Inside New York City's training for health care workers doing involuntary removals

NEW YORK — A man shaving his legs on a subway platform. Someone sparring with an invisible opponent. A homeless woman defecating on the street and shouting slurs at passersby.

These are all examples of people who should be brought to hospitals against their will, according to a manual used to train health care workers on Mayor Eric Adams’ new directive to send more New Yorkers with untreated serious mental illnesses to hospitals.

The presentation, which POLITICO obtained through a public records request, provides a rare look behind the curtain at how the city is teaching people to apply Adams’ directive on the ground. It is dated Nov. 29, the same day the mayor announced the new policy, and characterized as “refresher” training on the state law that governs involuntary transports.

It tasks crisis intervention teams, outreach workers and first responders with involuntarily transporting someone who “appears to have a mental illness and cannot support their basic human needs to an extent that causes them harm.”

It is a broader interpretation of a preexisting state law that authorizes certain health care workers and law enforcement officers to bring somebody to the hospital for psychiatric evaluation if they are behaving in a way that is “likely to result in serious harm to themselves or others.”

At least 42 people were sent to hospitals against their will since the directive was announced last year, according to a city Health Department official, but it is unclear what happened to them after that. City officials have so far declined to release comprehensive data on the new policy.

Adams said in November that outreach workers and first responders would receive comprehensive training that incorporates an “in-depth discussion” on the new focus on people unable to meet their basic needs due to mental illness. But city officials have disclosed few details on those instructions.

The presentation obtained by POLITICO was developed by the city Health Department and state Office of Mental Health to update clinicians on the new standard.

In the scenario of the man shaving his legs in the subway, the presentation describes him as disheveled and rambling nonsensically but uninterested in support services or psychiatric care. If no health care worker is available to assess the man’s capacity to make decisions, it “may be appropriate” for police to bring the man to the hospital against his will, the presentation concludes.

The presentation classifies the shadowboxing man as a possible risk to others, while the woman shouting slurs is deemed at risk of harming herself because of increasing signs of self-neglect. In both cases, an involuntary hospital removal may be “appropriate,” the presentation says.

It is unclear how training materials for police may differ from the presentation to clinicians.

NYPD Chief of Training Juanita Holmes said during a City Council hearing Monday that the police department is giving officers a 25-minute interactive lecture at roll call and a video presentation. She said 87 percent of patrol officers have received the training.

A police spokesperson said all training sergeants were briefed in December on the directive and that they have begun training officers in their respective commands.

“This builds on the training that all officers receive on how to respond to individuals suffering from a mental health crisis that begins in the academy and continues throughout an officer's career,” the spokesperson said in a statement.

The NYPD rolled out a four-day crisis intervention training course in 2015, but it was paused amid the pandemic. Holmes said all police academy graduates receive the training, and another 13,400 active officers who joined the department before its launch have completed it.

The city set up a hotline staffed by NYC Health + Hospitals social workers, mental health nurse practitioners and psychiatrists to counsel police officers on whether it is appropriate in a given situation to take the person involuntarily to the hospital. However, it only became operational on Jan. 31, officials said.

A Health + Hospitals spokesperson did not respond to a request for the number of calls the hotline has received.

A Health Department spokesperson said the agency "conducted these trainings for clinicians who do street and subway outreach — sections of the different types of teams that can be designated and conduct the removals under law. This is intended to ensure they have the many considerations front of mind in the situations they may encounter."