ALBANY — State lawmakers appear poised to include a legislative package in this year’s budget that would make it easier for licensed professionals to commit someone to a mental hospital. The directors of two north country mental health and community services departments aren’t convinced what’s on the table will help in rural New York.
In her budget proposal for 2025-26, Gov. Kathleen C. Hochul proposed an amendment to the state’s mental hygiene laws; her core push is to allow for someone to be involuntarily committed to mental health care when they demonstrate an inability to provide themselves food, shelter or medical care, separate from the existing requirement that the individual has to demonstrate evidence of imminent risk of harm, or recently committed acts of violence or self-harm to qualify for commitment.
She also proposed expanding the list of people who can authorize an involuntary commitment. Current laws require two physicians make the determination, which is then authorized by a psychiatrist. Hochul proposed changing that to require two doctors or one doctor and a nurse practitioner.
Other changes around the edges include more monetary investments in youth mental health, and a change to the 1999 Kendra’s Law that establishes involuntary outpatient treatment, by expanding who can apply for an outpatient treatment order against an individual, rolling out video conference options and enhancing voluntary post-treatment care opportunities.
Dr. Ann Marie Sullivan, commissioner of the state Office of Mental Health, said these are being rolled out to address the most significant cases of mental illness that are impacting communities across the state. In early April, she stood with a handful of local lawmakers from the Capitol Region and downstate mental health treatment facility executives, highlighting a handful of high-profile recent incidents.
She pushed back on arguments that involuntary commitment is a coercive tactic that doesn’t work well.
“It’s not like involuntary commitment is ever the first thing you think of, and involuntary commitment happens when we feel that nothing has been successful with this individual,” Sullivan said. “It’s a tough decision to make.”
Tim Ruetten, the director of the Jefferson County Department of Community Services, said in an interview that he is generally opposed to using involuntary commitment except in the most dire of circumstances.
“It’s always a last resort, because it’s traumatic, frankly,” he said. “When someone’s forced into a hospital, that’s a very difficult experience.”
In Lewis County, Community Services and Mental Health Director Anna Platz said that while each case is different and commitment is occasionally required, her goal is to keep patients in their communities.
“I think it only adds trauma when someone has to leave, especially in a community like Lewis County, because we don’t have a 9.39 hospital,” she said, referring to the state law definition of a hospital determined to be able to take involuntarily committed patients.
In Jefferson County, Samaritan Medical Center is a 9.39 hospital and has recently invested in expanding its psychiatric ward, but Lewis County General does not have such services. Many rural counties are similarly without any inpatient mental health care facilities.
As directors of county community services, Ruetten and Platz are empowered by state law to refer someone for an involuntary commitment evaluation, or designate people with medical knowledge to handle that within local hospitals.
Ruetten said he rarely uses that power, and involuntary commitments of any origination are rare in Jefferson County.
“When you do that, you’re taking someone’s rights away,” he said. “That’s serious.”
Hochul’s proposal would lower the standard for what qualifies for commitment — making it easier for homeless people on the street to get swept up into the system. Ruetten said he doesn’t think that’s the right approach for the situation in Jefferson County.
“It just doesn’t make sense to hospitalize everyone who can’t feed, clothe or house themselves,” he said. “Everyone who is doing the work knows that won’t work.”
He said that people unable to secure shelter or food reliably aren’t always mentally ill, and those who are suffering from a mental illness aren’t going to benefit significantly from a temporary commitment without some material change in their permanent living situation.
But Ruetten said that there has been a definite spike in need. He said his department has been referred more cases of serious mental illness than in years past, and there are far more cases involving violence. There’s also been a spike in the number of homeless people in Jefferson County — many of whom do need mental health care.
Platz, who is relatively new to her role in Lewis County, said she wasn’t able to directly speak to historic versus current demand for services in Lewis County, but said her colleagues who serve on the county Community Services Board have said demand is increased, especially for young people in the area.
“It’s not uncommon for me to hear about very complex, high need, high risk individuals who are struggling to get the support they need in our community,” she said. “I’ve been in quite a few conversations about the behavioral needs of our youngest community members, our littlest community members, and those seem definitely to be more complicated.”
Ruetten said a solution that Jefferson County officials have developed is to rely more on a collaborative, not coercive, pathway to treatment. Provide always-available, low-barrier shelter for homeless people, engage in street outreach and relationship building, and allow for choice.
“That works, that does what involuntary commitment and police pickup orders are trying to do here,” he said.
Jefferson County recently passed a package of legislation aimed at handling homelessness in the county — providing for 24/7 shelters outside of the cold season when the state helps cover costs with the Salvation Army and the New Life and Emmanuel Congregational churches, spinning up a street outreach program with ACR Health, and conducting a study on opioid addiction.
To address wider mental health concerns, not necessarily including homelessness, Jefferson and Lewis counties are also putting together a mobile crisis unit, which will respond to incidents of extreme mental illness and personal crisis without immediately involving law enforcement.
Those approaches are what Ruetten and Platz are focused on — ways to keep people in their community while addressing their mental illnesses, and giving people an opportunity to have choice and agency in their care.
According to a source close to negotiations over the state budget not authorized to speak publicly, the deal that lawmakers and Hochul have come to will largely follow Hochul’s original proposal, with a push to prioritize emergency medical services as the first point of contact for non-emergency pickups for evaluation, rather than police, for all pickups, and a requirement that involuntarily committed patients have more advanced discharge planning and outpatient service connections made before being sent out of the hospital.
They also indicated the deal would cut the physician review process to require only one doctor or a physician’s assistant and doctor agree that the patient needs to be committed before sending for a psychiatrist’s review.
Senate Majority Leader Andrea A. Stewart-Cousins, D-Yonkers, told reporters after a Thursday afternoon budget meeting with Assembly Speaker Carl E. Heastie, D-Bronx, and the governor that discussions are ongoing on most all topics and clear legislative language hasn’t been tendered on involuntary commitment
“I could tell you a little bit more definitively if we had language set on everything, but all of these things are still in process of being worked through, and we will have something as well with involuntary commitment,” Stewart-Cousins said.
Ruetten said he had some concerns about those changes as outlined.
He said that Jefferson County, like most rural counties, has only private ambulance services available, which can’t be directed to provide pickup services for involuntary commitment evaluations.
“They can’t bill for the service unless it’s medically necessary,” Ruetten said. “I’ve tried this in the past with ambulance services, it ends up being so cumbersome or impossible that I don’t use it. I wouldn’t, because unless I can provide a letter of medical necessity, the ambulance service can’t bill for it.”
Under state law, local police departments are required to transport involuntary commitment candidates to their evaluations.
Both Ruetten and Platz said they’re not likely to push for more involuntary commitments in their communities, even as the state tries to expand their use.
“The transportation, evaluation and potential admission of someone needing these supports is not something that we take lightly,” Platz said. “It can be an extremely traumatic experience. This is not something that myself or my colleagues take lightly. We’d much rather keep them here in the community and wrap support around them.”