The Subway Safety Plan

The Subway

Safety Plan

The Subway Safety Plan..................................................................................................... 3

Our Challenge.......................................................................................................................4

People ................................................................................................................................................5

Places ................................................................................................................................................11

Policies...................................................................................................................................12

Conclusion .....................................................................................................................................16

Endnotes .........................................................................................................................................17

Table of Contents

The Subway Safety Plan

THE SUBWAY SAFETY PLAN

New York City subways are the lifeblood of our city. They connect millions of working

people to our jobs, homes, and neighborhoods every day, and help visitors from all

over the globe explore the greatest city in the world. Yet for too long, our subway

system has also confronted a painful humanitarian challenge playing out right in front

of our eyes. Too many New Yorkers experience homelessness in our stations and our

trains each night.

Their challenges often begin long before that moment. Some have struggled with

unmet mental health needs or substance misuse. Some are veterans, who have

returned from service and have not received critical services. Still others have lost

a job or the roof over their head, realities that have become all too common in the

pandemic. All are our fellow New Yorkers. For too long, they have gone unseen by

every level of government. That must change. We will see every New Yorker, and we

will lead with compassion.

Tragically, we have also seen violence on our subway platforms and stations. And while

we know homelessness and violence do not equate and must not be conﬂated, we

must also acknowledge that a small minority of individuals who may be experiencing

several compounding challenges at once, including behavioral health challenges,

must be reached with immediate interventions to prevent deterioration and potential

danger. We have seen the lives of innocent New Yorkers taken, simply coming into

a station to take a train. We have seen threats and dangerous situations that make

our communities feel unsafe – whether people are going to work, returning home, or

visiting our city. We cannot allow that to continue.

We must address these concurrent, and sometimes interconnected, crises. We must

do so in coordination with the MTA, New York State, and Federal partners who all play

signiﬁcant roles in keeping our subways and communities safe. Public safety and

justice are the highest priorities of the Adams Administration, and they go hand-in-

hand. We can and will achieve both. We will protect all New Yorkers, including those

experiencing homelessness and those with severe mental illness, and we will help

every New Yorker receive the support they need.

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OUR CHALLENGE

We face two concurrent challenges: First, thousands of our fellow New Yorkers

experience street homelessness each night, many in subway stations across our city.

Every person has their own story and challenges and deserves a unique path to help,

whether through mental health care, treatment for substance use, or support ﬁnding

a home.

Second, our subways must be safe and feel safe for every person who enters them.

As we emerge from COVID-19, the subway system is a crucial piece of our economic

recovery – transporting students to school, helping workers back to ofﬁces, and

allowing tourists to travel our city. Our city’s prosperity depends on everyone feeling

conﬁdent and secure when they enter a station.

We must immediately protect our people, including those experiencing

homelessness and those with severe mental illness, who sadly are far more likely to be

the victims of violence and crime. We must immediately help New Yorkers struggling

to take the ﬁrst step towards a better future – a journey that the City will coordinate

every step of the way, from their ﬁrst moment out of the station to ongoing care and

a permanent home. And we must examine the systemic challenges that have led

New Yorkers to end up in this position, from a mental health crisis to a shortage of

affordable housing.

Our Subway Safety Plan addresses the gaps in the system where too many have been

lost. This plan recognizes that helping a person off our streets is only the ﬁrst step

of what the City can and must deliver – and it outlines a three-part system that will

seamlessly transition New Yorkers in need of care from: 1) outreach to 2) initial housing

and mental health care to 3) permanent housing and community. We will do so by

investing in three areas:

• People: Adding response teams throughout our city to connect with

unhoused New Yorkers on our subways, meeting them where they are.

• Places: Ensuring that these unhoused New Yorkers with multiple needs in

our subway system have both short- and longer-term destinations of care,

support, and housing.

• Policies: Working with every level of government to begin the hard work of

reforming our broken mental health and housing systems.

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PEOPLE

Investing in our people is the most immediate step we can take to protect New

Yorkers in our stations, and connect those experiencing homelessness to the care

they need. With new Joint Response Teams ready to provide personalized support,

new outreach teams to support mental health and wellbeing, and new collaboration

across City agencies, we will help our fellow New Yorkers begin their journey to

permanent housing and stable care, coordinated by the City every step of the way.

Immediate Action on Our Subways

We will state without reservation that our subways exist to move paying customers

from one point to another. They are not meant to house individuals or provide

recreational space, and we will make it clear our stations and trains are not intended

– or available – as an alternative. We will begin enforcing the subway system’s rules

of conduct, and do so transparently and fairly. We will also recognize: Enforcement

without short- and long-term support, from mental health care to housing, will not

solve this challenge.

One City Working Together

The City will deploy up to 30 inter-agency collaborative teams that bring together

the Department of Homeless Services (DHS), the Department of Health and Mental

Hygiene (DOHMH), the New York City Police Department (NYPD), and community-

based providers in high-need locations across our city. To expand the number of

clinicians who can refer individuals for assessment in hospitals, staff across agencies

will be trained in 9.58 assessments – enabling better engagement and evaluation

with individuals experiencing homelessness, their needs and connecting them to

advanced services better suited to triage and provide for their care.

Coordination between these intra-City collaborative efforts and teams provided

by New York State has already begun, and they will work as one to ensure we are

being efﬁcient and not duplicating efforts. Each inter-agency collaboration will

complement each other with different areas of focus. Some will immediately help

those dealing with a single challenge, like reaching temporary housing or receiving

mental health care, while others will provide holistic support, reaching individuals in

the best moments to engage them.

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Homelessness

• 5 community-based homeless outreach teams and additional Transit

Hub teams. Homeless outreach teams will re-deploy at the highest-need

stations in the city, including: Penn Station, Grand Central Terminal, West

4th Street, the W. 42nd St. Corridor, the Fulton Street Corridor, and Jamaica

Center. These teams will work with NYPD ofﬁcers to canvas platforms,

stairwells, mezzanines, and entrances. Additional Transit Hub interventions

will also occur at key transit hubs throughout the city, as individuals sleeping

on trains or otherwise breaking MTA rules will be required to seek alternative

shelter. Efforts will focus on helping transport individuals in need of shelter

to safe refuge.

Mental Health

• 12 new DOHMH Neighborhood Response Unit (NRU) teams. These teams

consist of medical staff, behavioral health clinicians, and peers. They will take

a trauma-and-resilience informed multidisciplinary community approach,

responding to a range of acute and ongoing community-speciﬁc crises

and mobilizing community assets. Teams will build relationships through

peer and supportive counseling, increasing opportunities to refer and link

New Yorkers to services they need as well as engage local communities to

become mental health ambassadors to destigmatize mental health and

increase awareness of mental health services in the community.

Holistic Support

• “End of the Line” teams. In partnership with the MTA, the City will propose

reinstating a policy calling for “End of the Line” exits from all individuals

still aboard at a train’s ﬁnal stop, with modiﬁcations. The ﬁnal stops on our

subway lines are one of the best moments to engage those experiencing

homelessness, and over the past two years the State and City have found

success reaching people in that moment. During that period, our teams

have successfully engaged unsheltered New Yorkers on the subways,

helping hundreds of individuals who were riding trains come off into shelter

settings (including shelter, Safe Haven, and stabilization beds). These “End of

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the Line” teams will expand that work to service high-priority stations across

the city, working with NYPD to encourage potential clients to disembark and

allow DHS to provide support.

• Up to 12 new cross-agency teams. Teams that combine an outreach worker,

clinician, and ofﬁcer will begin to engage New Yorkers in subway cars to steer

clients off trains to platform-based clinical teams to increase engagement

and care provision, including offering shelter to those in need.

Increased NYPD

Presence & Rules of Conduct Enforcement

As announced in early January, New Yorkers will continue to see an increased

presence of NYPD officers in subway cars and on platforms, especially at high-

priority stations. More than 1,000 additional officers have already been deployed

across the system.

Each ofﬁcer deployed in our transit system will now have a clear mandate to enforce

the MTA and New York City Transit Authority (NYCTA)’s rules of conduct, and will

undergo additional training in these rules before setting foot in our stations and on

trains. These rules include the prohibition of:

• Lying down, sleeping, or outstretching in a way that takes up more than one

seat per passenger or interferes with fellow passengers

• Creating an unsanitary environment by spitting, littering, and more

• Exhibiting aggressive behavior towards other passengers

• Using the subway system for any purpose other than transportation

• Smoking or open drug use

If New Yorkers are not traveling, they should not be in the subway system. We will

enforce these rules of conduct in a fair and transparent way. Our goal is corrective

action, not removal, and we will give individuals an opportunity to remedy their

behavior before taking further action. Yet for individuals in need of care who violate

these rules, enforcement cannot and will not be the long-term solution. We must take

this moment to engage these New Yorkers and help them on a path towards housing,

care, and support, with the City seamlessly coordinating every step of the way.

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Immediate Support for New Yorkers’ Health and

Well-Being

There are nearly 300,000 New Yorkers with severe mental illness, and they are our

neighbors, friends, co-workers and loved ones. Too many are left behind by our

systems, left to cycle through bouts of homelessness, hospitalization, and even

incarceration. All levels of government must work together to create a new system to

support these New Yorkers with comprehensive mental health support – especially

through an infusion of federal funding. Yet this will not happen overnight.

New York City cannot and will not wait to help our people. The City will take

immediate steps to bring more support to these New Yorkers, with multiple agencies

expanding services to reach those experiencing homelessness or severe mental

illness. These services include:

• Deploying additional joint FDNY & H+H Behavioral Health Emergency

Assistance Response Division (“B-HEARD”) teams to 6 new precincts,

more than doubling the precincts covered to 11. These teams will expand

on the already-successful pilot of answering non-violent 911 mental health

calls with mental health professionals. This initiative is coordinated by the

Ofﬁce of Community Mental Health. They will be trained and deployed in the

next 3-6 months, in North Manhattan and the South Bronx.

• Incorporating medical services into DHS sites serving individuals

experiencing unsheltered homelessness. DHS Safe Havens and

Stabilization bed programs will offer on-site physical and behavioral health

care to immediately address clients’ needs.

• Conducting an inter-agency review of Kendra’s Law (New York State

Mental Hygiene Law § 9.60) Assisted Outpatient Treatment (AOT) efforts.

The City will examine AOT referrals, applications, care-coordination, and

re-connection to care to identify efﬁciencies and ensure clients are placed in

the best-care pathway for their needs.

• Increasing information sharing and coordination. We will drive more

coordination between H+H emergency departments, psychiatric units, and

our outreach teams around subway stations and in the streets, for more

single-interaction multi-service care delivery for those in need. We also

will work with State partners, including the New York State Department of

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Corrections and Community Supervision (DOCCS), to improve transitions of

care and re-entry services to improve efﬁciencies and decrease gaps in care.

Immediately Improved Coordination Across

Government

Weekly “Enhanced Outreach Taskforce” (EOT) Meeting.

Building from the targeted approach of the NYPD’s revolutionary COMPStat strategy

– which through management, statistics, and accountability has helped drive crime

down to record lows over the past two decades – we will develop a similar strategy

for homelessness, public safety, and mental health challenges. A dedicated team of

senior leaders will meet once per week to address speciﬁc challenges throughout the

city, with a collaborative and precise approach.

This team will also coordinate new efforts to drive real-time data sharing across all

City agencies, partners, and State entities. We will create benchmarks and metrics

for our work to understand progress, replicate what works, and immediately make

adjustments where needed.

The EOT will include representatives from:

• The Mayor’s Ofﬁce

• The Deputy Mayor for Health & Human Services

• The Deputy Mayor for Public Safety

• The Deputy Mayor for Operations

• NYPD

• DOHMH

• DSNY

• Parks Department

• DYCD

• NYC Heath + Hospitals

• Ofﬁce of Community Mental Health

• Department of Social Services (DSS/HRA/DHS)

• The MTA

• The Transport Workers Union (TWU)

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In addition to this weekly meeting, the City will identify other daily opportunities to

foster better collaboration between the NYPD, City Hall, and the MTA – ensuring all

teams are acting in concert, enforcing rules and conduct violations consistently, and

not duplicating efforts.

New and ongoing engagement of transit workers.

As all levels of government work together to make our subways safe, our transit

workers on the ground – including train operators, conductors, dispatchers, and

station agents – must have a critical voice in the conversation. These workers are

essential to the success of our subway system and our city, and we must prioritize

their safety as well as the safety of the riders who enter our stations.

They often see trouble, or the potential for trouble, before law enforcement – and will

alert authorities from their train operator and conductor cabs, station agent booths,

and platform posts. In coordination with the MTA and TWU Local 100, we will engage

transit workers regularly, ensure they are being utilized to their fullest potential, and

provide the equipment and resources they need.

We will also convene a Subway Safety Summit with TWU Local 100 President Tony

Utano and his staff; MTA leadership; and the NYPD Transit Bureau to identify steps we

can take with workers to improve rider and worker safety.

Immediate Public Awareness Efforts

Investing in people doesn’t only mean new teams of City workers. It means all New

Yorkers working in common cause – connecting themselves, their friends, and their

loved ones to the care they need. The City will launch additional efforts to make

every New Yorker aware of the mental health services available to them, and will lead

ongoing discussions about community-building and community-based solutions.

Connecting To Care

We urge all New Yorkers: If you are experiencing mental health challenges, or know a

friend or loved one who is exhibiting concerning behavior, reach out to NYC Well, the

City’s free 24/7 helpline, available in 200+ languages:

• Text “WELL” to 65173

• Call 1-888-NYC-Well

Within moments, you will be speaking with a trained counselor who can connect you

to the care and services you need.

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“Re-Imagining a Healthier and Safer New York City for All”

In the next month, the Adams Administration will draw on the knowledge and lived

experience of our communities by hosting: “Re-imagining a Healthier and Safer

New York City for All.” This convening kicks off a multi-year conversation focused

on bringing together public and private partners, academic experts, practitioners,

persons with lived experience, advocates and government leaders, in order to

identify gaps, strategize ways to scale proven solutions, and push innovative new

interventions that will improve access to and quality of care for thousands of New

Yorkers living with severe mental illness, and especially for those facing intersecting

vulnerabilities including homelessness, substance use disorder, and complex physical

health needs. Solving our City’s challenges will require short, medium, and long-term

solutions, and this Administration is committed to addressing all three.

PLACES

While street homelessness is caused by a convergence of multiple systemic failures,

it is exacerbated by our city’s housing crisis. A compassionate, robust, and continuous

system of service and outreach can only be successful if there is an ample supply of

housing to place people into. To ensure that anyone experiencing homelessness has a

place to go, we will:

• Create new Drop-in-Centers to provide an immediate pathway for

individuals to come indoors, and explore opportunities to site Drop-in-

Centers close to key subway stations to directly transition individuals from

trains and platforms to safe spaces.

• Deploy an additional 3 H+H Street Health Outreach & Wellness (“SHOW”)

vans for a total of 9 active citywide. These vans create a safe space to engage

individuals from the transit system above ground, and bring medical and

behavioral services to the community.

• Increase availability of 140 Safe Haven beds and nearly 350 Stabilization Beds

in 2022.

• Expand the availability of supportive housing through new development and

by streamlining the placement process, reducing the amount of paperwork

it takes to apply.

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POLICIES

Finally, we must examine and address the larger, systemic challenges at all levels

of government that have led to this situation. This starts with an examination of the

City’s laws – yet we will also urge New York State and Federal legislators to take much-

needed action, especially to create a mental health system that supports all New

Yorkers.

City of New York

The City will continue to revisit existing laws to get individuals most impacted by

mental illness – who present a danger to themselves and others –the care they need

as one tool towards reshaping our mental health system. Immediately, we will revisit

existing law so that if someone who can’t take care of themselves refuses treatment,

they can be hospitalized if that is what a doctor and judge recommend. We will

use existing law in the most targeted way possible, especially for people with a

documented history of violence.

We will also be appealing for aid from our federal and state partners for additional

funding for hospital beds, so that those who can’t take care of themselves have

someplace to go. There must be a strong and well functioning mental health system

for Kendra’s law and civil commitment laws to work effectively and best meet the

needs of all New Yorkers, which requires our federal and state partners to work with us

to expand access to mental health care, ensure care providers have pertinent patient

clinical history and to ensure that mental health providers in our city take care of all

New Yorkers including those covered by Medicaid.

New York State

We will continue to work closely with New York State partners to expand subway

outreach and improve connections to the mental health, substance use, and social

services people need, building upon the recent announcement from the Governor on

joint NYS-NYC Safe Options Support Critical Time Intervention (“SOS CTI”) teams to

implement mental health services for street homeless New Yorkers. We are excited

to welcome 12 New York State Ofﬁce of Mental Health SOS CTI teams, which will be

comprised of up to 150 staff, over the next few months to join us in this work.

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We also celebrate the Governor’s $100M investment in Behavioral Health Crisis

Stabilization Centers, three of which will be in New York City. These represent a critical

front door for people to access peer-led recovery supports and services for mental

health and substance use, during or before a moment of crisis. Finally, we praise

the State’s recent budget investment in expanding our health workforce, including

behavioral health

. We particularly celebrate the immediate cost-of-living adjustment

(COLA) increase of $500 million

, which will be a crucial investment to recruit and

retain new health and human services professionals who will care for New Yorkers

most in need. On top of this progress, we urge the State to:

• Review Kendra’s Law (Mental Hygiene Law § 9.60) to examine the following

issues:

ï Increasing access to medical records in order to determine Assisted

Outpatient Treatment (AOT) eligibility and provide continuity in

treatment, in cases.

ï Reducing the barriers for patients to remain in continuous effective care

treatment.

ï Integrating AOT orders and the most updated treatment plans into

assessments and care delivery to provide continuity of care between

AOT services and inpatient psychiatric services.

ï Addressing the concerns regarding comorbidity of those with both

serious mental illness and substance use disorders.

ï Allowing a primary clinician (psychiatric nurse practitioner or

psychologist) to stand in for a psychiatrist in court.

• Increase the resources available for psychiatric beds, as well as Medicaid

funding, to grow the number of acute psychiatric beds at Health + Hospitals

and other hospitals throughout the city.

• Partner with the City to increase clinical training opportunities, and grow

a pipeline for much-needed mental health clinicians especially in under-

served communities.

• Expand Loan Repayment programs for clinical training programs, which will

foster a diverse pipeline of mental health professionals.

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• Engage in a public-private effort, along with our City’s world-class academic

and private health systems, to preserve access to psychiatric beds, crucial

resources that save lives during mental health crises.

• Advance regulations to certify medical respite providers, as medical respite

provides a safe, short-term place for those experiencing homelessness to

recover from a medical condition or recuperate following discharge from the

hospital.

• Update State Article 28 regulations to allow providers to bill Medicaid for

service provided in shelter.

Federal Government

We not only need dramatic levels of new federal funding for mental health and

substance use disorder, we need new mechanisms of funding. Block grants provided

to states from Washington place the onus on each state to create their own mental

health system from scratch, without establishing federal standards of quality of care

of mental health, or opportunities for inter-state coordination and cooperation. We

need better federal standards and a national quality of care framework for mental

health, which will drive investment into proven, evidence-based behavioral health

programs instead of the disorganization and fracture we all currently experience. We

urge Federal agencies and lawmakers to:

• Enforce mental health parity.

Insurance companies, on average, reimburse at 80 cents on the dollar

for behavioral health versus physical health. This drains billions of dollars

of revenue from our health care systems – funds that should be going

toward hiring more psychiatrists, nurses, social workers, and licensed peer

behavioral health workers. This happens despite The Mental Health Parity

and Addiction Equity Act of 2008

, which mandated insurers to reimburse

providers equally for mental and physical health. This landmark piece of

legislation is not enforced consistently and that must change. Mental health

is health, and we must follow the laws on the books to make it so.

• Support the Behavioral Health Crisis Expansion Act (S.1902)

This legislation is a critical step towards creating a better, standardized

behavioral health crisis response system across the country. The new system

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would be supported federally, and modeled after what is already happening

in localities like New York City.

• Repeal the IMD exclusion in the Social Security Act of 1965. (S.1905)

This provision, part of the same federal legislation that established Medicare

and Medicaid in 1965, prohibits Medicare or Medicaid reimbursement for

inpatient psychiatric care in any institution with more than 16 beds. It is an

outdated and discriminatory provision that has disincentivized the growth of

psychiatric bed capacity, especially at private hospital systems, and directly

contributes to negative consequences for those with severe mental illness.

• Make it easier to create more housing and get people housed.

We fully support President Biden’s Executive Order to reduce administrative

burdens that have stood in the way of creating more affordable housing,

and the Biden Administration’s efforts to address the nation’s history of

discriminatory housing practices. We must get people housed more quickly

in New York City and across the nation.

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CONCLUSION

Even with the immediate action this Administration is taking across our ﬁve boroughs,

we will not solve a decades-long crisis overnight. Yet we will, as a city, bring people

together to solve this crisis – from State and Federal partners to every New Yorker

working in common cause. Public safety and justice go hand-in-hand. We can do

both. We will protect every person who walks down into our subways, and we will truly

see our fellow New Yorkers who are struggling and get them the help they need.

We can build a better system. We can build a system in which helping a New Yorker

off our streets, trains, or subway stations is the ﬁrst step in a new journey, from

outreach to housing to ongoing care and a true sense of community all coordinated

seamlessly by the City. We will be there for each other. We will build a better city,

together.

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ENDNOTES

1 January 5, 2022. “Governor Hochul Announces Direct Payments to Health Care

Workers as Part of $10 Billion Healthcare Plan.”

https://www.governor.ny.gov/news/governor-hochul-announces-direct-payments-

healthcare-workers-part-10-billion-healthcare-plan

2 January 6, 2022. “Strong Support for Governor Hochul’s Human Services COLA

Proposal.”

https://mhanys.org/mh-update-1-6-2022-strong-support-for-governor-hochuls-

human-services-cola-proposal-from-human-services-council-and-strong-non-

proﬁts/

3 The Mental Health Parity and Addiction Equity Act of 2008.

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-

Protections/mhpaea_factsheet

4 The Behavioral Health Crisis Services Expansion Act.

https://www.congress.gov/bill/117th-congress/senate-bill/1902/text

5 Congressional Research Service.

https://sgp.fas.org/crs/misc/IF10222.pdf