Yeah, my wife works with homeless veterans. They run the gamut, from hard on your luck to absolutely insane. She had to call PD yesterday because one threatened suicide. She convinced another to speak to a therapist after she acted as a mediator for two hours between the vet and their landlord.
Some of these folks are just off the deep end. Some have very serious drug addictions. And some are fine. If people like my wife got to be part of the process for determining whether someone needed to be institutionalized, I feel like I could trust that process.
NYC is thrice as dense as Berlin, the densest city in Germany. Probably accounts for something.