Joyce Patricia Brown (September 7, 1947 – November 29, 2005), also known as Billie Boggs, was a homeless woman who was forcibly hospitalized in New York City in 1987. She was the first person hospitalized under a Mayor Ed Koch administration program which expanded the city's ability to forcibly commit homeless New Yorkers to psychiatric hospitals. Between 1987 and 1988, Brown worked with the New York Civil Liberties Union to challenge her hospitalization in a case which attracted significant media attention. During the ensuing trial, her lawyers argued that her behaviors were not in line with social expectations but did not rise to the level of posing a danger to herself or others. Brown took the stand, and her clarity while testifying became part of the public conversation. The trial ended in her favor, and while the city won on appeal, she was ultimately released after a subsequent case determined that the city could not forcibly medicate her. Following her release, she made several television appearances and spoke about homelessness at Harvard Law School, but came to avoid the press. Her case sparked national conversations about how best to care for people with mental illnesses.
Background The 1975 Supreme Court decision O'Connor v. Donaldson limited involuntary psychiatric hospitalization to those who posed a danger to themselves or others. Many states passed legislation following the ruling, including New York, which passed its Mental Hygiene Law in 1978, allowing involuntary hospitalization of people with mental illness if they were considered a danger to themselves or others. The case was one part of a larger trend of deinstitutionalization in the United States, which began in the late 1950s and resulted in the release of hundreds of thousands of people from psychiatric hospitals. These changes, along with inadequate social programs, housing policies, and broader economic conditions contributed to an increase in homelessness in parts of the United States.
In New York City, Mayor Ed Koch established Project HELP (Homeless Emergency Liaison Project) in 1982 to provide food, clothing, medical, and psychiatric services to homeless people in Manhattan. Sometimes staff would bring people to psychiatric hospitals but most were not admitted because they did not fit the legal requirements. Koch was frustrated that so many of the people his staff determined needed hospitalization were not being treated due to the typical interpretation of New York law, so he began exploring ways to interpret the legal language differently. He was advised that case law could support a reinterpretation of the Mental Hygiene Law's requirement that someone be a "danger to themselves or others" to include a consideration of whether people's behaviors, including self-neglect, might pose a danger to themselves or others in the future, even if there was no immediate danger. While considering these changes, Koch met with people who would be affected by this change, including Brown, who would later become one of the first people involuntarily committed due to Koch's reinterpretation. On October 28, 1987, Koch announced a new program for removing homeless people with mental illness from the streets for reasons including self-neglect and future harm, using his new legal interpretation, allocating a 28-bed unit at Bellevue Hospital to take care of newly admissible patients. Project HELP's psychiatrists could then direct police officers to take people to a hospital, although involuntary hospitalization remained contingent upon not just Project HELP's doctors but also an emergency room psychiatrist and a psychiatrist at the inpatient facility agreeing that the patient met the criteria. The New York Civil Liberties Union (NYCLU, the New York affiliate of the American Civil Liberties Union) firmly opposed Koch's program, criticizing it as a violation of the civil rights of mentally ill and homeless people. They argued that the Koch program attempted to hide homeless people, rather than help them through housing assistance and mental health clinics. Following Koch's announcement, NYCLU volunteers distributed fliers to people living on the street detailing their rights and advising them to contact the organization if they were involuntarily committed.
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