Not since the 1980s, when New York closed many of its psychiatric hospitals, has the fate of New York City's mentally ill been in such debate.
This week, a district court judge in New York ruled that under the Americans with Disabilities Act, all eligible mentally ill people living in adult homes should be offered the chance to move out into their own apartments integrated within the community through a process called "supported living."
The money residents already receive on disability would go to pay rent, rather than adult home fees, and a team of social workers, psychiatrists and other health professionals would visit them.
Though the decision only affects New York, national mental health experts saw possible national implications because the decision was an interpretation of federal law and other large cities follow models similar to New York's for housing the mentally ill.
The ruling was a "dream come true" for one resident of 200-bed adult home in Coney Island, Brooklyn. Indeed, many advocates for the mentally ill hailed the move as a way to improve the lives of people who are stuck for decades, regardless of their level of disability, in complexes that operate like unsupervised nursing homes.
But others saw the ruling as an open door for dumping vulnerable mentally ill people into situations that could lead them to live on the streets, end with them back in psychiatric hospitals or land them in prison.
"The idea of integrating them is a little like motherhood -- you can't argue with that. It's morally sound," said Dr. E. Fuller Torrey, a psychiatrist and Founder of the Treatment Advocacy Center in Arlington, Va. "But it's also unrealistic."
Torrey said he's seen firsthand while caring for his mentally ill sister for a lifetime how much care some need.
"It's dishonest to say that there is no danger of releasing thousands of patients and not paying attention to whether they are on their medication or not," said Torrey, who did not trust that a system of home visits to ensure all patients were taking their medications.
In the wake of the ruling, the state of New York was deciding what to do next, according to a statement by Morgan Hook, a spokesman for New York Gov. David A. Paterson.
"The state is reviewing the ruling ... by the federal District Court, which rejected the state's proposed remedial plan to offer supported housing to individuals with mental illness who reside in certain adult homes in New York City, and is evaluating whether to file an appeal," the statement said.
The state is responsible for finding housing for a person who has a psychiatric break, is admitted to a hospital, but then has nowhere to live when they are ready to be released.
"This is typical of the situation of many residents, where it's sort of like a last resort," said Norman Bloomfield, 62, a resident at the adult home Surf Manor in Coney Island. "They have a psychiatric diagnosis, there's no housing for them and they [the state] try to get them out of hospital."
Bloomfield said he felt his adult home was a dumping ground.
"There are people who are very high functioning, or people who are very low functioning -- but you're treated all the same," said Bloomfield, who landed in Surf Manor in 2002 after he was released from a psychiatric hospital.