Every day in New York City, familiar scenes unfold on repeat: A man yells and gestures erratically on a subway platform. A mother calls 911 because her son hasn’t slept in days and is pacing the apartment, terrified. An unhoused woman collapses outside a bodega in summer heat. Someone shouts. Someone panics. Sirens draw near.
In the United States—and particularly in New York City, the nation’s foremost urban experiment—we have been trained to believe this is what “public safety” means.
But what actually happens next tells a different story. Police officers wait for an ambulance. Emergency rooms hold people for hours, sometimes days, because there is nowhere else for them to go. Shelters cycle people back onto the street. Jails become overnight psychiatric wards. Nothing stabilizes. Nothing sticks. Over time, crises simply multiply and intensify. And, each year, as in two instances in New York that occurred within a six-hour span earlier this month—one involving a man who was already being treated in a hospital—some number of these crises result in police firing their weapons and killing a person in distress.
While most Americans agree that this represents a collective ethical failure as a society to care for our most vulnerable members, moralizing responses have done little to produce meaningful change. Worse, they often obscure what’s truly needed. To change our long-standing reality, what’s essential is to confront that this is first of all a failure of political definition. Across every borough, New Yorkers suffer from a long tradition of misidentifying what safety is—and as a result, billions of dollars are poured into the wrong institutions, which then fail to deliver.
That is the problem Zohran Mamdani has inherited. Much of his campaign was built around addressing this conundrum by redefining danger not as the absence of enough policing but as the persistent policy failure to invest public resources in crisis prevention. This is why his proposal for a Department of Community Safety now matters for far more than simply retooling the city’s mental health crisis-response systems—its most visible task.
To be successful, and to avoid inadvertently repeating narrow policing frameworks that fixate on reaction rather than preemption, Mamdani’s Department of Community Safety must refuse temptations to fixate on crisis and “serious mental illness” alone. Instead, this agency must insist upon reframing crisis moments—and the mental illness associated with such moments—as the consequence of years of failed opportunities to ensure the care, community, and resources people need to be safe.
This entails a public education mission that faces immense challenges and is twofold, requiring intertwined redefinitions of both mental health and safety.
New York, like the rest of the country, has been taught to partition mental illness itself into two categories: “serious mental illness,” or SMI, and everything else. Management of SMI is then said to require exceptional emergency systems—built around police powers and involuntary treatment—while everyday care for anxiety, depression, trauma, addiction, grief, and isolation are pushed into the private market or left for families to manage on their own. That is, until they can no longer do so and crisis erupts, resulting in a sudden category shift, by which public systems—but only crisis-response systems—are suddenly implicated.
The embedded, decontextualizing conceptualization of SMI and mental illness in general as simply neurobiological conditions separate from social conditions is not medically defensible. It is an administratively convenient political construction, providing a scapegoat—namely, people living with psychotic experiences—for policy failures. Crisis does not emerge from nowhere, nor does it arise simply from inside one’s brain. The crises associated with SMI are typically the end point of years of untreated or unsupported distress: Someone finally breaks down in public, after earlier needs for care and community have been ignored. Reacting to this by building variations on crisis-response systems without rebuilding everyday community mental health systems that provide support to people long before a crisis looms is how American cities have manufactured permanent, perpetual emergencies. And they’re still doing it.
Based in large part on this false notion of mental illness and extreme distress, New Yorkers have been told, relentlessly, by both media and politicians, that safety comes from force, police visibility, and the number of uniforms present on the scene. It hinges on police powers to remove “dangerous” people from public space, insisted former Mayor Eric Adams and his mental health adviser Brian Stettin, as they insisted that only expanding arrest powers could save New York from the unhoused and mentally ill people they represented as a scourge on the city. This kind of story is repeated by tabloids and leading national newspapers alike, by mayor after mayor, by police commissioners, and by technocratic liberals at all levels of U.S. government. Their insistent claim: While the nation’s reliance on policing as a substitute for care may be regrettable, it is nonetheless unavoidable—and we always need more of it.
The everyday reality of the city at a block-by-block level tells another story. When a mental health crisis unfolds in Harlem or the South Bronx, police are rarely the first or even the primary actors keeping anyone alive. EMTs, nurses, social workers, shelter staff, outreach workers, family members, and strangers on the street do the work of holding things together. Police mostly manage the edges: controlling space, documenting events—and sometimes dangerously escalating situations they were never trained to resolve.
In practice, New York already relies on everyday care to produce safety. Its politicians and police leaders have just refused to admit it—or to fund it as such. Instead, the city treats the care as an afterthought and the crisis as the main event. It spends lavishly on the institutions that are last to arrive, while starving the ones that might have prevented the emergency altogether.
The political fantasy behind this distinctively American vision of public safety is that force can substitute for social stability. That if police budgets are large enough and sentences long enough, the city will feel secure.
New York, like cities across the country, has tested this hypothesis for decades. The result is a city that, while it may be safer by narrow crime metrics that are at their lowest point in decades, has grown ever more anxious, more unequal, and more brittle in everyday life. Although most American cities are, in a sense, safer than at any point in the last 50 years, their residents repeatedly insist that they feel more unsafe than ever.
While many commentators have pointed out the disconnect between this subjective feeling and objective crime statistics, the fact is that this widespread intuition of danger is not in fact wrong: We are, collectively, deeply unsafe. Mental illness, crises, and suicides have dramatically increased, not decreased. Emergency rooms are overwhelmed. Jails function as psychiatric warehouses. Homelessness, or the threat of it, haunts huge swaths of the public as an unaffordable housing market controlled by megawealthy investors and corporate landlords squeezes people dry. More and more people are living paycheck to paycheck, struggling to afford adequate food and health care. Public space feels tense not because it is lawless but because so many people are barely holding on.
What gets labeled as “disorder,” “danger,” and “SMI” is the visible residue of public abandonment: It’s the housing that never materialized, the benefits that never arrived, the care that was never available until “crisis” erupted in public and other people’s discomfort compelled a response. The shouting man on the train platform is not evidence that the city is too permissive and inadequately policed, as Eric Adams repeatedly preached. He is instead evidence that everything meant to help him earlier quietly failed offstage.
Up to this point, New York’s leadership has tried to solve this problem by adding programs rather than building systems. Pilot projects. Demonstrations. Grants with expiration dates. Crisis teams without places to send people afterward. These efforts often work—briefly. And then they collapse under their own fragility and inability to meet public expectations without adequate public investment.
The city’s non-police crisis-response programs have shown that sending care teams instead of armed officers reduces arrests and violence. Violence interrupters have saved lives. Outreach workers and supportive housing have stabilized people living with psychotic experiences in the subway. None of this is speculative. What’s missing is not the evidence that these policies work. It’s the infrastructure to make it so.
New York treats care like charity and policing like plumbing. One runs on unstable funding and moral appeals; the other is permanent, protected, and politically untouchable. No one asks whether the NYPD should survive the next budget cycle. Essential care programs are asked that question every year.
The most radical thing about Mamdani’s Department of Community Safety is not that it proposes to deemphasize policing. It’s that it refuses to treat care as optional.
The success of Mamdani’s safety plan ultimately hinges on whether he manages to build a large, publicly funded care workforce whose job is to stabilize daily life before crisis takes over. Not clinicians alone, and not volunteers—but paid, trained community care workers embedded in neighborhoods, schools, libraries, housing, and transit hubs.
The heart of such an approach is people whose work is not emergency extraction but continuity: helping someone keep benefits, mediating conflicts, eldercare, parenting coaching, accompanying people through grief, addiction, reentry, postpartum distress, psychotic experiences, loneliness. This kind of care hinges on lay caregivers trained in task-sharing roles in coordination with professionals to provide psychotherapeutic support for anxiety, depression, and grief and to provide everyday companionship to those living through extreme states.
As all honest psychiatrists know, even if proponents of involuntary psychiatric treatment (like those who ran Adams’s mental health policy) refuse to acknowledge it, psychotic experiences are very often unresponsive to psychiatric medications, which impose such substantial side effects that the majority—even under controlled, supervised study conditions—stop taking them within 18 months. What people living with such experiences need is rarely more medication, coercion, or hospitalization. They need intensive social care to help them maintain housing and interpersonal connection in their communities. This is the unglamorous labor of community caregivers that no police department can perform and for which no psychiatric unit, clinic, or medication can substitute.
Crucially, this workforce refuses the simple distinction between “serious mental illness” and “mild-to-moderate” or “common” mental illness. People do not live their lives in diagnostic categories or symptom-severity ratings. Psychosis, suicidality, addiction, despair, panic, and withdrawal from shared reality rarely arrive fully formed; they emerge along a continuum shaped by housing, work, relationships, loss, stress, and time. As studies around the world have shown, the same kind of community care that helps someone through depression or grief is often what prevents a psychotic delusion or hallucination from developing into overwhelming anxiety and a violent police encounter.
If the Department of Community Safety becomes just another crisis-response unit, another hotline, or another pilot, then it will become yet another revolving door for unending crises. Eventually, this flawed creation will be swallowed by the same dynamics that defeated earlier reforms. Crisis will remain hypervisible while everyday care will remain invisible. Police will retain their role as default responders. And opponents will declare the experiment a failure.
Without a credible alternative to police at the moment of crisis and bold investment in a public care infrastructure behind it to prevent crisis and durably stabilize people after it occurs, no reform will ultimately survive the crushing inertia of the status quo.
The danger facing Mamdani is not backlash from the right—that is inevitable. It is the risk of aiming too low.
This is not just a debate about safety. It is a debate about what kind of city New York is becoming. Care is how people learn whether and how they belong. When help arrives only after crisis has already boiled over, and when it then arrives defensive or armed, people learn to expect abandonment. When the most consistent presence of the state for people who are suffering is either police or psychiatric coercion, people learn to fear public institutions rather than trust them.
That is the soil in which authoritarian politics grows and neoliberal disinvestment from public systems intensifies. But a city that invests in care as infrastructure teaches a different lesson: that help is not a privilege, that crisis is not a crime, and that safety is something produced together rather than enforced from above. By investing in public systems with which to support neighbors in caring for one another, New York would be investing in caring for democracy itself, or what my colleague Gary Belkin has called “democracy therapy.”
As NYPD’s $11 billion budget makes clear, New York has the resources to do this. It has clear evidence that it’s effective. It can build the workforce. What it has lacked is the political spine to identify public care systems for what they are—the city’s real safety system—and to allocate public resources accordingly, not just to crisis response but to the full spectrum of neighborhood-based care across the lifespan that’s required for community safety to become a reality.
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