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Decades Adrift in a Broken System, Then Charged in a Death on the Tracks

In late December, BronxWorks, a nonprofit that runs seven homeless shelters for the city, including one for 200 mentally ill men, sent a draft report, “Inpatient Psychiatric Care for Severely Mentally Ill Homeless Individuals in NYC,” to the incoming mayor’s transition team.

The document cited several recent episodes in which shelter staff members called 911 about a violent client, furnished medics with his psychiatric history and had a mental-health professional recommend admission, only to discover when the client showed up at the shelter again that a hospital had quickly released him.

BronxWorks, a city contractor for more than 20 years, wrote that some hospitals’ practices were “leading to poor health outcomes and increased criminalization of mental illness amongst homeless New Yorkers.”

In one case, BronxWorks said, after a client injured people, a hospital “refused to admit this client, stating that he posed too high a risk to their staff and other patients.” BronxWorks asked that the client be transferred to a hospital with a specialized psychiatric emergency room. Instead, he was released.

The agency that runs the city’s public hospitals declined to comment on the report.

Another social-services executive, Joe DeGenova, the president of the Center for Urban Community Services, which runs housing and mental-health services for homeless people, said he understood the pressures that hospitals were under. “Nevertheless,” he added, “I think the hospitals are too free to do things the way they want to do them.”

Dr. Amador said that there has been a shift in the psychiatric profession, away from considering the lifelong arc of illness.

“Psychiatrists are no longer trained to look at someone’s long-term needs,” he said. “They’re turned into mechanics, dispensing psychopharmacology over a 72-hour period, or a one-week period, and then, ‘My job is done.’”

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