He was handcuffed and hospitalized. Now he is on track for housing.

On the coldest night of the winter, Mazou Mounkaila was sleeping under an overpass in the Bronx when paramedics arrived.

The wind chill was minus 4 degrees. Paramedics and street workers told Mr. Mounkaila to either go to a shelter or to a hospital. Mr Mounkaila, a courtly former warehouse manager from the West African nation of Niger who has been homeless for about a decade, refused to do either.

But he had no choice. The police showed up. “To my surprise,” said Mr. Mounkaila, “they captivated me.” He spent the next 104 days at Jacobi Medical Center in the Bronx, where he was treated for schizophrenia.

The mayor’s directive calls on police, paramedics and groups working with homeless New Yorkers to send people to hospitals when mental illness leaves them unable to “meet their basic needs,” even if they don’t threaten to self or hurt others.

It was met with criticism and a legal challenge. But a Bronx social service agency that has sent people to hospitals says the policy is showing encouraging results, thanks in large part to more diligent and long-term hospital treatment.

As American cities struggle to stem a rising tide of homelessness, New York is part of a broader movement to rethink extended stays in mental hospitals, half a century after mental institutions that had become brutal warehouses of humanity were emptied but were never replaced by a coherent system of care.

Alex V. Barnard, a New York University sociologist who studies psychiatric hospitalization, said Mr. Adams was one of many prominent Democrats, including leaders in California and Oregonin an attempt to “reframe coercion as a kind of compassion”.

Relatively few people in New York have been hospitalized according to “basic needs” standards, though the city declined to say how many.

But BronxWorks, the agency with the outreach contract for the Bronx city, has sent nine clients to hospitals, including Mr. Mounkaila. Most have moved into permanent homes or are on track to do so.

A woman who was hospitalized was in her late 70s and had been homeless for so long that her campsite on White Plains Road appears in Google Street View images back to 2016.

BronxWorks said city hospitals, which have been criticized for quickly firing homeless mental patients without helping them, now often hold people long enough to give them meaningful treatment and get them ready for housing.

“These are seriously mentally ill people that we’ve been chasing for years,” said BronxWorks deputy director Scott Auwarter. “Something has changed out there. It functions.”

The people sent to hospitals on Mr. Adams’ orders aren’t usually the ones many New Yorkers are most concerned about: people who are violent. But city officials say the directive is designed to get help for those who fall through the cracks time and time again, whether they pose a threat or not.

“This is really about focusing on a pretty small population of people that we know,” said Brian Stettin, the mayor’s senior adviser on severe mental illness, “because they’re trapped in the revolving door of the system.” People who threaten violence are still hospitalized or arrested when the police are on the scene.

Mr. Mounkaila was one of six hospitalized BronxWorks clients who were on a so-called Top 50 watchlist of chronically homeless people with mental illness who the city says are particularly resistant to intervention. Being on the list doesn’t mean someone is the target of involuntary hospitalization, but it means the system is watching them — at least in theory.

Last month, Mr. Adams announced the death of Jordan Neely, a man on the Top 50 list who behaved erratically when he was fatally suffocated by a subway passenger, once again emphasizing the need for forced hospitalization.

“We need to look at involuntary removal of those who cannot meet their basic needs and put themselves at risk,” he said. “It breaks my heart how Jordan lost his life.”

Some families of patients hospitalized by BronxWorks had watched helplessly as loved ones deteriorated.

“I begged for help, I asked God to help me with my brother,” said Orlando Solano, who said his 67-year-old brother, a former doctor, began living on the streets about 15 years ago, haunted by paranoid delusions. . “I even found some paramedics and told them the situation, but they told me there was nothing they could do unless my brother had a very serious crisis.”

His brother is in a nursing home where his mental and physical health has improved to such an extent that he is like “a different person,” Mr. Solano said.

While there is still a shortage of psychiatric hospital beds in New York, the state and city recently opened about 80 beds where patients can receive comprehensive care for months.

“Nothing about seven to 14 days of hospitalization changes the course of life for someone who is homeless and has schizophrenia,” said Mitchell Katz, chief of public hospitals for the city.

Outreach groups have rarely invoked the power to have clients removed because their work — a delicate dance of getting someone to accept help and move in — relies on trust. If the hospital didn’t help the patient, it didn’t seem worth breaking that trust.

“If you’re going to take someone’s rights by force and take them to the hospital against their will, you want to make sure you don’t make the situation worse,” said Mr. Auwarter.

BronxWorks sent its first person to the hospital on the order of the mayor on Christmas night when the wind chill was 12 degrees. Emergency workers at an elevated subway station approached a woman in her 60s who had refused to speak to them for five years. Her legs were covered with sores and so swollen she couldn’t put on socks, and one foot was bare. She screamed when the police arrived, but she got into the ambulance.

With Jacobi, once the treatment and medication kicked in, the woman warmed up, Olivia Cooley, BronxWorks’ outreach clinical coordinator, said, “She started saying, ‘When are you going to visit again and see me next?'” After five months in a new state-run bed at the Manhattan Psychiatric Center, the woman was admitted to permanent supportive housing this month.

Five clients removed by BronxWorks are in or moving into permanent housing. Three remain in hospitals or nursing homes. The latter is out because, said BronxWorks, a city hospital, Lincoln Medical Center, fired him the same day, without notifying BronxWorks.

Juan Rivera, BronxWorks’ outreach director, said he saw “more collaboration and more acceptance” from hospital staff who in the past sometimes failed to consider patients’ psychiatric histories at discharge.

Mr Stettin said action led by the Adams administration had “made a difference in the way we handle these matters on the ground”.

The ongoing legal challenge to the mayor’s directive argues against the police deciding who should be sent to the hospital. The lawsuit does not cover hospitalizations such as those initiated by BronxWorks.

Matt Kudish, chief executive of the National Alliance on Mental Illness of New York City, a plaintiff in the case, said that while enforced short hospital stays typically don’t yield good results, it was “great to hear” from a reporter that BronxWorks had seen that customers moved from the street to homes under the directive.

Mr Rivera said involuntary hospitalization was always a last resort, but sometimes essential.

“Our job is to keep people safe,” he said. “We can leave someone with wounds that look clearly infected and are in stool and urine. Do you think they have the right to stay there? Maybe. But as social service providers and social workers and ultimately as human beings, do we have a responsibility to take care of this person, because if we don’t, who is going to?”

He added that too often they are called to identify deceased customers. According to the city, exposure to cold killed 12 unprotected people from mid-2021 to mid-2022 — the second leading “external” cause of death after drug overdoses.

While most of the people BronxWorks sent to hospitals were nonviolent, one woman had brandished an improvised weapon at street workers. She responded quickly to medication and has been moved into supportive housing.

While Mr. Mounkaila was at Jacobi, a city-run hospital, his younger brother, a nursing specialist, visited him. For years, the brother said, Mr. Mounkaila had angrily accused him of spying for the FBI and CIA. At the hospital, Mr. Mounkaila said, “We hug.”

Mr. Mounkaila had mixed feelings about his hospital stay. He liked getting three meals a day. He took his first shower in 10 months. He reunited with a daughter he hadn’t seen in eight years. But he was given drugs against his will and he was not free.

“I just got to jail,” he said one April afternoon in a bright visiting room decorated with patient art, including a menagerie of African animals that he drew.

On May 18, he moved into an apartment-style shelter run by BronxWorks, which is working to find him supportive housing. He takes his antipsychotic medication – not because he thinks he needs it, but because he says BronxWorks would be upset if he stopped.

“Life is good,” said Mr. Mounkaila outside his hiding place. “This place is better than living on the street.”

Joseph Goldstein And Raul Vilchis reporting contributed.