Gotham Gazette http://www.gothamgazette.com/component/tags/tag/823 Tue, 25 Sep 2018 19:00:12 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) Now ‘Resetting,’ Chirlane McCray’s $850 Million Mental Health Program Has A Lot Riding On It http://www.gothamgazette.com/?id=7630:now-resetting-chirlane-mccray-s-850-million-mental-health-program-has-a-lot-riding-on-it http://www.gothamgazette.com/?id=7630:now-resetting-chirlane-mccray-s-850-million-mental-health-program-has-a-lot-riding-on-it Chirlane McCray Bill de Blasio

Chirlane McCray, with Bill de Blasio looking on (photo: Benjamin Kanter/Mayor's Office)


On a sunny Wednesday morning in November 2015, more than 30 of New York City’s top public officials gathered together in East Harlem. They stood shoulder-to-shoulder and tiered in three rows on the ground floor of the City University of New York’s school of social work. An audience of hospital administrators, business leaders, mental health advocates and journalists watched from folded seats.

Chirlane McCray, wife of New York City Mayor Bill de Blasio, took the lectern. With a sing-song cadence and emphatic smile, she announced what would become her signature initiative:

“It is my great pleasure to announce the release of ThriveNYC: A mental health roadmap for all,” McCray said. The surrounding group, that included de Blasio and their children, Dante and Chiara, applauded. The plan, she said, is one of action. “It includes an investment of $850 million over four years.”

ThriveNYC is not an organization. Led by McCray, who cannot hold a paid position in the administration due to nepotism laws, Thrive is a “mental health roadmap.” It encompasses 54 mental health-related projects that are being housed across 20-plus city agencies. Richard Buery, former deputy mayor for strategic policy initiatives and Mary Bassett, the commissioner for the Department of Health, have helped spearhead many of the broad-ranging projects.  

With each of the projects, 31 of which previously existed before McCray’s 2015 announcement, the aim has been to address the stigma-laced culture around mental health as well as general barriers in accessing mental health care across the city’s five boroughs. In the two-plus years since McCray announced Thrive, her political profile has boomed and the city has published dozens of metrics meant to indicate the initiatives’ successes.

As even McCray and de Blasio admit, the city still has significant mental-health related issues and a long way to go. The Kaiser Family Foundation, a leading non-profit research organization, found that just 42 percent of the city’s mental health needs were being met as of December 2017.

Recently, a host of high-profile incidents between New Yorkers with mental health disorders and city employees, especially police officers, have topped headlines. In the first week of April, NYPD officers shot and killed a black man with bipolar disorder who was standing on a street corner in Brooklyn’s Crown Heights neighborhood. The man was holding a metal pipe as if it were a gun. The incident, one in a series of similar deadly encounters between police officers and New Yorkers suffering from serious mental illness, sparked protests and questions around city officials’ mental health training.

McCray recently said of two such incidents, including the killing of Saheed Vassell in Crown Heights, “neither one of those tragedies had to be,” according to Observer, and pointed to ThriveNYC as the plan to fill a long-standing void and prevent such tragedies.

Meanwhile, weeks before the most recent incident and an announcement of a new “crisis prevention and response task force,” in mid-March, the mayor’s office circulated a press release that the sweeping mental health initiative that is ThriveNYC had hired an executive director: Alexis Confer. Confer, who had been working on the initiative under Buery, is the first person to occupy a full-time administrative role under Thrive. The hire, McCray said in an interview in the following days, is part of Thrive moving into a second, “resetting” phase.

“The resetting is really necessary because the first two years we were really focused on getting everything off the ground, every program didn’t launch at the same time,” McCray said during a recent appearance on the Max & Murphy podcast from Gotham Gazette and City Limits. Now that nearly all of the 54 projects are up and running, the goal is to use the administration’s remaining years in office to ensure each project will reach its goals and live beyond the ticking political timeline. Tracking metrics and success, McCray said, are critical in accomplishing these goals.

“We know we have 3 years and 9 months,” the first lady said. “I want to make sure that all of these programs last beyond this administration, which means that we have to do careful analysis of how well they’re doing, and we have to actually embed them in the agencies.”

Yet as Thrive moves forward, questions linger around its structure, impact, and McCray’s role -- especially since the first lady has recently been toying with the idea of running for political office in the next city election cycle.

With speculation swirling around McCray’s future and a city muddled in what some experts have labeled a mental health crisis, much is at stake. In leading Thrive, McCray took on what she called “ambitious” goals. The result has largely been positive, it appears, in terms of reorienting how city government addresses mental health and the breadth of the services available. People working under Thrive-backed programs sing praise for McCray’s dedication and work ethic. Many people in the city’s mental health sector also commend efforts to address one of the city’s most pervasive issues.

According to McCray, there are about 400 metrics that indicate the various programs’ successes and, in some cases, shortcomings. While city officials working under Thrive are already applauding its impact, some of the metrics that have been published don’t seem to point to concrete improvements or to all of the programs’ being on track to meet their marks.

*****

Before de Blasio took office in 2014, the office of New York City First Lady was vacant for close to 15 years, whereby mayoral partners were not active in politics. During his mayoral campaign and into his transition into office, de Blasio and McCray had made clear that New Yorkers were getting something along the lines of ‘two for one.’ De Blasio regularly called his wife his number one advisor. She did, after all, bring her own political background to the table. The city’s mayoral duo met working under Mayor David Dinkins, the city’s first and only black mayor and last Democrat elected before de Blasio.

Under Dinkins, McCray primarily worked on the speech-writing team. She then worked on-and-off for elected officials and held a brief post at the foreign press service with the work always centered around writing. When de Blasio was first elected, McCray helped appoint top city officials, as she had done before during his political career as public advocate and a member of the City Council, they said.

Unlike some first ladies at various levels of government, McCray has used the role to bring publicity to topics and spearhead initiatives with real money behind them. De Blasio appointed her chair of the nonprofit Mayor’s Fund to Advance New York City, which raises tens of millions of dollars for public-private partnerships, and, of course, she helped develop and oversee the city’s sweeping mental health program.

On the day of the announcement for Thrive, McCray introduced a handful of the 23 new initiatives. For example, a 24/7 hotline would be launched to connect people seeking mental health services with treatment options. Primary care providers would be trained to prescribe buprenorphine, a medication that prevents withdrawal symptoms, to people recovering from opioid addictions.

McCray listed off a number of goals: train 250,000 people in mental health first aid; implement social-emotional learning in all the city’s 1,850 Pre-K for All programs; create a mental health corps that will clock 400,000 hours of outpatient care each year.

The 15-minute introduction the first lady delivered on that brisk 2015  day was the culmination of a handful of meetings, spread out over the course of the previous months, with the commissioners of more than a dozen city agencies. Traveling across the boroughs, McCray asked agency heads—from the Department for the Aging to the Administration for Children’s Services—about mental health services available to the populations they serve. All of the agencies already had some mental health initiatives in place and McCray wanted to know what was working and what wasn’t. Commissioners from at least two departments were impressed by McCray’s commitment and insightful questions early on.

“To me, the first lady has been incredibly active—way more active than I really expected or anticipated,” said Lorelei Vargas, a deputy commissioner for the Administration for Children’s Services who attended the early meetings.

In that first speech, McCray didn’t mention the planning behind Thrive. Instead, the veteran speech writer invoked the personal. She touched upon her family’s own struggles with mental health, from her daughter’s public struggle with addiction to her parents’ depression. She recited statistics about the prevalence of mental health problems in New York City— 8 percent of high schoolers tried to commit suicide, 26 percent of CUNY students reported having anxiety, and 13 percent of elders in care facilities suffered from depression.

McCray called Thrive’s goals ambitious and emphasized the collaborative demands of this type of work. The smile on de Blasio’s face grew as the mayor looked on and clapped with warm approval. The city, in trend with the state and country, was facing a shortage of mental health professionals. Thrive aimed to respond to this by equipping people already working in city agencies and interacting with residents with the ability to screen for mental health issues, and then direct them to adequate services. To accomplish this, McCray said reducing stigma was a necessity.  

“If we work together we can make it as easy to talk about anxiety as it is to talk about allergies,” McCray concluded.

*****

McCray speechTwo-and-a-half years later, nearly all of the 54 initiatives are underway. Hundreds of people have been hired to work on initiatives, old and new, and tens of thousands trained in mental health first aid. More than $818 million has been allocated across more than a dozen agencies’ budgets through fiscal year 2019. Two-thirds of the sum comes from city dollars. A combination of federal grants and private donations fund the $24 million Connections to Care program, also under Thrive, and Medicaid reimbursements back the shelter-based treatment for people who are homeless.

But getting a grasp of how the initiatives that span more than 20 city agencies fare requires looking beyond the official year-two update report that representatives of the mayor’s press office direct inquiries to. Tracking the funds alone demands examining each of the agencies’ budgets that are slated to receive Thrive-related funds. A team at New York City’s Independent Budget Office (IBO) spent months reviewing the budgets and compiled a report on Thrive.

The metrics measuring the programs’ success are similarly spread out. McCray mentioned that there are about 400 metrics being used across the initiatives to track their success. Some are being maintained by the city agencies operating the initiatives, others by the mayor’s and first lady’s offices, and at least one is being monitored and evaluated by the Rand Corporation. During her appearance on the Max & Murphy podcast, McCray said that she reads up on all of them every week.

“You know, we’re watching, we’re watching very carefully,” McCray said. “Every other week, we have a roster, or an implementation chart to show   how we’re making our bench-lines, how our timeline is moving, whether we’re on target, or off target, it's very thorough. We’ve got 400 metrics to measure our programs, and we’re very much focused on making sure that we’re doing a very thorough evaluation and assessment of  how we’re doing.”

Yet, following multiple requests and conversations with the mayor's and first lady’s offices, as well as requests over the course of weeks with 11 agencies working under the auspices of Thrive, metrics have trickled in slowly and sparingly. Spokespeople from the mayor and first lady’s offices have responded to multiple requests for the 400 metrics by sending along the "ThriveNYC Year Two Update" report, which lists 55 projects and associated metrics through October 2017 . Some of the initiatives have exceeded their goals, others underperformed. Some have few metrics, if any, by which to gauge progress.

People have critiqued Thrive overall for not specifically targeting programs toward New York City residents who suffer from more severe psychiatric disorders. The nine-hour mental health first aid trainings, for example, don’t necessarily equip city employees with the necessary skills to assist someone suffering from a severe psychiatric disorder or in the throes of an episode. Employees from three city agencies dismissed those claims, asserting that the varied programs address people across the spectrum.

“It’s simply not true. Thrive addresses the full span,” McCray said. She added that many of the programs are focused on early intervention and prevention because many people suffering from severe psychiatric disorders later in life often have had mental illness go untreated in the past. “This is why you see so many people on the street. That is the result of untreated mental illness, and not just a year or two, this is years and years and years in the making. If we act early, we could actually prevent, or certainly intervene,” she said.

De Blasio himself recently dismissed the criticism, pointing to both NYC Safe and the reasonable use of Kendra's Law, which necessitates a judge mandating treatment for individuals in need.

Yet in response to increasing attention on this subsect of the population, de Blasio and McCray announced the formation of the new task force on Thursday that will focus on some of these concerns.

The task force brings together city officials, mental health researchers and individuals with mental illness over the next 180 days who will identify ways to increase interventions, according to a press release. The group is also slated to address means to improve coordination between public health and safety agencies within the city. McCray along with the leading names on Thrive, including Confer and Bassett, are set to manage the task force. Thrive initiatives, meanwhile, continue onward.

One of the initiatives that’s among the most referenced during press events around Thrive is NYC Well, the hotline for people seeking mental health services. De Blasio and McCray recite the number -- 1-888-NYC-Well -- at public and private events on a regular basis, often asking their audiences to repeat it back or say it with them. Judged by the number of people who have utilized NYC Well, the initiative has been deemed a success.

More than 250,000 people have reached out to the hotline through phone calls, texts or online chats, according to Thrive’s two-year update report. This exceeded initial projections by about 25 percent. Prior to NYC Well, many city agencies, like the Department of Health and Mental Hygiene, ran independent hotlines where people tended to call for mental health services. NYC Well consolidated these numbers into one, where people on the receiving end of the calls would be better equipped to navigate the city’s mental health providers and other services.

The first lady and others involved in thrive said the numbers are a testament to advertising campaigns around the city. Nearly $15 million of Thrive’s overall funds through 2019 are dedicated toward media campaigns. However, some have questioned whether basing the program’s success on the number of people who reach out is most telling as to whether people are actually being connected to the care they are seeking.

Commissioners for the Department for the Aging said they were excited about the impact that Thrive’s funding has already had on the two projects the agency runs in partnership with Thrive. The Friendly Visiting program, which launched July 2017, trains and connects volunteers with homebound elders. In the program’s first four months, Thrive’s year-two update reported, 645 seniors were served. Thrive has also backed initiatives to provide additional mental health services in senior centers.

Some have expressed concern that programs that existed prior to Thrive are being lumped into the umbrella program without much benefit. But representatives from the Department for the Aging disagreed.

“It’s a more the merrier situation. We absolutely need more services than we can provide in our point in time,” said Jackie Berman, the director of research at the department who is closely involved in the administrative-side of the two Thrive initiatives. “Thrive opens up the door, but there’s even still a great need—it’s the tip of the iceberg.”

While initiatives like Friendly Visiting and NYC Well have hit their goals, others have faltered. City officials remain adamant that these initiatives are still on track to meet the targets that were recited in 2015 and echoed in appearances since.

For example, there are seemingly underwhelming metrics about the number of people who have received mental health first aid training. Thrive’s two-year update report, which collected data from 2016 through October 2017, indicated hat nearly 37,000 people had been trained in mental health first aid, which means taking a free nine-hour course offered throughout the city. The course is meant to teach participants how to screen people for possible mental health issues and educate them on the steps to take when concerned about another’s mental health. With the city experiencing a mental health professional shortage, the idea is to give residents the tools to fill some of the gaps left by the shortage.

For Thrive to meet its goal of training 250,000 city residents in mental health first aid by 2020—there would have to be significant growth in the number of people enrolling in mental health first aid programs. At least double the number of people will have to be trained in 2018 and 2019 that were trained in 2016 and in 2017 combined.

Confer, hired to be Thrive’s executive director as of mid-March, did not provide concrete ways that the city would scale up the number of people receiving mental health first aid trainings. She did, however, stress the importance of meeting the goals. The metrics, she said, not only promote benchmarks critical to the programs’ success, but also act as “a magnifying glass on ourselves.”

Yet, some metrics are difficult to ascertain. Though the city outlined a number of benchmarks for 34 initiatives in the year-two update, there are missing links between how lump sums in budgets trace to each of these metrics. For example, NYC Safe, which is run by the Department of Health and Mental Hygiene, is geared toward supporting people with mental illness who are more likely to exhibit violent behavior. The program has $22 million earmarked toward its development.

According to the year-two update, NYC Safe was responsible for adding  40 substance-abuse-disorder specialists to treatment teams across the city. In January 2016, three intensive mobile treatment teams launched and a fourth was added the following year. Overall, Thrive’s year-two update said that 405 New Yorkers were engaged in the NYC Safe program through October 2017. The link between how the $22 million is being employed and how money links to each of these metrics is not available.

Jane Meyer, a spokesperson for the mayor’s office, said that some data was simply not readily available. Some metrics were only available in quarterly update reports, for example. Meyer said the city was working on the weeks-long request for the most up-to-date information on each of the 54 initiatives. However, she said, consolidating all of the 400 metrics that the first lady said she keeps up-to-date with was proving a time-consuming task.

Confer said she’ll be spending 100 percent of her time on Thrive in the new post. Without a specific office or even the semblance of being an organization, Thrive doesn’t publically appear to have full-time staff other than Confer. She said she planned to spend the first few weeks taking stock of the initiatives that she has helped oversee from the deputy mayor’s office since Thrive’s launch. She also plans to touch base with the hundreds of people working on the projects that have been labeled as Thrive-based initiatives.

“The goal is to save lives, and to make sure people have the resources they need—that is the ultimate metric of success,” Confer said.

*****

Before Confer stepped into the executive director role, no single person was tasked with maintaining and organizing the initiatives under Thrive. McCray was as close as it got. She also spends her time heading the Mayor’s Fund.

The Fund, a non-profit organization, facilitates partnerships between the city and private stakeholders to implement programs advantageous to New Yorkers and, at times, experiment with initiatives that could become part of what city government does. McCray’s role has drawn criticism from some concerned that the appointment creates an expectation from private donors that the mayor will treat them with favor. McCray has waved those off.

“It’s not an overriding concern,” McCray said on the Max & Murphy podcast, saying that people donate to the fund because they are devoted to philanthropy, not because they expect political favors. “But we do have lawyers,” she said. “And lawyers are important to sift out the who does what and when, and that’s important.”

Tax filings for the fund between 2014 and 2016 list McCray working one hour a week. A spokesperson for the mayor’s office, responding to an inquiry about this filing, said McCray spends about 10 percent of her time working on the Mayor’s Fund and that the public schedules aren’t reflective of all her time. Thrive, meanwhile, appears to occupy much more time, and there is some crossover.

The most prominent is Connections to Care. The Mayor’s Fund contracts the McSilver Institute for Poverty Policy and Research, part of New York University, to train non-governmental organizations and nonprofits in screening for mental health issues. Connections to Care is based on the premise that very few people go out of their way to seek mental health care. Having city employees recognize mental illnesses when they do interact with the city’s population would provide more entryways to care.

“I would say it’s been a fantastic experience,” said Andrew Cleek, the institute’s chief program officer.

For McCray, the experience may be the first of many more politically-minded work in the future.

In mid-March, McCray packed her bags and boarded a flight to Puerto Rico to travel the region and assess the mental health climate in the territory following hurricane Irma. In the weeks leading up to her trip, McCray was showing up more frequently at public events. The mayor featured her at press conferences, where she often invokes Thrive.

Rumors began to spread that McCray was prepping to expand her future political aspirations. She didn’t dismiss the idea. McCray actually said it was on a list of things she’s considering. But, in order to get there, she said she needs to focus on the work that currently has her name on it—the most prominent being Thrive.

“I’m too focused on doing a really good job, of what I’m doing now—because my future depends on it,” McCray said when asked about whether she was beginning to plan out steps for her own run for office. “It really does.”

***
by Maya Miller for Gotham Gazette
@GothamGazette
The author is a freelance journalist currently earning an M.A. in health and science journalism at Columbia's Graduate School of Journalism.

This article has been corrected to reflect the number of NYC Well is a 1-888 number, not 1-800

This article has also been updated to remove an inaccurate mention of a discrepancy in reported numbers of people given mental health first aid training.

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Now ‘Resetting,’ Chirlane McCray’s $850 Million Mental Health Program Has A Lot Riding On It Sun, 22 Apr 2018 04:00:00 +0000
City Council Progressive Caucus Calls for Crisis Intervention Reforms http://www.gothamgazette.com/?id=7622:city-council-progressive-caucus-calls-for-crisis-intervention-reforms http://www.gothamgazette.com/?id=7622:city-council-progressive-caucus-calls-for-crisis-intervention-reforms mayornyc james o neil

(Credit: Michael Appleton/Mayoral Photography Office)


The New York City Council Progressive Caucus is stepping up calls for Mayor Bill de Blasio to reconstitute a citywide task force to examine how emergency responders help people suffering from mental illness, and are insisting that the mayor consider creating a parallel response force of social workers and therapists that can answer calls rather than police officers.

In a letter sent to the mayor last Wednesday, the 21 members of the Progressive Caucus said the mayor should act by the end of the month to revive the Mayoral Task Force on Behavioral Health and Criminal Justice, which was set up, and concluded its work, in 2014, or create a similar body.

“As we’ve seen once again in the last week, the tragic costs of not acting in a sustained and focused manner are too high,” the members wrote, referring to the shooting death of Crown Heights resident Shaheed Vassell by NYPD officers who were not trained to respond to situations involving “emotionally disturbed persons.” The letter noted that since the last task force’s recommendations were put in place, in the summer of 2016, ten people in emotional crisis were killed by police.

Late last year, City Council Member Jumaane Williams, a progressive caucus member, had led an effort calling on the mayor to do the same. He was among those who reiterated that request after the death of Vassell. But though the NYPD says it is on board, the mayor continues to drag his feet. “It’s really a City Hall conversation,” NYPD Deputy Commissioner Susan Herman said at a Council hearing last month.

The Progressive Caucus members’ latest request differs slightly from what has been previously sought.

Rather than directing efforts at improving NYPD officer behavior, which they nonetheless hope the task force will do, they are calling for the mayor to support a new system that prioritizes professional mental health providers in emergency situations, where 911 operators can divert calls to social workers or therapists instead of the police and where therapists or trained peers can join police at the scene of an emergency. They also call for an expansion of mobile crisis teams and co-response teams that include mental health professionals paired with officers that have received Crisis Intervention Training. Just over 8,000 officers in the 36,000-strong police force have gone through CIT. 

"Too often, individuals with behavioral and mental health conditions are wrongly introduced to the criminal justice system. In order to improve their safety, we must consider comprehensive strategies that will prioritize preventive care and response tactics by mental health professionals,” said Council Member Diana Ayala, co-chair of the Progressive Caucus and chair of the Council’s Committee on Mental Health, Disabilities and Addiction, in a statement.

The Progressive Caucus includes nearly half the 51 members of the City Council, and counts Council Speaker Corey Johnson among its ranks. Council Member Ben Kallos is co-chair with Ayala.

Although the Council members praised the administration’s efforts that resulted from the recommendation of the previous task force, they noted that many initiatives stalled and also pointed to the weaknesses in the NYPD’s approach to CIT training as evidenced by a January 2017 report by the Office of the Inspector General for the NYPD.

“The deaths of Dwayne Jeune, Saheed Vassell, and too many others have shown that there are fundamental flaws in the way our city handles EDP emergencies,” said Council Member Williams, in a statement.

Steve Coe, CEO of Community Access, decried the “lack of leadership around this issue” despite the action plan put in place based on the 2014 task force’s recommendations. He commended the Progressive Caucus’ efforts, stressing that bringing stakeholders such as district attorneys, the city’s health department, NYPD officials, mental health experts and advocates was necessary “to assess what’s working, what’s not working, and develop diversion and treatment strategies that are effective and sustainable.”

***
by Samar Khurshid, City government reporter, Gotham Gazette
     

Read more by this writer.

Note- This article has been updated. 

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City Council Progressive Caucus Calls for Crisis Intervention Reforms Wed, 18 Apr 2018 04:00:00 +0000
Max & Murphy Podcast: First Lady Chirlane McCray http://www.gothamgazette.com/?id=7568:max-murphy-podcast-chirlane-mccray http://www.gothamgazette.com/?id=7568:max-murphy-podcast-chirlane-mccray mxm logo

Ben Max, left, of Gotham Gazette, and Jarrett Murphy, right, of City Limits


March 26, 2018 - Max & Murphy Podcast: New York City First Lady Chirlane McCray

Chirlane McCray

New York City First Lady Chirlane McCray is leading the city's ThriveNYC mental health care plan and its many component programs, serving as Chair of the Mayor's Fund to Advance New York City, and providing guidance as her husband's top advisor. McCray joined the podcast to discuss the various components of her work, where she sees the de Blasio administration at this point in its tenure, the administration's struggles with getting its message out, her political future, and more.

Listen to the full conversation and let us know what you think -- we're on Twitter @TweetBenMax and @JarrettMurphy and guest @Chirlane McCray (@NYCFirstLady). You can listen to the episode through the embedded audio below or download the episode wherever you get your podcasts.

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by Ben Max, Gotham Gazette
     

Read more by this writer.

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Max & Murphy Podcast: First Lady Chirlane McCray Mon, 26 Mar 2018 04:00:00 +0000
Part of ThriveNYC, NYCHA Trains Staff in Mental Health First Aid http://www.gothamgazette.com/?id=7049:part-of-thrivenyc-nycha-trains-staff-in-mental-health-first-aid http://www.gothamgazette.com/?id=7049:part-of-thrivenyc-nycha-trains-staff-in-mental-health-first-aid 5716575756 06b18d2c43 z

NYCHA community gathering at Queensbridge (Pete Mikoleski/NYCHA flickr) 


At a recent training session, just over 35 New York City Housing Authority staff members assembled at the authority’s downtown offices last Thursday. The course, which included eight topics, was part of the city’s ThriveNYC mental health care plan, one piece of which is 2,000 NYCHA employees receiving mental health care training so that they can more carefully and helpfully interact with public housing residents who may be experiencing mental health challenges.

The eight session subjects included first aid, substance abuse, suicide, and eating disorders. Participants told personal stories of dealing with mental illness, discussed circumstances they had encountered in the past in serving NYCHA residents, and asked questions about how best to approach hypothetical scenarios they suspected may occur.

When suffering from mental illness, “people often turn to people they know or agencies they trust, or people they see in their communities,” said Dr. Gary Belkin, executive deputy commissioner of mental hygiene for the city, who visited the training. Belkin explained that mental illness and mental health challenges are more prevalent among NYCHA’s residents, who number around 500,000, than the population at large.

ThriveNYC was launched by New York City First Lady Chirlane McCray, who was motivated by seeing many around her benefit from receiving aid for mental health ailments. “I heard many stories of triumph that reminded me of a fundamental truth: Mental illness is treatable. When people have access to the resources they need, they can live their lives to the fullest,” McCray wrote in a roadmap for ThriveNYC. The $850 million program aims to make mental health care more available and changing norms around the general issue to make receiving care more appealing to New Yorkers, many of whom are unaware of their options or are unwilling to seek assistance.

According to a 2015 report from the city Department of Health, one in five New Yorkers suffers from mental illness, including challenges ranging from acute depression to schizophrenia. Forty-one percent of those with mental illness said they did not receive or were delayed in getting treatment in the past year, according to the ThriveNYC website. One major ThriveNYC goal is training 250,00 New Yorkers in mental health first aid, thus working to combat the larger problem by making New York City communities more aware of both the signs that an individual may be in need of assistance and the resources available to those with mental health challenges.

On the side of the room in which the NYCHA training session was held last week stood signs with contact information for mental health hotlines both nationally and in New York City, for use in connecting residents to care providers.

NYCHA is a particularly important organization in the city’s battle against mental illness, Dr. Belkin told the staff members gathered for the training. Just before the lunch break, he spoke to trainees about how their close relationships with New Yorkers are essential to providing help to those suffering with mental health issues.

Dr. Belkin said that NYCHA workers, who forge bonds and establish trust with NYCHA residents, are well-positioned to assist in achieving key ThriveNYC goals. NCYHA employees have a “kind of a familiarity and a closeness” with low-income New Yorkers that others, such as doctors and nurses, don’t, Belkin said in an interview with Gotham Gazette following his remarks to the NYCHA staff. “It’s a real opportunity to be credible to the people we’re trying to reach,” he said. “It seems like a natural fit.”

NYCHA residents are a particularly important cohort to reach, too, Dr. Belkin explained. “It's not just the proximity and credibility with residents that NYCHA has but also this is a group of New Yorkers we need to reach,” he said. “People residing in NYCHA housing or rental assisted housing, or either, are two to three times more likely to have what we call ‘serious psychological distress,’” said Dr. Belkin, referencing an umbrella term used in health department community surveys that includes a range of illnesses. NYCHA tenants are a “population we need to make sure is connected and feels like they have a point of entry to mental health that's more familiar and not as stigmatized,” Belkin said.

Marina Oteiza, Borough Administrator for Family Partnerships in Manhattan at NYCHA, echoed Dr. Belkin’s optimism in regards to non-medical professionals ability to help people on this front. “A lot of lay people can do this,” she said of efforts to identify mental illness and direct those in need of assistance to the right place. “You don't necessarily need a social worker,” she said of NYCHA employees making connections to services for residents. “If you’re meeting with them, you're comfortable talking to them, you have a rapport with them. You can facilitate that a lot quicker than a social worker,” she said. “It does not need to be with a trained mental health professional,” she continued. “It can be with someone who cares and has an empathetic ear.” Good bedside manner, coupled with formal training would create an effective force towards the goal of improving NYCHA residents’ health and safety with regard to widespread mental health issues, she argued.

During the session, the instructor placed strong emphasis on destigmatizing mental illness, and making sure employees adopted a sympathetic, non-judgmental posture towards those with acute and chronic mental health issues. These ailments are medically treatable conditions and should be seen as such. The session leaders emphasized that mental health issues come about from no fault of the victim’s and did not result from an individual’s actions or character nor from weakness. Nobody should be ashamed or embarrassed for requesting medical attention, they stressed.

Helen Reinstein, certified mental health instructor and senior management trainer with the Learning and Development Unit of Human Resources at NYCHA, was in attendance at Thursday’s training in NYCHA offices at 250 Broadway. “You wouldn't hesitate to talk to someone with a broken arm about getting their arm set and getting the follow up care they need,” Reinstein said of the need to normalize mental health care. “We want people to feel the same way about mental health issues.”

Trainees were introduced to frameworks for types of circumstances they may have to handle in the field and were provided with scripted lines to use should these situations arise. The NYCHA staffers -- employees who help run and maintain NYCHA buildings, properties, and programs -- were also instructed on warning signs of mental illness and techniques to reach people that do not make a concerted effort to alert others of their struggles. Look at “body language,” said Tajhma Carroll, assistant director of Brooklyn Leased Housing, a NYCHA division. She then listed a few frequent indicators they were informed often suggest someone may be in need of treatment. “Sweats, they mentioned, hands or legs shaking. Those are telltale signs,” she said. “It's not only in what they say,” Carroll added.

People “isolated and alone in their house” or who engage in hoarding, wherein individuals store an excessive amount of things in their homes, leading to cramped, unhygienic living environments, are also causes for concern, Oteiza said. “If they’re not letting you into the apartment, that’s going to be a red flag for us,” she said.

If signs aren’t identified and those suffering from mental health problems are unaware of options available to them or unwilling to access medical attention, people may turn to other means to relieve their pain, Reinstein noticed. “A lot of times, people are using illegal substance in order to try to get to a place of feeling normal and using it as self-medication rather than seeking the care and intervention they really need,” she said.

As part of their education, NYCHA workers were instructed to ask some of the toughest questions when evidence warrants them, such as “have you ever considered suicide?” and “do you have a plan to kill yourself?” Those involved acknowledged how hard it can be to ask those questions or to inform someone their condition can only be properly alleviated by receiving a medical evaluation. During the training sessions, NYCHA staff constantly grappled with the challenge of ensuring people are getting the assistance they need, while also lending them enough personal space. “I do think there is a natural reticence to be intrusive, which is a good thing,” said Sherman.

Most trainees appeared to buy into the strategy of being active and quick to inquire if they detect signals that something may be amiss for a NYCHA resident. “So far people have been very receptive,” Reinstein said. “We’re excited about this training,” said Sherman. “I think that we’re really creating a culture where our staff really has the confidence to be able to interact with people, to de-escalate where it’s appropriate, to connect people with resources.”

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Part of ThriveNYC, NYCHA Trains Staff in Mental Health First Aid Wed, 05 Jul 2017 04:00:00 +0000
Every Child Needs Access to Mental Health Services http://www.gothamgazette.com/?id=6960:every-child-needs-access-to-mental-health-services http://www.gothamgazette.com/?id=6960:every-child-needs-access-to-mental-health-services school guidance counselors kipp

(Dr. Thelma Dye, the author)


Prince Harry’s recent admission he is seeking treatment to come to terms with his mother’s death made headlines across the globe and for good reason. As recently as 20 years ago public opinion polls here in the U.S. found more than half the country believed depression was a sign of personal or emotional weakness. So when one of the world’s most recognizable and influential figures says not even a royal is immune to mental health challenges, it can have a significant impact.

Harry, along with his brother and sister-in-law, the Duke and Duchess of Cambridge, have started an advocacy campaign to remove the stigma of mental illness worldwide, primarily aimed at reaching the younger generations. Given that two out of every three children experience a traumatic event by their 16th birthday, this effort couldn’t have a better audience.

In working with children and families for more than 20 years here in New York City, I have seen firsthand how addressing mental health issues at an early age leads to better learning outcomes, stronger family relationships, and improved life outcomes. It’s not a secret that mental health is as critical as physical health in a child’s long-term development, and child psychiatrists see that every day in their work.

But advocacy alone won’t be enough to protect the countless children, including many in our own city, who fly under the radar. Untreated mental illness disproportionately affects communities of color. In fact, African-Americans are 20% more likely to experience serious mental health problems than the general population. In our schools, these are the kids most often labeled as “behavior problems” and disproportionately represented in our suspension and dropout rates and in our criminal justice system.

Over the past several years, New York City has started to take some important steps towards identifying and supporting the mental health needs of students, but of course we need an even more committed effort.

For example, Northside Center, which I lead, recently announced a partnership with CVS to expand Clinic in Schools, an initiative that provides in-school mental health services and referrals for families. In the ten schools in which we currently work, we have seen great strides in treatment for children with anxiety and depression. The partnership will allow us to expand our services more comprehensively in the ten schools we currently serve with an eye on expansion to more schools as space and funding permit.

In addition, First Lady Chirlane McCray recently expanded her ThriveNYC program, which provides free mental health services to children ages 0-5 throughout the city. These kinds of programs make a significant difference for the individuals they serve. Schools with full-time social workers and other mental health services report fewer classroom disruptions, lower suspension rates and absenteeism. And we know the more time children spend in school learning, the more likely they are to have better academic outcomes.

But we also know there are more than 1,700 public schools and a million school kids across the five boroughs, and many are slipping through the cracks.

Mayor de Blasio’s new “3-K” initiative holds tremendous potential in this area. By getting students into formalized education programs at three years old, we can identify and address learning and behavioral challenges even earlier – issues that if left unattended often become major barriers to achievement as these children grow up. As with any health issue, prevention is the most effective treatment.

Despite all this progress, I worry about the future. We don’t know how federal health care and Medicaid reforms will affect mental health services for our most vulnerable citizens nor the impact on insurance plans that already undervalue the importance of these treatments. Any program that increases the number of uninsured Americans bodes poorly for our health as a nation.

We’ve come a long way as a country in recognizing that mental illness is a common and treatable disease. New public opinion polls show two-thirds of the population view mental illness as a very serious health concern. If depression and anxiety can alter the life path for years of a man like Prince Harry, imagine what it does to a child who doesn’t have the advantages he does. It’s time we turn this increased awareness into action. We can start by making stronger connections for decision-makers that show mental health translates into school, career, and life success, and not just for royals but for everyone.

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Dr. Thelma Dye is executive director at Northside Center for Child Development.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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Every Child Needs Access to Mental Health Services Mon, 29 May 2017 04:00:00 +0000
Eleanor Bumpurs, Deborah Danner, and Finally Fixing Our Emergency Response http://www.gothamgazette.com/?id=6582:eleanor-bumpurs-deborah-danner-and-finally-fixing-our-emergency-response http://www.gothamgazette.com/?id=6582:eleanor-bumpurs-deborah-danner-and-finally-fixing-our-emergency-response NYPD lights officer car

(photo: @NYPDnews)


Heartbreak and outrage at another deadly police shooting - this time concerning Deborah Danner, a 66-year-old woman with a psychiatric disability. Police, responding to a call about an "emotionally disturbed person," entered her apartment and when the woman became agitated and combative, an NYPD Sergeant killed her.

It is all achingly familiar. In 1984, Eleanor Bumpurs, who was also a disabled elderly black woman in the Bronx, was killed with twin shotgun blasts in similar circumstances.

In the wake of Bumpurs' death, which generated widespread outrage but no charges or discipline to the officers involved, the NYPD tightened its use of force rules and internal procedures. Since then police are only supposed to use deadly force if there is an immediate threat to someone's life.

In this case, reports indicate Danner was naked and holding a pair of scissors when police confronted her. The officer was able to get her to drop the scissors but she then allegedly threatened the officer with a wooden bat. While a bat can be a serious weapon, capable of causing real injury, this shooting could have been avoided - something both NYPD Commissioner James O’Neill and Mayor Bill de Blasio quickly said on Wednesday, the day after Danner was killed.

Officers knew that they were going to be confronting someone with schizophrenia. They had been there several times before. The sergeant who killed her had his standard issue Taser.

Why did the officer not use his Taser? The reason for issuing them was to avoid exactly this kind of tragedy. Did cops have a plan to keep things from escalating? Did they have a plan to manage the presence of a weapon? Did they have a plan for retreating if necessary to preserve life?

Commissioner O'Neill stated that this was a failed interaction. That admission is a refreshing break from past defensiveness by police leaders.

There has been a great deal of discussion about how to better train police to deal with these kinds of situations, and some new training has occurred. But the problem runs so much deeper. Former cop and now law professor Seth Stoughton has documented the ways in which the bulk of police training teaches them how to be "warriors" rather than "guardians."

They are constantly reminded that any encounter can turn deadly and that they must be ready to use force at any time. That it's "better to be judged by twelve than carried by six." This helps explain recent tragic police killings like those of 12-year-old Tamir Rice, killed in a park, and John Crawford, killed in a Walmart.

But the fact that police had to even be dispatched in the first place is a sign that something went wrong.

Health officials knew about this woman's condition. Neighbors reported that they had recently seen her taken away in a straight jacket. Why was she returned to her apartment without adequate ongoing supervision or care?

The mayor has acknowledged that there is a problem with community mental health care. A recent report by his wife, Chirlane McCray, identified many of the gaping holes in the system and outlined some plans for closing them.

Yet thousands of profoundly disabled people continue to roam the streets and subways or idle away at home with little or no support, leaving police to deal with the crises that inevitably result.

There are alternatives. A coalition of service providers, advocates and family members has spent years calling on the city to create "crisis intervention teams" made up of medical professionals who could respond to calls for help.

They are trained to deal with difficult and combative people without resorting to deadly force. They could also coordinate with a community-based case worker who would be aware of the person's condition and past interactions with authorities, allowing them to develop a plan for safely resolving the call. The Health Department has a few of these teams but they don’t normally respond to 911 calls.

The mayor said that an “ESU,” or emergency service unit, was on the way, and that officers should have waited for its arrival. While that surely would have been better, it is not the same as having a crisis intervention team as first responder to such an incident with a known mentally ill person.

Even if we civilianize much of the responses to these calls, police will still have interactions with this population. We need a change in police training and culture that goes deeper than a few hours of de-escalation preparation. The mayor was wrong when he said that current training is adequate and this was just the mistake of a single officer. Ultimately, police are the wrong people to be responding to a person experiencing a mental health crisis. Until we develop robust community-based mental health services, tragedies will continue to occur.

***
Alex S. Vitale is associate professor of sociology at Brooklyn College and author of City of Disorder: How the Quality of Life Campaign Transformed New York Politics. He is senior policy adviser to the Police Reform Organizing Project and serves on the New York State Advisory Committee to the US Civil Rights Commission. On Twitter @avitale.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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Eleanor Bumpurs, Deborah Danner, and Finally Fixing Our Emergency Response Thu, 20 Oct 2016 04:00:00 +0000
City Council Embraces Mental Health First Aid http://www.gothamgazette.com/?id=6493:city-council-embraces-mental-health-first-aid http://www.gothamgazette.com/?id=6493:city-council-embraces-mental-health-first-aid MHFA Training

Mental Health First Aid training (photo via Council Member Cohen's office)


As City Council members we are known mainly for our work of enacting legislation, passing the budget, and land use determinations. What is often overlooked is the business our offices and staff do all day, every day -- the business of constituent services. Any community member can walk off the street into our district offices or call those offices by phone and will be assisted by staff on whatever the issue may be.

You can come in if you need a document notarized or if you call in a 311 complaint and want help to follow up. If you have a problem with your housing situation, a traffic and safety issue, or a quality of life concern in your neighborhood, we can help. It is through this work that we learn about the priorities in our communities and the needs of our constituents, and these interactions are often the inspiration for legislation or for funding a new project.

Constituent services are the lifeblood of our work as Council members. New Yorkers rely upon these services and it is through these services that we encounter all different people, with a variety of needs and concerns, including persons with mental illness. In fact, one in five New Yorkers experience a mental health issue in a given year. Therefore, the Council is participating in the Mental Health First Aid initiative, including a two-day program this week that includes dozens of participants that work for the City Council and its elected members.

Mental Health First Aid trains people to support someone who may be suffering from a mental health condition, helps to reduce bias against mental illness, and allows people to more comfortably engage with mental health issues. The program teaches the common risk factors and warning signs of specific types of illnesses, such as anxiety, depression, substance use, bipolar disorder, psychosis, and schizophrenia. It prepares participants to interact with a person in crisis and connect the person with help, whether it is professional, peer, social, or self-help care. Like CPR, Mental Health First Aiders are certified to deliver the initial intervention to an individual experiencing mental health problems until the appropriate treatment and support are received or the crisis resolves.

We are embarking on a new era in mental health, one where the shame, silence, and stigma that have surrounded mental illness are losing their stronghold. This City Council and this city administration are leading the way in bringing mental health out of the shadows and into the light. The Council is prepared to do its part in changing the culture of mental health, by doing what we do best: conscientious constituent services, one New Yorker at a time.

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Andrew Cohen is the New York City Council Member representing District 11 in the Bronx, which includes Bedford Park, Kingsbridge, Norwood, Riverdale, Van Cortlandt Village, Wakefield and Woodlawn. On Twitter @AndrewCohenNYC.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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City Council Embraces Mental Health First Aid Tue, 23 Aug 2016 04:00:00 +0000
As Council Begins Oversight, McCray Reports Progress in Mental Health Roadmap Implementation http://www.gothamgazette.com/?id=6134:as-council-begins-oversight-mccray-reports-progress-in-mental-health-roadmap-implementation http://www.gothamgazette.com/?id=6134:as-council-begins-oversight-mccray-reports-progress-in-mental-health-roadmap-implementation chirlane mccray richard buery mental health

Chirlane McCray & Richard Buery testify (photo: William Alatriste)

 


 

At a Jan. 28 oversight hearing held by the Committee on Mental Health, First Lady Chirlane McCray testified before the City Council for the first time, updating the Council on the city’s progress implementing its new “mental health roadmap.”

ThriveNYC, as the roadmap is called, is spearheaded by McCray and entails a comprehensive effort involving over 20 city agencies, 54 initiatives, and $850 million allocated over the next four years to improve access to quality mental health care.

McCray, joined by Deputy Mayor Richard Buery and Dr. Gary Belkin, executive deputy commissioner of the city's Department of Health and Mental Hygiene, emphasized the ThriveNYC focus on creating more points of entry into the mental health care system for New Yorkers, the importance of early intervention, and eliminating the stigma associated with mental illness. Buery has been named by Mayor Bill de Blasio and McCray as the City Hall point person for the implementation of ThriveNYC.

During the hearing, Council members praised McCray, who is the Chair of the Mayor’s Fund to Advance New York City, for her role in making mental health a priority for the city, and were generally impressed by the progress that has been made so far.

“The roadmap was only released at the end of November, and the fact that the ball is rolling on some of them bodes well for how this is going to go,” Council Member Andrew Cohen, chair of the Committee on Mental Health, told Gotham Gazette in a post-hearing interview. Cohen added that he was “very pleased” with the hearing and thought it went “very, very well.”

Cohen conceded that the McCray, Buery, and Belkin were not “100 percent certain” about what benchmarks or metrics would be best to measure the success of each of ThriveNYC’s initiatives, as one metric may be appropriate for one initiative, but different standards may be needed for another initiative.

“But, I think as they start rolling them out and as they start providing these services, we’re going to be very interested in seeing that there’s some way to quantify that the programs are successful, that the taxpayers are getting their money’s worth,” Cohen added.

Though Council Member Joe Borelli, who represents the South Shore of Staten Island, told Gotham Gazette he was “happy to hear that the First Lady has made [mental health] a priority and that it’s actually resulted in the city administration looking at mental health as a priority,” Borelli did take issue with ThriveNYC’s lack of resources and plans to address the opioid epidemic on Staten Island.

“Deputy Mayor, in your testimony you made a point to highlight a number of different ethnic and community groups that have specific needs, and what is potentially going to be done to address it...the number one county in the entire state [for heroin and opioid addiction] is Richmond County,” Borelli said during the hearing.

And in Richmond County, the problem is primarily concentrated on the South Shore of Staten Island, Borelli continued, “and yet, I look on the map and I see only three blobs that have any substance abuse counseling in this area - one of which is about to be closed.”

Ideally, Borelli said in an interview after the hearing, he’d like to see more SAPIS (Substance Abuse Prevention and Intervention Specialist) counselors in Staten Island schools. Tottenville High School, for example, has “almost 4,000 students, and it only has one counselor. There’s a real need,” said Borelli.

Some community-based organizations also expressed frustration during the hearing. Alan Ross, executive director of Samaritans of NYC, a 24-hour suicide prevention hotline, took issue with the fact that several ThriveNYC initiatives are being touted as “new,” yet organizations that already carried out such work in New York City had seen their funding cut and programs terminated.

“There are apparent contradictions in the plan that warrant further examination,” Ross said. “You’ve got these goals, but four years ago they terminated several programs and they said LifeNet was going to pick up all the service and then last year LifeNet couldn’t handle the weight,” Ross continued, looking to the de Blasio administration to address changes made under its predecessor.

“We need to acknowledge the tremendous efforts currently undertaken every day by community agencies,” added John Kastan, chief program officer of Jewish Board of Family and Children's Services. “For ThriveNYC to work, it must...build on the existing infrastructure of services, rather than create a parallel system.”

Cohen expressed agreement on that point, saying in an interview after the hearing, “ultimately the strength of that community is going to drive how successful the roadmap is going to be.”

“The RFPs have to meet the service-provider network that we have,” Cohen added,” I think these service providers need to be a part of developing the specifics of these RFPs so we get a lot of responses and so there’s a successful, not-for-profit program implementing these measures.”

City funding of $62 million has been allocated to ThriveNYC in the fiscal year 2017 preliminary budget unveiled by Mayor de Blasio on Jan. 21. According to McCray and Buery, some of the recent progress that has been made in implementing ThriveNYC and upcoming benchmarks for this year include:

  • NYC Health + Hospitals and Maimonides Hospital have committed to reach universal screening for maternal depression in women both during pregnancy and after giving birth within two years. -NYC Health + Hospitals will expand and standardize their current screening process for maternal depression in three facilities beginning this February, and Maimonides will begin training for maternal depression screening in February as well.
  • Hiring has begun for a network of 100 school mental health consultants, who will provide advice and referrals to schools currently without onsite mental health services. The first cohort of about 40 consultants is expected to be on staff in DOE support centers beginning in April.
  • Since the Department of Health and Mental Hygiene first began mental health first aid training a few years ago, 6,000 New Yorkers have been trained in mental health first aid. According to Buery, the city is on track to have 10,000 trained in mental health first aid by the end of ThriveNYC’s first year, with a total of 50,000 by the second year. Training spots are currently open three times a week to the general public. About 30 mental health first aid instructors have been trained since ThriveNYC launched, and 500 more are expected to be trained in the next five years. Mental health first aid classes in Spanish will begin to be offered in mid-to-late February, and classes in Mandarin will be offered later this year.
  • The RFP for NYC Support, an initiative which will give New Yorkers 24/7 access crisis counseling and schedule appointments with mental health providers via phone, text, or website, was released in January, and a contract will be in place by spring in order for service to begin later this year.

On February 23, a Mental Health Council comprised of the leaders of more than 20 city agencies will meet for the first time, in an effort to ensure effective planning and coordination across all agencies.

In March, the city will announce the community-based organizations that will participate in the Connection to Care program, a public-private partnership that aims to reduce stigma and increase access to mental health services by integrating mental wellness supports into existing social services agencies.

By this summer, the city, in partnership with schools and social workers, will have its first cohort of 130 new clinicians in the mental health workforce seeing patients. Starting in fiscal year 2017 (which begins July 1), the city will contract a community-based organization to train 200 peer support specialists per year.

To McCray, the mental health roadmap may just be the “tip of the iceberg...ThriveNYC is not intended to be a cure all - it wasn’t intended to fix the problem, it’s intended as a first step, as a conversation starter, and it’s intended to deal with those things that are in front of us right now that we can actually treat and address.”

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by Meg O'Connor, Gotham Gazette
     

Read more by this writer.

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As Council Begins Oversight, McCray Reports Progress in Mental Health Roadmap Implementation Tue, 02 Feb 2016 02:52:43 +0000
Ending the Revolving Door of Homelessness http://www.gothamgazette.com/?id=6054:ending-the-revolving-door-of-homelessness http://www.gothamgazette.com/?id=6054:ending-the-revolving-door-of-homelessness swann homelessness revolving door

Patricia Swann, the author


While Mayor Bill de Blasio works on the details of a 15-year, $2.6 billion supportive housing program to address homelessness, Gov. Andrew Cuomo is creating a statewide plan to reduce homelessness. New York should draw on approaches that have helped in the past as well as those that seem promising, especially supportive housing, which offers job training, debt counseling, mental health care, and other crucial services to residents in an effort to stop the revolving door of homelessness.

We all have to start by acknowledging reality: homelessness is a chronic New York problem, as we can tell from walking the streets or reviewing simple statistics. On any given night the number of people sleeping in shelters is close to 60,000 -- 25,000 are children.

New Yorkers fatigued by the crisis tend to identify it with street dwellers – often middle-aged men with substance-abuse or mental health issues. The truth is that homelessness is rising among families, younger men and women, and the working poor.

The one-two punch keeps getting worse: housing costs are exorbitant while wages are stagnant. Last year, 30.1 percent of the city’s renters paid more than half their incomes in rent. The result: New York City saw 26,857 evictions in 2014.

So much for de-stigmatizing homelessness — the reality is that these are our neighbors and coworkers.

The urgent question is, what works?

In the past 20 years, the New York Community Trust has given about $30 million to nonprofits addressing different aspects of the problem. One proven approach is not simply to increase shelters but to create permanent supportive housing for lower-income New Yorkers. That includes on-site services for medical and physical disabilities, HIV-related illnesses, and mental and substance-abuse disorders. This housing should coordinate with nearby groups that provide other basics, including childhood education centers, employment and financial training, health and substance-abuse clinics, open spaces, access to quality food, libraries and cultural venues.

Studies show such supportive housing cuts taxpayer costs while helping vulnerable people become productive citizens. In the past, the state and city split the cost of supportive housing as well as stronger protections for existing low-cost housing; we hope they will resume that agreement.

Still, it takes years for new units to come online, and meanwhile nearly 60,000 people subsist in shelters that the city’s Department of Investigation calls dilapidated. We need to test alternate strategies. That’s why the Trust is funding an initiative called Gateway Housing, a coalition of nonprofits that run city shelters. Under Gateway, the nonprofits are committed to working with the city and state to rebuild shelters.

More important, they’ll use proven practices and undergo regular evaluations of their social-services programs. Because a strong community is critical to addressing homelessness, Gateway seeks to make shelters integral to neighborhoods.

We have learned that well-directed money can deliver lasting results. For example, we’ve funded several groups that had success in assisting families deal with rising housing costs — by freezing rents for the elderly and disabled, or by providing emergency aid and financial counseling to low-wage New Yorkers. Many times, a head of family who loses a job or is dealing with a health crisis needs just a few weeks’ aid to avoid eviction.

The Trust also funds a promising initiative called Joint-Ownership Entity. Under that model, nonprofit developers — the same organizations that saved the South Bronx, eastern and central Brooklyn, and northern Manhattan from disappearing into rubble in the late seventies — are combining developments into single-ownership entities. This should help them achieve economies of scale in running and maintaining their properties, keep rents down, and generate revenue for services. These nonprofit developers are important neighborhood anchors; if not for the housing they manage at affordable rents, many of the residents would become homeless.

We’re not naïve: No one can end homelessness in an expensive city with persistent pockets of poverty. But by finding ways to keep rents affordable in some neighborhoods, supporting those facing temporary financial setbacks, and offering job training, substance-abuse counseling, and other wraparound services, we can buttress thousands of New Yorkers who are trying to provide a stable home to their families.

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Patricia A. Swann is a Senior Program Officer for Community Development at the New York Community Trust. On Twitter @NYCommTrust.

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Have an op-ed idea or submission for Gotham Gazette? E-mail editor Ben Max: bmax@gothamgazette.com 

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Ending the Revolving Door of Homelessness Sun, 27 Dec 2015 05:00:00 +0000
McCray Set to Unveil ‘Mental Health Roadmap,' Signature De Blasio Plan http://www.gothamgazette.com/?id=5877:mccray-set-to-unveil-mental-health-roadmap-signature-de-blasio-plan http://www.gothamgazette.com/?id=5877:mccray-set-to-unveil-mental-health-roadmap-signature-de-blasio-plan McCray roundtable

Chirlane McCray hosts a mental health roundtable (all photos: the Mayor's Office via flickr


Over the past several months, New York City First Lady Chirlane McCray has had conversations with many of the city’s service providers, non-profit organizations, and long-time advocates for mental health care provision. In preparation to unveil a “roadmap” addressing the “mental health crisis in New York City,” McCray has spoken with a diverse array of constituents who will be directly impacted by new policies.

In collaboration with key departments of her husband’s administration, McCray, who is Chair of the Mayor’s Fund to Advance New York City, is leading a multi-agency effort to evaluate mental health care provision city-wide, particularly for low-income and at-risk communities, and chart a path forward.

“It is long overdue to acknowledge that our inattention to mental illness is a public health crisis that requires a public health solution,” McCray wrote in a recent column at CNN.com, in which she discusses mental health care in a national context.

Key to the push behind the initiative is the notion that better mental health care can not only help people live healthier, happier, and more productive lives, but that an improved approach to mental health care can help the city’s education, housing, criminal justice, and other systems.

Schools, homeless shelters, senior centers, and jails have been highlighted in the city’s new fiscal year 2016 budget as targets of funding for improved mental health care services. In unveiling her roadmap, McCray is likely to follow up with additional initiatives supporting and tying together these and other sectors, “bringing more resources and better resources to those who need it most,” as she writes. McCray’s plan is due to be released this fall and is certain to discuss mental health as important to all aspects of life, and city services.

Gotham Gazette spoke with service providers and experts in anticipation of the release of McCray’s roadmap and many applauded the work of the First Lady and Mayor de Blasio. There is widespread appreciation for their efforts to prioritize reforming mental health care in New York City - and relief that it is being spoken about so openly and with such urgency.

Regarding the roadmap, general suggestions were consistent, with experts and stakeholders saying that it should call for:
-Improved and sustained communication among service providers, city government and organizations for mental health care advocacy;
-Prioritizing mental health care in all aspects of city government policy;
-Reducing stigma of mental illness and promoting larger public education about mental wellness.

Last week, de Blasio’s office announced that Richard Buery, Deputy Mayor for Strategic Policy Initiatives, will spearhead the implementation of the plan “to create a more effective mental health system.” Over the past two years Buery has overseen and coordinated the rollout of de Blasio’s ambitious and initially successful universal pre-Kindergarten program. Dr. Mary Bassett, commissioner of the city Health Department, is also sure to play a key role in implementing any new mental health programming.

“Mental illness touches the lives of most New Yorkers,” McCray said in a statement, adding that there has long been two separate health care systems, “one for physical health and one for mental health."

“We can – and will –  improve access to mental health care in New York City and bring mental health care services where New Yorkers live, work and study," McCray promised.

In drawing a “mental health roadmap” to accomplish those lofty goals, it appears that McCray will focus on reducing stigma around mental illness and treatment; conducting a detailed assessment of the current state of service provision city-wide; and, creating a comprehensive and sustainable plan for mental health care for all New Yorkers. Informing the entire plan will be the notion that both governmental and non-governmental service providers of all kinds can contribute to a better, more intertwined mental health care system.

Programming efforts will surely be tied with outreach and publicity campaigns pushing New Yorkers to seek treatment and ensuring that people are more aware of both warning signs of mental illness and available services. There will all but certainly be a focus on equity throughout the city’s boroughs and neighborhoods, with a special focus on the poorest New Yorkers and those who do not speak English - aligning with the motivating theme of the de Blasio administration.

A few recent announcements regarding mental health care show key elements of the roadmap and give indication of what the larger plan will look like. McCray's map and contracts with service providers should provide indication of how the city will measure the effectiveness of its efforts.

On August 6 Mayor Bill de Blasio announced the NYC Safe program, “an evidence-driven public safety and public health program.” NYC Safe, a $22 million program, centralizes oversight of efforts by public health and public safety officials to intervene or prevent violence from people with mental health challenges.

“This is a subset of a much bigger mental health reform plan that you’ll hear about from the First Lady in the fall. This is just the first of many pieces,” said the mayor.

Connections to Care (CTC), a $30 million program launched in a public-private partnership between the Mayor’s Fund to Advance New York City, the federal Corporation for National and Community Service (CNCS), and private funders, seeks to expand access to mental health care for low-income and at-risk communities.

The Mayor’s Fund announced the program on July 30, having successfully secured a $10 million federal grant, to be administered over the course of five years, from the Social Innovation Fund of the CNCS; an additional $20 million has been matched by the Mayor’s Fund and selected service partners. CTC will expand mental health care access by collaborating with community organizations to integrate mental health services into existing programs, providing training and support for staff.

The program will also fund a study to assess the efficacy of service providers and the experiences of those receiving care. In the fall, proposals from service providers will be accepted for review.

In May, de Blasio announced his fiscal year 2016 Executive Budget, allocating a projected total of $132.7 million for mental health care during fiscal years 2016 and 2017. The City increased funding for mental health care services in the sectors outlined below. The investment is intended to “build a more effective and inclusive mental health system in New York City” and create a national model. It is sure to form much of the backbone to McCray’s roadmap.

McCray de Blasio

Schools
According to the Office of School Health, it is estimated that 9% of 6-12 years olds in New York City suffer from anxiety, depression and other mental health challenges. A survey conducted in 2011 reveals 8.4% of high school students have attempted suicide one or more times. McCray described the need to eliminate stigma around mental illness, citing statistics that 61% of adults and 35% of children in the city are not receiving the services they need.

More counselors and outside clinicians at city schools, especially in the "community schools" being opened by the de Blasio administration, are key to the effort of providing better mental health care to students.

Maria Astudillo, Director of Mental Health Services at the Children’s Aid Society, asks “what are some of the universal interventions we can do [in schools]?” Given that every year students are required to have physical examinations, Astudillo believes there should be social and emotional screenings for students as well. “We have to be creative, we have to think outside the box,” she said.

Jails
“What we effectively have seen in this country is that the largest mental health facilities in the country now are jails. And people who are mentally ill end up going through the criminal justice system in ways that are utterly inappropriate and hugely damaging and not at all helpful for community safety,” JoAnne Page, President and CEO of The Fortune Society told Gotham Gazette.

Rikers Island jails, recently headlining news due to the deaths of Bradley Ballard, Kalief Browder and others, are under review by the de Blasio administration and outside entities for both immediate and long-term reform.

“Being at Rikers is trauma -- when you’re talking about mental illness, both creation of it and exacerbation of it,” Page added.

Most recently, the de Blasio administration announced in June it would not renew the contracts with two contracted for-profit Rikers health care providers, Corizon, Inc. and Damian Family Care Centers, Inc. New York City Health and Hospitals Corporation (HHC) will take over as the primary provider.

“We have an essential responsibility to provide every individual in our City’s care with high-quality health services – and our inmates are no different,” said Mayor Bill de Blasio in a June press release. “This transfer to HHC will give our administration direct control and oversight of our inmates’ health services – furthering our goal of improving the quality and continuity of healthcare for every inmate in City custody.”

John Boston of the Legal Aid’s Prisoner’s Rights Project noted, “It is especially appropriate to make this change with respect to mental health care, since the City is attempting to improve mental health treatment in the jails,” adding that Corizon had a “track record” of failing to administer appropriate treatment.

Often anyone receiving treatment while in jail, juvenile detention centers, or homeless shelters has had “experiences with mental health services that were more about control than treatment,” says Page of The Fortune Society.

Furthermore, Page says that policing policies such as adherence to the “broken windows” model leaves “people getting arrested for things like being mentally ill and homeless. So the criminal justice system is stigmatizing people even more.”

In December 2014, the de Blasio Administration launched a $130 million, 4-year plan detailed in a report by the Task Force on Behavioral Health and the Criminal Justice System in order to “drive down crime while also reducing the number of people with behavioral health issues needlessly cycling through the criminal justice system.”

First Lady McCray described the criminal justice system as “a maze [New Yorkers with mental health and substance use disorders] can never escape. The City has made a real commitment to addressing the root causes of this urgent problem.”

Initiatives outlined in the Task Force’s Action Plan -- fewer arrests for low-level crimes and, largely, more alternatives for police can use; better community-based treatment for mental illness; and better alternatives for incarceration or detention -- Page believes are a good start to  implementing any sustainable change.

“People should be in jail as a last resort – not on low bail,” Page says. “Not because nobody knows what to do with them, they should [only] be in jail because they’ve done something serious and there’s no better alternative. We lock up way too many people.”

McCray Oddo

Homelessness
The Coalition for the Homeless reports that every night thousands of unsheltered homeless people sleep in the streets and other public spaces. The large majority of street homeless people live with mental illness or other health problems, according to the Coalition.

“Many cities have a troubling number of cases in which a person with mental illness is subjected to unnecessary arrest or unnecessary violence,” said Alex Vitale, a sociology professor at Brooklyn College.

NYC Safe, the violence prevention program introduced in August by de Blasio, will partially assist in serving the homeless with “mobile treatment teams” and other resources for immediate care.

Though improved access to services and treatment is necessary, Vitale stresses that “ultimately, it is not just mental health outreach workers or a few targeted programs for violent offenders that is needed." To deal with chronic homelessness, to help mentally ill homeless people, “a supportive housing program” is essential, Vitale says. He wrote about such a need in a recent Gotham Gazette column.

Susan Wiviott, CEO of The Bridge, shares this sentiment. Wiviott believes McCray’s roadmap will revolve around preventative care and access to mental health services in communities, which is needed, but the costlier programs of supportive housing and in-treatment services must be on the agenda as well. “If you really want to help people and change their lives so they’re not living on the street, then there must be some access to a stable place to live.”

McCray’s outline could very well advocate for an increase of city funds toward supportive housing and renew de Blasio administration calls for the state government to significantly up its contribution to a new NY/NY supportive housing program, the source of recent controversy.

Seniors
Senior adults – 60 years and older – represent the fastest growing population in New York City. By 2030, one in five New Yorkers will be a senior adult. The Department of Health and Mental Hygiene (DOHMH) estimates that approximately 20% of New Yorkers 55 and older experience mental illness.

The de Blasio administration has allocated $800,000 in fiscal year 2016, which began July 1, to place clinical social workers in the city’s 20 largest senior centers.

This is not quite enough, though, for some service providers. “You have to recognize that a good portion of the people who are older, who will need mental health services, are homebound. There has to be support for those services,” Nancy Harvey, CEO of Service Program for Older People (SPOP), told Gotham Gazette.

“You can’t just be at senior centers because a lot of the older populations can’t get to senior centers,” Harvey adds. “Forty percent of clients at my agency are homebound, they cannot get out so you have to be able to deliver the services to their homes, there has to be support and recognition for that model, which is more expensive, but certainly less expensive than them ending up in hospitals or nursing homes.”

Harvey credits the First Lady for “bringing visibility to mental health” in New York City and is hopeful about the attention highlighting the need for greater services and treatment, especially for older adults. Senior centers cannot remain the sole focus, however, because “we need to have a broader view of how we’re going to reach [homebound] people,” she says.

McCray Bassett

Building a Better Mental Health Care System
DOHMH created the Center for Health Equity in 2014 under the direction of Commissioner Mary Bassett, hoping to employ a community-based approach toward healthy New Yorkers.

Marlon Williams works at the center as Director of Cross Agency Partnerships at DOHMH. He uses a “health-in-all-policies” (HiAP) approach, focusing on promoting community health in the work of different city agencies.

In an interview with Urban Omnibus, Williams spoke of external factors affecting the health of New Yorkers.

“Very few health outcomes actually have to do with your access to healthcare services,” Williams said. “Much of what determines your ability to live to your fullest health potential is about the physical and social context in which you live. Issues of race, discrimination, class, and poverty all have a tremendous impact on health and create specific health inequities.”

As has been cited in the recent Legionnaires’ Disease outbreak in the South Bronx, poverty and health care issues often overlap. The new Connections to Care program will soon be looking to contract with community-based organizations where vulnerable populations can be reached and people with symptoms or at risk of mental illness can be identified and helped. These can include people struggling with stable housing, employment, or sobriety; new or expecting parents; and out of work young adults.

McCray and her husband’s administration have announced programming so far that reflect the complexities of health, particularly mental health, disparities. McCray’s roadmap is all but certain to follow a HiAP model, including schools, jails, and other places where New Yorkers may access services and evaluating needs based on income, cultural background, and more.

Creating an effective and comprehensive mental health care system will require, Williams believes, that the city government figures out “place-based intervention to address, mitigate, or even prevent [health inequities] — so anyone anywhere in New York City has an opportunity for optimal health.”

Essential to the city's efforts will be tracking its programs and the work being done by community organizatins, service providers, and city agencies. With more investment comes more scrutiny and the need to prove the efficacy of devoting resources to new work.

In her recent op-ed for CNN, McCray extended a call for action to other local and national leaders, urging them to commit the time and resources to implement needed mental health care services.

“Stigma, a lack of resources and the marginalization of mental health for decades have left us a fragmented and broken system that must be fixed. Too many people's lives are at stake, in New York City and beyond.”

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by Kaela Sanborn-Hum, Gotham Gazette
@GothamGazette

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McCray Set to Unveil ‘Mental Health Roadmap,' Signature De Blasio Plan Tue, 08 Sep 2015 19:06:12 +0000