New Yorkers are remarkably united in their support for involuntary treatment for the seriously mentally ill. According to polling from the Association for a Better New York, New Yorkers across boroughs, political parties, and demographic groups overwhelmingly back forced treatment.
Nonetheless, some city and state officials oppose the policy, which they argue hurts black New Yorkers. A recent city council report on involuntary hospital transports for psychiatric evaluation takes this position. “The racial disparities in involuntary transports are stark,” the document claimed. “While Black New Yorkers make up about 23% of the city’s population, they accounted for 54% of involuntary hospital transports last year.”
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The city council is wrong to imply that disproportionate involuntary transport rates are evidence of discrimination. Black New Yorkers are overrepresented in the city’s data for reasons that likely have nothing to do with racial animus. Arguing otherwise could hinder efforts at more equitable treatment.
Studies reveal that black Americans may have higher rates of schizophrenia, even accounting for evidence that the disorder is overdiagnosed among blacks. If that’s true, it would contribute to a disproportionate number of black New Yorkers requiring involuntary care. Schizophrenia can make its sufferers less likely to seek treatment and more likely to engage in self-harm and violence, both criteria for forced hospitalization under state law.
Black people with mental illness also tend to have more persistent, severe, and disabling disorders, and tend to have higher rates of psychological symptoms. That would make them more likely to require more intensive care.
Additionally, blacks are less likely than other groups to use mental-health services voluntarily, less likely to receive routine treatment for psychiatric disorders, and more likely to receive poor quality services. This may cause a disproportionate number to suffer declines in mental health to the point of requiring involuntary care. Indeed, in 2023, black adults had the highest rates of mental-health- and substance-abuse-related emergency department visits of any racial group.
These factors more likely explain the racial gap in involuntary transfers than does racism. They also suggest that some black New Yorkers who need care aren’t receiving it.
Consider the case of Daniel Prude, a black man who was psychiatrically evaluated in Rochester, New York in 2020. Prude had been using PCP and having paranoid outbursts, and he was brought to the hospital by his brother after jumping headfirst down a flight of stairs. Despite his suicide attempt, he was quickly discharged after the hospital decided that he no longer met state commitment criteria. Within hours of his release, police found Prude wandering the streets naked and pinned him to the ground when he began spitting at them. He stopped breathing within minutes and later died. Prude’s family believed that he needed more treatment. The state’s involuntary commitment laws stood in the way.
New Yorkers overwhelmingly see Governor Kathy Hochul’s proposed reforms to state civil commitment laws as a more compassionate approach than leaving the mentally ill on the streets. Ironically, one of the proposal’s opponents represents the Rochester district where Prude’s death occurred. New York state senator Samra Brouk has long been a critic of involuntary care, claiming in 2022 that Kendra’s Law—which compels a small number of seriously mentally ill New Yorkers with a history of non-compliance and repeated hospitalizations or violence to receive treatment as a condition of remaining in the community—produced “glaring disparate racial impacts.”
The state senator’s assertion displayed the same misunderstandings as the city council report. An independent review found “no evidence” that Kendra’s Law “disproportionately select[s] African Americans for court orders, nor . . . evidence of a disproportionate effect on other minority populations.”
This does not mean that black Americans never face racism in health care. But the city council report is bad analysis. More troublingly, by suggesting that too many black New Yorkers are receiving involuntary care, it could be used to justify denying needed mental-health treatment on the basis of race.
Mayor Eric Adams has made clear how misguided such an approach would be: “We are not going to say, ‘Hey, this person needs to be involuntarily removed, but hold on, they’re black, so we’re not going to do it’. . . . We’re going to go where the issue is.”
Photo by: Deb Cohn-Orbach/UCG/Universal Images Group via Getty Images
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