Cuomo Says New York Has a Mental Health Crisis. Here’s His Plan.

In his bid to become mayor, Andrew M. Cuomo has portrayed New York City as being in crisis mode and has said that his top priority if elected would be keeping people safe.

To do so, Mr. Cuomo, the former governor of New York, says the city must do more to remove people with severe mental illness from the streets and ease fears over high-profile attacks involving homeless people.

On Tuesday, Mr. Cuomo will release a detailed 36-page plan about how he would do that, including expanding involuntary hospitalizations and requiring people who are discharged from public hospitals and jails to be screened for mandatory outpatient treatment.

The plan includes more than a dozen proposals to address what he calls the city’s “mental health crisis.” Mr. Cuomo will call for adding more supportive housing units and psychiatric beds at hospitals and improving access to preventative mental health services. His main focus is on removing people who are a danger to themselves and the public.

Mr. Cuomo’s plan would spend about $2.6 billion in capital funding over five years to build at least 600 additional units of supportive housing — deeply subsidized apartments with social services offered on site — each year. He also calls for expanding the use of court orders under Kendra’s Law, a state law that allows courts to mandate outpatient treatment.

Mr. Cuomo wants to require “universal screening” when people are discharged from public hospitals and from the Rikers Island jail complex, to see if they should be subject to a Kendra’s Law order. He would also work with state leaders to require private hospitals to do the same.

Mr. Cuomo’s opponents have argued that he deserves blame for making the mental health system worse by overseeing a reduction in psychiatric beds as governor. From 2012 to 2019, the number of beds in state psychiatric facilities fell by 23 percent.

The loss of beds, which also happened in private hospitals in response to falling Medicaid reimbursement rates, accelerated in the wake of the pandemic. A shortage of psychiatric beds is cited as one of the main reasons that hospitals rush to discharge psychiatric patients, often before they are fully stabilized.

Mr. Cuomo, who leads in polls ahead of the Democratic mayoral primary in June, defended his record in the plan and in the interview. The plan suggested that inpatient settings “are often ineffective and inefficient places to deliver care” and that the reduction in state-hospital psychiatric beds was more than offset by the increase in beds in supportive housing and other residences for people who did not need inpatient care. The plan also calls for the city’s Health and Hospitals system to add between 100 and 200 new inpatient psychiatric beds for people involved with the criminal justice system.

Under Mr. Cuomo, the state also sharply reduced the portion it paid of the cost of sheltering people in New York City, shifting the burden onto the city.

Zohran Mamdani, a state lawmaker who is in second place in mayoral polls, wants to create a new city agency called the Department of Community Safety to shift many mental health issues away from the police. Another candidate, Brad Lander, the city comptroller, has focused on a “housing first” approach, which moves people straight from the streets into apartments, not into shelters, and does not require drug testing.

Mr. Cuomo’s plan said that the housing first model is a “valuable strategy” but “not a silver bullet,” in part because it does not do enough to ensure that unstable people, who can be “disruptive to what is already a fragile ecosystem,” accept services.

The plan argues that more people should be referred to treatment under Kendra’s Law, which was approved in 1999 and named after Kendra Webdale, a woman who was killed that year when she was shoved in front of a subway train.

But the system is already overburdened and allows people to fall through the cracks. A 2023 New York Times investigation found that people under Kendra’s Law orders had been accused of more than 380 violent acts in the previous five years.

Mr. Cuomo said that there were not sufficient penalties for noncompliance. If someone refuses to follow their treatment plan, the only consequence is that they can be taken to a hospital for evaluation, which often leads to their being discharged after 72 hours.

Improving the mental health system was a central issue in state budget negotiations this year. Ms. Hochul and state lawmakers agreed last week to enshrine into state law existing guidelines that expand the criteria for taking people in psychiatric crisis to a hospital against their will.

Mr. Adams, who withdrew from the Democratic primary to run for re-election as an independent in the general election in November, has called for more involuntary hospitalizations. In January, he announced his own $650 million plan to address street homelessness and severe mental illness.

Mr. Cuomo said that Mr. Adams must do more to make sure that city health officials involuntarily hospitalize people who cannot meet their basic needs.

“We’re not enforcing the legal standard, we’re not really helping anyone, and we’re endangering the public,” he said.