After decisive rejection by the Legislature, the head of the state Office of Mental Health on Thursday defended Gov. Kathy Hochul's budget proposal to ease the criteria for involuntary committment, which would increase New Yorkers hospitalized with a mental illness.

The Senate and Assembly did not include the proposal in each chamber's one-house spending plans released earlier this week — aligned to fight the governor's push to keep severely mentally ill patients in hospital care.

"These are things that are going to be discussed at length," Senate Majority Leader Andrea Stewart Cousins told reporters this week. "We understand that the people are rightfully concerned, and we are too, which is why we invested more in mental health. We just want to make sure we get it right and it will be a broader conversation."

Hochul proposal to expand the state's involuntary commitment statute would clarify what information clinicians should consider when deciding the likelihood a person with a mental illness would "result in serious harm," and include the person's inability to provide for their essential needs, including food, clothing, medical care, safety or shelter due to their condition.

It would also make it easier to recommit a patient whose initial court order for treatment has expired.

"Coercive treatment has a consequence, and one of those consequences is that there is a much heightened likelihood of suicide post hoc," Assembly Mental Health Committee chair Jo Anne Simon said Thursday.

Simon said more money for voluntary programs would keep people safer, and it would be difficult to have the trained workers to implement Hochul's proposal successfully.

But the governor and her top aides are doubling down — ready to defend expanding involuntary comittment during budget talks.

State Office of Mental Health Commissioner Dr. Ann Marie Sullivan said the change would impact a small number of people with a mental illness who pose a risk to themselves or others.

"Forty-three other states have this in their statute because over time, they found it to be important to have this to help this small group of individuals that you really want to make sure have the chance to live a healthy life," Sullivan exclusively told Spectrum News 1.

Lawmakers proposed more for mental health crisis response teams and a 7.8% cost of living increase for mental health and human services workers — up from the governor's slated 2.1% hike.

The Senate and Assembly also proposed $22 million to implement Daniel's law pilot programs statewide, which would require a crisis team respond to emergency calls involving a mental health issue or substance abuse.

"We also need to make sure that we are removing barriers to getting that mental health care and those mental health services, and a huge piece of that is who shows up when one of those mental health crisis calls comes in," Senate Mental Health Committee chair Samra Brouk said. 

Brouk said she knows of cases in the state where people received better mental health services after being involuntarily committed — and it shouldn't be that way.

Sullivan argued the change would not criminalize homelessness and involuntary commitment is used as a last resort. Lawmakers kept proposals in Hochul's budget to spend $10 million to open up to seven new clubhouses and four for youth to help people with serious mental health conditions, and $4 million to create a hospital-based "peer bridger" program and expand Intensive and Sustained Engagement, or INSET, teams.

"But another piece is, sometimes, to help people who, despite having offerings of all those services, seem to have difficulty accepting them and due to their mental illness, are put in a position of harm," Sullivan said.

The commissioner said the state has enough open in-patient psychiatric beds — about 1,400 — to accommodate the proposed increase, even though hundreds were cut by former Gov. Andrew Cuomo.

"Across New York state right now, we have 85% occupancy — that means they're 85% full," Sullivan said. "That's a good number for a hospital."

Simon said she agrees with the commissioner that the proposed change would impact a small group, but fears the expansion would lead to more people getting committed improperly.

"She's not wrong that it's actually a very small number of people, but it's getting to that small number of people," the assemblywoman said. "You have too much wiggle room around the edges, let's say right, of people who are going to be harmed by the fact that they're picked up and brought to a hospital, as opposed to them really needing that."

The Legislature also removed the governor's proposal to give $16.5 million to counties to invoke the statute more often and connect people with mental health issues with voluntary programs.

Assembly Speaker Carl Heastie said the lower house tries to avoid injecting policy in the yearly spending plan. The chamber proposed a $256.5 billion budget.

"I do think we want to come to some recognition that people who need help get the help they need," Heastie said. "We've always been supportive of that. We've always felt that jails (are) not the place to help people with mental health issues and I think you'll see us address that. We want people to feel safe on the subways. Subways should not become temporary living places for people with mental health issues. We also have to deal with homelessness and every person who is homeless is also not 100% connected to mental health issues, but I think we have to do something."

Heastie said he expects criminal justice issues and the involuntary commitment debate to be the most significant sticking points that could delay the budget, which is due April 1.