Stephen Eide joins Brian Anderson to discuss “Marijuana and the Mentally Ill” and other issues.
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Audio Transcript
Brian Anderson: Welcome back to the 10 Blocks podcast. This is Brian Anderson, the editor of City Journal. Joining me on the show today is Stephen Eide, he’s been on the show before. He is a senior fellow at the Manhattan Institute and a valued, contributing editor of City Journal. He writes extensively about social policy, especially in the areas of homelessness and mental illness. Today we’re going to focus on some of his recent writing, looking at mental health illness issues, including a terrific feature he wrote for our spring issue, “Marijuana and the Mentally Ill.”
Steve, thanks as always for joining us on 10 Blocks. In this essay, you’ve observed that the U.S. is conducting an ongoing pot legalization experiment. This is a topic City Journal has covered for many years, including work by Steve Malanga, Charles Lehman, yourself, and others. Steve recently wrote a big essay, Steve Malanga, for us, noting that legal pot’s promises striking a blow for social justice by ending the war on drugs, igniting economic growth, being medically harmless. All these have proven false, so the claim about medical harmlessness, particularly regarding mental health seems especially dubious. So I wonder, what do we know to start off about pot’s effects on mental health, both its role in causing or contributing to mental illness and the real subject of your essay, which is its impact on those who are already struggling with mental health challenges?
Stephen Eide: Yeah, well, the question of whether marijuana causes mental illness is an old question. I mean, it goes back over a century that people have been debating that question. It’s an important question and people should continue to debate it, in part because there’s a fairly substantial body of evidence that’s been around for a while that strongly suggests that marijuana use may cause the development of serious mental illness, but also if you’re someone who just doesn’t want to believe that or disbelieves particular studies, we have to revisit that question every so often because habits of marijuana use change and the potency of the drug changes, so we always have to be assessing that question of the causality. But in my particular essay, I’m looking not only at that, but also just what do we think about the situation of people who are already mentally ill and using a lot? That is, they have a serious mental illness, such as schizophrenia and bipolar disorder, or bipolar disorder. Maybe they got it from using pot, maybe they got it some other way, but they have that diagnosis and they are now using marijuana a lot, and this is something that’s a problem that characterizes hundreds of thousands of Americans with serious mental illness have a clinically significant marijuana use disorder. It’s a big problem that I don’t think we pay enough attention to, and I’m trying to raise awareness of it with my article.
Brian Anderson: We’ve seen a number of memoirs about mental illness in recent years where pot does play a prominent role. New Yorkers probably recall the case of Jordan Neely, who was a mentally ill young man and regular pot user who died on the subway in 2023 after menacing passengers, famously. I wonder how is the effects of pot or how are the effects of manifesting themselves as a public problem on the streets of New York and other cities? How is this manifesting itself?
Stephen Eide: Yeah, I think the way to think about that is when you’re talking about legalization, you’re also talking about normalization. I mean, all of us are struck by just how flagrant the use is in places like Midtown Manhattan, like people in the middle of the day, delivery drivers, whatever, and so people are complaining about that for a number of reasons, and I think that the flagrancy of that conduct has contributed to why some states are not actually legalizing, but in places like New York, legalization has deep ruth and so does normalization, therefore, and then is important consequences for what we call the community mental health system. There’s this old debate about how you help seriously mentally ill individuals. We used to have an asylum-based approach. City Journal has weighed in on how that rollback of that approach went too far. We need to think about restoring the asylum, but in practice we are going to have a community-based mental health system, and that’s life.
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We don’t think enough about the trade-offs involved in that. That means that people who have serious mental illness are expected to receive their mental health services somehow through a community-based program, but they’re also exposed to community risks, and there have always been lots of community risks and sending the message that marijuana use is just a normal thing that working, everyday adults do to someone who you’re desperately trying to stabilize is yet another risk for the mentally ill and yet another burden that we are placing on the mental health system, which had a difficult enough job already
Brian Anderson: Given some of these tragic incidents in recent years, how should policymakers really be thinking about this issue? What steps would you consider useful in addressing what seems to be a growing problem?
Stephen Eide: Well, it’s very hard in the kind of normalization context, to kind of carve out these little interventions that prohibits pot use amongst seriously mentally ill individuals while at the same time you’re telling them We’re trying to keep you stable. We’re trying to keep you connected with friends and family. Maybe we’re trying to help you work somehow. Maybe we’re trying to help you with your housing. We want you to live a normal American adult life, but oh, there’s certain things that normal American adults do that you can’t do. By the way, how you kind of send that message will have to require some sorts of policy interventions, and we have forms of kind of restrictions that we place in the behavior of seriously mentally ill individual through the legal system, through court programs. We all already wanted to do that to help seriously mentally ill people, independent of the marijuana question, but increasingly, we’ll have to start thinking very specifically about marijuana use and exposure to marijuana as we develop these systems of just kind of structure to keep people stable and make sure as much as possible they’re connected to effective treatment.
Brian Anderson: You’ve been writing about mental-health-related issues for some time now. Recently you did a piece discussing changes to New York’s involuntary commitment laws that Governor Kathy Hochul championed in the budget process successfully. You argue in this piece that New York’s mayor Eric Adams deserves much of the credit for this shift in the laws. I wonder if you could walk us through these legal amendments and their implications for people with serious mental illness and what exactly Adams contributed to the process.
Stephen Eide: There was this attitude a long time ago that, okay, there is a mental hospital. There’s a seriously mentally ill individual. We think he would benefit from going to that place. He doesn’t want to go, but he’s going to go, because we think he’ll benefit from it. He needs treatment and that’s going to happen. We decided that that sort of need for treatment standard was not something that we wanted to do anymore. As a result, a series of changes related to the deinstitutionalization movement around about the 1970s, so we had to come up with another standard under what standard, what criterion do you use to say, even though you don’t want to go to a psychiatric hospital, you got to go? The standard criterion that’s used is dangerousness, dangerousness to self or others. That’s what street-line bureaucrats, street-level bureaucrats, police use to rely on, but there was just this sense that Mayor Adams has that led to a very reactive approach.
Essentially, you’re waiting until somebody does something dangerous or manifests very, very violent behavior. Then you intervene. We got to start intervening earlier, and so that’s then brought up the discussion about something called a “basic living needs” standard, which exists in other cities, like if somebody is deteriorated psychiatrically to the point where they’re just not even taking care of themselves, and you walk past these people on the subway all the time, look, they’re not in a good way. They’re obviously getting worse. We have to have a way to intervene already. Now, arguably, that’s already dangerous behavior, and in fact, there was an argument that New York already had that power, but it was really important to put that “basic living needs” standard directly into state law to clarify that that is the standard and also especially to send a message to cops that we need to start intervening earlier and you don’t have to wait until violence strikes to start to begin the psychiatric intervention process.
Brian Anderson: You’ve noted that involuntary commitment laws and something like psychiatric bed availability, which is another big issue, are primarily state and federal responsibilities. The municipal level, at the city level, mayors oversee police departments and they’re often on the front lines dealing with the mentally ill homeless population These days. Officers I think need clear guidance from leadership. What messages should the next mayor send to the NYPD and its brass about handling seriously mentally ill residents who might be acting in a self-destructive way or in a way that’s potentially going to be harmful to the public?
Stephen Eide: Yeah, we have to rely on the cops to kickstart the treatment process. If the cops are just not involved in mental health, which is something, a position that some progresses favor, then you’re just going to have a lot of abandonment in the streets and subways of New York City, so cops need to be involved and whoever the mayor is, it could be Mayor Adams or it could be somebody else, need to make sure they continue the work of the Mayor Adams administration, and that means continue the messaging. We want you to intervene. Don’t wait for violence. If someone is deteriorating, begin the evaluation process. Psychiatrists, medical professionals will still be the ones who have the say about whether or not somebody is involuntarily committed, but we want cops to get this message that we want you to intervene earlier than you necessarily would’ve been disposed to, and that conflicts a little bit with the message that a lot of cops were getting during the 2010s about how the most important thing to understand is when you’re dealing with mentally disordered people is don’t escalate the situation or be very patient or sit with them. Let them calm down. Stay on the call as long as possible, as long as possible to avoid tragic outcomes, but I think that conflicts a little with the more important messages. Let’s start intervening earlier. Let’s stop abandoning people so much.
Brian Anderson: I mentioned psychiatric bed availability. That is a significant problem. We just don’t have enough beds to take care of a large number of mentally ill people.
Stephen Eide: The bed count just goes down and down and down. Sometimes these are beds in state hospitals, there was also a period during which private hospital systems were providing beds. Now they seem more reluctant to provide beds, and so this is just something that government is really going to have to own both on the funding side and also the provider side. A strong answer to that psychiatric bed shortage problem is going to have to involve the federal and the state government, and you need to go back and forth between the legal and administrative and financial dimensions of it. It will cost more money, and that’s a very awkward argument to make because it probably means Medicaid dollars and a lot of congressional Republicans want to cut Medicaid at the moment, but it also means kind of pressure on the legal and administrative side of things, saying, we want to move people into beds, like start figuring out how to build these systems better and then as much as possible work on the funding end, to the extent such bipartisan agreement is possible in modern America.
Brian Anderson: You do wind up paying for this one way or the other because so many mentally ill people left without treatment wind up in the jails where they’re a public expense, so you either pay for it directly or indirectly, right?
Stephen Eide: Yes. Jails or city-funded homeless shelter or city-funded transit systems, big costs there. Public libraries, we could have a long discussion about the mental health bill imposed on public libraries. Yeah, and they’re not getting treatment in those systems, crucially, or not the proper kind of treatment that they would be getting from a system under the mental health authority, which is what a psychiatric hospital is. They’re inside the mental health system, not in some other system, and it’s just a very frustrating situation that my mentor, the late DJ Jaffe used to always say, why is it that the mental health system itself seems to be caring for the kind of milder cases where it’s these other systems, jails and homeless services, who are the ones entrusted with care for the most serious cases? We need to fix that.
Brian Anderson: I just want to return in conclusion to the cultural question of the normalization of pot, its intersection with these very significant problems of public order. One of the effects of legalization has been the proliferation of these pot dispensaries, many of them operating in what you’d have to call legal gray zones, particularly in New York City. I wonder if you could say a little bit more about how that kind of accessibility has an impact on vulnerable populations, not only those with preexisting mental health conditions, but also adolescents. What can we do from a regulatory standpoint to curb that problem?
Stephen Eide: Yeah. There’s this Rawlsian understanding that we need to be evaluating these government, these policies in terms of their impact on the most disadvantaged among us, and I see a lot of harm being inflicted on very vulnerable populations with these legalization policies. I mean, the legalization community was always open to the idea that there should be restrictions on teens. Many of them said that, yeah, people who are definitely mentally ill should not be using. We’ve taken measures to try to prevent access to alcohol to those types of populations, traditionally speaking, but on the other hand, you’re getting a lot of messaging about why it is normal. If there’s anything regarding marketing involving cannabis products like cannabis tourism or whatever, that’s normalization. It’s normal thing to do, and so how you essentially create two different messages if that’s what we want to do in this new order. Inevitably the signals are going to get crossed. I guess you continue to try to crack down on things. You try as much as possible to run this legal franchise system with integrity, but at the same time, how do you get the message to people who need it the most that in their case, it’s really not a good idea for them to use?
Brian Anderson: Well, thanks very much, Steve. Very insightful comment. Don’t forget to check out Steve Eide’s work on the City Journal website, including the essay that we were discussing today, “Marijuana and the Mentally Ill.” It’s in our most recent issue. We’ll link to Steve’s author page in the description. You can find City Journal on X @CityJournal and on Instagram @CityJournal_mi.
If you’ve liked what you’ve heard on today’s podcast, please give us a good rating on iTunes, and as a reminder, we’ve also launched a new twice weekly podcast called the City Journal Podcast hosted by CJ‘s Charles Lehman. It’s looking at issues in the news with a rotating group of Manhattan Institute policy experts. New episodes drop every Monday and Thursday, so be sure to check it out on YouTube and subscribe. Steven, I’d great to talk with you. As always,
Stephen Eide: Thanks for having me.
Photo: 24K-Production / iStock / Getty Images Plus
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