An essential civil liberty: the right to stay alive

Decriminalize prostitution, maybe. Criminalize psychiatry, definitely. Or at least radically transform it back to its roots. Away from politics and its strangling alliance with Big Pharma, the insurance industry cabal, the treatment program rackets and cagey advertising. 

Mental illness, homelessness and addiction often overlap and pose complex challenges. Cure is not in the cards, because corporate profiteers are stacking the cards to perpetuate the industry of failure-assured treatment.

They have made psychiatrists and other practitioners their pawns, establishing a system that makes them pimp their credentials and lend the prestige of their licenses to protect the status quo. Often they play along because resistance is futile and they have a livelihood to protect.

They submit to the dysfunctional mental health protocols and tainted philosophy that has doomed patients to perpetual stagnation or worse. No matter what treatment programs the state or city devises, they all seem disposed to fatal flaws. That's the case, even when soundly conceived and not a scandalous boondoggle, as was ThriveNYC, under former Mayor Bill de Blasio.

Mental health-care services in New York are more about politics than medical practice, human rights or civil liberties.

Psychiatrists heel more than they heal. They have signed on to what most of them never signed up for: soldiers and stooges of the psychotropic drug culture; its manufacturers, purveyors, policy and protocol hawkers.

Many are forced into the charade or else become reluctantly resigned to it, even though it means being subservient to bureaucrats. A few may be enamored of it because it streamlines their duties so ridiculously.

Psychiatrists are largely figureheads in hospitals and even private outpatient treatment programs.  

Their role is to satisfy the state's requirement that only licensed medical doctors prescribe medicines, most of which are more likely to lock in patients' illness than ameliorate it. Psychiatrists are little more than officially sanctioned psychotropic drug-pushers. 

By ritualistically re-filling prescriptions, they gamble and toy with their patients' blood chemistries in order to make them artificially compliant. They need to play this game of roulette because insurance companies will not reimburse providers otherwise.

Patients are rendered into zombies. It becomes impossible to distinguish what behavior is due to their mental illness and what to chemical intoxication.

Media advertisements have tricked the collective psyches of the general population into subscribing to the "new normal" of practicing "self-care" via self-diagnosis, almost to the point of equating the two. 

Mayor Eric Adams has announced a non-punitive plan to get the mentally ill and the homeless off the street and into productive, long-lasting treatment programs that would sustain and reintegrate them into society.  It would save them from the often lethal result of what former Mayor Ed Koch called " passive self-neglect.”

The collateral benefits to the city would include improved public safety, and  general confidence and participation in a more robust economy. But it probably won't happen, because the mayor cannot annul, supersede or even question the state's mental health laws that inhibit first responders, kin, therapists, doctors and judges, or often cripple them from meaningful action.

The law allows removal of emotionally disturbed persons and homeless people without their consent, but only under extremely restrictive conditions and only for very brief periods. It also permits 911 responders to hospitalize people who are creating severe disturbances or threats of violence at home or elsewhere.

What typically happens then is that the individual is released the same day or within 72 hours at the latest. To qualify, all patients need to do is attest they don't want to harm themselves or anybody else.

They know the drill. Their potential targets keep their fingers crossed.

In many situations involving domestic or elder abuse arising from mental instability from a tenant or family member, the only way to obtain relief is an order of protection. The folly of patients' rights at the expense of their safety is embedded in law: a hospital must seek a court order to feed patients who won't eat because they believe they are being poisoned.

The City Council recently passed a bill that will make social workers and other qualified personnel available virtually and face-to-face in every New York City homeless shelter by July 2025. They will make assessments and referrals.

That sounds promising. But no viable intervention or long-term treatment program is possible under the present system of ideologically driven government regulation, faddism and psychotropic drug-fetishism.

The criteria for involuntary removal and details of treatment must be broadened, made more flexible, and less within the grasp of patients. Their rights must never be sacrificed, but sometimes they must be held in abeyance. The Health Insurance Portability and Accountability Act (HIPAA), enacted by Congress and regulated by the Office of Civil Rights, must be relaxed.

The excesses and inflexibility of  these confidentiality laws have protected the privacy of patients, but some have died because of their exercise. It's the old story of "the operation was a success but the patient died.”

Society should not abet incompetent patients high on the methamphetamine of freedom to commit self-euthanasia.

Authorized crisis interventionists should possess "qualified immunity' as defined by law. Their judgment calls must be enforceable. 

Detaining patients in extremis is not false imprisonment. It's like bruising the sternum of a patient in cardiac arrest instead of dispatching them to the morgue.

The New York Department of Health and Mental Hygiene calls the new removal policy a "sweeping mental health agenda." Its backers on the City Council encompass the spectrum of agents provocateurs from rightist Vickie Paladino to leftist Tiffany Cabán.

The opposition to the mayor's plan comes from predictable, dogma-owned sources who likely plan to spike it with legal obstructionism, claiming it is unconstitutional. The New York Bar's testimony conjured some pat phrases, such as "autonomy in decision-making” and  "least-restrictive environment" and warned that the measures will inflame intolerance against the homeless and the mentally ill and disproportionately impact persons of color.

Prominent bioethicists Paul Appelbaum, Thomas Gutheil, Willard Gaylin and Bruce Jennings all endorse the involuntary but not indiscriminate commitment of mentally ill patients, but it is fiercely opposed by New York Lawyers for the Public Interest, the National Alliance on Mental Illness and the Coalition for the Homeless.

Thirty-five years ago a very similar program proved a debacle. The new policy will fare no better if a court rules that the removals criminalize homelessness and violate the Americans with Disabilities Act. 

The U.S. Supreme Court ruled in 1999, according to Joe Rappaport, executive director of the Brooklyn Center for Independence of the Disabled, that "denying mentally ill people the right to live in the community, rather than in institutions — unjustified isolation — can constitute unlawful  disability discrimination.”

That could be ominous.

The mayor's critics allege that his cynical goal is to force the homeless out of public view to enhance the city's self-image and to make it more appealing to tourists. The truth is that his aim is to expedite a process by which the homeless and mentally ill will receive long-term care.

But the logistics are horrible. The head of one of the city's nonprofit mental health clinics told an NPR reporter that he has a 1,500-person waiting list for a therapist.

The removal of these patients from the streets and subways will require police to act with intense and fail-safe sensitivity and restraint. It is not a scenario for swagger.

But cops have often talked people out of jumping off bridges and buildings. Let's not assume they are a bunch of quick-draw cowboys.

The shortage of hospital space dedicated to psychiatric care will become even more acute than it is already, because Albany drastically reduced the number of beds. The more beds were needed, the fewer were made available. Today there is only a small fraction of the beds that were decades ago, although the need for them is exponentially greater now.

 It was a political decision passed off as a moral obligation.

We must fight for the helpless. The prime operable civil liberty by which New York is bound and which applies to these souls is that they stay alive.