In November 2022, Justin Brannan, a city councilman who represents a big patch of South Brooklyn, was worrying about a woman who had been living in the same spot on the street in his district for so long — at least since he took office in 2018 — that she had been immortalized on Google Maps. Appearing to be in her 70s and missing many teeth, she had resisted services in the past, but now the councilman had reason to hope she would get the help she needed.

At the time, Mayor Eric Adams was rolling out a controversial directive known as involuntary removal. It explicitly authorized outreach teams, police officers, nurses, emergency medical workers and others to get people with mental illness severe enough that they could not meet “their own basic human needs” off the streets whether they consented or not, if they posed a threat to themselves that seemed close at hand.

But how were these decisions being made? Mr. Brannan felt that the woman who had been living on a sidewalk in Bensonhurst behind “a fortress of cardboard boxes,” as he put it to the city, fit the criteria. Surely, she was a danger to herself if not necessarily in immediate terms. So he was baffled to receive an email from City Hall indicating that the outreach team who approached her had reasoned that she was fine. The team noted in its assessment that she had been fixated on getting a dental appointment, which seemed to be the basis of its determination of her stability, along with the fact that she “was also inquiring about getting a metro card!”

The back-and-forth with city agencies went on for months, with Mr. Brannan asking that the woman be taken into shelter and connected with housing. Administrators explained that she had repeatedly refused help and that she could not be made to accept it, which seemed to contravene the mayor’s policy.

“I’m not sure how we can say she can care for herself,” Mr. Brannan wrote at one point, “if she has been living outside a shuttered fruit store for four years.”

The entwined crises around homelessness and mental health are among the central issues of the mayoral campaign; how they are resolved, or not, may well define what New York becomes. The attendant issues are ethical as much as they are political: At what point is overriding personal choice justified for the benefit of both the individual and the civic whole? Advocates for civil liberties have been saying the same thing since the Koch administration: never.

“There’s a question in front of all of us,” said Sandy Nurse, a member of the City Council’s Progressive Caucus who represents East New York. “What does it mean to forcibly remove people when you’re not sure that they have a mental health issue?” Implicit in that question is the absence of consensus about how mental health issues present when the observable behavior is not unmistakably wild or erratic.

“Field workers, outreach workers — they don’t believe that removal is appropriate for someone who is just homeless,” Ms. Nurse said. And they are the ones making the initial judgments. The woman Mr. Brannan was concerned about was suffering, in his view. But in the opinion of those who approached her, she seemed resilient and sane despite the choices she made.

Proposed legislation in Albany that is being promoted right now by both the Adams administration and Gov. Kathy Hochul would make it easier to conduct removals in cases of extreme self-neglect, when people might not even recognize the threat they pose to their own well-being. Though removals are often conducted by police officers, they are by no means arrests. Between 2023 and 2024, the city conducted more than 7,000, most of them — 70 percent — originating in private houses and shelters after someone made a call on behalf of a relative or client in distress.

The system is hampered by a shortage of psychiatric beds in public hospitals as well as a shortage of psychiatrists. But the attention paid to violent crimes at the hands of mentally disturbed homeless people has obscured some of the progress the city has made. Since the beginning of the Adams administration, 1,500 “low-barrier beds” have been added to the system. These are quieter alternatives to congregate shelters, which many homeless people reject because they find them terrifying.

Close to 700 more of these beds are expected to become available by the end of this year. Last year, roughly 1,200 people who had been living on the street were moved into permanent housing, Molly Wasow Park, the city’s social services commissioner, told me. At the same time, it is hard to make gains: During the same period, 1,100 people were discharged from state psychiatric hospitals — a revolving door that Ms. Park said she found “infuriating.”

Last May, Ms. Park appeared at a City Council budget hearing at which Mr. Brannan talked about the woman in his district. Mr. Brannan, who is chairman of the finance committee and is running for city comptroller, asked about involuntary removals. A year and a half later, the woman was still in her same perch, a situation he called heartbreaking and inhumane. He argued for involuntary removal on compassionate grounds.

“How many times does an outreach worker have to engage with someone before it would inherently trigger an involuntary removal?” he wanted to know. “If we are visiting a client 20, 30, 40, 50 times, how long before you say, ‘This person clearly needs help’?” Ms. Park answered that sometimes it could take a hundred encounters to get people to come inside.

Was this sustainable? “I don’t know who this is for,” Mr. Brannan told me recently. “Who is benefiting from this exercise of going out there and saying: ‘Hey, do you need anything? No?’ OK. Check a box.” It certainly struck him as inefficient. “This is money that would probably be better spent toward supportive housing than going out there 70 times and offering someone a shower.”