After Neely homicide, mental health workers explain what to do if someone is in crisis on the subway

Since Jordan Neely was strangled to death on the subway this week, social media has been awash with New Yorkers discussing how they would react to a person who appears to be in a medical or mental health crisis. Gothamist spoke to mental health workers and advocates about how they would respond in this type of situation – and what members of the public can do to keep situations from ending in tragedy.

Their responses highlighted some of the challenges these scenarios present and the limitations of New York City resources. And while there was no consensus on the right approach to take, they all urged compassion.

“I was always taught to treat it as you would any emergency with a family member or a loved one or a neighbor,” said Rebecca Linn-Walton, a social worker and chief clinical officer at Services for the UnderServed, a nonprofit organization that provides behavioral health services, including to people who are homeless. “People don't have to be housed to be our neighbors.”

For many New Yorkers, encountering someone who’s agitated or appears to be in crisis on the train is an everyday occurrence. While that can be frustrating for some straphangers, many have cautioned against accepting violence against those who appear to be homeless or have a mental illness.

City officials have no clear answers for how subway riders should react. Mayor Eric Adams has so far declined to condemn the violence against Neely even after his death was ruled a homicide by the city medical examiner. Adams issued a statement Wednesday that noted “there were serious mental health issues in play.”

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At a glance

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• Sometimes people just want someone to connect with them, said Nancy Young, director of OnRamps, an outreach program at the mental health center Fountain House. She said to try asking questions like, “What do you need? How about we take a walk? Why don't we talk about what's going on with you and if there's anything I can help you with? What's your name?”
• You can always walk away or switch subway cars, said Matthew Kudish, CEO of the NYC chapter of the National Alliance for Mental Illness. “I'm a social worker by training and education, and I would not intervene if I didn't feel safe,” Kudish said.
• Calling 911 can be fraught, given that police sometimes respond with violence toward people in mental health crisis.
• But in some cases, it may be necessary to get someone rapid medical attention, said Rebecca Linn-Walton, clinical director of the nonprofit Services for the UnderServed. “Someone could appear intoxicated, but it could be because they're in really, really severe dehydration,” she said.

Asked on CNN how a commuter should respond in this type of situation, Adams said, “We cannot blanketly say what a passenger should or should not do.” The investigation into who killed Neely is ongoing, and few details have been released about what happened in the lead-up to Neely’s homicide. An attorney for Daniel Penny, a Long Island man, has said his client is the man caught on video restraining Neely with a chokehold.

Experts say it’s untrue that people with mental illness are disproportionately likely to be violent to others.

“Most people with mental health conditions are no more likely to be violent than anyone else,” and “only 3% to 5% of violent acts can be attributed to individuals living with a serious mental illness,” according to the Substance Abuse and Mental Health Services Administration. Media studies — from places like Northwestern University and Johns Hopkins — convey how the media’s overemphasis on the connection between violent acts and serious mental illness can lead to prejudice against people with those conditions.

When to engage and when to walk away

If you feel personally threatened, you should switch subway cars or walk away, said Matthew Kudish, CEO of the local chapter of the National Alliance on Mental Illness.

But he emphasized that no two people or situations are the same.

“If you've met one person living with mental illness, you've met one person, so there's not a one-size-fits-all approach to care or support or help,” Kudish said.

Commuters shouldn’t assume they know what someone’s going through if they are acting agitated or upset, said Nancy Young, the director of OnRamps at Fountain House, a social clubhouse and resource center for people with serious mental illnesses. Through the OnRamps program, Young does outreach to people with mental health issues who are not yet connected to care, including at an outpost in Times Square.

In some cases, she said, someone’s behavior might be a cry for help.

“There are occasional moments where people are upset,” she said. “Something might have been triggered where they got into an argument with somebody, or they might not be getting their needs met.”

Young said she responds by trying to have a calm conversation and make a connection. In Neely’s case, for example, she might have said, “What do you need? How about we take a walk? Why don't we talk about what's going on with you and if there's anything I can help you with? What's your name? My name is Nancy.”

Young acknowledged that may not be the easiest thing to do when someone is acting erratically on the subway. But, she said, “that person who's in this situation who might seem scary might actually just need to connect with somebody.”

Kudish pushed back on that approach for those who don’t have any special de-escalation training.

“If you feel unsafe in the subway or anywhere else, you should do the best you can to remove yourself from that situation,” Kudish said. “In this instance, I would suggest that people explore leaving the train car.”

He added that everyone has their own boundaries. “I'm a social worker by training and education, and I would not intervene if I didn't feel safe,” Kudish said.

What happens when you call 911

If someone appears to be in distress, commuters can alert the conductor or call 911 – although police officers are often ill prepared to deal with mental health crises, and some encounters have ended tragically.

Linn-Walton previously served as a behavioral health official at NYC Health + Hospitals and has participated in one of the city’s subway outreach teams. She said she’s provided people with assistance such as a shelter referral, but in case of an emergency is always aware of where the conductor is on the train.

“I've definitely reached out to the conductor,” Linn-Walton said. “I also have called 911 many times.”

Linn-Walton acknowledged that some people are scared to call 911 for someone in a mental health crisis. In recent years, police have shot some people during such incidents. This was recently the outcome for Raul de la Cruz in the Bronx after his father called 311, a non-emergency city hotline.

When I call 911, I always say someone seems like they may be intoxicated or may be in psychiatric distress, because then maybe they'll send out a team that knows how to respond to that.

Rebecca Linn-Walton, Services for the UnderServed

Linn-Walton said people could also call the 988 line designed specifically for mental health issues. But she noted that the only way that’s currently available to ensure a quick response with emergency medical workers in tow is through 911 – something some mental health advocates are trying to change.

“Someone could appear intoxicated, but it could be because they're in really, really severe dehydration,” which would warrant rapid medical attention, Linn-Walton said.

The city has special teams of social workers and EMTs that respond to some mental health calls without police, but they don’t cover the whole city and the 911 operator has discretion over whether they should be dispatched. “When I call 911, I always say someone seems like they may be intoxicated or may be in psychiatric distress, because then maybe they'll send out a team that knows how to respond to that,” Linn-Walton said.

The danger with blaming mental illness

Despite their different takes, Kudish, Young and Linn-Walton all expressed concern about the frequency with which violence is associated with mental illness in some media reports, potentially increasing people’s fears of those who appear mentally ill.

When there’s a shooting, for instance, “Very often people will say that this is not a gun problem, it's a mental health problem,” Kudish said.

Politicians across the country often link acts of violence to mental illness quickly after they take place. Looking at this trend, a 2019 study found that Americans have become increasingly likely to perceive people with mental health issues as a threat over time. The analysis compared responses to a study on perceptions of mental illness in 1996, 2006 and 2018.

Following Neely’s death, Mayor Adams has also been accused by some of fanning fear toward homeless New Yorkers who appear to have mental health issues.

But Linn-Walton said she has also witnessed moments of kindness on the train, citing one example from “deep in the pandemic.”

“I was on the train home and there was a woman sobbing and she was saying, ‘I just need help, I just need help,’” Linn-Walton said.

“And it was this beautiful moment, exactly the opposite, where the entire car said, ‘How can I help you?’”

This story has been updated to correct the condition of Raul de la Cruz, who was shot by police, but survived.