NYAPRS Note: There are some who believe the best way to get people with major mental health conditions help in New York City is to, following a very rare tragic event, push the image of our community as violent and one who invariably needed to be legally committed to treatment. The new NYC mental health commissioner is rightly answering those criticisms today in the Daily News emphasizing outreach and engagement, crisis response and diversion, housing and anti-stigma efforts.
How We Help The Mentally Ill: Those Claiming The City is Failing to Aid People in Serious Psychological Distress Are Just Wrong
By Dr. Oxiris Barbot New York Daily News March 13, 2019
There is a persistent narrative that New York City is failing people with serious mental illness. That storyline is false.
Serious mental illness affects about 4% of New Yorkers, but its impact extends to their loved ones and communities. The term is actually not a diagnosis, but an indicator that someone with a diagnosis such as major depression, schizophrenia or bipolar disorder is having a period of serious functional impairment of some major life activity.
Historically, New York City has invested lots of money and effort in combating serious mental illness; much has been written, for example, about Kendra’s Law, which provides court-ordered treatment to patients with mental illness who have difficulty staying in treatment on their own. The program has successfully reduced hospitalization, homelessness and incarceration. It serves about 2,260 individuals annually, and there has been a 28% increase in its use under Mayor de Blasio.
But Kendra’s Law is not the only solution. Nor is more hospitalization. While hospitalization might be lifesaving for some, an essential part of the city’s goal is to keep people in recovery after they leave so that they do not experience another mental health crisis.
Over the past three years, the de Blasio administration has made unprecedented investments to create and expand programs for treatment, prevention and support for people in deepest psychological need. Currently, the Health Department alone manages more than $300 million annually in funding for people with serious mental illness — a mix of city, state and federal dollars. Through ThriveNYC, we are able fill gaps that have been challenging with conventional treatment.
First, we are meeting people where they are — in communities — because that is key to engage them in care. We created a program called NYC Safe to increase interventions for the narrow population who pose a concern for violent behavior. Highly-specialized, new community and mobile treatment teams are effectively serving people who have had frequent contact with the mental health, criminal justice and homeless systems.
Among the targeted population, incarcerations and psychiatric emergency are on the decline, and from 2009 to 2016, our largest community treatment initiative saw a decrease of 30% in people in the program who reported as homeless.
Second, supportive housing makes a dramatic difference. More than any medical intervention, it keeps people with serious mental illness safe and healthy. Today, the Health Department contracts for over 8,700 units of supportive housing available to homeless individuals, and 80% of this housing is for individuals with serious mental illness. We are now well underway on our commitment to adding 15,000 more units in 15 years.
Third, like all New Yorkers, people with serious mental illness are not well served by the failed strategy of relying mostly on hospitals and acute responses. That means we have to stop caricaturing serious mental illness as only a moment on the subway or an altercation on the street.
The Health Department has innovative programs that serve as an alternative to hospitalization. For example, crisis respite centers provide community-based peer support and education. And the NYC Start program reaches people hospitalized with a first onset of psychosis so they may transition to community care; over 85% of participants attend an outpatient appointment within 30 days of hospital discharge.
These initiatives are being complemented by ThriveNYC, which adds behavioral health workers to primary care settings; clinicians in senior centers; and a helpline for anyone in need of counseling.
These initial efforts are not the last word, nor will they erase the reality of serious mental illness being neglected for so long. But they are showing us how to keep moving forward.
Barbot is commissioner of the city’s Department of Health and Mental Hygiene.