As discussed in my forthcoming book Exiles in New York City, it is important that the part of Ward’s Island that houses MPC’s campus be recognized as an untapped resource, but not in the way that Borough President Levine recommended. Ward’s Island currently houses roughly 1,300 socially marginalized people in seven institutions: two psychiatric hospitals, two homeless shelters, two congregate housing facilities, and a residential substance-use treatment facility (until recently it also was the location of a 2,000-person shelter for international asylum seekers). Its status as a location of institutions is nothing new and in fact dates back to the 1840s (a history that I detail in my book). Yet despite the number of people who live there, Ward’s Island has no amenities of any kind and is reachable by only a single bus (the M35) that infrequently shuttles between the island and 125th St. and Lexington Ave. in East Harlem. Life for these residents is quite isolated and difficult, as discussed in my book, with one resident stating that they are “New York’s forgotten people, discarded, not treated like people.” Any effort to expand the role of Ward’s Island to address socially marginalized people must include these individuals.

Borough President Levine’s proposal correctly recognizes that homelessness among people diagnosed with serious mental illnesses is a problem that Manhattan needs to address. However, his recommendation that in-patient state hospitalization is the solution represents a common misunderstanding of the causes of the problem. As summarized in the book (and discussed extensively by others), homelessness among people diagnosed with severe mental illnesses is largely a function of their inability to afford market-rate housing within the very restricted income offered by the US Supplemental Security Income (SSI) program (roughly $1,000 per month for an individual living alone in New York State). Psychiatric symptoms do not cause homelessness, and treating them does not lead one to find housing (I know this all too well as a public-sector mental health provider). Since it is impossible to afford market-rate housing in Manhattan (or anywhere in the United States for that matter) on this restricted income, it is essential that SSI recipients be offered housing subsidies that cover the majority of market-rate rent. The only evidence-based solution for homelessness among people diagnosed with serious mental illnesses is the Housing First approach, which offers immediate access to subsidized housing along with flexible and comprehensive supports. This approach, in addition to being clearly superior for facilitating housing stability and other outcomes (and vastly preferred by service recipients) is also much less expensive than many other approaches, especially long-term hospitalization. Not that it is cheap: between housing subsidies and services, this approach would likely cost roughly $50,000 per person per year in New York City. But this is considerably less than the roughly $1,136 per day (over $400,000 per year) that it costs to house a single person at MPC.