WBFO's Disability Reporter Emyle Watkins analyzes a portion of Governor Kathy Hochul's State of the State speech that caught many in the disability and mental health communities off-guard: the Governor is now supporting expanding involuntary commitment to people deemed unable to provide or unwilling to accept help with basic needs.
Watkins spoke to an expert on institutionalization about the historical context of involuntary commitment, a local peer advocate about why people with serious mental health conditions are worried, and legislators who are for and against this controversial proposal.
TRANSCRIPT
This is a rush transcript provided by a contractor and may be updated over time to be more accurate.
Emyle Watkins: Hi, I am Emyle Watkins, and this is the WBFO Disabilities Beat.
Governor Kathy Hochul: Our state must be livable and safe. My fight for your family also means New Yorkers feel secure on the streets, on our subways, in their communities. And we're going to do this with common sense measures that everyone can get behind. Because people should be able to get to work in the morning, tend to play, enjoy restaurants without the fear of random violence or dodging someone in the midst of a mental health crisis. We cannot allow our subway to be a rolling homeless shelter.
Emyle Watkins: One of the more divisive stances Governor Kathy Hochul took in her state of the state address Tuesday [January 14th], was expanding the requirements for being involuntarily committed to inpatient mental health treatment.
Governor Kathy Hochul: Our laws must be stronger, and that's why I'm willing to stand up and say we need to expand involuntary commitment into a hospital [to] includes someone who does not have the mental capacity to care for themselves, such as refusing help for the basics, clothing, food, shelter, medical care.
Emyle Watkins: But this idea isn't new. A bill was first introduced in 2021 to make the same change. 57th District Senator George Borrello, who represents much of rural Western New York, introduced the bill and continues to co-sponsor it. When asked why he has been pushing for this change, he told WBFO, in part...
Senator George Borrello: We've seen the impact of folks that you know are suffering with mental illness and substance use disorders on our streets. They cannot provide for themselves. They are homeless, they are malnourished. They're suffering from hygiene issues and their clothes are clearly not adequate. No shelter. So, these are the basic markers of folks that are suffering from mental illness. So, I think quite frankly, it's obvious that these are people that need help.
Emyle Watkins: He, like the governor, sees it as a public safety issue.
Senator George Borrello: And then you see, ultimately, even though it's a small percentage of people, many of those people end up in our criminal justice system. And unfortunately, some of them end up committing acts of violence, including murder. And that is the societal issue that has to be addressed. And that's why it is a public safety issue as well for us. We have to address that public safety element of this.
Emyle Watkins: This idea of expanding involuntary commitment is controversial. On the cost end, some argue inpatient treatment costs more than outpatient support. But on the social side, some worry that the state is backtracking. There's concerns over losing the personal autonomy and self-direction that people with mental health conditions fought for when the state deinstitutionalized and transitioned to outpatient care.
Michael Rembis: Well, I mean, I think that the transition came about for a number of reasons in the mid-20th century.
Emyle Watkins: Michael Rembis is an associate professor of history at the University of Buffalo, and an expert on institutionalization and eugenics. He recently published a book, "Writing Mad Lives in the Age of the Asylum."
Michael Rembis: There was push back from below, from former residents of state institutions and current residents of state institutions, who were neglected, and abused by the state and not cared for properly within institutions.
Emyle Watkins: This led to people with disabilities, including people with mental health conditions, advocating for alternative modes of care.
Michael Rembis: In the 1950s, governors of various states came together and realized that they couldn't afford the state institutions anymore. State governments can't run at a deficit, and so they needed to do something to undo these huge state systems that were developed in the 19th and early 20th centuries.
Emyle Watkins: Rembis says the development of new medications, as well as the Community Mental Health Act of 1963, continue to help more people move out of institutions and live with outpatient support.
Governor Kathy Hochul: I know the phrase involuntary commitment reminds people of the prison-like institutions of the past, but that's not the objective of these proposals. We're in a different time now.
Emyle Watkins: If things have changed, why are people worried?
Michael Rembis: Well, I think that involuntary commitment is a really sensitive topic and a really important thing to consider, because people who were often committed against their will in the past, brought to these large state institutions, they could be held indefinitely. Wives were committed by their husbands. People were committed by family members or neighbors, or friends in consultation with physicians, and often also in consultation with the court. But it was often quite easy to commit somebody involuntarily. And once somebody was considered, back then the term would be insane, and now they would use different labels, they were not considered reliable conveyors of their own experiences. They were not considered to be rational, and so they were committed against their will, and often held against their will and sometimes held indefinitely, and for very long.
Emyle Watkins: For Maura Kelley, it's more than a sensitive topic. It's her life.
Maura Kelley: Why would I share some vulnerable stuff that they might lock me away because I'm sick? That just doesn't make sense. So, we need a safe place, a confidential place, informed, be part of my care, part of the treatment. I want to run the show. I want my control of my life in all areas. My mental, physical, spiritual... why can't I have that?
Emyle Watkins: Kelley is an expert because she works as a behavioral health peer liaison at Western New York Independent Living, where she represents and advocates for Western New Yorkers like her with severe mental health conditions.
Maura Kelley: We're targeting the wrong problem. The problem isn't serious mentally ill people in our community. The problem is there aren't services available.
Emyle Watkins: Kelley says instead of focusing on committing people, the state should focus on fixing the mental health system itself.
Maura Kelley: So, people are asking.... they get help, it's terrible, and then, "Oh, why don't you want to get help again?" Because people with mental illness are not thinking right. They're not dumb. If something bad happens or hey, you have a negative experience like going out for a restaurant, you don't want to go there anymore. So, targeting on those people that aren't getting care, well, let's target on let's get some care, some care that people want, and choose, and are treated with dignity and respect and compassion. The way the governor wants to treat everyone in our communities with compassion, with their families. Well, we want compassion, too. We don't just become subway pushers. There's a lot that happens before we get that bad. Speaking from someone that used to be homeless.
Senator Samra Brouk: ...And so, what I have said to individuals who have shared concern, that they feel as though this is a slippery slope in which they end with no rights, I say, "I'm going to fight like hell to make sure that that's not the case."
Emyle Watkins: 55th district senator and chair of the Senate's Mental Health Committee, Samra Brouk, who represents East Rochester, doesn't support expanding involuntary commitment.
Senator Samra Brouk: What concerns me is that we have barely scratched the surface of building up a workforce, of building the supportive housing we need, of making sure beds are back online, of making sure that the community resources are funded and staffed in each of our communities. We have barely scratched the surface on doing so many of those things, to so boldly revert to a very antiquated approach of essentially locking people up and throwing away the key, and stripping them of civil rights.
Emyle Watkins: But a narrative linking violence and mental health can also have negative public health implications, including on how patients are treated when they seek care. It's also contested if mental health impacts the prevalence of violence. One study showed that excluding people impacted by substance use, when comparing neighborhood controls and recently released mental health patients, there was no significant difference in the prevalence of violence. Violence in both groups also mostly took place at home, and was targeted at family and friends.
Michael Rembis: Way back in the 19th century, that violence was used as a rhetorical or discursive tool to expand asylums and to commit people. And people weren't necessarily violent and they were often the victims of violence.
Emyle Watkins: As our state looks to the future at how our mental health system can better serve people with severe mental health conditions, we asked Rembis what people should be keeping in mind about the contributions of ,or what we historically know about, the people we're talking about. He had this to say.
Michael Rembis: People don't need to be exceptional in order to be accepted in society. I think we need to be inclusive of all people in society. And people with mental illness or mental health labels don't need to be exceptional in order to be accepted. In society, we need to accept all people, and meet them on their own terms and support people to live their best lives.
Emyle Watkins: You can listen to the Disabilities Beat segment on demand. View a transcript in plain language description for every episode on our website at wbfo.org. I'm Emyle Watkins. Thanks for listening.
