The Revolving Door of Mental Health Crisis Care – What Killed Jordan Neely Long Before that Subway Ride

Adam Iscoe does a deep dive into New York City’s mental health treatment system for The New Yorker, and finds a system that hasn’t changed much in decades:

In the late eighties, following a legal challenge to Koch’s involuntary-hospitalization initiative, one judge described the city’s approach as “revolving door mental health—that is, forcibly institutionalize, forcibly medicate, stabilize, discharge back into the same environment, and then repeat the cycle.” Thirty-five years later, the vocabulary that’s used to describe the city’s mental-health-care system hasn’t changed. “It’s a revolving door,” a cop who was working an overtime shift on a subway platform in Clinton Hill told me. “We bring them in, and the hospital just discharges them!” She and her partner both had a few streaks of gray in their tidy black hair, and wore matching N.Y.P.D. beanies. The second cop sighed. “In and out,” she said. “I’m not sure anything we do is going to help if the hospitals keep letting them go.”

There are some efforts that have been made over the years. Mental Health training for police officers to help de-escalate a situation, specially-trained groups assigned to treating the homeless with serious mental health issues, temporary shelters, etc. In the end though, what Adam found is that they barely scratch the surface of the problem.

The article linked above lays out the scope of the problem. There are 200,000 people in NYC living with severe mental illness, and about 13,000 of them are homeless. The system doesn’t even begin to cover effective mental health treatment for the homeless let alone all of the other people in the city in need of treatment.

A hundred thousand city residents with severe mental illness are not receiving any mental-health treatment.

And so, when someone like Jordan Neely suffers a mental health crisis, if he’s lucky the officers who respond have been trained in mental health situations, can get him into some temporary help, and he can live until the next crisis. If he’s not lucky, he could die. He could die from his own actions, he could be killed by police response or a bystander who has no training in de-escalation.

Jordan was arrested over 40 times. He went through the revolving door at least 40 times that we know of until the door stopped revolving while he was in a full mental health meltdown on the F train a couple of weeks ago.

A lot of people have read about what happened and taken a very different approach, heaping praise on the man who killed Jordan Neely as a hero, who did the right thing by protecting the “normal” people on that train from a crazed lunatic. I tend to think that believing that requires a certain kind of stigma about mental health that places anyone having a mental health breakdown firmly into the “them” category instead of the “us” category. I also know first-hand how thin the line is between those two groups. A traumatic event can easily push someone over to the “them” side, and proper treatment can also push someone back to the “us” side, but in our discussions around serious mental illness, we don’t tend to get that full context. We tend to look at the “crazies” as people who should be avoided at all costs, lest they become dangerous, despite the fact that they are much more likely to be the victim of a crime than the perpetrator. We rarely spare a thought for their dignity and humanity. Even fewer thoughts are given to the possibility that they could get better. So, we just keep throwing these fellow human beings into the revolving door over and over again.

Who knows, maybe in the current system there really was no hope for Jordan and many like him. That’s hardly a reason to celebrate his death and the person who killed him. It should be a wake-up call about how poor our current system is and a push for systemic change. Unfortunately, that’s a serious discussion that too many people in politics are not interested in having.