New York County Defender Services

Testimony of

Carly Shapiro, LMSW, MPH

Forensic Social Worker

New York County Defender Services

Before the

Committee on Mental Health

From Crisis to Care: How New York City Connects New Yorkers to Mental Health Services.

March 4, 2026

My name is Carly Shapiro and I am a Forensic Social Worker at New York County Defender

Services (NYCDS). NYCDS is an indigent defense office that every year represents tens of

thousands of New Yorkers in Manhattan’s Criminal, Family, and Supreme Courts. Thank you to

Chair Cabán for holding today’s hearing and to all of the Council Members who have sponsored

the bills on today’s agenda that seek to bring more transparency to our City’s behavioral health

system. In addition to a Masters in Social Work, I also possess a Masters in Public Health.

I. Background:

For the people we serve, timely access to mental health and substance use treatment can be the

difference between incarceration and stability in the community.

We have specialized expertise serving justice-impacted New Yorkers living with serious mental

health challenges. Many of our clients face untreated mental illness, co-occurring substance use

disorders, and complex trauma histories. Our forensic social work units are central to this work.

These licensed professionals are trained in trauma-informed care, substance use disorders,

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serious mental illness, and family systems. Working closely with our attorneys, they address the

emotional, clinical, and social needs of our clients, helping them navigate public systems, access

treatment, secure housing, and obtain alternatives to incarceration. This approach improves both

legal outcomes and long-term well-being.

Our Re-Entry Unit focuses on stabilizing individuals before release from facilities including

Rikers Island and sustaining that stability once they return home. We coordinate behavioral

health appointments, ensure medication continuity, connect clients to housing and benefits,

provide warm handoffs to community providers, and advocate during parole hearings. Nearly

half of individuals with serious mental illness return to Rikers after release. By connecting

clients to consistent, community-based behavioral health care and providing intensive re-entry

support, our unit interrupts this cycle, reduces recidivism, and promotes public safety.

Through our work, we have identified systemic barriers that prevent timely access to care. The

Single Point of Access (SPOA) system is severely backlogged and opaque, leaving people

waiting indefinitely for critical services. Emergency Transitional Housing lacks a central

application system, forcing clients and providers to navigate a confusing patchwork. Across

behavioral health services, New York City needs more investment, greater transparency, and

simplified access to ensure that people can get the care they need when they need it.

Mental health has been criminalized for decades. Problem-solving courts offer alternatives to

incarceration, but access is inconsistent. The City should call on the State to enact the Treatment

Court Expansion Act (S4547/A4869) to establish mental health courts in every county and

modernize problem-solving courts so that people with mental health challenges are diverted from

the criminal legal system and into treatment.

Connecting New Yorkers to behavioral health care requires coordinated systems, timely access,

and meaningful diversion from incarceration. NYCDS is ready to partner with the City to

improve SPOA, centralize transitional housing applications, increase investments, and expand

treatment courts. These reforms are not abstract policy changes. They are life-changing

interventions that promote stability, dignity, and public safety.

1. Navigating a Broken System: Incremental Fixes in the Face of Structural Failure

On-the-Ground Observations and Recommendations

Our social workers encounter barriers at nearly every stage of connecting justice-impacted New

Yorkers to mental health and related services, be it during referral, placement, or follow-through.

The obstacles are numerous and well-documented by others in this space. We focus here on two

specific areas—access to Single Point of Access (SPOA)-connected services, and emergency and

New York County Defender Services

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transitional housing placement—not because they are the only problems, but because they are

areas where we can identify concrete, implementable solutions. Where a clear fix exists, there is

no justification for delay.

Reforming Access to SPOA Services

SPOA, the Single Point of Access program administered by the NYC Department of Health and

Mental Hygiene, is the primary gateway to high-intensity community-based mental health

services. Referrals move from a basic wellness coordination tier, through Assertive Community

Treatment teams providing intensive 24/7 support for people with severe and persistent mental

illness, up to Intensive Mobile Treatment units serving those with the most acute mental health

needs, housing instability, or recent criminal justice involvement. This continuum, when

functioning, is exactly what our clients need.

SPOA is not functioning as intended. It is severely backlogged, and in the pretrial context, such

backlogs have immediate, measurable consequences. Whenever public defenders like our office

include SPOA-connected services as part of an alternative-to-incarceration plan for the timely

release of incarcerated clients, a judge must be satisfied that those services will materialize.

Without any ability to confirm a timeline, judges decline to release our clients who remain

detained, losing jobs, losing housing, losing the social ties that are foundational to recovery,

while waiting for services that may be days or months away. No one can tell us which. The

waitlist is not just long; it is opaque.

The City Council should work with the NYC Department of Health and Mental Hygiene to

establish a HIPAA-compliant system allowing providers to track where a referred client stands in

the queue. A secure portal where a case worker can enter a unique client identifier and retrieve

an estimated connection date would be sufficient. A dedicated liaison hotline staffed to

communicate timelines to providers would also work. Either would be a significant improvement

over the current situation, in which our social workers and attorneys are making consequential

decisions without basic information.

Establishing a Centralized Portal for Emergency Transitional Housing

MOCJ's Emergency Transitional Housing program, offering stays of six to twelve months across

all five boroughs through a nonprofit network and now operating at 850 beds, is a meaningful

resource for justice-impacted New Yorkers returning home. This began in 2020 as the pandemic

created issues of overcrowding within the facility. It is a lifeline for residents that is

transformative for people’s lives. As one person described, “It’s amazing. You feel you’re

coming home to something. You’re not just going back to the streets. You’re not going to jail

then back to, ‘I gotta do what I need to do to eat.’ I have a warm bed.”1

1 Annie Grossinger,

“‘I Know That I’m Living This Cinderella Life’

,

” Curbed (Dec. 16, 2022),

https://www.curbed.com/2022/12/photo-rikers-former-inmates-hotel-emergency-housing.html.

New York County Defender Services

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But currently, there is no centralized intake, no publicly available bed availability and vacancy

data, and no shared referral system. Every placement requires our staff to contact individual

providers from scratch who have different application processes, with no guarantee of a timely or

informative response. People fall through the cracks during the most precarious window of their

lives not because beds do not exist, but because no one can locate them in time.

This is a solvable problem. As discussed in the previous section, SPOA exists precisely because

the healthcare field recognized that fragmented intake creates dangerous delays. MOCJ’s ETH

operates in direct contradiction to that lesson. The City Council should establish a centralized,

real-time portal for ETH housing, a single interface showing current bed availability by borough

and provider, and with a single referral form with clear instructions for the application and its

submission, and with information about the application screening process. The reduction in staff

burden with a centralized referral system would be real and substantial. More importantly, it

would prevent avoidable placements from collapsing simply because our team ran out of runway.

Support and Connection Centers, administered by the NYC Department of Health and Mental

Hygiene, which can place clients in emergency housing on or before the day of a court

appearance, also have no consolidated public-facing information about how many SCC locations

exist, which locations are currently operational, how many beds in each location, or what

capacity is coming online. A lack of forethought about how practitioners actually use these

systems produces failures that may feel minor from a policy distance, but are catastrophic for our

clients. Consequently, such repeated systemic failures contribute to intense moral injury and

rapid burnout for on-the-ground case workers.

SPOA AND ETH are Not Isolated Examples of Systemic Barriers

Justice Impacted Supportive Housing (JISH) is a crucial lifeline for our clients. Not only does

JISH provide critical and timely housing, but also it offers treatment and wraparound services for

those cycling between various institutional settings. This housing program not only provides a

safe and stable landing for those emerging from incarceration, it stops the cycle of recidivism. Of

the people presently living in the JISH units currently up and running in NYC, close to 90% have

had no rearrests since JISH placement.2 Expansion of supportive housing, particularly for those

who are justice-impacted, is critical to the City’s efforts to close Rikers Island by the legally

mandated date.3

2 NYC Health Department,

“NYC Health Department Releases Updated Request for Proposals to Expand

Supportive Housing for Formerly Incarcerated and Homeless New Yorkers,

” press release, February 12,

2026, NYC.gov,

https://www.nyc.gov/site/doh/about/press/pr2026/request-for-proposals-to-expand-supportive-housing.pag

e.

3 Independent Rikers Commission, A Path Forward: The Blueprint to Close Rikers Island (March 2025),

https://static1.squarespace.com/static/5b6de4731aef1de914f43628/t/6802a228b5619e3f5bafd0cf/174500

3055967/Independent+Rikers+Commission+Blueprint+to+Close+Rikers+Island+March+2025.pdf.

New York County Defender Services

100 William St, 20th Floor, New York, New York 10038 | t: 212.803.1500 | f: 212.571.6035 | nycds.org5

In 2019, as part of its plan to close Rikers, the City increased its commitment of JISH to 500

units, and the City has substantially increased funding and streamlined access in recent years.4

Unfortunately, most of these units have failed to materialize, and the city currently operates only

120 open JISH beds.5 Just last month, the City released a request for proposals (RFP) for 190

JISH units. However, there’s no clarity on when 190 more units will become available, and when

the City hopes to catch up to the City’s 500-unit commitment.6

The Structural Argument

We offer these recommendations with a precise understanding of what they are: interim measures

that would make a broken system somewhat more navigable. They would not fix it.

Decades of disinvestment have produced underfunded, siloed systems in which people are

routinely lost in the cracks and repeatedly returned to the criminal legal system.

Deinstitutionalization came with a promise of robust community-based care. That promise was

not kept, and the resulting debt - in unmet need, in incarceration, in human cost - continues to

compound.

What we ultimately need is sustained investment in emergency and transitional housing, and

other housing, expanded ACT and FACT teams, and respite centers such as SCCs that provide

barrier-free and immediate access to genuine alternatives to emergency rooms and jails. These

interventions work. The evidence is not in dispute. What is lacking is funding and political will

for a real investment in the people and communities in great need of timely access to quality

resources and services.

If this Council is serious about public safety, it must reckon with where the money is currently

going. The cost of incarceration at Rikers Island is well documented. The cost of the alternatives,

proven, evidence-based, community-rooted, is substantially lower and substantially more

effective. The question before this Council is not whether New York City can afford to build

these systems. It is whether it can afford not to.

4 Jeanmarie Evelly,

“Funding Boost Could Fulfill City’s Pledge to Expand Housing for New Yorkers Who

Cycle Between Shelter and Jail,

” City Limits, August 14, 2025,

https://citylimits.org/funding-boost-could-fulfill-citys-pledge-to-expand-housing-for-new-yorkers-who-cycle-

between-shelter-and-jail/.

5 NYC Health Department,

“NYC Health Department Releases Updated Request for Proposals to Expand

Supportive Housing for Formerly Incarcerated and Homeless New Yorkers,

” press release, February 12,

2026, NYC.gov,

https://www.nyc.gov/site/doh/about/press/pr2026/request-for-proposals-to-expand-supportive-housing.pag

e.

6 Id.

New York County Defender Services

100 William St, 20th Floor, New York, New York 10038 | t: 212.803.1500 | f: 212.571.6035 | nycds.org6

II. Proposed Legislation:

A. Int 0722-2026 - a bill that would require quarterly reporting on 911 calls

flagged as mental health emergencies.

NYCDS supports this legislation. Int. No. 722 expands transparency and accountability for

B-HEARD, the City's behavioral health emergency response program.

B-HEARD deploys teams of first responders and mental health professionals to respond to 911

calls in covered areas, operating sixteen hours a day across an expanded pilot that now covers

roughly forty percent of police precincts. This legislation would require quarterly reporting on

key program metrics, including whether a B-HEARD team was dispatched and able to respond,

response times, and critically, whether the individual experiencing the mental health emergency

was left at the scene, subjected to involuntary removal, experienced a use of force incident, was

issued a summons, or was arrested.

That last category of data is particularly significant. People with serious mental illness are nearly

ten times more likely to experience use of force from police than the general population, a

disparity rooted in how officers can misinterpret the symptoms of psychiatric crisis as

threatening behavior.

7 What is less understood is how Kendra's Law is being operationalized in

practice following its expansion in the FY2026 state budget, which gave police greater authority

to involuntarily commit individuals deemed a threat to themselves or others.

This legislation also appears directly responsive to gaps identified in a May 2025 Comptroller's

audit, which found that 13,042 people eligible for B-HEARD, representing 35% of eligible calls,

did not receive program services. An additional 14,200 eligible calls came in outside the

program's hours of operation.8 The audit emphasized that due to a gap in data collection by the

Mayor's Office, the reasons behind these failures remain unknown.

Int. No. 722 addresses this problem directly by requiring reporting on why eligible calls do not

result in a B-HEARD response and whether calls resulted in a warm handoff to a treatment

provider. A January 2025 Independent Budget Office report also found that average B-HEARD

response times have more than doubled, from 12 minutes to over 26 minutes, a trend that

7 National Alliance on Mental Illness (NAMI),

“Police Use of Force,

” Stopping Harmful Practices – Policy

Priorities, accessed March 4, 2026,

https://www.nami.org/Advocacy/Policy-Priorities/Stopping-Harmful-Practices/Police-Use-of-Force/

8 Office of the New York City Comptroller, Audit of the Behavioral Health Emergency Assistance

Response Division’s Effectiveness in Responding to Individuals with Mental Health Crises and Meeting Its

Goals, Audit Report MG24-060A, May 23, 2025,

https://comptroller.nyc.gov/reports/audit-of-the-behavioral-health-emergency-assistance-response-division

s-effectiveness-in-responding-to-individuals-with-mental-health-crises-and-meeting-its-goals/

New York County Defender Services

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warrants close monitoring and is consistent with capacity constraints seen in comparable models

in other jurisdictions.9

We want to be clear about how this data should be used. The proof of concept for B-HEARD is

well established. The gaps in its service provision are not inherent to the model; they are the

direct result of understaffing, insufficient sites, and limited hours of operation. Transparency is

necessary and overdue, but data collection should serve as a catalyst for full-scale

implementation, not a precondition that delays it further. We have witnessed too many fatalities

that result from deploying law enforcement to respond to psychiatric crises for which officers are

not trained or equipped. This legislation should mark a step toward expanding B-HEARD to

meet the full scope of need, not a pause while we gather the evidence we already have

B. T2023-3879 - a bill that would create a task force to study the current 988

system and make recommendations for its improvement, and would require

the City to create a public education campaign to promote 988.

NYCDS supports this legislation. 988 represents one of the most important shifts in how this

country responds to mental health crises, redirecting people away from law enforcement and

toward trained behavioral health professionals. But implementation of 988 has yet to reach its

laudable promise. This bill takes meaningful steps to close that gap.

Since its national launch in 2022, 988 has faced significant structural obstacles. The most

immediate is chronic understaffing, a problem that is not unique to New York but reflects a

nationwide crisis in behavioral health workforce development and retention. When calls go

unanswered or wait times are too long, people in crisis default back to 911, risking exactly the

kind of law enforcement interaction that 988 was designed to prevent. Fortunately, New York

does meet the nearly 90% target response rate10 and this is promising.

The task force established by this bill has the potential to accelerate meaningful reform by

drawing on innovations already proven in other states. Some states have created 988 advisory

boards with continuous improvement mandates. Others have developed non-law enforcement

transportation options to bring callers to treatment without police involvement, and dedicated

lines staffed by specialists serving specific populations, such as Indigenous populations11

. New

9 New York City Independent Budget Office (IBO), From Dispatch to Doorstep: Tracking B-HEARD’s

Response to Mental Health Crises (January 2026),

https://www.ibo.nyc.gov/assets/ibo/downloads/pdf/public-safety/2026/2026-january-from-dispatch-to-door-

step.pdf.

10 New York State Office of Mental Health, The 988 Suicide and Crisis Lifeline Legislative Report for New

York State (Albany, NY: New York State Office of Mental Health, 2024),

https://omh.ny.gov/omhweb/statistics/988suicideandcrisislifelinereport.pdf

11 Inseparable, A Better Response: Improving America’s Mental Health Crisis System (June 2024),

https://www.inseparable.us/wp-content/uploads/2024/06/Inseparable-2024CrisisReport-Final.pdf.

New York County Defender Services

100 William St, 20th Floor, New York, New York 10038 | t: 212.803.1500 | f: 212.571.6035 | nycds.org8

York should not have to reinvent these models from scratch, and a well-constituted task force

with real authority to make recommendations can move this work forward efficiently.

Perhaps the most pervasive challenge 988 faces, however, is simply that most people do not

know it exists. We learn to call 911 from childhood. 988 is new, and its appropriate uses are more

nuanced. Many New Yorkers experiencing a mental health crisis, or witnessing one, reach for

911 by default, not because it is the right call, but because it is the only one they know. The

public education campaign required by this legislation addresses that gap directly, providing

communities with clear, accessible information about when to call 988, what to expect, and what

services are available. Critically, the bill requires this outreach in designated citywide languages,

which is essential to reaching the communities that are most overpoliced and least connected to

behavioral health services.

We want 988 to become the default response to mental health crises in New York City. Every call

that goes to 988 instead of 911 is an opportunity to connect someone to care rather than to the

criminal legal system. This legislation will not fix everything, but it builds the infrastructure, the

accountability, and the public awareness that a functioning 988 system requires. We urge its

passage.

III. State Legislation That Would Open Connections to Mental Health Services for

Justice-involved New Yorkers.

New York County Defender Services supports the Treatment Court Expansion Act

(S.4547/A.4869), state legislation that would establish the statutory framework necessary to

meaningfully connect individuals in the criminal legal system to mental health treatment. More

specifically, this bill would expand and modernize New York’s network of treatment courts,

reducing our reliance on prisons and jails while addressing the growing mental health crisis

across New York state.

In our daily practice, we represent thousands of individuals whose criminal legal involvement is

linked to untreated or poorly treated mental health conditions. However, access to treatment

through the courts currently depends on a patchwork of diversion programs operating without

uniform statutory authority. While every county has a “judicial drug diversion” program as

mandated by statute, these programs operate under very exclusionary eligibility criteria,

admissions procedures, and control.

In many jurisdictions, including Manhattan, admission to any of the various mental health

diversion programs is dependent on prosecutor approval. This leads to lengthy, burdensome

application requirements that exclude far too many and substantially delay entry into care.

Applicants are typically required to undergo multiple sequential screenings that take months at a

time, including submitting years of medical records to be reviewed by the DA’s office, and

New York County Defender Services

100 William St, 20th Floor, New York, New York 10038 | t: 212.803.1500 | f: 212.571.6035 | nycds.org9

personally meet with the Manhattan DA’s office for extensive interviews about their personal,

healthcare, and legal histories and needs.

These barriers and delays often prolong incarceration or leave people destabilized in the

community for months on end without the services they require. It’s not uncommon for people to

languish at Rikers for over a year during this arduous screening process without any real sense of

certainty. Importantly, applicants can be rejected by the DA or the specialty court in question at

any point of the lengthy screening process.

The absence of a clear, statewide legal framework is a barrier to treatment. Without statutory

authority, there is no consistent, reliable pathway from the courtroom to community-based care

for people with mental health challenges. TCEA addresses this structural deficiency. By

amending Criminal Procedure Law Article 216 to authorize treatment opportunities for both

substance use and mental health conditions statewide, and lifting the arbitrary admissions criteria

that currently exclude so many deserving candidates, this bill creates a uniform legal mechanism

where eligible individuals can seek diversion. It clarifies roles, streamlines the admissions

process, and places judicial oversight at the center of eligibility determinations, which reduces

the unnecessary delays cited above and promotes equitable access for individuals with a serious

mental health diagnosis.

The significance of this reform lies not only in expanding treatment courts, but in formalizing

access to care as a legally recognized pathway. A clear statutory structure will ensure that

individuals whose conduct is driven by mental health conditions are connected to appropriate

services, rather than continuing to cycle through the criminal justice system. For our clients,

TCEA creates a clear legal pathway from destabilization and incarceration to treatment and

community reintegration.

IV . Conclusion

NYCDS supports Intro 0722-2026 and T2023-3879. We ask that you improve SPOA by

creating a secure portal where people can check where they are on the waitlist and improve

accessibility to Emergency Transitional Housing by putting all applications in one centralized

repository. Ultimately the City Council needs to invest in all forms of behavioral providers from

FACT teams to IMT to address our mental health crisis, as well as deliver on its promise to

provide 500 JISH units to support the stabilization of people cycling between Rikers, shelters,

and other institutions. The City also needs to call upon the state to pass the Treatment Court

Expansion Act (S4547/A4869). Our mental health system is our legal system. We are at a critical

moment to change that.

If you have any questions about my testimony, please email policy@nycds.org.