Clinician-led Involuntary Removals in New York City: Understanding Patterns and Outcomes from an Inter-agency Initiative

• In Event: Cross-Agency Administrative Data Sets for Actionable Intelligence

Abstract

Introduction: Across the United States, many jurisdictions are exploring strategies to support individuals who experience unsheltered homelessness and have severe mental health conditions. In November 2022, the New York City government issued a directive to authorize a more expansive interpretation of the circumstances under which an individual may be involuntarily removed from a public area and transported to a hospital for psychological evaluation. This directive spawned multiple outreach initiatives to coordinate resources across health, homeless services, transit, and law enforcement agencies, contributing to an increase in clinician-led involuntary removals in recent years. This study from the NYC Department of Social Services Office of Evaluation and Research (OER) analyzes the characteristics, care trajectories, and outcomes among individuals engaged through clinician-led involuntary removals.

Method: This study leverages information from multiple sources of administrative data. OER obtained a dataset to track a cohort of individuals recorded through involuntary removals led by DSS outreach clinicians between April 2021 and March 2025. This dataset also included information on clinicians’ documented reason for removal, where it occurred, and the hospital to which an individual was transported. The cohort was matched to the Department of Homeless Services (DHS) shelter database to identify individuals’ demographic characteristics, their engagement with shelter and street outreach services, and their current parole status and any nights spent in jail. We also matched to the New York State Medicaid Data Warehouse (MDW) to identify individuals’ use of inpatient and emergency department services and recent behavioral health diagnoses billed through Medicaid. In addition to presenting descriptive data from this match, this study identifies a typology of clients based on individuals’ history of engagement with shelter and street outreach services.

 

Results/Implications: This study observed familiar outreach patterns borne from this initiative, as removals often occurred in subway stations, and individuals were typically transported to one of the City’s public hospitals. Evidence suggests that clinicians removed individuals with severe mental health needs: a consistently high share of individuals were admitted to the hospital, and the sample matched to the MDW indicated a high prevalence of prior diagnoses related to chronic mental illness. Among individuals matched to the DHS database, we find that many had engaged with the agency’s services within one year prior to removal. Within this subgroup, individuals who recently stayed in a DHS shelter bed were also more likely to record stays in hospitals/EDs and jail; individuals who were recently engaged only through street outreach were less likely to record this cross-systems involvement. Further, a nontrivial subset of individuals also had no recent engagement with DHS services prior to an involuntary removal, raising questions about the trajectories and touchpoints of care for this population.

 

Authors

• Jack Mullan, NYC Department of Social Services
  Non-Presenting Co-Author

• Kinsey Dinan, NYC Department of Social Services
  Presenting Author

• Edith M. Kealey, New York City Department of Social Services
  Non-Presenting Co-Author

• Andy Goldstein, NYC Department of Social Services
  Non-Presenting Co-Author