don’t see things clearly at all, because the issue of psychiatry is a mere symptom of a disease that is total, global, psychosocial. You are like the commentators on the sinking of the titanic and the issue of psychiatry WILL NEVER BE ADDRESSED. Psychiatry and society will be destroyed. So the issue isn’t psychiatry or the brains of our children at all, but it is the spiritual and psychological state of humankind as a whole and in all of it’s parts. So you are the whole problem and the whole solution. The problem is human consciousness: the solution is for that consciousness to know itself, so it is the solution and the problem at the same time. And if you don’t get to understand what you are, then I promise you my full sincerity when I say that your life is absolutely in vain, you are something like a cross between a social functionary and a factory farm animal without autonomy or direction of your own, and the disease process in which your life has been caught up is destroying all that is good, healthy, perfect, clean, beautiful in your life as in the Earth, because the Earth is your life – your life is the Earth. After considering the full gravity of all of this we reflect back on the problem of psychiatry and see that even our full appreciation of the magnitude and horror of its violence is a mere escape from the even more disturbing and violent picture of the social-psychological process as a whole, of which it is but a detail, or example, or part.

    Now let us be kind and strangle all of our babies. There would be dignity in that. There is no dignity in burying your head in the sand and pretending it’s all going to be OK. You know it will never be OK for your children. They have no future. That is their only guarantee.

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  3. Now with the Supreme Court ruling that Homeless or those deemed unworthy of life can be fined and arrested at will by police enforcing “the laws”- the states and cities could do whatever they want.

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  4. I have rarely seen such a perceptive and truthful description of the immoral power wielded by psychiatrists, who seem to have no ability to tell right from wrong, given to them by politicians without a conscience.

    I learned about this kind of disaster as a patients’ rights attorney in California for many years. The details would vary, but the basic truth was exactly what the author described.

    But I learned even more many years earlier, in New York, when I had my entire childhood taken away from me by psychiatrists, who among other abuses “treated” me with electric shock “therapy,” and turned their eyes away when I was repeatedly raped, at age six and seven, by a staff member. Rape was and is very common in psychiatric institutions. With the cult mentality much of the public has now about psychiatry, I am wondering if psychiatry will start claiming soon that rape is therapeutic, at least as therapeutic as shock treatment. This is not meant as sarcasm, but as a real possibility, given how willing the public is to believe any destructive nonsense that psychiatrists claim.

    The spirit of the psychiatric profession was and is no different now, in 2024 California, than it was eighty years ago in 1944 when I was a child in New York.

    These atrocities will never stop until psychiatric survivors and their supporters FIGHT BACK!

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    • Our Minister for Mental Health when asked about a report that claimed nearly 50% of women in psychiatric institutions said they had been sexually abused stated, and I quote from the Hansards from Parliament, “You can’t listen to them, they’re mental patients”.

      When places like Lake Alice exist it would hardly be surprising to hear that rape be redefined as “desensitisation therapy” by psychiatrists

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10466991/

      In much the same was that the “torture” (U.N.) was redefined by Dr Selwyn Leeks as “aversion therapy”

      I posed a question the other day about the psychiatrist who sat in on a meeting with an Operations Manager for the sole purpose of finding ways to psychologically harm someone they knew had been tortured. I asked “what sort of person does that?”

      I found one on the internet yesterday. There is a documentary called “Don’t F**k with Cats”. I got through 30 seconds of the Trailer, and it was obvious this young man was going to torture and kill two kittens for the viewing pleasure of his audience on Youtube. I have been crying and sick since. But, what it did make me realise was that this Dr S. (psychiatrist) was just that sort of person…. and his ‘fan club’ was the Minister spoken about above. I believe the young man in the video eventually started killing people and was sent to prison. He could just have easily been given a job at the Lake Alice facility and been paid for his services.

      Sorry, I have to go.

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  5. First, all Muslims were unfairly targeted after 9/11. After the tragedy on the subway, Kendra’s Law similarly demonizes people with mental illnesses. Most people in any demographic are ordinary people who are not dangerous. So sorry you got stigmatized because of one person’s bad behaviour. I moved cities after autism was falsely equated with terrorism and violence, (I am autistic and non violent), only to find even more discrimination in the city I moved to because of a rare stigmatizing event regarding schizophrenia. Neurodivergent, POC, Muslim, all are targeted because of a few people.

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