Comptroller Lander Announces Blueprint to End Street Homelessness for People with Serious Mental Illness in New York City

New York, NY– Today, New York City Comptroller Brad Lander released Safer For All: A Plan to End Street Homelessness for People with Serious Mental Illness in NYC. The report takes an in-depth look at the crisis of people with serious mental illness cycling between the city’s streets, subways, hospitals, and jails, which has been amplified by high-profile, tragic incidents of violence in recent weeks.  

The comprehensive recommendations include a detailed approach for improving City Hall’s management and coordination across agencies, expanding options for both voluntary and mandated treatment, and outcomes-based investments in the mental health system. At the heart of the plan is a “Housing First” approach that has proven effective at connecting people to stable housing with mental health and social services in cities around the country and was utilized by New York City over a decade ago to end street homelessness for veterans.  

“For too long, New York City has taken a ‘housing last’ approach that keeps people with serious mental illness cycling from street to subway to hospital to jail, and back again,” said Comptroller Brad Lander. “With a ‘housing first’ approach that has been shown to work 70% to 90% of the time to keep people stably housed, with more effective mandated options for those cases when it doesn’t work, and with better management from City Hall, we can end the crisis of street homelessness for seriously mentally ill people in New York City.” 

The report estimates that there are approximately 2,000 people with serious mental illness who are experiencing unsheltered homelessness, or currently in City hospitals or jails who are likely to return to the street upon discharge. Meanwhile, there are over 2,500 units of supportive housing sitting vacant – more than enough to house the vast majority of seriously mentally ill New Yorkers currently sleeping on the street.  

A series of audits and investigations has shown that, despite billions of dollars spent on outreach, police overtime, city jails, shelters, and emergency hospitalization, the Adams Administration has failed to effectively coordinate a continuum of care. Outreach teams lose track of clients. Hospitals release patients back to the street when inpatient beds are full, or do not take them in the first place. Judges cannot refer people to alternative to incarceration programs that have no slots. Jails discharge people with serious mental illness back to the street, even when they are homeless and eligible for supportive housing. Without stable housing or effective coordination, adherence to required treatment plans becomes far more difficult. 

In a 2023 audit by the Comptroller’s Office, the Adams Administration’s homeless encampment sweeps connected just three out of the 2,308 people removed to permanent housing during the audited period. The Intensive Mobile Treatment (IMT) program presents a promising approach to treating the hardest-to-serve clients, but a 2024 Comptroller’s Office audit revealed the City has failed to develop key performance indicators, effectuate inter-agency coordination, or track outcomes over time. The percentage of clients able to retain stable housing in the City’s IMT program dropped from 44% to 37% over a 21-month period.  

Hospitals, Comprehensive Psychiatric Emergency Programs (CPEPs), and jails do not adequately connect individuals to housing at discharge. Available data indicates that just 25% of qualified people discharged from State psychiatric centers, transitional living residences, hospitals, and treatment programs were accepted in supportive housing. Many wind up back on the street. 

Safer for All’s Key Findings 

• Mismanagement from City Hall and lack of coordination between agencies leaves many people falling through the cracks. 

• Significant barriers keep people from accessing mental healthcare. 

• Mandated mental health treatment can be difficult to effectuate and is constrained by a lack of appropriate residential facilities.   

• Lack of access to stable housing with support services leaves people with serious mental illness cycling through crises.   

Safer for All’s Recommendations 

• Improve City Hall management and coordination across agencies and outreach programs, with a diligent focus on outcomes. 

• Create a “Housing First” program with robust wraparound support services for people with serious mental illness experiencing street homelessness. 

• Expand and improve involuntary and court-ordered treatment and secure detention programs. 

• Both the City and State must invest in the capacity of the mental health system. 

Housing First combines existing supportive housing, single room occupancy (SRO) units, vouchers, and service dollars to get people off the street and directly into stable housing with wraparound services. A previous report by the Comptroller’s Office found 70-90% of Housing First participants remain stably housed two-to-three years after receiving services (compared to 30-50% of participants in traditional “treatment first” programs). Building on the models from Houston, Denver and Philadelphia, New York City’s own experience with its small Street-to-Housing pilot program, the report details what New York City should do to establish a large-scale Housing First program.  

Comptroller Lander continued, “New Yorkers are stressed out about lack of safety on the subway and our streets, and a huge amount of that is mentally ill homeless folks who, in some cases, become a real danger, as we’ve seen in recent weeks. We dug in and realized this is a solvable problem.”

Read the full report here.

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