 Good morning, New York City. I want to talk to you about a crisis we see all around us. People with severe and untreated mental illness who live out in the open, on the streets, in our subways, in danger and in need. We see them every day, and our city workers are familiar with their stories. The man standing all day on the street across from the building he was evicted from 25 years ago, waiting to be let in. The shadow boxer on the street corner in midtown, mumbling to himself as he jabs at an invisible adversary. The unresponsive man unable to get off the train at the end of the line without his assistance from our mobile crisis team. These New Yorkers and hundreds of others like them are in urgent need of treatment. They're often refusing when offered. The very nature of their illnesses keeps them from realizing they need intervention and support. Without that intervention, they remain lost and isolated from society, tormented by delusions and disordered thinking. They cycle in and out of hospitals and jails. But New Yorkers rightly expect our city to help them and help them, we will. For the past 11 months, my team and I have studied the challenge of severe mental illness in the streets of our city. We have spoken to those who suffer from it and the experts who treat it. We have analyzed data gathered by our outreach teams. We have worked across many agencies, and we have consulted with our partners at the state level. I want to update you on the results of these efforts and lay out the next phase of our plans to address this urgent and complex challenge. My administration is determined to do more to assist people with mental illness, especially those with untreated psychotic disorders who pose a risk of harm to themselves, even if they are not an imminent threat to the public. It is not acceptable for us to see someone who clearly needs help and walk past. For too long, there has been a gray area where policy, law, and accountability have not been clear, and this has allowed people in need to slip through the cracks. This culture of uncertainty has led to untold suffering and deep frustration. It cannot continue. We need to change that culture and clarify our expectations. No more walking by or looking away. No more passing the buck. Going forward, we will focus on action, care, and compassion. If severe mental illness is causing someone to be unsheltered and a danger to themselves, we have a moral obligation to help them get the treatment and care they need. Today, we are embarking on a long-term strategy to help more of those suffering from severe and untreated mental illness find their way to treatment and recovery. It begins with an immediate shift in how we interpret our obligation to those in need and calls upon our outreach workers to take deeper actions and more intensive engagement. We can no longer deny the reality that untreated psychosis can be a cruel and all-consuming condition that often requires involuntary intervention, supervised medical treatment, and long-term care. We will change the culture from the top down and take every action to get care to those who need it. To do this, we need significant help from our partners in Albany. I want to thank Governor Hoku for her support on this issue. Thanks to her leadership, we have greater resources and a stronger commitment to making progress on one of the most enduring challenges facing our city. She has been an excellent partner in every effort, and I look forward to working with her and the state lawmakers to address the long-standing gaps in our state mental hygiene law. To begin that process, our team has developed an 11-point legislative agenda to address those gaps. And getting it enacted would be a major priority for us in 2023. This agenda is already available online and to the public. But even as we move forward on that agenda, there's much we can do now by properly interpreting and carrying out existing law. Job one is to make it universally understood by our outreach workers, hospital staff, and police officers that New York law already allows us to intervene when mental illness prevents a person from meeting their basic human needs, causing them to be a danger to themselves. This policy has been confirmed in written guidance from our state office of mental health. Yet a common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent, suicidal, or presenting a risk of imminent harm. This myth must be put to rest. Going forward, we will make every effort to assist those who are suffering from mental illness and whose illness is endangering them by preventing them from meeting their basic human needs. And let me be clear, we will continue to do all we can to persuade those in need of help to accept services voluntarily. But we will not abandon them if those efforts cannot overcome the person's unawareness of their own illness. In short, we are confirming that a person's inability to meet basic needs to the extent that it poses a risk of harm is part of the standard for mental health interventions. And we will accomplish this in five specific ways. First, we have issued a new directive to our Department of Health and Mental Hygiene Mobile Crisis Teams, FDNY EMS, and the NYPD. This directive lays out an expedited step-by-step process for involuntarily transporting a person experiencing a mental health crisis to a hospital for evaluation. It explicitly states that it is appropriate to use this process when a person refuses voluntary assistance. And it appears that they are suffering from mental illness and are a danger to themselves due to an inability to meet their basic needs. We believe this is the first time that a Merrill administration has given this direction on the basic needs standard and official guidance. Second, our Mobile Crisis Teams and police officers receive enhanced training on how to assist those in mental health crises. There will be a new focus on the need to intervene in situations when an individual appears to be suffering from mental illness and in danger due to an inability to meet their basic needs. This would include an in-depth discussion on what inability to meet basic needs means and an array of options to consider before resorting to involuntary removal. The first training to this is going to be incorporated today. This new focus took place this morning and we will soon roll it out to all current members of the Mobile Crisis Teams and the NYPD. Third, we'll be launching a hotline staffed by clinicians from our H&H hospitals that will provide guidance to police officers who encounter individuals in psychiatric crises. State law already authorizes a police officer to make a judgment call, to have a person involuntarily removed to a hospital. But many officers feel uneasy using this authority when they have any doubt that the person in crisis meets the criteria. The hotline will allow an officer to describe what they are seeing to a clinical professional or even use video calling to get an expert opinion on what options may be available. Fourth, we will develop a special cadre of clinicians paired with NYPD officers dedicated to the difficult work of getting New Yorkers in crisis into care. These specialized intervention teams will have the training, expertise and sensitivity to ensure that those in need are safely transported to a hospital for evaluation. Fifth, we will work to have the basic needs standard for involuntary intervention explicitly written into state law. This is point one in our 11 point legislative agenda that I mentioned earlier. State law already gives us the scope and authority to help those who are unable to meet their own needs. But to have it clearly spelled out in legislation would help dispel the misconception that we must wait for a threatening, violent or suicidal act to get those in crisis their help they need. We will also seek a common sense expansion of the criteria that a hospital doctor considers and deciding whether or not to discharge a psychiatric patient. All too often, a person's enters the hospital in crisis and gets discharged prematurely because their current behavior is no longer as alarming as it was when they were admitted. The law should require hospital's evaluators to consider not just how the person is acting at the moment of evaluation but also their treatment history, recent behavior in the community and whether they are ready to adhere to outpatient treatment. Our agenda also calls for allowing a broader range of licensed mental health professionals to staff our public crisis teams and perform these evaluations. This will help us get more outreach teams on the ground and enable hospital psychiatrists to spend more time providing medical care directly to patients. We will also seek changes in the law to improve communication between inpatient and outpatient treatment providers, allowing better continuing of care and discharge planning. And we will look to extend the reach of one of our most successful programs, assisted outpatient treatment, also known as Kendra's Law. When used, Kendra's Law has been shown to help those with severe mental illness avoid, repeat hospitalization and arrests. But we know that many who stand to benefit from this approach are not finding their way into the program. To remedy that, hospitals must be required to screen all psychiatric patients for Kendra's Law eligibility. These relatively simple changes to the law will have an outsized impact. They will strengthen our mental health laws and incorporate what we've learned through experience. And they will do so without threatening anyone's civil or legal rights. This plan represents a major shift in how we care for our fellow New Yorkers in crisis, even as we build on improvements we have already made over the past 11 months. It is the logical extension of what we have been doing from day one of this administration to repair our broken mental health system. That includes the subway safety plan that put more outreach brokers and police officers on the trains and platforms and increased investment into dropping centers, safe havens, stabilization beds and street health outreach and wellness bands. The result so far has been over 3,000 New Yorkers connected with care, support and shelter. Our city also implemented the Be Heard pilot program which deploys social workers and EMTs to respond to nonviolent mental health 911 calls. And we have worked with the sanitation department to remove illegal encampments throughout the city. Many of them extremely dangerous for those living there. We want all New Yorkers who have access to safe place to live. And we are working to expand the supply of supportive and low barrier housing. We are also piloting innovative models to connect people in shelter with the services they need to succeed including Medicaid home and community-based services which includes mental health care, socialization and connection to housing. We will be enrolling appropriate people living in shelter and to specialize Medicaid managed long-term care plans. This will offer them enhanced services with the goal of stabilizing their medical condition, increasing connection to healthcare services, reducing hospitalization and increasing access to community housing. We are adding more support and connection centers and increasing investments in other community support options. And we have launched our connect program which offers continuous engagement between clinical and community partners. All of these efforts are based on our core conviction that people with severe mental illness deserve care, community and treatment in the least restrictive setting possible. Some may see the policy shift announced today as a departure from that goal. But let me be clear. When we hospitalized those in crises, we'll be with a sense of mission to help them heal and prepare them for an appropriate community placement. We can't just stabilize people for a few days and send them back out into the city. We must build a continuum of care that helps patients transition into step-down programs and eventually into supportive housing. But nobody should think decades of dysfunction can be changed overnight. The longest journey begins with a single step. And we can't wait another day to take this one. You must lead with a sense of purpose and conviction, not get lost in the wilderness of bureaucracy and fear. You must train, teach and empower our city workforce. To get help to those who need it and know that our city supports them in this effort. We must build out a system that will bring people into care, alleviate their pain, keep them from harming themselves or others and give them treatment and support they need in the long term. Those suffering from severe mental illness have more than a right to exist or survive. They have a right to healthcare, housing and treatment, a right to dignity and respect, a right to safety and security and above all, a right to hope. Hope for treatment, community and healing. Hope that their future will be safe and that their illness can be managed. But that hope starts with a spark of engagement on our part, followed by a strong and supportive program of help and housing. We all are brothers and sisters that much. And in helping them, we will also be protecting the rights of every New Yorker to live, work and thrive and be safe.