There is a word buried in New York City’s new plan for mental health crisis response, and it is not a word city budgets usually contain. The Department of Community Safety, the centrepiece of Mayor Mamdani’s public safety platform, would put response teams in a hundred subway stations. Each team is to be built from three parts: emergency medical technicians, mental health clinicians, and peers.
A peer, in this context, is not a professional. A peer is someone who has been through psychiatric crisis themselves and is employed, on purpose and for money, because of it. The plan would add one to every B-HEARD team in the city, run them around the clock, and raise the programme’s funding by 150 per cent.
It is worth asking how that word got into a budget line, because nobody handed it over. It was argued into place over fifty years by people the rest of this debate talks about rather than to — and the argument was conducted, for a good stretch of it, from a walk-up office in Manhattan that published a newspaper.
It is also worth noting what happened to the plan. In March 2026, THE CITY reported that the new office had soft-launched with two staffers and a $260 million budget, against the $1.1 billion version its author had campaigned on. B-HEARD, the programme it is meant to expand, already fails to respond to more than a third of the calls it is eligible for, according to a comptroller’s audit; police are sent instead.
So: the idea has arrived and the money mostly has not. That is the shape of nearly everything in this story.
Contents
- The number underneath everything: 90,000 beds to 3,572
- Willowbrook, and the legal template that emptied the institutions
- Where people went instead: shelters, jails, the trains
- “We Are Not Alone”: the movement that started in a hospital club room
- Ken Steele, and the newspaper that counted a constituency
- The loneliness the clubhouse was built for is not confined to it
- What New York actually has now
- The same argument, back again
The number underneath everything: 90,000 beds to 3,572
New York State once ran the largest psychiatric hospital system on earth. At its peak it held more than 90,000 beds, including Pilgrim State on Long Island, the largest psychiatric hospital in the history of the world. It had its own farms, its own power plant, its own cemetery.
As of February 2025, the same state ran 3,572 psychiatric centre beds in total — adult, children’s and forensic combined.
That is the fact underneath every argument New York is currently having about mental illness, and it is worth sitting with before going any further. The reduction is not a rounding down. It is the near-total dismantling of a system, carried out over roughly sixty years, and it was not done by accident or in secret. It was done deliberately, for reasons that were mostly good ones, by people who believed something else would be built.
Deinstitutionalisation had three engines. The first was pharmacological: from the mid-1950s, antipsychotic medication made it possible for large numbers of people to live outside a hospital who previously could not. The second was moral, and it was the strongest of the three — the institutions were, in plain terms, places where terrible things happened to people who could not leave. The third was fiscal, and it is the one that determined the outcome. A state hospital bed is paid for by the state. Community care, after the federal reforms of the 1960s, could be paid for substantially by Washington. Emptying the hospitals moved a cost off Albany’s books.
The replacement was supposed to be a national network of community mental health centres. Some were built. Nothing like enough were, and the ones that were built were not funded to take the sickest people, who were the ones being discharged.
Willowbrook, and the legal template that emptied the institutions
The event most New Yorkers remember, if they remember one, is Willowbrook — and it is worth being precise about it, because the precision is the point.
Willowbrook State School on Staten Island was an institution for people with developmental disabilities, not a psychiatric hospital. Intellectual disability and mental illness are different things, and the century of policy that treated them as one category is a large part of what went wrong for both. But Willowbrook belongs in this story because of what it did to the law.
In 1972 a young WABC-TV reporter named Geraldo Rivera took a camera inside without permission and broadcast what he found. Willowbrook: The Last Great Disgrace showed several thousand children and adults in conditions that are still difficult to describe. It won a Peabody. Parents brought a class action, and in April 1975 Governor Hugh Carey signed a consent decree requiring the state to cut Willowbrook’s population to no more than 250 residents and to move people into community placements. The school closed for good in 1987.
The Willowbrook decree established the template: a court order