These experiences of coercion are not only ethically troubling but also impose considerable clinical harm. Mandated long-term antipsychotic use can cause metabolic syndrome and diabetes that, in turn, cause cardiovascular disease and early death. Antipsychotics can can also cause severe movement disorders that substantially increase rates of suicide. Supervised residential placements may restrict autonomy over finances, food, and social life. Court involvement can disrupt family bonds and caregiving arrangements. These chronic experiences of subordination—what some researchers call “social defeat”—are themselves implicated in the development and worsening of psychosis.

Many such harms are poorly measured because they are hard to quantify: the psychic consequences of being governed as a non-equal citizen; the chilling effects on help-seeking and ability to trust others; medication side effects experienced under conditions of constrained choice; and the long-term social effects of being managed through surveillance and threat rather than genuine care and support.

This especially matters right now as Mayor Mamdani makes pivotal decisions about how he will address mental health, homelessness, and community safety in the wake of an outgoing administration that made psychiatric coercion a centerpiece of governance.

Former Mayor Eric Adams’s approach to homelessness and severe mental illness was framed through a law-enforcement lens: expanding the city’s police powers to remove people from public spaces, widening pathways into involuntary hospitalization, and framing psychiatric coercion as a necessary and enlightened form of compassion. The architect and public face of this agenda was Adams’s senior adviser on mental illness, Brian Stettin, who described the administration’s push as bringing people to hospitals “with or without their consent” and pursuing broader criteria for longer-term involuntary hospitalization. Stettin is a longtime advocate of coercive mental health policy and AOT, and built his career through association with the psychiatrist E. Fuller Torrey’s Treatment Advocacy Center, an organization that has aggressively promoted tougher involuntary treatment laws nationwide. He was involved in drafting Kendra’s Law.

Under Stettin’s direction, New Yorkers have been offered a simple bargain: Accept a larger machinery of coercion and police power and you will get better public safety, better health outcomes, and fewer people suffering in plain sight. This bargain has been politically powerful—and empirically vacuous.

A second story line, echoed in public commentary around the Adams approach, is that coercive hospitalization or AOT is what finally gets people connected to housing and services.

But this confuses leverage with care. When the system withholds housing, benefits navigation, intensive case management, and follow-up until the moment a person is taken in custody, stabilized, and made administratively manageable, it will always look as if coercion “worked.” What actually worked was housing and sustained services from community care workers—the very things the city could fund and offer proactively to people in need, without making liberty contingent on compliance.

If New York wants fewer people cycling between streets, subways, emergency rooms, and jails, the most evidence-based path is not the courtroom. It is building and guaranteeing the voluntary care infrastructure that actually changes trajectories: stable housing, intensive mobile support enabled by a publicly employed corps of community care workers, and continuity of care that does not collapse the moment someone misses an appointment.

Mayor Mamdani was elected on his promises of change, and he now has an opportunity to make good on those promises. Instead of doubling down on policing logics, he could invest in scaling voluntary assertive community treatment, expanding supportive housing, strengthening peer-led engagement by building a robust community care-worker corps, and ensuring follow-up without police involvement.

Alarmingly, so far, the Mamdani administration has instead signaled continuity with elements of the entrenched approach he promised to reject, first by backtracking on campaign promises to end homeless encampment sweeps and then by appointing Erin Dalton as director of social services. Dalton arrives from Allegheny County, where she pushed for expansive use of AOT and psychiatric policing, making Allegheny County the first in Pennsylvania to opt in to AOT over the objections of many local stakeholders and statewide civil rights and disability justice groups. She also led expanded use of homeless encampment sweeps by police, defunding of supportive housing, and a predictive algorithm that flagged poor families—disproportionately families of color and those living with disabilities—for preemptive child-abuse investigations.

These strategies do not reduce homelessness at scale or build durable voluntary care infrastructure; instead, they entrench cycles in which access to housing and services is mediated by police contact and the threat of court orders. This echoes the model advanced in California under Gavin Newsom, who has coupled expansion of social-service bureaucracy with intensified street-level police enforcement, consuming enormous public budgets without resolving chronic homelessness or improving mental health.

People should not be denied freedom, dignity, or rights simply because their distress appears frightening, inconvenient, or socially unintelligible. For decades, AOT has been sold as a tragic necessity—one that dictates we must deny autonomy and suppress differences in order to protect health and safety. The best available scientific evidence undercuts that claim. New York does not need a system of coerced outpatient “treatment” to fund housing, services, and care. What it needs is the political will to provide those goods without making them conditional on compliance with psychiatric mandates, and without converting care into a branch of policing.

Mental health policy is not just a technocratic nor scientific matter. It begins from a fundamental ethical and political question: What kind of society do we want to make—one that prioritizes care, freedom, and universal rights to difference, or one that insists upon control and homogeneity? If policymakers support the continued use of forced psychiatric treatment and expansion of police powers over people living with mental illness despite the absence of evidence that it improves health or safety, it should be very clear where they stand.