“If It’s State-Sanctioned, It’s Carceral!”

NYC Mayor Adams Made Me Go Live

“Community Care… [is] about being there for people without them having to take the initial first step. It’s about adopting an ethos of compassion and very intentionally applying that.” — Nakita Valerio

A few weeks back, the Executive Director of the Transformative Mental Health training org IDHA (for which I am a Board member) reached out to me to see if I was interested in speaking as part of a panel hosted by the Network to Advance Abolitionist Social Work. The topic was the carcerality of mental health systems, and what community care could look like. It’s a topic that IDHA covers regularly in our Decarcerating Care series, notably in our October 2022 panel. That said, I was surprised to be personally asked.

“Uh….yeah! Wait, me?”

I was a little concerned. First, I’m not a Social Worker. And second, although I’m a radical Mental Health Counselor and mobile treatment shelter worker in NYC I am 100% part of the carceral systems that the NAASW is working so hard to expose and change.

“Jessie — is this like one of those things where everyone else is in on the joke and I’m the fool?” I asked. “Like, they’re all there to talk about what’s wrong with the mental health industrial complex and I’m there representing the system?”

It turned out that was not the case.

Vivienne Guevara was hosting, with Maria Thomas from Interrupting Criminalization and Professor Nev Jones (interviewed here: https://www.madinamerica.com/2020/09/a-conversation-with-nev-jones/) was there as well. The topic was “No More Carceral Mental Health Services”. Even Cameron Rasmussen from The Center for Justice was helping organize. These are heavy hitters! The talk was in response to NYC’s Mayor Adams looking to further criminalize people who have been unhoused and who are living with mental health concerns. They thought that my perspectives from inside NYC’s mental health system would be helpful.

My perspective is quite simple: please put me out of a job.

I desperately want to see community members reach out to their most vulnerable neighbors and offer support and connection so social services can be deprofessionalized and eventually become a dustbin relic of late-stage capitalism. I’m all about it.

So, I think my hesitation in participating was less a case of imposter syndrome and perhaps more of a gut check on how aligned my analysis and practice are. Let me explain.

I lead an ACT Team in NYC. We are mobile mental and behavioral health treatment team that includes nursing — something folks refer to as “integrated health care”. It’s also referred to as “Community Mental Health” — a category that includes clinics, mental health clubhouses, Respites, etc. ACT Teams step into the fray when capitalism’s underbelly is exposed. The folks served by my ACT Team are those that have been traumatized by life, stigmatized by society, and left behind by everyone. Our participants serve as a threat to the middle class. “Behave, or that will happen to you.”

ACT was ostensibly designed to “clean up” the “mess” (although this is a practical impossibility and not actually the intent…the pain is the point.) To be clear: the “mess” are people who are unhoused, people living with serious mental health concerns that sometimes scare their neighbors, and people who are using drugs problematically — according to some. If that sounds fucked up to you, it is.

But you can be sure that “capitalism’s clean-up team” isn’t the language used. “Community Mental Health” is the language that is used for ACT Teams. This is the comfortable, convenient lie that we tell.

Let me summarize the work we do as briefly as possible. My team of eight to ten “professionals” (Social Workers, Mental Health Counselors, Peers, RNs, Psychiatric Nurse Practitioners, SW Interns, and Case Managers) have up to 68 New Yorkers assigned to us through a central mental health processing registry known as SPOA (Single Point of Access). These are folks living with “SMI” who are very, very expensive to NYC (or New York State, or the other states that have ACT Teams). These humans use the hospital (not always by choice) and the criminal justice system (never by choice) often enough that New York has basically said “we’re going to assign an absurdly expensive team of licensed “professionals” to follow you around and hope that they can keep you from being so expensive.” Ironic, right? Because the only reason these folks are expensive to the state, is that the state didn’t spend the resources on making sure folks were housed, or on publicity campaigns destigmatizing mental illness, or on providing trauma-informed responses to crises earlier in folks’ lives.

Wait — sorry — I was processing externally there.

What I meant to say was that New York has asked us to support these individuals in setting and reaching their goals, and finding mental health recovery.

Yeah. That’s it.

And both things are true. My team does in fact help folks set and achieve goals. And we do promote recovery as the participant (our preferred term instead of “client” or “patient”) defines it. But I never let my team forget who we are. We are mandated reporters. We have the authority to send people to the hospital for psychological evaluation and psychiatric incarceration (psych inpatient). We have an outrageous amount of power.

Because of this, I spend a large chunk of my team time with staff naming that power and attempting to blunt it. How can we use a harm reduction lens in all that we do? How can we center each participant’s self-determination and their choices? How do we honor folks’ bodily autonomy? How can we support participants in staying as safe as possible, no matter what they are doing? And in the bitter end, how can we help them from being incarcerated by…well, by us? It’s messed up — but there it is. I’ve literally said to a participant “If this continues I will send you to the hospital. Help me help you.”

Yuck.

Although — let me be real. I probably said “I’ll have no choice but to send you to the hospital…” to protect my own ego. I gotta make sure to always own it. Rationalizing away my carceral responses — as infrequent as they are — doesn’t paint an accurate picture of my cop-hood and it makes sleeping too easy. I should be uncomfortable wielding this power. Hell, the participants are. Why should I get a free pass in this system?

So yes, we help folks on their mental health recovery journey, perhaps. And also, we are a soft arm of the Prison Industrial Complex.

Back to the IG Live planning meetings. Cameron and Vivienne facilitated some wonderful dialogue between we three panelists, and we had a fascinating document going where we were all highlighting some of the themes and details we each wanted to go over, and playing off each others’ ideas. It was lovely. From Nev’s sharp analysis of the carcerality of mental health systems in general — straight down from the DSM to Social Work school today — to Maria’s highlighting the praxis of daily abolitionist work through the Beyond Do No Harm 13 Principles that are designed to help health care workers interrupt criminalization of the people they serve — there was a lot of powerful content to sift through. We knew that we wanted to highlight the racial disparities in mental health care in addition to everything else, and wondered how fast this hour would fly by. Organizing for justice takes lots of different forms but often feels rushed. I appreciated the thoughtfulness and generosity of this group.

My own contributions were (and typically are) about community and how stigma around “metal illness”, being unhoused, and substance use keep people sick and disconnected. Here is one of my notes:

Community Care in the way I envision it does not / cannot exist without the literal community members embracing difference and walking into the streets and meeting folks. Individuals who are unhoused, experiencing what has come to be known as “psychosis”, and especially members of BIPOC communities, have been either invisibilized or dehumanized in public opinion (shaped by politicians using corporate media). It is this dehumanization that allows the state (and individual actors) to deny bodily autonomy and self-determination with impunity, as those being stripped of their human rights have been publicly declared less than human — and thus aren’t really being stripped of anything (in this twisted reality). If we want to address the root causes of mental health concerns — which I believe to be stigma, disconnection and trauma — then I can think of no worse idea than augmenting stigma around MH — exacerbating disconnection and adding the trauma of additional removals — which is exactly what this move by Adams does. It is literally the opposite of what is needed, and also will be be popular because it requires no effort by anyone and carceral responses have been normalized as solutions instead of problems.

I wanted to highlight in this talk that all of us have a responsibility to meet the people in our communities and get to know them. It is the “othering” of folks living with a schizophrenia diagnoses (for example) and experiencing distressing internal stimuli that allows us to turn a blind eye when NYC’s Mayor Adams — a cop — says that cops will be taking more people off of the streets who might not be caring for themselves adequately. Disabuse yourself of any notion that this is somehow philanthropic. Adams and his ilk are playing to the audience — a voting middle class that needs someone to blame for our disintegrating self-image. Who or what is the bogeyman, that has stolen the American Dream from us? Why do we have diminishing real income and skyrocketing housing prices? Why is there a dearth of meaningful employment opportunities for people without a college degree (and even those with) and all the other logical outcomes of the contradictions of Capitalism?

It must be the “homeless”, the “mentally ill”, and the “drug addicts” who are to blame. Lock’m up. That’ll make everything better. (Oh, and immigrants. Get them too.)

This is Faciasm 101, y’all. Create an enemy with a lie (Black people and immigrants are destroying “our” (read “white”) country). Get elected on a fear / criminal justice platform. Create the conditions where your lie is made true (by impoverishing the “enemy” and then stigmatizing them for being lazy or greedy.) Incarcerate everyone.

Welcome to America.

If you take the time to read through the press release from Mayor Adams and the involuntary removal document you will have two things:

a) a vomit-soaked shirt-front

b) a headache

That’s about it. There’s not a redeeming turn of doublespeak in the damn thing. Check out this quote:

“As a city, we have a moral obligation to support our fellow New Yorkers and stop the decades-long practice of turning a blind eye towards those suffering from severe mental illness, especially those who pose a risk of harm to themselves,”

— Mayor Adams

What’s the “moral obligation” and “support”? Universal basic income? Housing? Community-based care options funded with monies that are currently spent on policing?

Of course not! More carcerality, in the name of “not turning a blind eye”. Send people that make the middle class uncomfortable to the psych ward. FFS Adams, we’re not buying it. In my planning doc I wrote the following:

What *really* concerns me is this smacks of “if you see something say something”. We are on a surveillance precipice. The next step is that 911 calls become the first choice for any- and everyone who behaves differently than you. The police have no business making the evaluation of safety on site — an evaluation that has no possible objective standard. If a person could be evaluated at all — an inherently slippery slope — it should be against how they typically are — not against a made-up standard (i.e. “danger to self or others”). And, with no penalty for denying someone bodily autonomy the police will do what they do best — revert to a liability mentality and just lock folks away. What’s the cost to them?

At any rate — there was much to talk about.

The night of the IG Live was really exciting. We had tons of folks join and even more watch the event afterwards. You can see the 1-hour talk here. We covered the topics, dug into some interesting questions, and got the word out about options other than criminalizing fellow New Yorkers who already have so much less than many of us do.

But the one line of the night out of my mouth that seemed to have the greatest impact was actually not written by me. In prep work for the live event I was working with the question “How can we tell what is actual community care vs. what is carceral? How can we move away from a carceral frame in mental health treatment?” and my partner yelled out:

“If it’s state-sanctioned, it’s carceral!”

-Leah Pressman

She was and is right, of course. My own team is licensed by OMH. State-sanctioned mental health programs — no matter how hard those of us who are members of them try to temper the effects of our positionality and the power of the hierarchy — are by their nature carceral and always will be. They are cruddy bandages with glass embedded in the gauze. We harm as much as we staunch, and we aren’t responsible for any healing.

Real healing for communities and the people that comprise them will only come from community care — a concept without much of a testing ground. Like communism or anarchy, capitalism will not allow something like community care and mutual aid to take hold and prove itself as a viable alternative to the carceral state. That would take all of the policing, jailing, and prescription drug money out of pockets that are closely watched. Also, how do you monetize community care? It’s a non-starter.

What might community care look like? It would be services that people create for their own communities, in their own communities. It would include a culture of community members prioritizing the health of their neighborhoods over their personal interests — because our liberty is bound together. It would be people walking towards those who are suffering, instead of away. It would be filled with Transformative Justice, Disability Justice, Harm Reduction, Compassion, and Love. It would be crisis response by led by people who have lived through mental health crises, and who are uniquely positioned to support. Take a close look at the C-PMHA model proposed by Stefanie Lyn Kaufman-Mthimkhulu and all of the amazing work done by Project LETS . But all of this starts with individuals — you and I — refusing to let the state police our communities with social services workers, and instead going out into our communities and actually meeting folks. It will be uncomfortable. Also, we have to do it. Otherwise the next knock on the door might be a CPS worker, wanting to know if you’re able to care for your child adequately. Don’t think it can’t happen.

And maybe — just maybe — a world based in community care would be governed not by the golden rule — because I don’t want you to treat me like you want to be treated. Maybe it would be governed by my maxim:

Treat others the way that they want to be treated.

If you want to know how they’d like to be treated you’d better start a conversation.

True community care needs resources and will. The resources aren’t there systemically, so we have to use the resources we have now, today. Our privileges, our time, ourselves.

And the will for a system of community care? The will might come if a vision is articulated that energizes action.

I hope we were able to be a part of that visioning in our live event, and I encourage you to go out and meet the man on the corner in your own neighborhood. Ask him what he needs, and believe him when he tells you. Let him know what support you can offer and when, and honor that. Bring him in instead of pushing him away, and then locking him up.

Because we all need community care, and it starts with me.