Ed Koch, Billie Boggs, and Mental Illness

In the 1980s, when Ed Koch was mayor, the streets of New York were full of homeless psychotic mentally individuals who had been abandoned by the mental health system. This was before Mayor Rudy Giuliani decided to implement his "three strikes and you're out" laws to incarcerate the mentally ill for loitering, urinating, sleeping and other things the mentally were forced to do in the streets.  

Ed Koch recognized that sleeping on the streets when temperatures were below freezing was a 'danger to self'. So he had outreach workers try to get the homeless mentally ill who were about to freeze into shelters where they wouldn't. But some people who are psychotic don't understand their need for treatment.  

The first homeless psychotic mentally ill person he tried to help who didn't recognize she was ill was Billie Boggs (Joyce Brown).

She was seriously mentally ill, had been multiply psychiatrically hospitalized and her family provided housing. But her refusal to take medications to restore her sanity and resultant violence and substance abuse led to a dangerous untenable situation at home, so Ms. Boggs ended up becoming a permanent untreated inhabitant of subway grates on Second Avenue.  As a result of hallucinations and delusions and impaired thinking she intentionally covered herself with feces, urinated on money and babbled in a way that made most who walked by feel sorry for her and instantly recognize she needed help.

When temperatures went below freezing Koch's outreach workers offered her food and shelter. When she refused, the police took her to Bellevue to prevent her from freezing and help her get her treatment. Because the emergency room professionals agreed with the police, that she was danger to self or others they involuntarily committed her so she could access treatment.

Norman Siegel, then President of the  New York Civil Liberties Union (NYCLU) objected and made Billie Boggs a cause celebre. The NYCLU said Koch was violating Ms. Bogg's civil right to be psychotic, going as far as to argue that covering oneself with feces is not dangerous. The NYCLU further argued the hospital could not treat her because she was rational. On a radio show debate I had with Siegel, he cited the movie "One Flew Over The Cuckoo's Nest" as a reason she shouldn't be treated. I tried to explain that was a movie.  At the time of the court proceedings, as a result of medications she was receiving in the hospital, she became rational so the court said the hospital could not treat her over her objections. The hospital, no longer able to treat her had no choice but to release her.

While the medicines stayed in her system, she was able to lecture at Harvard. But as the medicines wore off, she quickly deteriorated and became homeless and mentally ill again and went back to living on the subway grate. I haven't been able to find what happened to her after that.

Koch did the right thing to try to help Ms. Boggs overcome her serious mental illness. Unfortunately many in New York City, opposed Koch because they thought being psychotic was an exercise of free will, rather than the inability to exercise free will. We know better now. Ed knew better then. Ed Koch was a leader. And he had a heart.

Denouement: Under the Koch administration, Bellevue Hospital started the Bellevue Outpatient Commitment Program, which was eventually extended statewide as Kendra's Law and is New York's most successful program for the seriously mentally ill