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, a population cap, a promise of community alternatives. It was applied to institution after institution across the country. The population caps were, on the whole, met. The community alternatives were, on the whole, not built at the scale promised. That asymmetry is the mechanism by which a humane reform produced the streets New Yorkers argue about now.
Where people went instead: shelters, jails, the trains
If tens of thousands of psychiatric beds close and the promised community system arrives at a fraction of its intended size, the people do not disappear. They are relocated, and the relocation is legible in other institutions’ numbers.
As of June 2025, roughly 1,600 people with serious mental illness were held in New York City jails. More than 7,000 were in the city’s shelter system. Those are not people receiving psychiatric care in a psychiatric setting; they are people whose illness is being managed, badly and expensively, by the correctional and homelessness systems because there is nowhere designed for them to be.
This is the part of the story that reaches the public, and it reaches it in the worst possible form: as an incident on a subway platform, usually involving a stranger, usually reported without any of the preceding sixty years. The policy argument that follows is always the same argument — whether to make it easier to hospitalise people against their will — and it is always conducted at maximum volume and minimum context.
What is almost never in that coverage is that the people being discussed have spent fifty years building an alternative, and that a good deal of what the city now says it wants to do came from them.
“We Are Not Alone”: the movement that started in a hospital club room
In the early 1940s, a group of patients at Rockland State Hospital, north of the city, began meeting in a room they called the club room. They were preparing each other for discharge — for the practical business of finding a room, finding work, holding on to both, and surviving the relapses they knew were coming.
They named themselves the We Are Not Alone Society.
Consider what that name is doing. These were people with serious mental illness, in a state hospital, in the 1940s, and the thing they identified as the problem to be solved was not their symptoms. It was isolation. They had worked out — from the inside, decades before the research caught up — that what would determine whether they survived outside was whether there was anywhere to go and anyone to go there with.
After they were discharged they kept meeting, on the steps of the New York Public Library, because they had nowhere else. In 1948, with help from two volunteers, Elizabeth Schermerhorn and Hetty Richard, and a donation from the National Council of Jewish Women, they bought a building on West 47th Street. It had a fountain in the garden, and they named the place after it.
Fountain House invented what is now called the clubhouse model, and the model is the opposite of a clinic in almost every respect. Nobody is a patient; everybody is a member. Membership does not expire. The work of running the place — the kitchen, the reception desk, the newsletter — is done by the members, not for them, because the point is not to be looked after but to be needed somewhere at a particular time on a particular day. Its formulation of what a person leaving a psychiatric hospital requires has been quoted for seventy years: somewhere to go, something to do, someone to be with.
The model was exported from West 47th Street to hundreds of clubhouses across the world. It is one of the most successful things New York City has ever produced, and it was designed by psychiatric patients in a hospital room.
Ken Steele, and the newspaper that counted a constituency
Ken Steele began hearing voices as a teenager. They told him to kill himself, and they did not stop for thirty-two years. He spent much of that time in and out of hospitals and on the street.
Then, at forty-seven, a few weeks after starting a new antipsychotic, they stopped. He wrote about the silence afterwards as the strangest thing that had ever happened to him.
What he did with the years he had left is the part worth knowing. In 1995 he founded a newspaper, New York City Voices — written by and for people with psychiatric diagnoses, with columns like Ask the Housing Experts, Ask the Peer Specialists and Ward Stories. And he ran a voter registration drive aimed squarely at psychiatric patients: in hospitals, in clinics, in day programmes, in shelters. Accounts of the total differ — one puts it at 35,000 in New York City alone; another at 28,000 across the state.
The reasoning was cold and correct. Mental health policy is made by elected officials. Elected officials respond to voters. A group that does not vote is a group whose conditions are a matter of charity rather than politics, and charity is not enforceable. Steele was not asking to be cared about. He was assembling a bloc.
He wrote a memoir with Claire Berman, The Day the Voices Stopped. He died of heart failure in October 2000, at fifty-two, before it was published.
The paper outlived him. It is still publishing — as City Voices, edited by Dan Frey, who was Steele’s mentee, and now a peer-run organisation as well as a publication.
A note on the old address, since anyone following a twenty-year-old citation will land on it. New York City Voices published for years at nycvoices.org. That domain lapsed, and what sits there now is not the journal: the archive has been deleted except for the handful of pages that had links pointing at them, and those have been refilled with machine-generated text on unrelated subjects. Wikipedia still cites one of them. The journal itself moved, and the link above is where it went.
The loneliness the clubhouse was built for is not confined to it
The We Are Not Alone Society identified isolation as the thing that would decide whether its members made it. That diagnosis has held up, and it has widened.
The clearest New York measurement is narrow and worth quoting exactly, because it is easy to inflate. In April 2023, researchers surveyed 519 adults with serious mental illness living in supportive housing across Manhattan, Brooklyn and the Bronx. Just over a quarter — 26.4 per cent — screened as lonely. The authors flag that figure as roughly what you would expect in the general population, which is not the result anyone predicted: people with serious mental illness are usually estimated at around twice the general rate. Supportive housing appears to be doing something. It is a small study of one population and it should not be asked to carry more than that.
The wider version is not clinical at all. It is the ordinary condition of a city where most people arrived from somewhere else and the social infrastructure that used to catch them — the union hall, the parish, the block — has thinned out.
We can add one measurement of our own, from a corpus that exists for entirely different reasons. We hold an archive of 64,197 New York City forum posts, scraped to work out what people actually ask this city for. Of those, 809 mention doing something alone; 141 are genuinely about it. Sorted by what the person is asking for:
- 43 per cent want a companion — they are explicitly asking for someone to come with them.
- 23 per cent are an on-ramp — fine going alone, hoping to meet people once there.
- 23 per cent want solitude, and 11 per cent are logistics — is this safe, is this weird, will they seat one.
The solitude category does not survive inspection. Half of it is visitors who simply were not asking for company, which leaves five people out of 141 — New Yorkers who genuinely wanted to be by themselves.
Which is to say: when someone asks how to do something alone in New York, they are almost never asking how to be alone. They are asking how to stop being. “Alone” is the constraint they are working around, not the objective.
That is a very long way from a psychiatric diagnosis, and the two should not be run together — a person in supportive housing in the Bronx and a twenty-seven-year-old who moved here in March are not the same story. But they meet at one point, and it is the point the We Are Not Alone Society made first: the determining factor is whether there is somewhere to go, and whether it is possible to walk in.
Which is where this site’s own small, unglamorous finding sits. The free things are not scarce here. On any ordinary week this city runs more free events than one person could physically attend, in every borough, most of them fine to turn up to by yourself. The recurring complaint in that archive is not that they do not exist. It is that people cannot find them, which is the small thing a daily list of what is on in New York exists to fix. That is a much smaller problem than the one this article has otherwise been about, and it is worth saying plainly that it is a smaller problem — an events calendar is not an answer to serious mental illness, and nobody should pretend otherwise.
What New York actually has now
What exists, described rather than recommended:
988 is the national crisis line, answered locally, free and confidential, by phone, text and chat, around the clock, in over 200 languages. It is also the route to the city’s mobile crisis teams.
Mobile crisis teams are groups of clinicians who go to a person rather than waiting for the person to arrive somewhere. They operate on referral, in a defined window, and are meant to visit within hours.
B-HEARD sends mental health professionals and EMTs to appropriate 911 mental health calls instead of police. It was transferred from the fire department to Health + Hospitals in late 2025 and is the programme the Department of Community Safety is built on expanding.
Crisis respite centres are short-stay, home-like settings for people in or approaching crisis who do not need a hospital — a middle option between nothing and an emergency room, and one of the peer movement’s own inventions.
Clubhouses continue, in New York and worldwide, on the model built on West 47th Street.
And supportive housing — housing with services attached — is the intervention with the least public argument around it and, on the evidence of the study above, a plausible claim to be quietly working.
The same argument, back again
The debate New York is having in 2026 is the same one it has had every decade since the hospitals began to empty: whether the answer is to make it easier to compel treatment, or to build the community system that was promised in exchange for closing the institutions and then not delivered.
What is new is not the argument. It is that the plan on the table has peers written into it — a paid role, on every team, for people who have been through it. That is the We Are Not Alone Society’s proposition, made in a hospital club room in the 1940s, arriving in a municipal budget eighty years later.
It arrives with two staffers and about a quarter of the money it was designed for. Which is, as ever, the whole problem: in this city the idea shows up decades before the funding, and the people who had the idea first are the ones asked to wait.
Sources
- Manhattan Institute: Systems Under Strain — Deinstitutionalization in New York State and City — the 90,000-bed peak, the 3,572 beds as of February 2025, and the jail and shelter counts
- NYS Office of Mental Health: Pilgrim Psychiatric Center — the hospital’s own history, including its size at peak
- NYU Libraries, Undercover Reporting: Geraldo Rivera’s Willowbrook exposé, WABC-TV 1972
- National Council on Disability: Forty years after the Willowbrook consent decree — the 1975 decree and what it required of the state
- Fountain House: our history — We Are Not Alone, the Rockland State patients’ group, and the 1948 purchase on West 47th Street
- Psychology Today: Living Voices — Ken Steele’s story
- City Voices — the paper Ken Steele founded in 1995, still publishing
- National Library of Medicine (PMC): loneliness screening prevalence — the 26.4 per cent figure
- THE CITY: the new office, its two staffers and its budget — the $260 million actual against the $1.1 billion proposed
- NYC Office of the Mayor: milestones and strategies on 911 mental health response — B-HEARD, the teams sent instead of police
- SAMHSA: 988 Suicide & Crisis Lifeline
If you or someone else is in crisis, call or text 988. It is free, confidential and answered 24 hours a day, in over 200 languages.
We’ve also written about the Independence Party of New York City, interesting facts about New York City and how long Manhattan is tip to tip.