By Amanda Woods Nikki Henkin stood in front of her apartment on East 77th Street, between Lexington and Third avenues, holding up a flip camera to capture a video of Susan (not her real name), a neighborhood homeless woman who screams wildly, coughs repeatedly and deliberately spits on passersby. Pedestrians in Susan's path clear sidewalks, subway platforms and cars to avoid her. Henkin hoped she would be able to show her footage to the police as proof of Susan's disturbing behavior. But once Susan spotted Henkin, she grew outraged. "She started to scream at me, 'It's against the law to take my picture. You can't do that. I'm going to call the police,'" Henkin said. Henkin went inside her apartment's lobby. Minutes later, Susan darted in and threw a plastic cup filled with a clear liquid at Henkin. "I don't know what the liquid was-water, bleach, acid," Henkin said. "Luckily, I'm OK and she left." Residents say Susan has made the Upper East Side her stomping ground for about six months and has been a nuisance and a hazard ever since. "She will burst out screaming and you can hear her 10 floors up," Henkin said. "She coughs violently, which made me think she has a communicable disease, and then she purposely, intentionally spits on people, spits on children in strollers and spits on people walking dogs." One resident who wished to remain anonymous said she and a friend visiting from France had to walk in the street to avoid the spitting woman. "All that came on to my radar screen is that she had a strange look in her eyes, and at that moment, this woman started hissing and spitting and making almost animal noises," the resident said. "It was horrifying and scary-like having a rabid animal in your presence." Pedro Ramos, a window washer on East 77th Street, said Susan once spit on passengers on the 6 train, prompting a commuter to call the police at the 86th Street station. Eliott Rebollo, an apartment superintendent in the neighborhood, said that six people who live in his building have told him they felt threatened by Susan. And Jimmy Gouvakis, owner of Soup Burg, located on Lexington Avenue between 76th and 77th streets, said Susan once traipsed through his restaurant, causing a scene and disturbing diners. Susan, a thin, middle-aged woman with dark hair, clad in sweat pants, a brown T-shirt and a black woolen cap, travels with a younger man who may be her son or her nephew, but he usually remains quiet, residents say. Together, the two haul three or four suitcases and bags, which they carry down into the 77th Street subway station to travel elsewhere-but they always return to the Upper East Side. Henkin and other locals want Susan off the streets, or at least treated for her cough, which some believe may be a sign of tuberculosis or whooping cough, and her supposed mental illness. (http://nypress.com/wp-content/uploads/2012/07/homeless21.jpg) But Susan is only an example of a larger issue in New York City. The number of homeless living in New York City shelters has grown to 43,000, according to Patrick Markee, senior policy specialist at the Coalition for the Homeless. Three-quarters of the shelter population are families, of whom only a small number are mentally ill. But out of the 10,000 single adults who live in the city's shelters, one-third to one-fourth are mentally ill, Markee said. The number of street homeless in New York City, those who don't go to shelters, totals 3,262, according to a Department of Homeless Services spokeswoman-and two-thirds of them are mentally ill, according to Markee. Last week's report of a deranged homeless man stabbing and attempting to rob a young woman on Second Avenue near 86th Street has intensified local concerns about the homeless and mentally ill and whether they could be dangerous. Although Susan has not committed a violent crime, some Upper East Siders fear that her behavior could escalate, and they're hoping the police will take action before then. After the liquid-throwing incident, Henkin wanted to press charges but police told her that because the incident was only a violation and officers weren't present when it happened, no charges could be lodged. Police are monitoring Susan, according to Nick Viest, president of the 19th Precinct's Community Council. The NYPD's policy for this and similar issues is to send the precinct's Conditions Unit, which handles quality-of-life and minor street concerns, to the area. "What they do is they monitor it-they send police over to observe," Viest said. "This one in particular is on the radar screen. They can't make an arrest if they don't observe the person doing something illegal. They try to stay on top of it and watch it." Viest explained that for police to act, the woman's behavior would have to be more severe. "If she assaults someone or attacks someone, that's a crime and police can act on it," Viest said. "It's simply that she appears menacing and she's disturbing to a lot of people, so it seems like that's the difficulty here." Spencer Korwin, an Upper East Sider, doesn't believe police have reason to act just yet. "I don't know if anything she does is illegal," Korwin said. "She's not doing anything wrong, just causing a disturbance." A source familiar with mental health issues said that if the police believe Susan is a danger, they can bring her to a hospital to be checked in. The hospital can keep her for 72 hours, but if the staff doesn't find her dangerous, they can allow her to leave. The problem is that there is no easy or immediate way to address Susan's problems, according to Mary Lee Gupta, a social worker and the program director for the National Alliance for the Mentally Ill of New York City Metro. The criteria for psychiatric institution admission are stringent, and as Gupta sees it, Susan doesn't fit the bill. "If a person is not a danger to themself or others, you can't have the police come and take her to a psychiatric hospital," Gupta said. "She wouldn't be admitted. Clearly, she has symptoms, but unfortunately, the bar is high for admission." If Susan threatened to hurt someone, carried a weapon or had a plan to commit suicide, she could be admitted, but her case isn't nearly that severe, Gupta added. "There are literally several thousand people on the streets of New York, and it's simply not possible to scoop people up and mandate treatment," said Ira Mandelker, executive director of the Neighborhood Coalition for Shelter, located on the Upper East Side. Susan could voluntarily enter a hospital if she "has a mental illness for which care and treatment in a mental hospital is appropriate," according to New York State Mental Hygiene Law, outlined by the State Office of Mental Health. But questions often arise about when a person should be considered dangerous enough to his or herself and others to be involuntarily entered into a mental health facility, making it difficult to find a safe and fair balance between protecting the rights of the mentally ill to refuse treatment and the rights of the people who feel threatened by them. A Department of Homeless Services spokeswoman noted that a client can only be taken to a mental health facility involuntarily if he or she reaches "the highest threshold of danger." In this case, Section 9.58 of the Mental Hygiene Law, which states that people who appear to have a mental illness and present a danger to themselves or others can be involuntary taken to a psychiatric emergency room to meet with medical doctors, licensed psychologists, registered nurses or certified social workers, would be enacted. Of the 85,820 people in the five boroughs who are mental hospital patients, only 2 percent were homeless before admission, according to the Patient Characteristics Survey, a one-week survey conducted by the Office of Mental Health of all mental health programs statewide. In Manhattan, where 19,190 people are enrolled in mental hospitals, 5 percent were homeless. Coupled with the hurdles to entering a state mental institution, the movement in state hospitals toward deinstitutionalization that began in the 1960s makes mental hospitals an even more unlikely place for the mentally ill homeless, according to a psychiatrist who lives on the Upper East Side and worked in the state mental health system for many years. "It became a mania with state people to discharge patients wildly to reduce censuses because it was economical for state budgets," the psychiatrist said. The chances of Susan entering a homeless shelter are also unlikely. Homeless outreach teams can confer with her and ask if she would be willing to go into a shelter for evaluation, but if she is not willing, it can't happen, Gupta said. Kristen Edwards, director of the Manhattan Outreach Consortium at the Goddard Riverside Community Center, said the center's outreach teams have gone out to see Susan, but she would not elaborate on specifics. The Homeless Services spokeswoman said Susan appears to be part of the street homeless population rather than a shelter client. Homeless Services cannot force clients to enter a shelter, the spokeswoman said, but they can encourage them to seek help at a Safe Haven program, which is geared toward street clients and has semiprivate rooms and more relaxed curfews. She said an outreach team had met with Susan and considered her "civil and engaged with them." They thought she didn't pose an immediate danger. But Mandelker said this behavior is to be expected. "People, when they're meeting with outreach workers and psychiatric outreach workers on the street-they can bring it together pretty well and not seem threatening when they're in the presence of outreach workers," he said. Residents concerned about Susan or other neighborhood homeless people can respond in a few ways. Residents concerned Susan's cough may be a sign of tuberculosis can contact the Department of Health and Mental Hygiene; the law allows people to be picked up for public health safety concerns, according to a source who wished to remain anonymous. The Manhattan Outreach Consortium seriously considers community concerns, Edwards said, and residents can call 311 and request a homeless outreach team to come to a specific location. Team representatives will arrive immediately, Edwards added, though the person of concern must be at that location when the teams get there. The teams conduct basic psychosocial assessments of each case, determine if they need to be seen by a psychologist and work to connect them to transitional and permanent housing. But community concerns alone won't be enough to get Susan help, Gupta said. Locals can begin by talking to Susan and encouraging her to seek help, she added. "I think that people can try to engage her in conversation and try to talk with her about whether she would be willing to go into a shelter," Gupta said. "They can try to get a sense of what's going on with her. If she says things of a level of concern, it would be helpful for them to call for help from the police." Henkin, though, is still looking for concrete answers. "I understand the issues, but I also understand that I have to walk on the sidewalk and not be assaulted by somebody," she said. "I don't want anyone spitting on me and coughing. I think people in this community are entitled to an answer."