In response to New York City’s homeless crisis, Mayor Eric Adams announced last month that he would be expanding the city’s existing authority to involuntarily hospitalize the mentally ill, so that those “in desperate need would no longer be allowed “to slip through the cracks.” Adams’ controversial plan to make it easier to involuntarily hospitalize individuals with serious mental illness has ignited a national debate on what role local governments should play in making treatment decisions for the severely mentally illIn a recent interview with Harvard Gazette, Mass General psychiatrist Katherine Koh, MD discusses the many challenges in delivering care to the mentally ill living on the streets.
First, the focus should be on expanding community-based mental health services and access to permanent supportive housing — i.e., housing with support services provided — not on hospitalizing more people.
As a street psychiatrist working with Boston Health Care for the Homeless, Dr. Koh is keenly aware of how tremendously this population is suffering. While Adams’ proposal for New York City has raised concerns, it highlights the urgent need for improving access to mental health services for the homeless. There are other solutions to remedy this problem. For example, Koh points to studies which have shown that providing permanent supportive housing, when paired with high-quality mental health services, can keep people with mental illness off the streets. Koh notes that while these solutions show promise, we need to demonstrate the political will to enact them.
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Katherine Koh, MD, MSc is a practicing psychiatrist at Mass General Hospital, a member of the Street Team at the Boston Health Care for the Homeless Program and an Assistant Professor in Psychiatry at Harvard Medical School. As a member of the street team at BHCHP, she focuses her clinical care on homeless patients who live on the street through a combination of street outreach, clinic sessions, and home visits for patients recently or unstably housed. She also maintains a general outpatient practice at MGH and conducts research on the health of homeless populations. Her primary interest is improving systems of mental health care for homeless patients.
