Saks, who has schizophrenia, is well-acquainted with the rougher edges of the system that processes the mentally ill in the United States.
She has devoted a large portion of her legal career to advocating against inappropriate use of restraints, which were used to hold her down for 20 hours at a time during one of her first psychotic episodes many years ago. Involuntary commitments like these caused deep psychological scars that have stuck with her for decades, Saks says.
She also believes they saved her life.
To this day, when she sees a person living in the streets with clear signs of untreated psychosis, she thinks: That could so easily have been me.
So when New York City Mayor Eric Adams announced a new initiative that authorizes police officers, with the help of mental health professionals, to take someone for a mental health assessment if the person "appears to have a mental illness and cannot support their basic human needs," her response was: "Great!" The initiative fell clearly within the "gravely disabled" standard that so many states use as well as within the conscripts of New York state law. "Plus," Saks thought, "it would help people like me with severe mental illness."
Yet hundreds of civil rights groups and homeless and mental health advocates have protested the initiative. Critics say it tramples on the civil rights of people with mental illness.
Rather than hauling in people who are homeless for assessment or treatment, says Lewis Bossing, senior attorney at the Bazelon Center for Mental Health Law, "we need to do a far better job of outreach so that we're actually engaging people and helping them figure out what might be of value to them."
Real care for those with SMI, says Bossing, involves services that "wrap around" the individual. They do need assessments, but also need street outreach teams, peer mentoring, family engagement, counseling, specialized housing, medication, and careful monitoring. And there's no doubt that the most successful treatment programs use some combination of these "wraparound" services.
"That's certainly true," says Saks, who is also on the board of the Bazelon Center. "And I wholly support their ambition and desire to put these programs in place." But by themselves, she says, these programs simply aren't enough to reach the immense number of people in need.