Compassion without results is not compassion. It is waste. And nowhere is that waste clearer than in New York’s mental health system.
For decades, New York politicians congratulated themselves for closing psychiatric hospitals and cutting inpatient beds. They called it progress. In reality, it was abandonment. Since 2000, more than two thousand psychiatric beds have been eliminated across the state. During COVID, New York City shut down nearly a fifth of its psychiatric beds and never brought them back. Entire counties—twenty in all, covering almost a million residents—now have no psychiatric beds at all. Families in crisis sit in emergency rooms for hours, hoping for care that often doesn’t exist.
What has been built in place of institutions is not a system of care but a system of recycling. The mentally ill are shuttled from shelters to case managers to emergency rooms, only to land back on the streets again. Our New York correctional facilities have become the state’s largest psychiatric institutions, with roughly forty percent of inmates suffering from mental illness. For Black and Latino New Yorkers, who make up the majority of the incarcerated population, this is not an accident of geography but a predictable outcome of bad policy. When hospitals closed, police became the default first responders. In Black neighborhoods, that meant a mental health crisis was more likely to be treated as a crime than as an illness.
As a Correction Officer for Westchester County, I have witnessed this failure firsthand. The number of young Black men and women entering our facilities on heavy medications for mental illness has increased year after year. It has gone beyond housing them in special mental health units; now it is common in the general population. Prisons and jails were never designed to be hospitals, but they have become the front line of New York’s mental health system. Instead of treatment before a crisis, the state waits until someone is locked up to medicate and manage them. This is not care. This is containment.
This is also why I had a problem with New York’s bail reform. Politicians claimed it was about fairness, but they overlooked the ecosystem they had already built. Many of the homeless and mentally ill who cycled through jails did so because it was the only place they could reliably access medication, treatment, and even a warm bed in the winter. Some committed minor crimes deliberately—trespassing, petty theft—not out of malice, but as a means of survival. Jail was their only doorway to health care and structure. Bail reform took that away without fixing the broken system that made jail their last option. Once again, it was the poor and mentally ill—disproportionately Black men and women—who paid the price.
The Criminalization of Mental Illness in Black Communities
The numbers make it plain. In New York City, nearly 30 percent of jail discharges are flagged with significant mental health needs, a share that has only grown in recent years. Among those flagged, Black and Hispanic individuals make up more than 80 percent, mirroring their disproportionate representation behind bars. Statewide, Black New Yorkers account for about 40 percent of all convictions despite being only 14 percent of the population. Even at the street level, Black residents are issued criminal summonses at more than eleven times the rate of whites.
These are not abstract disparities. They show how untreated mental illness and broken policies combine to criminalize entire communities. In Black neighborhoods, the lack of hospital beds and preventive care means more encounters with police, more arrests for survival-based crimes, and more families torn apart. Mental illness that should be treated in hospitals is punished in courtrooms. And the cycle continues.
The irony is bitter. In New York, the only law enforcement officers mandated to receive training in mental health monitoring, crisis intervention, and de-escalation are correction officers—men and women who encounter the mentally ill only after the handcuffs are on. On the streets, where these crises begin, the officers are rarely trained. The state does not intervene until a young Black man has been processed into the system. That is not a mental health system. That is a pipeline.
President Trump’s recent executive order on homelessness and mental illness takes a sledgehammer to this failed model. It restores civil commitment authority to address individuals who are unable to care for themselves. It directs resources to institutional treatment and step-down facilities instead of funneling billions to nonprofits that “manage” the problem without solving it. It makes housing assistance contingent on actual treatment and ties federal grants to enforcing laws against open drug use, squatting, and encampments. In short, it insists on outcomes.
Not surprisingly, the pushback has been loud. Governor Hochul promises a billion-dollar reinvestment in community programs, although decades of budget cuts make such promises appear like patchwork. Nonprofit executives cry cruelty because their budgets depend on a status quo of Housing First and harm reduction. Attorney General Letitia James pressures hospitals into restoring psychiatric beds, but resists the idea of federal enforcement. Everyone wants to look compassionate, but no one wants to measure results.
And the results are undeniable. Black neighborhoods carry the heaviest burden. Fathers and sons with untreated psychosis end up in jail instead of hospitals. Mothers wait in overcrowded emergency rooms with no beds available. Children grow up in communities destabilized by untreated illness, drug addiction, and the violence that follows. Nonprofits get their contracts renewed. Politicians get their donor checks. And the problem remains.
Critics call Trump’s approach harsh. But what is harsher: leaving a schizophrenic to freeze on a Harlem sidewalk, or giving him a bed in an institution? What is harsher: treating our New York correctional facilities as hospitals for young Black men, or funding real treatment centers? The cruelty is not in Trump’s order. The cruelty is in New York’s neglect.
Like or dislike Trump, if people put aside their emotions, they will see his policy for what it is: effective. If Trump is wrong, then why haven’t we fixed it?
References for Readers
- Trump’s Executive Order on Homelessness and Mental Illness (July 24, 2025) – Full text published by the White House.
- Office of the New York State Comptroller – Percentage of New Yorkers with Mental Illness Rose as Available Psychiatric Beds Declined (March 2024).
Link - New York State Nurses Association – Decrease in Psychiatric Beds Spells Disaster (2018).
Link - Data Collaborative for Justice (John Jay College) – Disparities Report: Mental Health and Jail Discharges in NYC (2023).
Link - NYCLU – Racial Disparities Across New York Are Truly Jarring (2023).
Link - ABC7 New York – Mental Health Crisis in NYC: Fewer Beds, More Patients (2023).
Link - The Washington Post – In the NYC subway: Rising assault, mental illness and a nurse who decides when to intervene (2025).
Link - The Atlantic – American Prisons Can’t Handle the Mentally Ill (2018).
Link - Wikipedia (overview with references) – Mentally Ill People in United States Jails and Prisons.
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