The Big Apple’s $30-billion social safety net amounts to a badly frayed patchwork of systems that still cannot reliably get New Yorkers in psychiatric crisis from subway platforms to hospital beds, a Streetsblog investigation has found.
Those billions support the largest municipally owned health care system in the country with 11 major hospitals; fund a shelter system that, by court order, must provide a bed for every homeless person; and put thousands of cops, firefighters and paramedics on the beat everyday.
However, that sprawling safety net often fails to get needed medical care to the hundreds of homeless New Yorkers with severe mental illness who call the subway system home — a population of barely 1,000 people that has an outsized affect on New Yorkers' perceptions of safety underground, surveys consistently show.
The challenges begin at the core: every call for aid is split among a half-dozen agencies, each with different, and sometimes conflicting, roles:
- There are contractors doing outreach for the Department of Homeless Services;
- There are police officers;
- There are EMTs with the FDNY;
- There are workers in the public hospital system's emergency rooms and psych wards;
- There are shelter intake and placement workers for the Department of Homeless Services;
- There are treatment service providers with the Department of Health and Mental Hygiene;
- And there are train and station staffers for the Metropolitan Transportation Authority, who often bear the brunt of the violence.
This alphabet soup leads to disjointed responses, which can even result in people being left on subway platforms in the middle of psychotic episodes, officials acknowledge. Other times, the mentally ill are given mood stabilizers and quickly discharged from hospitals, which will give them a MetroCard — literally returning them to the subways from whence they came.
“The system is definitely not working,” said one veteran emergency room doctor. "I don’t know whose fault it is."
The problems that stem from that crack-filled foundation are compounded by a near-total lack of data about the effectiveness of the city's response. For example, the Police Department only began tracking key information about mental health calls — such as if the removal was from the subways — in 2024; the Fire Department only started tracking if the patient on the ambulance was in a mental health crisis in 2023. City Hall only published the first detailed dataset tracking removals from the subway due to psychosis in August, 2025, nearly at the end of Mayor Adams's term.
In the previous administration, officials spoke of "engagements" with homeless people in the subways — essentially conversations and an offer of food by outreach workers in a bid to get the homeless to come inside. This soft-touch approach generated big numbers, but few results: only 103 homeless New Yorkers had stayed in a shelter for more than a night, following 3,000 "engagements" acknowledged by then-Mayor Bill de Blasio late in his term.
Nowadays, both City Hall and the MTA are experimenting with a different approach. It's called "co-response" and it pairs clinicians and police officers, combing several aspects of the response into unified teams that are sent underground. Early numbers suggest the program may be helping to patch some of the holes in the existing system. But the effort is expensive; with each team costing more than $1 million per year, it could cost $100 million per year to deploy 60 teams to hit each of the 472 subway station every day.
This investigation is drawn from extensive interviews with officials, activists and providers; and hundreds of pages of government reports and audits. Many people interviewed for this story asked for anonymity because of strict privacy regulations and the delicacy of the relationships among the myriad of agencies, providers and levels of government involved in the response.
The clock starts
Every minute matters when involuntarily removing someone in the midst of a mental health crisis from the subways. But the process of getting someone from the platform to the front door of a hospital routinely takes two hours and involves a half-dozen agencies and providers — some of whom are frequently at odds — even in the best-case scenario. The end result is a system so full of holes that sometimes sick New Yorkers in the midst psychotic episodes are left languishing in stations, potentially endangering straphangers.
Other times, the response is so slow that the sick person flees the station or simply gets on an arriving train before the removal process is completed.
There are also holes at the hospitals, which may refuse to admit the patients into the psych wards. Instead, mood stabilizers are administered and the patients are quickly discharged. There is no known tally of how frequently this happens either, but it happens often enough that social workers have a nickname for it: “treated and streeted.”
The widespread dysfunction affects the morale of social workers, nurses, paramedics, cops and MTA employees, interviews show.
“If the system doesn’t work, everyone in it knows it,” said Laura Kavanagh, who, as Fire Department first deputy commissioner and then commissioner, oversaw a key element of the city’s response for de Blasio and his successor.
"If a police officer brings someone in and then the person gets kicked out of the emergency room, they're like, 'Then, what was the point?'" she said. "They" — the first responders — "were sent there to help but the actions they're allowed to take can't actually get that person the help they need. They can only move them down the conveyer belt. It leaves them incredibly demoralized.
"They'll see that person again, in an hour, a day or a week," Kavanagh added.
The removal and hospitalization process described in interviewees was nearly identical to the eight-step process illustrated in a 2017 report commissioned by the de Blasio administration, which is no longer accessible on the city websites.
In response to questions, a DHS spokeswoman said in a statement that outreach teams call 911 for "prompt assistance when an individual is in crisis."
The problem
New York City has one of the most expansive safety nets in the country. Combined, the Department of Homeless Services, the Human Resources Administration, the Health and Hospitals Corporation, and the Department of Health and Mental Hygiene will get nearly $20 billion in the city's 2026 budget. That money provides healthcare, beds and social welfare services to hundreds of thousands of New Yorkers every year.
City Hall spends another $9 billion (or more) on the Big Apple's vast public safety apparatus: the Police Department, whose cops are eventually involved in almost every mental health call; and the city Fire Department, which both runs the city's EMS service and regulates and coordinates the private ambulances.
On top of all that, there's the state Office of Mental Health, the state-controlled MTA, plus the private hospitals.
But these dollars and programs struggle to reach the city's sickest and neediest.
The problems begin with data collection.
Start with the simplest question: How many people there are in the subways and suffering from severe mental illness? There is no firm figure.
One official put the number at roughly half of the the overall homeless population living underground, approximately 1,000. Other estimates put the figure at "several hundred."
And then there's the data that does exist. But it is badly fragmented because it is divvied up among the half-dozen agencies tasked with responding to this crisis. This means there is no comprehensive portrait of how these New Yorkers move through the system.
In the snippets of data that do exist, evidence of dysfunction abounds.
Half of the suspects identified in assaults on MTA staff in 2023 — 20 out of 38 — had histories of mental illness and a history of prior arrests, according to hundreds of pages of records this reporter has examined. Advocates point out assaults are committed by just a tiny fraction of the homeless population underground.
However, surveys show that straphangers rank erratic behavior in stations and on trains as one of their biggest concerns.
Shocking episodes of violence underground in recent years have made those stats real. Martial Simon, who fatally shoved Michelle Go in front of a train, is schizophrenic and was deemed unfit for trial in 2022. Jordan Neely, who suffered from a long history of mental illness, checked himself out of treatment in violation of a court order, but wasn’t found again until he was killed on the floor of an F train on the Lower East Side. Daniel Penny was charged with this death, argued self-defense and was acquitted in a case that became an acid test for how the city views and cares for the mentally ill underground.
Most cases don't grab the front pages of the tabloids. Wayne Robinson was deemed unfit to stand trial and sent to a state mental hospital after four separate arrests for assaulting MTA staff in 2023. William Talbert was declared unfit to stand trial and ordered into treatment after allegedly slugging a man on an M train. He was somehow released and then arrested for a string of assaults on the Lower East Side.
Just recently, in August, a doctor at Harlem Hospital was shoved onto the tracks as he headed home from work by a man who was muttering to himself.
Every second counts
To comprehend why one of the biggest rips in the social safety net is in the subway, grab a stopwatch.
Every second is an opportunity for something to go horribly awry amid the constant arrival and departure of 600-foot trains. Time matters. But the pace of what’s about to unfold — pieced together from interviews from officials and providers — doesn't show it.
Much of the social service outreach in the subway system is performed by contracted outreach workers, clad in orange, who make $24-an-hour working an overnight shift and are tasked with an impossibly difficult job. Say they see a man — people struggling with mental illness in the subway are almost always men — in the midst of a psychotic episode on a platform in Midtown Manhattan. He is in real trouble, likely meeting the legal standard of posing a serious risk of harming himself or others.
But the outreach worker doesn’t have the authority to make that judgment under the state's mental hygiene law. That requires a licensed clinician, so a phone call must be placed to the central office to request the dispatch of such a clinician to the scene. Involuntary removals like this one are commonly shorthanded as "nine-five-eight," its numeration in the state's hygiene laws.
The Department of Homeless Services renewed its contract with non-profit, Bowery Residents' Committee, in 2023 to do this work.
That dispatch call begins a chain of events that should result in a sick New Yorker being placed in a hospital bed for short-term stabilization, and, hopefully, back into treatment and on the path to recovery and permanent housing. The failure to even collect the most basic data becomes evident at this first step. No one knows how long it takes for the clinician to arrive because no one keeps track. It could be 30 minutes, it could take hours, sometimes the clinician arrives the next day, officials said.
Contracting documents don't explicitly say how many clinicians the Bowery Residents' Committee has assigned to subway duties, but they show that just $417,000 per year is allocated for clinician salaries and benefits. If each only made $100,000 per year, including benefits, that would be just four people to cover the entire subway system all day, every day.
(The Bowery Residents' Committee referred questions about staffing and the contract to the Department of Homeless Services. A DHS spokeswoman said in a statement that BRC had 14 full-time clinicians on staff, but would not say how many were assigned to the subways or their hours.)
Every second spent waiting for the trained clinician poses a potential risk to the outreach worker, straphangers and the person in the midst of the psychotic episode, officials say. The person could attack someone or jump in front of a moving train. The person could flee by running out of the station. The wait for the clinician is the first gap in the system. Tick, tick, tick.
Assume the clinician arrives in only 30 minutes. Assume that he or she agrees with the social worker’s assessment and uses his or her authority to declare that the person should be removed from the station and taken to the hospital. This leads to the second phone call: to the NYPD to send officers to help with the response and removal.
Interviewees said the wait for the cops becomes the second hole in the city’s response. If the call is marked as critical by the operator, and it should be, the average time for the officers to arrive is about eight minutes. That’s another 480 seconds ticking by. In the best-case scenario, 38 minutes have now passed since the social worker initially spotted the person in a psychotic episode.
By law, the clinician is supposed to decide what happens, officials say. Frequently though, arriving officers treat the situation as a police matter and they are the ones with the radios to call for an ambulance. If the person is still there — a big if — the officers sometime dispute the clinician's determination. Perhaps the psychotic episode has passed; perhaps the cops don’t believe the person’s actions pose a serious risk to themselves or others; perhaps, they assume it’s drugs, and the hospital will just send them right back to the streets. The discussion can take 15-20 minutes, one social worker said.
Sometimes, of course, there is no argument and the clock keeps moving. It only takes a couple of minutes to call for the ambulance. In this best case scenario, 40 minutes have passed — 40 minutes during which literally anything can happen as subway trains pull in and out.
City dispatchers assign a priority level to each call for an ambulance made by a cop or through 911. The codes go from one to seven as a way of triaging who needs care the quickest. A call for cardiac arrest would be ranked as priority 1. Calls for psychotic behavior used to be ranked as priority level 7, but were upgraded in March 2023 to priority 5. City data show that the average response time for a Priority 5 call was almost 22 minutes in August. That’s another 1,320 seconds.
By the time the ambulance arrives, in the best-case scenario, 62 minutes have elapsed since the psychotic episode was first reported. The person suffering from the psychotic episode is still on the platform. This is the system when it works.
The ambulance represents the third potential hole in the process of getting the sick person from the subway to a hospital bed. Like cops, ambulance drivers often exert their own unwritten authority to determine who gets on "their bus," social workers and officials said. If there's a debate, it can take 15-20 minutes, said one social worker. If the driver refuses, the clinician has the option to transport the person in the psychotic episode to the hospital themselves in a private car, an obviously fraught proposition. Typically, the call is abandoned and the person remains in the station unaided, officials acknowledged.
Nurses interviewed by Streetsblog shared examples of this happening. And both City Hall and the MTA say it's an issue, though neither knows how frequently it happened.
“There are frequent flyers,” said Kavanagh, the former Fire Department chief. “Cops and paramedics usually know these patients and just assume it’s drugs. The hospital will just sober them up and kick them out.”
In response to questions, a City Hall spokesman said the Adams administration had updated training for both police officers and paramedics to reiterate that clinicians control the scene in mental health calls like this hypothetical example.
In the best-case version of our reconstructed scenario, no one has objected. The patient is quickly loaded into the ambulance. This takes five minutes. In all, 67 minutes have now passed.
The clock is still running and transport takes time. The two-mile trip across Midtown to Bellevue Hospital from the Port Authority Bus Terminal, a frequent spot for reports of a person in mental distress, can be 20 minutes. Ditto the trip from Atlantic Terminal in Downtown Brooklyn to Kings County Hospital in Flatbush. That’s 1,200 seconds. The sick man is now at the hospital’s front door. Eighty-seven minutes — more than 5,200 ticks of the stopwatch — have elapsed. Again, this is the system working.
At the hospital, more time passes, and more gaps open up.
Each person who arrives in the hospital has to make it through the triage before he is evaluated by a psychiatrist. This can take hours on a busy day at a city-run emergency room, where matters of life-and-death — heart attacks, car crashes, gunshots — are given priority. Many hospitals have no way of making sure that patients remain on site once they arrive and await their intake, opening the door for them to simply leave. Each tick of the clock is an opportunity for the patient to slip out of the hospital. It's called "eloping," but there are no stats for how often it happens either. This is the fourth gap in the system.
But let's assume that intake takes just an hour. That brings the total amount of time that has elapsed since the first phone call to two hours and 27 minutes, more than 8,800 seconds.
The patient is finally sent "upstairs" to the psych ward for a formal evaluation that could lead to him being held for up to 72 hours. This is where every single one of the seconds that contributed to the two-plus hour journey from the underground to the psych ward admissions adds up into the fifth hole in the system: If the patient now appears to be rational, he's often released. Or if his medical chart indicates a history of abusing drugs or alcohol, the episode is often chalked up to narcotics and he is released. Never mind that self-treatment is frequent among those with severe forms of mental illness.
“People are burned out and they feel like their hands are tied — the person doesn’t want help, the person’s not taking their meds, the person’s doing drugs on the street, the person doesn’t want placement,” the ER doctor said.
“It takes more energy than they have.”
If the psych ward rejects the person, it's "game over," in the words of one official: The person is discharged and gets a MetroCard for a trip home. Except there is no home, so the patient ends up back underground. Straphangers see them riding the trains with all the tell-tale signs of recent hospitalization: no laces in their shoes, hospital bracelets still on their arms.
Officials say there is no way to tally how often patients are, in their parlance, treated and streeted.
The medication wears off and the cycle starts again.
How did we get here?
In the 1950s, New York State’s system of asylums and mental institutions was unfathomably large. More than 93,000 people had been declared unfit and locked away by the 1950s. The system consumed one-quarter of the state’s entire budget and employed 57,000 people, making it almost twice the size of the modern NYPD. Long Island’s Pilgrim State Hospital, perhaps the largest mental institution in the world, had 14,000 patients. And the conditions in which they were kept were often cruel and squalid.
The costs and scandals here and in other states helped to ignite a push for what would become massive de-institutionalization: replacing prison-like asylums with intensive care at hospitals and in community clinics, with an emphasis on providing treatment in the patient’s community. The feds would help fund the transition for the first few years.
This new strategy was built on the development of mood-stabilizing drugs that controlled many of the symptoms of psychosis. These medications were seen as another miracle of science in the Space Age, which would make institutionalization obsolete — and, with that, solve one of the biggest financial challenges facing states like New York. Local emergency rooms would provide a short-term backstop for patients who fell off their medication. There wasn’t much thought about patients who didn’t want to take medication or who didn’t have the safety net — an apartment, the family or friends — that ensures they stay in treatment.
The reform push included a rewrite of the state's mental hygiene code: the mentally ill would live in their communities and go to a nearby clinic for treatment. The law included provisions that would allow hospitals to hold someone for up to 72 hours for short-term stabilization.
By 1970, in New York, the population of the mental health lockups was roughly 64,000, down nearly 30,000 in less than two decades. The pressure to cut further was growing. The first foreshocks of City Hall and Albany’s coming brushes with bankruptcy arrived in 1971 when Gov. Nelson Rockefeller cut 3,000 employees from the Department of Mental Hygiene, which ran the asylum system.
State officials emptied the asylums, but the local care that was supposed to provide its humane replacement never arrived. Federal officials set a goal for 2,000 community mental health clinics nationally. But, by the late 1970s, only 725 of the new centers had secured financing. The shortage was excruciating in New York. There were just two clinics in Manhattan and only one in Queens. Officials had predicted they’d need 73 to meet the need citywide. (The clinic figure would only grow to 14 citywide by 1989.)
By early 1978, the population in the asylums plummeted to 26,000 — down more than 70 percent from the all-time high. Mayor Ed Koch and his deputies charged the mentally ill were being dumped into the city, triggering a bitter feud with Albany that would last for a decade.
Stanley Brezenoff, a top Koch aide now retired from public life, was key figure in City Hall's response during the late 1970s and 1980s, serving as both the chief of the Big Apple's main welfare agency, the Human Resources Administration, and the public hospital system.
"The public policy wasn’t there, the resources weren’t there, the thoughtfulness wasn’t there," Brezenoff said in a recent interview. "The great emancipation — as it were — was not replaced by anything really rational.”
One lawsuit estimated the state’s deinstitutionalization put onto the streets 6,000 people who once lived in asylums. Thousands more landed in squalid single-room apartments — often referred to by their initials, SROs — mainly on the Upper West Side or in the Bowery. And they ended up underground, too.
“New York's subway system has been called the largest SRO,” the Times declared.
Bellevue and the city’s other public hospitals were so overwhelmed with cases that they declared they would only take those “the most violent.”
That, Brezenoff recalled, was a desperate attempt by the hospital system to cope.
"You held onto whoever you could – but when you’re holding onto somebody, you’re keeping someone else from coming in," he said. "If the ward was really crowded, then you had to have a knife between your teeth to get in."
This was about the time that City Hall settled a lawsuit brought by homeless New Yorkers by agreeing to promise everyone a bed, now known as the "right to shelter."
The shelter system quickly became a central feature of the city's revolving door: State institutions refused to take patients from a broke city's public hospitals, but the hospitals had to discharge patients to make room for new arrivals. They ended up on the streets, which meant many got swept into the shelters.
"You began to have this mix: the homeless, homeless with alcohol problems, the homeless with serious mental health problems," Brezenoff said.
At one point, state officials acknowledged that too many people were released too quickly.
“People rushed pell‐mell away from the ‘snakepit,’ the notion of the asylum,” said James Prevost, the then-commissioner of the state’s asylum system. “They forgot that there were some good aspects about the asylum, the sense of belonging, the structure, protective living that was not provided in the community.” Prevost and other state officials later reversed, authoring reports for an embattled Gov. Hugh Carey, which sought to blame the crisis on the city's efforts to shut down or convert the SROs into permanent housing — SROs that were never meant to house those with serious mental illness in the first place.
New York's history makes one thing clear: combining housing and mental health services is essential to successful treatment, experts say.
"You have this mental health crisis and you have this housing crisis and you keep running into them together, because you can't disentangle them," said one former city official. "It's hard to solve a mental health crisis without dealing with the housing crisis.
"You have the SROs, but you don't have any treatment or any services, so that doesn't work," this person added. "But then you don't have enough supportive housing, so people are just stuck in the streets or stuck in shelters or the subways."
There have been efforts, in fits and starts, to build this sort of housing, beginning in the early 1990s with the New York/New York initiative launched by then-Mayor David Dinkins and Gov. Mario Cuomo. Subsequent spats between City Hall and Albany resulted the development of competing programs, with some apartments controlled by the city and others by the state. Advocates have complained that both the city and state require too much paperwork and that applicants face lengthy waiting lists.
City Hall has rolled out two small programs to tackle premature discharges from hospitals and the long waits for supportive housing.
First, three public hospitals — Bellevue, Kings County and Elmhurst — now have mental health units each with 20 to 25 beds where patients undergoing mandatory treatment stay for up to four months. Officials say this helps reduce the strain on emergency psych wards.
Second, the public hospital system has leased a West Side hotel to provide recent discharges with a room, meals and treatment while they wait for permanent supportive housing slots to open up.
Officials describe the "Bridge to Housing" program as "transitional housing." The program initially opened with 46 slots though there are plans to expand it to 100.
Vex in the city
The number of murders in New York City was relatively low until the 1970s, surpassing 1,500 in 1974 and hitting 1,814 in 1980. A similar pattern was playing out underground, with the number of homicides jumping from 10 in 1978 to 20 in 1980 — an alarming increase, though crime underground has always been a tiny fraction of the citywide tally.
It was about this time that cops, prosecutors and defense attorneys began linking random violence in the subways with mental illness, newspaper accounts show. The first case dates to 1978: An Eastern Air Lines flight attendant named Anne Picyk was robbed and shoved onto the tracks while waiting for a train at 96th Street and Central Park West. Picyk managed to pull herself back up. Cops later found the attacker, Davereaux Wiggins, who pleaded guilty and said at trial that Picyk was his fourth attack that month. A parole report read aloud by the judge described Wiggins as a paranoid schizophrenic. That was the first time schizophrenia and a violent act underground were tied together in the archive of The New York Times.
The case quickly fell out of the news. In a way, that’s not surprising. The initial attack in July happened the same week that John D. Rockefeller died; and that NYPD patrolmen threatened newly minted Mayor Ed Koch with a work slowdown. The events of December 1978, the month the judge sentenced Wiggins, would have blotted out the sun. Suspected mobsters heisted millions from the Lufthansa cargo hangar at JFK on a Monday (the "Goodfellas" caper); a subway derailed at Columbus Circle on a Tuesday; that Thursday, the feds raided the famed disco Studio 54; and, by Friday, A-list actress Bianca Jagger had flown in from London in a show of support for the club’s proprietors, Ian Schrager and Steve Rubell. Another attack, in February 1979, garnered little notice beyond the initial reports. A “chronic mental patient,” John Lee, was charged with pushing a good Samaritan, Yong Sou, in front of a D Train and killing him.
That all changed in June 1979 with the shoving of high school honors student Renee Katz. A promising flautist, Katz was attacked on her way to high school and her hand was severed. Cops found it between the tracks, put it on ice and rushed it to Bellevue, a horrifying drama captured on camera. Doctors reattached it using then-novel microsurgery techniques during a marathon operation. But the severity of the injuries meant that Katz could never play the flute again. The Times described the high schooler as the “latest victim in a series of shoving or similar incidents.”
The case remains unsolved. But it cemented a new fear into the public consciousness beyond pick-pocketing and frequent train breakdowns: The crazed attacker.
Stats and perceptions
These attacks would cement perceptions of New York as a place of unpredictable violence — despite still representing only a sliver of total crime. The worst year on record for homicides in New York City was 1990, when 2,245 people were killed, 26 of whom were killed underground. Streetsblog identified and traced back 21 of those 26 subway homicides — the ones written about in the papers — and found that only two were tied to mental illness or erratic behavior.
That same year, a report from the Permanent Citizens Advisory Committee to the MTA found that homelessness was “imposing a stress on MTA facilities and operations that must be alleviated.”
“[P]assenger discontent has been escalating, and as consumers, they have requested their due safety and order in exchange for their fare,” the familiar-sounding report said.
What followed were the first attempts to reform the reforms. In 1993, a mentally ill man beat an elderly woman, Doll Mamie Johnson, to death in front of her church. That broke the logjam between City Hall and Albany, with state officials finally agreeing to place shelter residents who were dangerously mentally ill in state hospitals.
By the end of 1998, the citywide homicide count had been slashed to 633, only one of which took place in the subways. But that progress was overshadowed by the subway shoving death of Kendra Webdale in 1999. Her attacker, Andrew Goldstein, was a severely mentally ill man who repeatedly went off his medications and turned violent. He couldn’t get the help he needed from an overstretched bureaucracy.
Pataki then reversed previously proposed cuts and backed the so-called Kendra’s Law to gave families and doctors the ability to ask a judge to put the mentally ill in treatment. That imperfect legislation has become a central part of the state’s response: A recent audit found revealed delays in evaluating candidates for mandatory treatment and in scheduling their first appointments; the Office of Mental Health promised reforms.
“The closest we come to trying to deal with this is after something horrible happens, particularly in the subways,” said Brezenoff. “But there is no staying power and there is no one really dedicated to dealing with this. Even of the things that we know that work" — like permanent housing — "we don’t have enough of it."
There is some progress and a lot of frustration. Three decades ago, officials estimated 4,000 homeless New Yorkers lived in the subway stations, trains and tunnels and that roughly 1,000 suffered from mental illness, according to tallies included in the 1990 MTA advisory committee report.
Now the overall population is estimated at 2,000, down by half — but that there are still potentially 1,000 people with severe mental illness is evidence of the difficulty in making a permanent dent in the crisis.
The old maestro of the city bureaucracy had two thoughts about this. First, there needs to be a system to handle the several hundred people who just will not stick with treatment: “The legal system is not geared to deal with it," Brezenoff said.
And, more important, he added, “There needs to be somebody who lives this, breathes this, comes up with a specific agenda based on what we know – and reports on it every six months, a special Mayor’s Management Report." Potentially, he suggested, a czar-like position that combines and orchestrates the city and state efforts.
Yet despite a social safety net that costs more than $30 billion per year, there is no such person.
SCOUT to the rescue?
The clock strikes 8 a.m. on a brisk, sunny morning in February. A conference room full of cops, nurses and MTA officials have assembled in a non-descript conference room in Harlem near the elevated tracks to Grand Central.
They are part of an experiment launched by the MTA and City Hall. It teams up cops and nurses and sends them into the subway system together. The nurse has the authority to declare that a person is a serious risk to themselves or others and, thus, should be removed the subway and put in a hospital bed. The cops are there, officials say, to provide more structure for the interactions and to protect the nurses if things go sideways. The MTA calls its version SCOUT, which stands for Subway Co-response Outreach Teams. The program currently now has 10 teams, up from five.
City Hall has its own version, called PATH, which stands for Partnership Assistance for Transit Homelessness. The biggest difference is that MTA's SCOUT teams use MTA cops and the PATH teams use NYPD officers. Officials say there are five PATH teams.
And then there are four "co-response" teams, depending on the day, assigned to overnight shifts at end-of-line stations. The end-of-line teams in Queens use MTA cops. The teams in the other boroughs use NYPD cops.
Combined, the three programs can put as many as 17-19 co-response teams in the subways during any given 24-hour period. It's a big number on its face, but the teams cover only a fraction of the 472 stations in the system. The limited manpower forces SCOUT and PATH to focus on people in the worst shape, which further limits the teams' impact because getting a single person from a subway station through hospital intake can consume an entire shift.
The co-response teams are assigned eight stations, but rarely get to all of them because something always comes up. Covering the entire system would take approximately 60 teams — a number that would double to 120 if each station were checked both night and day.
Growing the program to 60 teams could increase the cost to $100 million annually, an analysis of staffing data shows. The MTA's teams are currently funded through the end of the year by a $20 million grant Gov. Hochul put in the state budget in 2024.
(Both the MTA and City Hall declined to provide a per-team dollar figure. Requests have been filed with both agencies for that data under the Freedom of Information Law, which are pending.)
The "co-response" approach provides structure and safety for New Yorkers in the midst of awful episodic illness. But that promise leaves out crucial and uncomfortable context: At their core, SCOUT and PATH are a manpower play — an attempt to deploy enough personnel to overwhelm the inertia in the system. It's not reform, at least not in the truest sense of the word, but simply badgering the bureaucracy into working.
Combining the cops and the nurses eliminates the need to call for a clinician and then for the clinician to call for the police. This closes two holes in the safety net. Having three or four people on-scene and witness to the behavior that led to a "nine-five-eight" declaration helps with the ambulance, which constituted the third major gap. It means that any debate with the driver is an argument of several-versus-one.
The SCOUT team's nurse and cops will ride with the patient to the hospital to allay concerns about safety during transport. The MTA and City Hall have an agreement to try and funnel the cases to pre-selected public hospitals — Bellevue is one, Kings County is another — where the emergency room and psych ward staff have been specifically briefed about the program. A special email address has been set up so the clinician on the ambulance can send word ahead. The nurse and cops then stay with the person until they make it through the emergency room triage and are taken to the psych ward for evaluation. This helps to close the remaining major gaps between the subway station platform and the hospital bed. The other elements of the badly fractured system are beyond their remit.
The gaps, the time consumed — it’s all mentioned in passing during an hour-long conference where nurses and cops talked through their recent cases in the presence of Streetsblog (which was allowed to attend after agreeing to withhold the names of suffering people and to not post identifiable pictures of them).
One nurse had trouble getting an ambulance to accept a patient. Another got stuck for hours waiting for admission to an emergency room because the hospital was slammed that day. City and MTA officials on the call take notes. The ambulance operator — this time, a private one — would be contacted, they promised. They said the emergency room, delays aside, cooperating the whole way through was evidence the program was working. The diligence displayed is heartening. But the safety net holes that are alluded to are maddening: What do you mean an ambulance driver can just not take someone?
Statistics suggest the jawboning of the bureaucracy may be working. The co-response teams have taken 1,006 people to the hospital from when the first teams were launched in October 2023 through July 2025. About half of those trips, 566, were involuntary.
It's not uncommon for people to refuse to give their names to the teams, but officials were able to identify 470 of the people they transported. Of them, 50 people — roughly 10 percent — have been taken to the hospital at least twice by a SCOUT or PATH team.
That data suggests that ensuring mentally ill New Yorkers get to the hospital has helped many of the program's patients get into treatment, but it also illustrates the Sisyphean task of keeping a small number on their meds.
On the job
It's now 9 a.m., and the team bundles out into the February morning air. The team is led by Michael — first names only for the street staff was another rule — a nurse clinician with the Department of Homeless Services. Michael is small in size and big in personality. He’s been doing this sort of work since 2021 and takes pride in it.
“I care about people, the least and the lost, the people who fall through the cracks,” he says. He’s joined by several cops and the MTA’s chief of SCOUT, Jeremy Feigelson. Feigelson is a lawyer, who returned to the public sector after decades in private practice, and a stats nerd who reads the Baseball Prospectus like an Egyptologist poring over hieroglyphs. His initial assignment was to investigate how the seriously mentally ill kept falling through the safety net underground. SCOUT was his answer, and is now his baby.
The first stop of the day is East 149th St. on the No. 6 line in The Bronx. The team sweeps inside. The cops stop each train coming into the station to quickly check to see if anyone aboard is in bad shape. They signal the conductor to hold the doors open with a wave of the flash lights; step into the cars, look around; move to another set of cars, and do the same. Michael is summoned if they see someone who appears ill. If not, the train is quickly cleared to leave. The doors close, the No. 6 train continues its run into The Bronx.
What unfolds across the rest of the day is, at the very least, active and engaged. Michael and the cops approach everyone who is laying down, nodding off, or appears to be in distress. It’s the opposite of what Streetsblog observed at Coney Island-Stillwell Avenue earlier this year. Coney Island is a key terminal in the system that is supposed to be a focus of city outreach efforts to the homeless and mentally ill. Streetsblog saw cops and city-funded outreach workers walk past dozens of people sleeping on trains, failing to clear them or offer services.
Michael has unknowingly seen first-hand the costs of the failures on the other side of the city. The week before our ride-along, he discovered a dead homeless man aboard a D train at the 205th St-Norwood station in The Bronx. The body was stiff. The clock helps tell this story, too. A study by the National Institutes of Health says that rigor mortis tends to begin about two hours after a person dies. It takes a little more than 90 minutes for a D train to make the run to 205th Street from Coney Island. The math says that the man, Gregory Harris, was dead before the train left. This was likely another welfare check that wasn’t done.
The Medical Examiner later determined Harris died from pneumonia, which is usually treatable. Harris was 61 and left the world alone. City records listed no next-of-kin. His last known address was a post office box in Mississippi.
At 149th-Pelham, Michael and the cops find a homeless man on the bench, near the fare gates. He’s buried beneath a pile of coats and there are two backpacks strung together beside him. They talk to him for a few moments and he eventually gathers his things and leaves.
The conversation goes something like this: "Can we help you?" "How are you doing?" "We want to get you a bed." "We can’t make you go anywhere, but you can’t stay here."
There is value in the interaction. Michael will come across the same people underground in the subway system. He makes note of their condition, relative cleanliness, responsiveness and level of organization. This gives him a baseline for future interactions, allowing him to determine if they are beginning to spiral. Decompensation is a basis for removal and hospitalization under the state’s law.
There’s another man lying down at the end of the damp and cold platform, and Michael knows him. He’s conscious, alert and communicative. Michael suspects drugs and offers him a palm card with a list of nearby treatment options. Being high isn't a basis for involuntary hospitalization, and Michael won’t try to have him removed from the station. A removal can take a half-hour or more if there’s any resistance and there often is from addicts. There are seven more stations that Michael needs to visit. A split-second decision is made to move on.
The team’s van bounces down 149th Street to the station at Third Avenue, which serves the No. 2 and 5 lines. Here is evidence of the money and manpower that Hochul has poured into the subways. Both city police and National Guardsmen are present. The homeless, the mentally ill and the addicts are often looking to stay away from authority figures, Michael says, so just their presence has made what would typically be a tough station quiet this morning.
The team moves down 149th Street to the station at Grand Concourse, which is one of the last stops for the No. 2, 4 and 5 trains before they dive under the Harlem River. Michael and the cops sweep the station after the token booth clerk tells them a straphanger reported being spit on by a homeless male. The station is comprised of a deep maze of passageways that don’t really go anywhere, but make it easy for folks to tuck away. The sweep only turns up a couple of younger guys who were on the large tool chests at the end of one of the corridors. Michael talks to them for a few minutes and then moves on. He still has five more stations to check.
The fourth station stop is Norwood-205th Street, the station where Michael discovered Gregory Harris's body the week before. Word’s come down the line that it’s been a busy day for the other SCOUT teams out in the system: two of them are on their way to hospitals with involuntary hospitalizations. Feigelson, the program’s boss, says the program — then with just five teams — typically did two removals per week.
Here, at the end of a line, the geography of the subway means the work carries a slower tempo. Trains can spend 10 minutes or more here before heading back toward Manhattan, compared to the seconds allocated per stop in the middle of the line. Here, at the terminal, each train that comes in is checked. The cops approach every person who doesn’t exit after the conductor makes the end-of-the-line announcement to clear the trains. This seemingly ridiculous rule serves two purposes: It helps keep people from camping out and it provides for a spot wellness check. Can the person follow directions? Is he too sick to move? Can he keep track of his things? One woman grabs her bags and walks across the platform to board the other train in the station, which will pull out in just a minute or two. She is well, or rather, well enough.
That train leaves and another pulls in. The exercise repeats. The cops find three people aboard. Two leave. The third appears to be nearly catatonic from the platform. He’s young and has stashed bags on both sides. “Where are you going, sir?” a cop asks. “Just tell us you’re OK?”
Michael is summoned. He’s more soft-spoken, so it’s not possible to hear the exchange over the din of the station. But he emerges from the train and walks over to explain. The man had responded to him, he says; and his things were comparatively well organized. He’s anti-social, but anti-social doesn’t meet the standard for involuntary hospitalization, which is posing a serious risk to himself or others. Michael and the cops could eject him, but that takes time, too. There are still three more stations to check and there are only so many hours in a shift. They have to move on.
The day’s fifth stop — and the final one Streetsblog observed — is a few stops down the D line at Kingsbridge Road, where Michael and the cops find a scene that's unusual even for New York City: A man is sitting on the platform, next to the sort of fold-out chair you’d find by a campfire; and in the chair, buried beneath sweaters, is a dog. He banters with the cops about dogs, his is a bull terrier, he says; the officer says he has a shepherd. Michael crosses the platform to check the man out. The homeless man tells Michael that he’s waiting on a downtown train to take him to a program in Midtown. The train rolls in, he grabs his things and the dog and gets aboard.
My photographer and I linger in the station just a bit longer before catching a train to go back downtown ourselves. We make it to 125th Street, where the doors open and the man with the chair and the dog who was headed to Midtown for an appointment with his program reappears. He bends down and kisses the dog. There’s a cardboard sign tucked under his arm. It says he's homeless.
