In the downtown core of cities both big and small, the picture is increasingly the same: growing encampments of people sleeping rough and using drugs, coupled with a rise in violent crime, in particular random attacks on pedestrians and people using public transit.
Social-service agencies are overwhelmed, tensions with police are bubbling over and politicians and policy-makers are struggling to tackle the fallout of widespread homelessness and addiction.
That’s why all eyes are on New York. Mayor Eric Adams has already taken aggressive measures to disperse homeless encampments, and last week he announced that police could take people to hospital, even if they do not give consent, if they are deemed to be in “psychiatric crisis.”
These policies of involuntary hospitalization hearken back to a time not so long ago when mental illness was essentially criminalized, and mass institutionalization was the norm.
Mr. Adams, a former police captain and a tough-on-crime Democrat, has argued that the city has a “moral obligation” to help those living on the streets, many of whom suffer from untreated mental illness. At the same time, he is trying to assuage New Yorkers who are increasingly fed up with legions of people sprawled out on sidewalks, subway stations and other public spaces. They are also growing fearful, especially after a high-profile incident in January when a man living with schizophrenia pushed 40-year-old Michelle Go to her death in front of a subway train. Martial Simon, the unhoused man charged with that killing, has become a symbol of the system’s failure, and Ms. Go’s death has spurred the mayor to take these harsh measures.
A similar zeitgeist exists in Vancouver, a city with highly visible and expansive homeless encampments that stretch for blocks in the Downtown Eastside. During the pandemic, the number of people living rough exploded, exacerbated by a deadly overdose crisis and an affordable housing crisis, all inextricably linked in a complex web.
Vancouver police now routinely release security camera footage of random attacks: a woman assaulted walking outside a chic downtown hotel, a man stabbed at a Tim Hortons, and so on. The attackers are often people living on the streets who are repeat violent offenders. (Most people living with mental illness are not violent, but a small number can be; drug use can exacerbate the problem.)
The city’s recently elected Mayor, Ken Sim, swept to victory in part because of a campaign promise to hire 100 more police officers and 100 mental health nurses to help tackle the problem. B.C.’s new Premier, David Eby, has also made public safety his number-one priority, with a plan outlined in an astonishing 5,000-word press release. Among other things, the provincial plan includes provisions for making involuntary hospitalization easier.
Doubtless, there are some situations where a person should be hospitalized against their will, particularly when they pose a danger to themselves and others.
But there are many problems with many of these new initiatives.
First of all, they depend on police officers to make diagnoses, and to decide who should be taken to hospital. Police are not social workers, let alone psychiatrists.
The criteria by which they make their assessments are unclear, too. Is someone being unkempt or muttering incoherently grounds for hospitalization? How can police tell whether an unwell person poses a clear and serious danger to themselves or others?
And once people get to hospital, what will happen to them? In our strained health system, there is already a glaring shortage of beds, especially in psychiatry wards. As a result, when unhoused people go to the emergency room after an overdose, injury or illness, they are typically released back onto the streets not long after. There is a dire lack of supportive housing that could assist with this post-release transition.
The movement toward mass deinstitutionalization in the 1960s and early 1970s is, in many ways, at the root of the current homelessness challenge. We tore down institutions – but then we effectively imprisoned the sick in a poverty trap on grimy city streets.
But returning to the days of mass hospitalization in institutions such as the now-abandoned Riverview Hospital in Coquitlam, B.C., is not a good approach. Replacing one failed model with another is no solution.
For decades now, we’ve lacked a coherent system to care for and support people with severe mental illness. That’s a problem that won’t be resolved with simplistic approaches such as police roundups. Instead, it will require a commitment to long-term solutions, such as Housing First initiatives and mental health supports in the community. If you’re going to force people with mental illness and addiction problems into hospital, what matters most is where they go next.