Addressing the mental health crisis was a frequent topic in the 2025 mayoral debates in New York City, but the main focus of discussion was crisis work. This either looked like more capacity for police to force people into treatment, or the seemingly more progressive option of increasing mental health crisis workers to connect people to treatment. As a mobile crisis worker, multiple people approached me asking if I was excited that the now mayor-elect Mamdani wants to expand crisis work in his department of community safety to help connect people with evidence based treatment. My response — that I was not necessarily excited about this — was surprising to most. I said this, not because I am against crisis work, which I believe has a role to play, but rather because the focus on crisis work displaces our attention and resources onto the symptomatic rather than the essential issues.
It is politically viable to talk about mobile crisis work because it appeases the people who are afraid of “the mentally ill,” as well as the mental health advocates who want police out of mental health response. More importantly, it provides us with a fantasy that if we just had enough crisis workers out in the streets, we could catch all the people falling through the cracks and connect them to care. This fantasy misses the fact that the mental health crisis is twofold, and must be fought on both fronts. The first crisis is the well-known crisis of rising mental health challenges, but the second is the less obvious crisis of the neoliberal psychiatric establishment itself, which not only fails to address the first but exacerbates it.
Crisis 1: The Mental Health Crisis
The crisis of rapidly rising rates of mental disorder, substance abuse, and suicide is the crisis that everyone has in mind when talking about “the mental health crisis”. What we fail to say, however, is that this is the direct product of a social order that is destroying us: mind, community, and planet. At its core, the essential mechanisms of capitalism work to keep people unable to sustain themselves autonomously in order to force them to work and live under authoritarian conditions. People’s life drives, desires, imagination, and intellect are subordinated to the ends of profit accumulation or bureaucratic management, in a social order that elevates the production of things (over the care for humans) to ultimate value. To obfuscate the real reasons for our suffering and to justify the planetary work order, the economic elite modulate the affects of fear and aggression that capitalism generates, turning them into racism and sexism, and attack critical explanatory frameworks, while spreading various reductive-individualist and economic ideologies.
The cutting of all social programs alongside the marriage of financialization and new technologies in the 80s, pushed these capitalist processes of exploitation into the extreme. From childhood onward, global technological and financial automations operate directly on families and children (down to the unconscious levels), subordinating psychic and communal life to competition, endless production, and the foreclosed futures of war, surveillance, concentration camps, and meaningless work. In response, we see everywhere psychic collapse, withdrawn libido, attentive depletion, emotional overload, panic attacks, drug induced psychosis, and general life desertion. While psychopathology may still develop in the family, this family is pressurized and fragmented by integrated world capitalism, and due to the incursion of the technosphere into every facet of life, the family can no longer shield children from the chaos and collapse of what was paradoxically referred to as liberal democracy. As a crisis worker, so many of the seemingly confusing “symptoms” of the people I meet with, who generally fail to conform to DSM diagnoses or even classic psychotic/neurotic distinctions, appear to be rational responses to over-work, over-stimulation, and foreclosed futures.
There should be no conversation today about the mental health crisis that does not start from the crisis of integrated world capitalism, which some have argued recently morphed into an even worse system, better understood as techno-feudalism. By only discussing mental health as part of the department of community safety and crisis work, Mamdani, and democrats generally, miss the opportunity to connect mental illness to capitalism and mental health to democracy, egalitarianism, and autonomy. By tying the mental health crisis to inequality and authoritarianism, Mamdani could go a long way in making clear the connection, long obfuscated by the biomedical model, between mental health and social conditions, while also combatting the social psychosis of the far right induced by exploitation, symbolic negation, and unbound fear and aggression.
Crisis 2: The Neoliberal Psychiatric Establishment
The second crisis is that the psychiatric establishment supposedly dedicated to addressing the mental health crisis, instead contributes directly to its production by providing reductive theories and inadequate treatments that block access to transformation. The establishment approach argues that mental illness is a matter of individual malfunctioning. At its most extreme (the biomedical model) these disorders are seen as caused by bad genes that once triggered assume an autonomous, irreversible course. Yet this is not backed up by current research indicating that neurobiological risk toward particular manifestations of distress are significantly mediated by psychological and socio-environmental factors, and that mental disorders are extremely heterogeneous in their expression and development, and capable of complete resolution.
Instead of reflecting this, people are accepted into the psychiatric establishment where they are shaped into the mentally ill rather than shifted away from the position of illness. This should not be surprising because the mental health system was developed not by those who were in distress nor by the concerned communities in which they lived, but primarily by men in the dominant class invested in the new global work-order and faced with a problem and a potential. With the transition to the capitalist work order, the masses of newly suffering individuals posed 1) a threat to the new order in which the proto-psychiatrists held power and 2) a potential for profit.
The psychiatric establishment then was born out of the transition to capitalism with the purpose of segregating and converting heterogenous suffering bodies who could not, or refused to fit into the new work-order back into productive citizens, and to warehouse the rest in institutions where they could become a steady stream of income. This continues to solve multiple problems for the economic elite and their politicians today — it explains and hides away our system’s failures as individual failures, it controls the distressed who might otherwise collectivize around their suffering and revolt, and it creates fear in those who are working about what could happen if they stopped.
While the national mental health systems that developed for the purposes of social management were not emancipatory due to their inherent connection to the capitalist system, the more robust welfare programs and general prosperity of the post war period (premised upon exploitation of the global south) allowed for degrees of counter-establishment practice within institutional settings, and at least some continuity of care for more chronic patients. With the neoliberal turn, however, everything only became unimaginably worse.
The privatization of so much of healthcare, alongside the rise of health insurance companies and the deregulated pharmaceutical industry, led to a fragmented array of public and private services where the work is determined not only by the classic disciplinary needs of capitalist society but also by new competing interests around funding, budgets, and profit. Even from a purely disciplinary standpoint (get people back to work) the psychiatric establishment is failing, as competing profit drives take over as more important than disciplinary ends. In order for clinics to get reimbursed for the work they want to do, they have to provide services determined by private health insurance companies, organized psychiatry, and the pharmaceutical industry, all primarily motivated by profit rather than “science”. Not only are reimbursable services not determined by those doing the work, but those doing the work now spend more and more of their potential time with patients, doing administrative work to justify inadequate interventions, get reimbursed, and protect corporations from risk of being sued.
All of this arrives at the same time as neoliberalism threw the masses into debt and shifted exploitation into hyper-speed, leaving more people than ever rushing to outpatient clinics and flooding psychiatric ERs. Rather than anyone in the psychiatric establishment doing much therapeutic work, caseloads grow, sessions are shortened and spread out — a 30 minute check-in every two weeks becomes “therapy.” Psych workers are less and less taught complex theories or depth-focused work because of capitalist society’s demands to crank out ever more people-managers and because universities are dominated by the profitable interests of organized psychiatry and the pharmaceutical industry. At a time when therapy and mental health are slightly less stigmatized due to this being in the interests of the economic elite, therapy and therapists are significantly “deskilled.” Psych workers in the establishment resemble less healers today than a growing class of neo-feudal people-managers who can sustain themselves off the economy of distress, while misrecognizing themselves to be fundamentally different from their patients (precarious and on the brink of psychic collapse).
People seeking care, or forced into it, navigate a Kafkaesque institutional circuit in which there is no room for their complexity, let alone their basic needs, and many conclude there is no point. When they rationally determine they cannot be helped by the pills and skills on offer from the mis-attuned psychiatric establishment, they are deemed to be sicker, and now marked for long-term surveillance and forced psychiatric detention. When people miss three appointments in the psychiatric establishment, and they are deemed by the corporation to be a risk, an automatic mobile crisis referral is placed, triggering an unwanted team to show up at one’s apartment.
As funding becomes ever scarcer and the political need to blame and hide individuals for capitalism’s failures becomes more pressing, the mental health system is at risk of reverting back to its most anti-social functions of segregation and elimination (as it has in the past, as evidenced by psychiatric genocide). In September 2025, a Fox news host suggested live on TV to give lethal injections to the houseless mentally ill, and the state of Utah is moving forward with plans for what are onward toward concentration camps for the same population.
Addressing the Twofold Mental Health Crisis
Addressing the roots of the mental health crisis then means addressing the crisis of capitalism as it both generates mental illness (crisis 1) and overdetermines the work of the psychiatric establishment in the direction of social control and profit (crisis 2). Mamdani’s platform of affordability is a start in the direction of increasing a space for ordinary people to catch their breath, and when discussing mental health, he should connect these; but progressive politics need to go beyond this. Political platforms should include universal health care (such as the New York Health Act) and a universal basic income program to provide people a real out from being forced into the slavery of wage-labor and financial and medical debt, and therefore a chance for mental stability. Policies should also be created to incentivize worker-cooperatives over corporations, returning autonomy to the people. These directions which would combat capitalism and the mental health crisis across the city, are also ways that we take capitalism out of mental health care.
For New York City to provide good mental health care would require a combination of 1) passing the New York Health Act to create a single payer healthcare system that would effectively eliminate private insurance companies and 2) the municipalization and democratization of the psychiatric establishment and its various semi public, semi private, and non-profit organizations. Municipalization should be understood in the most radical sense of taking back city control over community clinics, clubhouses, respites, shelters, supportive housing, etc. but also purchasing (or appropriating) the land so as to free care providers from the unnecessary burdens of rent. This could also go for new social clinics, respites, and supportive housing in unused spaces which could be purchased by the city and turned over to care workers to quickly expand self-determined care. Municipalization would also lead to the consolidation of patient and worker information in one city-wide system, which would facilitate continuity of care between currently fragmented locations and decrease the need for repetitive intake rituals that hold people back from genuine encounters in times of crisis.
In order to avoid hierarchical management of the system, municipalization needs to be paired with democratization. This means establishing consensus-based, worker councils to determine the type of care provided, which would counter cross-discipline fragmentation and allow for flexibility and a diversity of approaches to flourish. If democratization is about giving people a say in the governance of their lives, then democratization needs to be extended to psychiatric patients as well, who have historically been excluded from discussions around the type of care they feel they need. A solution to this would be the creation of a city patient union, where anyone hospitalized or diagnosed at a city community mental health center would be given the option to join the patient union. They could manage a fund which they could use to invest in social projects and activities (itself therapeutic), they could connect with the labor movement for dignified labor, and they could have representatives participate on the city worker councils to play a critical role in determining mental health care.
When we think about the failures and determining forces of the psychiatric establishment, and the vast potential that could come with single-payer healthcare, municipalization and democratization, it should not be surprising that I was disheartened by the exclusive focus on crisis work in the mayoral debates. Crisis work today tends to play a simple function in a vast system of social control: hospitalize someone who is loosely considered a danger to themselves or others, or connect them with woefully inadequate “treatment,” which looks more like a personally assigned bureaucrat. Far more important than crisis work is changing the conditions generating mental health crises and creating the participatory democratic conditions for transformative approaches to mental health to emerge.
Mamdani and progressive politicians can play an important role, but what is required is also an organized democratic movement of workers and patients, promoting municipalization, participatory democracy, and a campaign of reeducation to attack the entrenched biomedical framing of psychological and social alienation and to provide useful frameworks for disalienation. While I would like to see Mamdani frame mental health not as a problem of community safety but of neoliberal failure, and to explicitly link his plans for a more affordable NYC to mental health, it is not his fault that his explicit mental health plan is limited. This is rather a reflection of how little we have come to expect and how basic our demands have become, amounting to not much more than “don’t let police kill people in crisis.” To me, this is evidence of the victory of neoliberal ideology but equally so the fault of mental health workers who have failed to organize with patients to reimagine and recreate a holistic mental healthcare system oriented around psychological and social transformation and rooted in participatory democracy. In fact, the only real mental health organizing going on today is among patients in the clubhouse movement, many of whom no longer want clinicians included in the process at all. This is entirely understandable and clinicians need to heal the relationship with patients in order to work together for psychological and social transformation.
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