Gotham Gazette https://www.gothamgazette.com/component/tags/tag/823 Sat, 15 Aug 2020 03:09:42 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) Defund the NYPD and Save Black and Brown Lives by Reforming Mental Health Crisis Response https://www.gothamgazette.com/130-opinion/9531-defund-the-nypd-save-black-and-brown-lives-by-reforming-mental-health-crisis-response https://www.gothamgazette.com/130-opinion/9531-defund-the-nypd-save-black-and-brown-lives-by-reforming-mental-health-crisis-response police shooting

Questioning one role of the NYPD (photo: Edwin J. Torres/Mayor's Office)


The protests that have erupted across American cities in response to the murder of George Floyd, together with the larger movement for Black lives, have amplified advocates’ calls to defund the police and reallocate resources toward services that would better meet the needs of Black Americans and over-policed communities nationwide. 

New York City’s police budget alone surpasses its spending on housing, hospitals, youth services, and homeless services combined. In response to public outcry, the City Council finally appears ready for a historic reckoning as it now pushes to cut $1 billion from the New York Police Department

The coalition we help lead, Correct Crisis Intervention Today - NYC: Fighting to Transform Responses to Mental Health Crises (CCIT-NYC), has proposed one such defunding measure, which would remove mental health crisis responses from the NYPD’s portfolio entirely.

CCIT-NYC urges the City Council to redirect $16.5 million of NYPD funding to a five-year pilot project in two of the city’s most impacted precincts, Brooklyn’s 75th and Midtown South. 

At the cost of $3.3 million per year, our proposed pilot would pair Emergency Medical Technicians with trained “peers” (people with lived experience of mental health crises). These teams, in place of law enforcement, would serve as first responders for people experiencing a mental health crisis.

Unlike the city’s current Health Engagement and Assessment Teams, which are only available for part of the day and cannot be dispatched directly to the general public, the teams proposed by CCIT-NYC would be available 24/7 and accessible to the public.

This is a proven model. It is similar to the hugely successful CAHOOTS program used in Eugene, Oregon, for over 30 years without any serious injuries to the health-care workers. It is easily adaptable to neighborhoods here.

Critically, this approach enjoys wide public support. A national survey conducted in early June found that nearly 70% of likely voters support “creating a new agency of first-responders, like emergency medical services or firefighters, to deal with issues related to addiction or mental illness that need to be remedied but do not need police.” A majority of those surveyed also agree that police frequently use unnecessary violence; in our city, we know this to be all too true. 

Over the last five years, 14 New Yorkers experiencing a mental health crisis were killed by police responders, a 15th died by a self-inflicted gunshot during a police engagement, and another three were shot by police and left critically wounded. Just this week, one more New Yorker with mental health concerns died at the hands of NYPD after being repeatedly tasered at his home, having threatened no one.

What’s more, that number killed between 2015 and 2020 is double the number killed during the preceding years spanning 2007 to 2014. Notably, these shootings increased despite the fact that, during the same five-year period, 15,000 officers received Crisis Intervention Training to use de-escalation techniques under these very circumstances.

Having worked in the fields of mental health, human services, and criminal justice for decades, we are well aware of the racial disparities in accessing care, and of the wrongful criminalization of Black and brown individuals. As documented by the U.S. Surgeon General, people of color have less access to mental health services than white people, are less likely to receive needed care, and are more likely to receive poor-quality care when they are treated. Of the 18 individuals shot in police encounters in New York City, 16 were Black or other persons of color. 

Of particular note during these precarious financial times is the fact that instituting mental health response teams would pay for itself in savings. Each year, New York City spends approximately $250 million on cases involving police misconduct by the NYPD, and we estimate that roughly one-third of those cases involve people undergoing a mental health crisis. 

The time is right to pilot a culturally competent and compassionate, peer-driven model for responding to mental health crises that avoids inflicting further harm by eliminating the unnecessary use of police, emergency rooms, and psychiatric hospitals. Our proposed pilot’s use of non-police responders trained in engagement and de-escalation techniques would spare the city expensive lawsuits and save lives – particularly those of Black and brown New Yorkers. 

Let’s restore faith that when people call for help in times of crisis, they receive actual help and health care, not the law enforcement response they have come to fear. 

*** 
by Cal Hedigan of Community Access; Jim Mutton of Concern for Independent Living, Inc.; Matt Kudish of National Alliance on Mental Health Illness NYC; and Ruth Lowenkron, Esq., of New York Lawyers for the Public Interest.

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

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Defund the NYPD and Save Black and Brown Lives by Reforming Mental Health Crisis Response Thu, 25 Jun 2020 04:00:00 +0000
Coronavirus Death Toll at State Psychiatric Facilities Climbs Quickly https://www.gothamgazette.com/state/9336-coronavirus-death-toll-at-state-psychiatric-facilities-climbs-quickly https://www.gothamgazette.com/state/9336-coronavirus-death-toll-at-state-psychiatric-facilities-climbs-quickly kingsboro

Kingsboro Psychiatric Center (photo: New York State Office of Mental Health)


The death toll from the novel coronavirus at state psychiatric facilities is rising, according to what scant official figures are available, hinting at a nightmare unfolding inside some of New York's least visible institutions. In just over a week, the number of residents confirmed to have died from the virus has tripled, according to data provided by the state Office of Mental Health (OMH), which runs the 23 centers.

Thirty residents are dead and another seven are suspected to have died from COVID-19, out of roughly 3,500 patients living in state-run inpatient psychiatric facilities. Another 259 current residents, many of whom are there involuntarily after being diagnosed with a severe mental illness, have tested positive for the coronavirus as of Wednesday, April 22. An OMH spokesperson said the agency is in the process of updating the number of employees who have tested positive. On April 17, officials reported 283 out of about 14,400 staff members had contracted the virus.

Citing privacy laws, OMH would not report on staff deaths or even comment on a tip that an employee at Manhattan Psychiatric Center had died of the virus. The agency has also denied requests for a breakdown of positive cases and deaths by facility, county, or region.

This snapshot of the virus' wreckage, now common in other contexts, has only begun to surface 55 days after Governor Andrew Cuomo declared a state of emergency in New York, and only after inquiries. Asked by Gotham Gazette, OMH acknowledged 10 resident deaths at its facilities on April 14. For more than a week after, OMH did not provide updated numbers on its facilities until Thursday, April 23, when the 37 confirmed and suspected coronavirus-related deaths were reported.

People with knowledge of the facilities say the pace at which officials are releasing information and the amount left undisclosed is part of a pattern of obscurity that is able to flourish around a population with few people advocating for it on the outside. It may also suggest an agency without a firm grasp on conditions in its facilities, where the virus is claiming many lives.

Gotham Gazette had identified close to 20 resident deaths in just two psychiatric facilities in downstate counties, when OMH was still reporting just ten. An OMH spokesperson wrote in an email Thursday that the initial ten referred only to confirmed cases.

Meanwhile, the number of confirmed COVID-19 cases and deaths statewide, and in other congregate living sites like nursing homes, ticks up by hundreds each day.

"OMH said that there were ten deaths in all 24 facilities?" asked an employee with direct patient contact at Rockland Psychiatric Center in an interview Wednesday. "No. It's more like ten deaths per facility."

"They are officially acknowledging at least 9 deaths at my facility. I think we are currently up to ten or eleven," the employee told Gotham Gazette.

Members from the Public Employees Federation, a union representing thousands of employees working in the state-run psychiatric centers, have reported to union leadership that at least seven residents at Pilgrim Psychiatric Center on Long Island have died from COVID-19. A patient advocate who works with residents at Pilgrim said they were aware of nine patients who have died there since the outbreak began. (The New York Times reported Friday that the state had confirmed that 10 patients at Rockland and nine patients at Pilgrim have died.)

Everyone who spoke with Gotham Gazette for this story spoke on the condition of anonymity out of fear of reprisal from OMH or for the protection of their clients.

"I think Manhattan Psychiatric also [has] about nine or ten" residents who have died, said the Rockland employee. That information came to them through an informal grapevine of doctors, nurses, and other direct care workers who have become increasingly concerned about the conditions in facilities and the silence surrounding them.

"We talk to each other," the Rockland employee said. "The administration does not communicate that information."

OMH inpatient facilities have been among the hardest hit but most under-discussed congregate living settings in New York. Throughout the months of March and April, patients have continued to gather in close quarters and employees have struggled to get sufficient personal protective equipment (PPE), as Gotham Gazette first reported, creating a fertile environment for spreading the virus. Reports from various service-providers say patients, also lacking PPE, do not have the resources to maintain sanitary conditions and many do not apprehend social distancing and hygiene guidelines.

Patients in New York's psychiatric institutions suffer from severe mental illness like bipolar disorder and schizophrenia. Most residents are admitted through the criminal justice system and are held involuntarily. Many have underlying medical issues that exacerbate the risk of dying from COVID-19.

According to union officials, in the last week of March OMH leadership told labor unions they were still in the process of assessing how much PPE was available at each facility. The Rockland Psychiatric Center employee told Gotham Gazette it wasn't until the second week of April that staff with direct patient contact began receiving one N95 mask per week. Multiple accounts from union leaders and psychiatric staff suggest employees were not allowed to wear certain PPE, even if it was available, until April. Only last Friday, April 17, did employees at Rockland Psychiatric who worked with patients start getting one N95 mask, one surgical mask, and one gown per day.

With the supply of PPE low statewide, the new arrangement is as much as workers feel they can hope for. "This is the first week where we feel we are adequately staffed and have adequate PPE," said the Rockland employee. "But we've had many, many patients get sick, many, many staff get sick in that time."

As in the general population, the distribution of coronavirus cases and deaths at psychiatric centers is not even across New York. While downstate institutions like Rockland, Pilgrim, and Manhattan have many positive cases and deaths, upstate centers have not been hit as hard. Some upstate facilities have had few if any positive cases -- Rochester Psychiatric Center, for example, has not had any positive cases as of Sunday, according to an employee there.

Other facilities have been ravaged. Mid Hudson Psychiatric Center, in Marcy, New York, is one of the biggest and most notorious psychiatric institutions in the state. With a high number of so-called forensic patients -- residents who have come in involuntarily through the criminal legal system -- the facility is already prone to violence and chaos. Since the outbreak began, at least 89 employees there have called out sick, according to a Public Employee Federation leader.

At Rockland Psychiatric, only three units out of 14 are without COVID-19 positive patients, according to an internal report from union leadership that was reviewed by Gotham Gazette. Forty union members have tested positive there and at least one staff member, a mental health therapy aide, has died, the report says. At Kingsboro Psychiatric Center in Brooklyn, staff members exhibiting COVID-19 symptoms could not take paid sick leave unless they tested positive, even if they had a note from a doctor, per emails among employees shared with Gotham Gazette.

OMH has not released information on how many facility-based workers have died of the novel coronavirus, despite numerous requests for that information from Gotham Gazette. In the most recent response, on Friday April 24, OMH Director of Public Information, James Plastiras, wrote: "Suspected COVID-19 related employee death totals at the facilities do not meet the data privacy reporting threshold." In response to a tip that an employee at Manhattan Psychiatric Center had died after contracting the coronavirus, Plastiras last week wrote, “OMH is prohibited by State and Federal privacy laws from providing protected health information.”

But an OMH employee newsletter sent in the beginning of April and obtained by Gotham Gazette includes the names and biographies of four "heroes," workers at OMH psychiatric facilities "who were lost to us during the epidemic." The employees -- a secure care treatment aide at Rockland Psychiatric; a security officer at Kirby Forensic Psychiatric Center; and two mental health therapy aides, one at Kingsboro Psychiatric Center and one at Manhattan Psychiatric -- had a collective 86 years of service, according to the newsletter.

Plastiras said OMH had gotten permission from the employees' families to publish the information, and that the newsletter was only meant to be seen by OMH staff, not the general public.

Cuomo has faced intense pressure from members of the media to provide detailed information on testing, positive cases, and deaths in nursing homes, where residents live closely to one another and are already highly susceptible to the virus because of their age and underlying conditions. In response to scrutiny about incomplete information on where nursing home deaths have taken place and other details, Cuomo has repeatedly said the state can only report to the public what nursing homes, most of which are privately run, report to the state Department of Health. But the Office of Mental Health runs the state's 23 public psychiatric institutions directly and is not dependent on outside entities for information about its facilities.

OMH is not the only government agency restricting information about inpatient mental health facilities, and their patients and staff. Gotham Gazette has been seeking data from New York City Health + Hospitals, the city's public hospital system, about the number of patients transferred since the start of the coronavirus outbreak from city hospitals to OMH inpatient centers.

A Health + Hospitals spokesperson did confirm to Gotham Gazette that psychiatric patients that could not be discharged from hospitals were transferred to state institutions as part of the city's effort to free up hospital beds for COVID-19 patients.

"We have not disclosed the number of inpatients psychiatric transfers to State facilities," the spokesperson wrote in an email. The spokesperson did not directly respond to questions about why they are not publishing the figures, writing, "We haven't shared this data publicly. We'll let you know when it's available."

***
by Ethan Geringer-Sameth, reporter, Gotham Gazette
     

Read more by this writer.

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Coronavirus Death Toll at State Psychiatric Facilities Climbs Quickly Fri, 24 Apr 2020 04:00:00 +0000
10 Dead, Hundreds Infected as State Psychiatric Facilities Become Another Crisis Point in Coronavirus Outbreak https://www.gothamgazette.com/state/9321-ten-dead-hundreds-infected-new-york-state-psychiatric-facilities-crisis-coronavirus-outbreak https://www.gothamgazette.com/state/9321-ten-dead-hundreds-infected-new-york-state-psychiatric-facilities-crisis-coronavirus-outbreak hospital pano

Manhattan Psychiatric Center, Wards Island (photo: @nicknormal via Flickr)


Ten people have died of coronavirus and another 193 have tested positive among the nearly 3,500 residents living in state-run inpatient psychiatric facilities, according to officials, making them one of the hardest hit institutional settings per capita in New York State. Another 283 staff that work at the state's 23 centers have tested positive for COVID-19, which has killed well over 13,000 people across the state.

After inquiries, the information was provided to Gotham Gazette on April 14 by the state Office of Mental Health (OMH), which runs the 23 sites. On April 17, just before publication of this story, OMH said it did not have any new numbers to share.

The centers are home to people with the most severe mental illnesses, who cannot manage their symptoms alone, and are proving to be particularly fertile settings for the virus' spread. They are experiencing exacerbated risks, similar to other congregate settings like jails and nursing homes, which have thus far received virtually all the attention.

Testimony from psychiatric center staff, labor union leaders, and an elected official with oversight of the centers paints a picture of sites where patients continue to gather in groups and staff lack the personal protective supplies needed to limit exposure to the coronavirus, where even basic hygiene and space to quarantine positive cases is lacking. Experts are concerned that the potential for violence among residents, already high, is heightened as they respond to life under the austere conditions of a societal lockdown.

Officials at OMH say the agency has taken precautions to protect residents and staff from the virus, but frontline workers say they have seen few changes on the ground. Union officials representing the workers said they are considering legal action to protect their members.

"There is a degree of fear and uncertainty amongst our workforce as well as, I think, amongst the patients," said Randi DiAntonio, vice president of the Public Employees Federation (PEF), a union representing thousands of healthcare workers in inpatient facilities. "We want to provide the services but we want to be safe and we want the right equipment. We don't want to be going into places when it's not absolutely necessary and critical and we want to be heard."

OMH did not provide information on coronavirus deaths among its staff. In response to an inquiry about a tip that an employee at Manhattan Psychiatric Center had died of COVID-19, spokesperson James Plastiras did not deny the fatality, but wrote: “OMH is prohibited by State and Federal privacy laws from providing protected health information.”

When asked, OMH also did not provide a breakdown of the patient deaths and positive cases by facility or county.

Based on confirmed cases, the psychiatric center coronavirus figures represent an infection rate twice that of nursing homes, and a death rate four times greater than in New York City jails, two settings that have been the focus of significant public attention, as their populations live in crowded spaces, sometimes against their will, and are often more likely to be killed by the virus.

Governor Andrew Cuomo and Mayor Bill de Blasio have each, in the face of public pressure, supported to varying degrees reducing the populations in other congregate living sites and taking stricter precautions to protect the people living in them. Cuomo has faced intense pressure to release more prisoners using his powers of clemency.

But staff and union leaders have reported "business as usual" in psychiatric centers with group therapy sessions of up to 20 people and residents gathering at mealtime in a single large dining room. Health-care workers often see patients with no protective face coverings as they continue to provide support for dozens of residents in shifts of eight to twelve hours.

"In most of the facilities patients were sitting right on top of each other," said Darlene Williams, an occupational therapist at New York State Psychiatric Institute in Washington Heights, of the group sessions that continue to meet during the pandemic. She is a 40-year veteran of the state's inpatient centers and a regional coordinator for PEF members in downstate facilities, including some of the largest in the state, like Manhattan, Bronx, and Kingsboro Psychiatric Centers.

"Somebody is going to have to die and then maybe a change will happen," she said. "I had one co-worker just tell me three days ago, 'Darlene, I don't want to die because I had to come into work.'"

In response to the outbreak, Plastiras said OMH has taken steps to ensure the safety of residents and staff, including restricting visitors except in certain cases for children, and during discharge. The agency is no longer congregating people in groups and that clinicians and staff are providing services via video and phone whenever possible, he wrote in an email to Gotham Gazette.

"OMH is taking every precaution to protect our staff and the people we serve while we continue to provide essential behavioral health services,” he wrote.

But Williams says at the Psychiatric Institute, which is attached to Columbia Presyterian, group sessions have only been reduced to no more than five patients, and that at other larger institutions in the city the sessions continue without distancing of at least six feet between individuals, as recommended by public health officials. OMH may issue directives, she said, "but that information doesn't trickle down all the way into facilities."

Protective Precautions
Workers in OMH facilities are expressing concern that they have not been given the proper protective equipment to keep themselves and the residents safe. In emails among employees at several psychiatric centers reviewed by Gotham Gazette, workers shared with one another heartbreak and extreme duress at having to work with patients who are ill and dying without personal protection.

"We were begging, begging OMH to make sure that we could wear surgical masks because we were still so close working together, employees along with patients," Williams said. She added, if it was not for Wednesday's executive order requiring masks in public at all times, "we still wouldn't be wearing masks."

In an April 7 letter to OMH Commissioner Ann Marie Sullivan, State Senator David Carlucci, a Rockland County Democrat and chair of the Senate’s mental health committee, raised alarms about conditions at an inpatient facility in Sing Sing Prison jointly operated by OMH and the state Department of Corrections and Community Supervision.

"[T]he deteriorated mental health of many of the patients in the program have prevented them from abiding with recommended hygiene practices…,” he wrote. “Despite these concerns, the Sing Sing ICP has not been provided with any hand sanitizers, cleaners, nor protective supplies."

Plastiras said OMH is working to procure and distribute personal protective equipment from available sources in accordance with CDC and state Department of Health guidance.

Staff aren't the only people in need of protective supplies, according to Williams. "The patients are also frightened because a lot of them this is their home and we're coming in and bringing in the virus. A lot of the patients are afraid, 'what will happen to me if I do get the virus?...where am I going, who is going to look after me?'" she said.

The residents of state psychiatric centers have substantial mental health factors that make it difficult for them to live on their own and meet their own daily needs. Many suffer from severe depression, delusions, bipolar disorder, and schizophrenia.

Patients may check into an inpatient facility voluntarily, but often people wind up admitted against their will after being seen in a general population hospital or other clinical setting and deemed by psychiatric doctors to be a danger to themselves or others.

Like other congregate living situations, state psychiatric centers are susceptible to unique consequences of the current coronavirus crisis. In addition to needing round-the-clock staffing, treatment for residents typically requires regular therapy, medication, and evaluation, as well as the structure and routine of life in an institution. Patients frequently have additional medical complexities that may make them more susceptible to the virus and patients may not be inclined to adhere to public safety guidelines.

"Our members, they care about this work and they want to do what's right for the patients,” said DiAntonio, the vice president of PEF. “And we recognize that there is a delicate balance between taking care of people that have high needs and that are going through real disruption, but also keeping people safe."

"One of the biggest issues we had with OMH is they made everybody ‘essential’ and refused to allow any remote working," DiAntonio told Gotham Gazette. "I've worked in facilities, I get that there are things that are hard to do from a distance. But again we are talking about a temporary situation that really may make a difference between life and death."

Plastiras said OMH is no longer holding non-essential trainings, though PEF leaders say they are still taking place. Workers are also afraid of what they have described as substandard quarantining procedures for patients who have tested positive for COVID-19.

Psychiatric wards in the past had isolation rooms for patients with infectious diseases but over the years facility budgets have been reduced and the quarantine rooms have disappeared, according to Williams, the occupational therapist at the Psychiatric Institute in Washington Heights. When a patient -- typically two to a room -- tests positive, their roommate is removed, she said, but the air is still circulated throughout the entire unit.

The union has struggled to get information on positive cases and deaths of patients and its members. "They are not openly sharing that. We finally were able to get them to make sure quarantine notices were being sent to employees if a home or location was under quarantine or there was a suspected case but for the longest time we were not getting that notice. They just started this week," DiAntonio said.

As the Times Union first reported, the New York State Correctional Officers & Police Benevolent Association has filed a complaint with the state and plans to go to court over conditions for its members working in the Central New York Psychiatric Center.

"The health and safety of our members is our number one priority. We are considering any and all actions, including legal action if necessary, to ensure their safety," wrote a PEF spokesperson, in an email to Gotham Gazette.

More Like a Hospital Than a Nursing Home
Reports from several sources indicate public health officials have treated OMH facilities, themselves hotbeds of coronavirus infection, more like overflow for overburdened city hospitals than like the homes of vulnerable populations.

According to DiAntonio, they have become overcrowded in recent weeks as hospital psychiatric units seeking to free up precious bed space for COVID-19 cases transfer to the facilities patients who cannot be discharged on their own or to a caregiver.

The Office of Mental Health did not respond to inquiries about how much the inpatient population has grown since the coronavirus outbreak began, but Plastiras said that 65 new employees had been hired in the last three weeks. The screening process for patient admissions has been "enhanced," according to Plastiras, but he did not elaborate on what the new protocol consists of.

The state Department of Health, which is coordinating the state's hospital system, did not directly respond to questions about patient transfers to OMH facilities, but a spokesperson for New York City Health + Hospitals, the city's public hospital system, confirmed that psychiatric patients that were not ready to be discharged were transferred to state psychiatric centers.

In a March 30 letter, PEF President Wayne Spence wrote to OMH Commissioner Sullivan imploring the agency to adopt a quarantine plan for patients transferred from coronavirus "hotspots" in hospitals to psychiatric centers, including isolation for the 14 days estimated to be the virus' incubation period. PEF representatives say quarantining protocols still do not include a full 14-day isolation.

On April 2, Dr. Brian Belfi, executive director of Kirby Forensic Psychiatric Center on Ward's Island, sent an email to staff saying the center would soon be taking admissions from female units on Rikers Island. "These are inmates that would have historically gone to Elmhurst which is overburdened with COVID," read the email, which was reviewed by Gotham Gazette.

Williams said there was a push by OMH to discharge patients from psychiatric centers but it was largely unsuccessful. "The movement of patients was a lot easier before the pandemic," she added. "Admissions are still happening but patients aren't going anywhere."

Meanwhile, a five-story addition to South Beach Psychiatric Center on Long Island, which was set to open this month to replace an old building damaged by Superstorm Sandy, is now being used to treat coronavirus patients and will no longer house psychiatric residents, according to Plastiras.

Element of Violence
It isn't all business as usual in the pandemic. Major disruptions in residents' routines are taking place as family visitations are cut off, favorite staff members fall ill, and off-campus movement is restricted. "It's sadder on our unit than it used to be. For a person who has been there for so many years and has seen so many things -- I've never seen anything this depressing," Williams said.

The limitations mean some required therapy sessions or family visits cannot take place, which for some is a barrier to being discharged. "We have some places where people are pissed because ‘I'm not getting out as quick’," she said.

OMH has one of the highest rates of workplace violence of any government agency. According to a state Department of Civil Service report, "patient restraint" is a leading cause of workers' compensation incidents, accounting for roughly 9 percent of the total in fiscal year 2019. The report says the job titles with the three highest workplace incident rates were Correction Officer, Direct Support Assistant, and Mental Health Therapy Aide. The two facilities with over 500 employees that had the highest rates were Mid-Hudson Psychiatric Institute and Bedford Hills Correctional Facility.

Williams says physical altercations are not uncommon in inpatient psychiatric settings, but the current strain on daily life may push it to extremes. "It puts staff and our patients at risk because now violent outbursts can happen" more easily, she said.

"I think that's also probably one of the reasons that OMH is so resistant to changing things that might keep employees and patients safer because they do worry that too many changes will create more problems," said DiAntonio, the union vice president. "However...I think there are a lot of things that are in between having no services and having services provided in an alternative way."

"Radio Silence"
Inpatient psychiatric centers have gone entirely unmentioned in the daily briefings held by Governor Cuomo and Mayor de Blasio, where they’ve fielded many questions about other vulnerable populations, including those in nursing homes and correctional facilities.

"In the realm of this specific branch of healthcare delivery it just feels like there's radio silence from providers, from the press, and just I think the general public awareness," said Dr. Julia Eilenberg, a psychiatrist who runs a private practice in Rhinebeck, New York.

"I have a patient who I just spoke to today who is profoundly depressed," she said. "And I'm trying so hard to keep her from needing to be admitted somewhere because I just don't know enough about where it would be safe from an infectious disease standpoint for her to go."

***
by Ethan Geringer-Sameth, reporter, Gotham Gazette
     

Read more by this writer.

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10 Dead, Hundreds Infected as State Psychiatric Facilities Become Another Crisis Point in Coronavirus Outbreak Fri, 17 Apr 2020 04:00:00 +0000
Resources: How New Yorkers Can Access Help with Food, Unemployment, Health Care, Domestic Violence, Small Businesses, & More https://www.gothamgazette.com/state/9275-resources-how-new-yorkers-can-access-help-with-food-unemployment-health-care-domestic-violence-small-businesses-more https://www.gothamgazette.com/state/9275-resources-how-new-yorkers-can-access-help-with-food-unemployment-health-care-domestic-violence-small-businesses-more 1 cm carlina rivera baruch

(photo: John McCarten/City Council)


As the coronavirus outbreak causes more and more health, social, and economic damage, many New Yorkers need help. Below is a guide to some available resources (please let us know if there’s something we should add).

For updates from New York City about the pandemic, you can text the word “COVID” to 692-692, or “COVIDESP” to 692-692 for the same notifications in Spanish. 

Unemployment Insurance
If you lost your job due to the coronavirus outbreak and its fallout, the state is waiving the seven-day waiting period to claim unemployment insurance benefits. But the state’s Department of Labor has been overwhelmed with website traffic and calls, which the governor has said a large team is working to remedy. Visit the New York Department of Labor here.

Those filing for unemployment insurance should do so based on the first letter of your last name: A-F, file your claim on Monday; G-N, file your claim on Tuesday; O-Z, file your claim on Wednesday. (You may file Thursday, Friday, or Saturday if you missed your filing day.)

Last week, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security (CARES) Act, a $2.1 trillion package that provides various aid programs during this crisis. For unemployment insurance, it provides “$1 billion emergency grants to states and 100 percent federal funding for extended benefits in states with an unemployment rate above 10 percent”; expands eligibility to include part-time workers, independent contractors, self-employed, and gig economy workers; $600 per week increase in unemployment insurance benefits for up to four months; allows for additional 13 weeks of unemployment insurance beyond what your state already provides; and “funds states with existing work-sharing programs, such as New York.”

Jobs
While there are many jobs websites across the internet, New York state government offers the NY Hire Now portal of job listings, and the Department of Labor itself is hiring, while also offering a variety of tips and services related to job searches.

New York City’s Workforce1 Centers are offering virtual help to individuals looking for work, and the city’s Department of Small Business Services also runs a jobs listing.

Food Access
435 schools across New York City have been allowing students and families to pick up three meals per day. Mayor de Blasio announced Thursday that starting Friday, any adult who needs food could also access it at those locations. He said family hours are 7:30-11:30 a.m. and adult-only hours are 11:30 a.m.-1:30 p.m. People can find the location nearest them through this web portal run through the Department of Education website.

People can also text FOOD or COMIDA to 877-877 to get food access information from the city.

Many food pantries and soup kitchens across the city are open and available for people who need food assistance, though some have had to close and others may be on the brink, both due to the spread of the virus and challenges with supply lines. To find a nearby option, people can use this city website to find a food provider. 

City-funded senior centers are closed but providing pick-up and delivery meals for seniors who may not have access to food services.

Many grocery stores are adjusting hours to accommodate more people and opening early for seniors to be able to shop without exposure to the rest of the population. People should check the websites and social media feeds of their grocers.

Under the CARES Act, $15.5 billion was approved to support participation in the Supplemental Nutrition Assistance Program (SNAP) and temporary ability to expand the program, and $450 million was allocated for food banks.

The Families First Coronavirus Response Act, passed earlier this month, “provided the WIC Program with $500 million to remain available through Sept. 30, 2021 for increases in program participation,” according to the federal government’s Food and Nutrition Services website.

The New York City Human Resources Administration (HRA) has moved its application process online, so New Yorkers can apply for SNAP benefits digitally, increasing access during this time of social distancing and when walk-in offices are closed.

For those with SNAP benefits, they can now be used online at three retailers for those who wish to protect themselves and avoid being around other people. SNAP benefits will be accepted online in New York at Amazon, Walmart, and ShopRite, as designated by USDA.

The Hunter College NYC Food Policy Center is in the process of creating a comprehensive rundown of food resources by neighborhood, across all five boroughs, called Coronavirus NYC Neighborhood Food Resource Guides

Utilities/Mortgage/Evictions
Utility companies in New York have halted gas, electric, and water shut-offs until further notice.

All evictions have been halted by New York State Courts as of March 16, with Governor Cuomo ordering a 90-day moratorium on evictions. According to the NYC Coronavirus (COVID-19) and City Life website, this means people “will not need to apply for rent arrears (back rent) to stop an eviction until further notice,” and that “you will be able to stay in your home during this health emergency.”

For a period of 90 days, the Department of Financial Services (DFS) issued an order that requires “New York State regulated financial institutions provide residential mortgage forbearance on property located in New York. This will be for a period of 90 days and applies to any individual residing in New York who can demonstrate financial hardship as a result of the COVID-19 pandemic."

Health Care Coverage and Insurance
New York State of Health, the state-run marketplace for health insurance, reopened enrollment for health insurance for “uninsured individuals to ease coronavirus fears.” The special enrollment period will remain open through April 15, allowing for many uninsured individuals to access health care.

In New York City, “NYC Care provides low-cost or free healthcare for all New Yorkers regardless of ability to pay or immigration status. This is not an insurance plan. Call the 24-hour NYC Care service at 646-NYC-CARE (646-692-3373) to enroll and make an appointment. Primary care, specialty, and emergency services (including hospital stays) are all available for NYC Care members. For help in other languages, visit https://www.nyccare.nyc/.”

Mental Health
In response to the COVID-19 outbreak and its fallout, the New York City Department of Health and Mental Hygiene is providing tips and resources for how to manage the stressful situation, including limiting screen time, keeping connected with people, and maintaining daily routines. The city points people to federal CDC guidance around coronavirus “stress and coping.

Beyond tips, there are other resources available, including through NYC Well, a free, confidential service with counselors available 24 hours a day, who can “provide brief counseling and referrals to care in over 200 languages” for New Yorkers. People can call NYC Well’s helpline at 888-NYC-WELL.

Seniors specifically can call the city’s helpline at 212-AGING-NYC and military veterans can call 800-273-8255.

Governor Cuomo announced on March 29 that more than 12,000 mental health professionals have volunteered to help New York State provide free online services to those who need it during the crisis. This service can be accessed by calling 1-844-836-9314.

Domestic Violence Survivor Resources
There are widespread concerns that the coronavirus fallout will include increases in domestic violence.

“Domestic violence often escalates during and after a disaster,” said Connie Neal, Executive Director of the New York State Coalition Against Domestic Violence in a press release from the office of Attorney General Letitia James. “Because survivors of domestic violence are often already isolated, with limited access to financial resources and social networks, it can feel even more challenging to find and receive the support they need.  But help is available through a network of domestic violence advocacy services across the state of New York. Advocates can provide confidential assistance with safety planning, emotional support, shelter, and referrals for a range of other community services.”

In an emergency, people should call 911.

The New York State Domestic and Sexual Violence 24-hour hotline is 1-800-942-6906.

The National Domestic Violence 24-hour hotline is 1-800-799-7233. The 24-hour live-operated bilingual (English/Spanish) hotline for the Violence Intervention Program is 1-800-664-5580.

The New York State Coalition Against Domestic Violence has a list of available programs, broken down by county.

Safe Horizon, a non-profit serving individuals in New York City, can be reached 24/7 at 1-800-621-4673. Safe Horizon also has a one-on-one online chat system.

The NYPD’s Domestic Violence Unit has also put out some tips.

Small Businesses
Mayor de Blasio announced in early March that New York City will provide relief to small businesses impacted by the economic downturn brought on by coronavirus.

The NYC Employee Retention Grant Program offers small businesses with fewer than five employees a grant to cover 40% of payroll costs for two months in an effort to help the businesses retain employees through the crisis. To be eligible, those smallest small businesses must demonstrate that COVID-19 caused at least a 25% decrease in revenue, been in operation for at least six months, and have no outstanding tax liens or legal judgments.

For more information about the NYC Employee Retention Grant Program visit this website.

The city is also offering the NYC Small Business Continuity Loan Fund, which helps businesses with fewer than 100 employees that have seen a 25% or more revenue drop to apply for zero interest loans of up to $75,000.

For more information and to apply for the NYC Small Business Continuity Loan Fund visit this website.

Thanks to the recent $2.1 trillion federal stimulus package, the U.S. Small Business Administration (SBA) has a series of relief programs that can help small businesses nationwide survive through the pandemic.

The Paycheck Protection Program “prioritizes millions of Americans employed by small businesses by authorizing up to $349 billion toward job retention and certain other expenses.” Eligible businesses can qualify for a loan of up to $10 million determined by 8 weeks of average payroll plus an additional 25%; loan payments will be deferred for 6 months; and if the business doesn’t lay-off staff, SBA will forgive the portion of the loan used to cover two months of payroll.

The SBA is also providing the Economic Injury Disaster Loan program that can be accessed here.

The SBA will provide some debt relief for businesses. According to the SBA website, “SBA will pay the principal and interest of new 7(a) loans issued prior to September 27, 2020,” and “the SBA will pay the principal and interest of current 7(a) loans for a period of six months.”

Finally, SBA is providing the Express Bridge Loan Pilot Program that allows small businesses who already have a relationship with an SBA Express lender to access $25,000 with less paperwork and faster turnaround. “These loans can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing and can be a term loans or used to bridge the gap while applying for a direct SBA Economic Injury Disaster loan,” the SBA website says.

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by Katie Kirker, Gotham Gazette

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Resources: How New Yorkers Can Access Help with Food, Unemployment, Health Care, Domestic Violence, Small Businesses, & More Fri, 03 Apr 2020 04:00:00 +0000
ThriveNYC Looks to Turn Corner with New Outcome-Focused Data https://www.gothamgazette.com/city/9179-thrivenyc-looks-to-turn-corner-with-new-data-assessing-programmatic-effectiveness https://www.gothamgazette.com/city/9179-thrivenyc-looks-to-turn-corner-with-new-data-assessing-programmatic-effectiveness first lady deputy mayors comm

Chirlane McCray, leader of ThriveNYC (photo: Michael Appleton/Mayoral Photography Office)


First Lady Chirlane McCray’s signature mental health initiative ThriveNYC has faced withering criticism for spending hundreds of millions of dollars with few concrete results to show for it. But amid increasing scrutiny the de Blasio administration is seeking to put those concerns to rest as the Office of ThriveNYC for the first time releases detailed data tracking the outcomes of dozens of programs that have been launched under the Thrive banner.

It’s part of a reclamation project for McCray and her husband, Mayor Bill de Blasio, who have heralded ThriveNYC as a one-of-its-kind roadmap and national model, but struggled to show evidence of its effectiveness, particularly whether it was helping New Yorkers with serious mental illnesses. The mayor and first lady brought Susan Herman from the NYPD to the mayor’s office to establish better benchmarks, data-tracking, and standing for the program, and Herman is now showing the initial results of her work as executive director of ThriveNYC.

ThriveNYC’s proposed budget for the 2021 fiscal year, which begins July 1, is about $235.3 million, bringing its total spending to nearly $1 billion since the umbrella program was launched in 2015. Its programs include a mental health hotline, on-site mental health services at city schools, dedicated outreach teams for veterans, mental health screenings for younger adults at Department of Corrections facilities and for seniors at centers run by the Department for the Aging, to name a few.

Herman was named the director of Thrive a year ago, when it was formed into a standalone office under the mayoralty. In June of last year, the office released a list of about 100 metrics that it would be tracking to indicate program outcomes, the result of sustained criticism of the program by the mayor’s political opponents, budget watchdogs, City Council members, and others, which came after multiple media exposes and an embarrassing City Council oversight hearing.

When Herman took over, she set out to refine the program’s goals, culled down to four – strengthening crisis prevention and response, promoting mental health for the youngest New Yorkers, eliminating barriers to care, and reaching those with the greatest mental health needs.

While specific programs have been up and running for years – some have been refined, others expanded, and some cut back – they have so far only showed the city’s investments and inputs rather than outcomes. Last week, Comptroller Scott Stringer even added ThriveNYC to his “watch list” of city agencies, criticizing its profligate spending and lack of transparency.

The data released on Tuesday finally shows how much money is being spent on each program under ThriveNYC and the results of that spending. In an interview at the ThriveNYC office on Friday, Herman explained the new data and why it took so long to produce.

She said the office could only collect results once the programs had been implemented. “This was the undertaking that we went through very carefully last spring with all our partner agencies,” she said. “So some of them had to create new ways of collecting data and that takes time. Some of the effort is extremely time consuming.”

The data will be updated every quarter, with some indicators being updated semi-annually and annually, Herman said. The office also launched a new website to display the data and released a report showing its progress, including how many New Yorkers have received services between 2016 through June 2019, and highlighting how the program has achieved its four core goals.

Herman emphasized that the data release was not a scrambling response to the repeated criticism ThriveNYC has faced. “This is clearly a part of good government,” she said. “When you have a program, and you're ready to say this is how it's working. I think it will address many people's concerns but that's not why we're doing it. We’re doing it because it's part of what you do.”

She also noted that the comptroller may have jumped the gun when he claimed Thrive was not providing him with data he requested last week. Herman said Stringer requested detailed information on budgets, contracts and more, part of which includes the data released on Tuesday. “It’s a massive undertaking and he’ll get that shortly,” she said.

“I'm not really sure why he's added Thrive to the watch list,” she added. “I'm happy to talk to him about Thrive anytime he wants and I'm sure that some of this will satisfy some of his concerns. I don't think anybody can look at this data and not think that we are not only reaching a lot of people, but we're changing people's lives for the better.”

Stringer criticized the Thrive initiative’s failure to show line-by-line program expenditures and their results, which had been promised by the end of last year. “It should not take this long to produce metrics,” he said. “The current structure of Thrive can only be considered successful if it can prove its effectiveness.”

The new ThriveNYC progress report highlights some of those impacts. For instance, it shows that many people with serious mental illness are getting consistent help, something Herman also stressed in the interview. About 89% of clients treated by Intensive Mobile Treatment teams continue to receive treatment for more than a year, it says. According to other metrics, 90% of crime victims said they felt better after receiving services from the Crime Victim Assistance Program and 47% of seniors showed clinical improvement in depression symptoms after three months of treatment at a senior center.

The next stage, Herman said, will evaluate whether Thrive is having an impact at the larger population level by measuring whether New Yorkers with mental health needs get the treatment they require and whether fewer mental health needs turn into crises.

Herman also addressed questions about specific Thrive programs that have cropped up over time. The Mental Health Service Corps program, one of the most expensive aspects of Thrive, has been significantly scaled back after a disastrous launch and severe structural issues. “I would say it's been right-sized,” Herman said.

She also drew a distinction between an existing Home Visits program for new parents that is run under Thrive, as opposed to the new one recently announced by McCray that City Hall said is not considered part of the Thrive umbrella, without explaining why. Thrive’s program is aimed at filling a gap for families living in shelters, while McCray’s announcement covers the expansion of a program currently run by the Health Department, Herman said.

“What some people are missing is that Thrive isn't the mental health care system. It's much, much bigger than Thrive,” she said. “The Thrive initiative was to identify particularly critical gaps, and try and fill them in innovative ways, to reach people who haven't been reached before, to serve particularly underserved neighborhoods, to serve people in new ways.”

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by Samar Khurshid, senior reporter, Gotham Gazette
     

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ThriveNYC Looks to Turn Corner with New Outcome-Focused Data Mon, 02 Mar 2020 05:00:00 +0000
With Youth Suicide Rates Rising in New York, Now’s Not the Time to Cut State Funding for Mental Health Treatment https://www.gothamgazette.com/130-opinion/9017-youth-suicide-rates-rising-new-york-now-not-time-cut-state-funding-mental-health-treatment https://www.gothamgazette.com/130-opinion/9017-youth-suicide-rates-rising-new-york-now-not-time-cut-state-funding-mental-health-treatment Cuomo kids health

(photo: the Governor's Office)


Rates of youth suicide are climbing across the country. New York State, where youth suicide is the second leading cause of death for adolescents, is no exception. With adequate investment in mental health and substance use services for children and adolescents, many of these deaths could be prevented. Yet, New York is planning to further reduce access to these kind of behavioral health services for children, even as more than half of children across the state with a mental or behavioral health condition do not receive the treatment they need.

At the end of 2019, New York State plans to cut reimbursement rates for behavioral health services for Medicaid-eligible children and families offered under Children and Family Treatment and Support Services. These critical and sometimes life-saving services include community psychiatric supports and treatment, family peer support services, crisis intervention, rehabilitation from substance use, and more.

At a time when children and families are chronically underserved and unable to access needed mental health treatment options, the state must place an immediate moratorium on any cuts to children’s behavioral health services to ensure they can receive the high-quality care they need and are legally entitled to.

Under federal and state law, commercial insurance companies and Medicaid programs must provide mental health and substance use benefits that are equal to coverage for physical medical treatments. But the reality looks far different for New York children and families.

In the 2016-2017 school year, roughly half of children in New York State with a mental or behavioral condition who needed treatment or counseling did not receive it. One study found that 55.1% of youth with major depression did not receive any mental health services in New York.

These numbers are less surprising when you consider that for every 10,000 children in New York, there are only two child psychiatrists. In rural areas, that number is often zero.

There simply aren’t enough trained medical professionals or public investments to meet the need, in part due to low pay for staff and the subsequent issues of high turnover and recruitment challenges.

When an overworked staff member quits or an agency is forced to no longer offer a service, it is children and families who suffer.

What do we do? Where do we go? The state must answer these questions and one more: how can we justify moving forward with these cuts while our children and family suffer? We are talking about an entire generation of our most vulnerable children who won’t get the help they need.

The data alone makes this clear. But in our work at Families Together in New York State, we see the individual children and families behind each statistic.

We see school counselors and social workers without the resources to meet the mental health needs of their students. We see students unnecessarily hospitalized or pushed into the juvenile justice or child welfare systems because they did not get the care they needed when they needed it. We see families struggle to find the quality services their children need to thrive.

As part of the rollout of Children and Family Treatment and Support Services (CFTSS) in 2019, the state estimated that 200,000 children would be eligible to receive behavioral health services under the program. However, only 7,800 children are currently receiving CFTSS, which is less than 5 percent of eligible children.

This under-enrollment is due to a number of factors, including under investment and a delay in start-up funds, which lead to issues like entire regions of the state lacking a designated provider of any of these services and families traveling several hours just to get an assessment. The bottom line is that we are not reaching nearly the number of children the state promised to serve, and the state is about to move ahead with its plan to reduce rates for these services.

Reducing access to mental health care services at a time like this moves New York State in the wrong direction for children’s mental health. That’s why Families Together is one of 40 leading behavioral health providers and child advocacy organizations across the state calling on Governor Cuomo to place an immediate moratorium on all cuts to behavioral health care for children. The current reimbursement rates for CFTSS services must be maintained to ensure children and families can receive the quality mental health care they need.

Mental health is a right for every child. New York State can and must do better for the children and families struggling to find adequate, high-quality mental health and substance use services. With the wellbeing and safety of our youth in the balance, we ask that the state do its part and stop these cuts.

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Paige Pierce is CEO of Families Together in New York State.

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

 

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With Youth Suicide Rates Rising in New York, Now’s Not the Time to Cut State Funding for Mental Health Treatment Sun, 22 Dec 2019 05:00:00 +0000
How the City's New Jails Plan Accounts for Those with Serious Mental Illness https://www.gothamgazette.com/city/8910-how-city-close-rikers-jails-plan-serious-mental-illness https://www.gothamgazette.com/city/8910-how-city-close-rikers-jails-plan-serious-mental-illness Rikers Island inmate detainee

(photo: Michael Appleton/Mayor's Office)


In an historic vote last month, the New York City Council approved the plan to close the Rikers Island jail complex and replace it with four borough-based jails by 2026. When the Council voted through the plan, estimated at $8.7 billion in new construction costs, it also announced, with Mayor Bill de Blasio, a $391-million package of citywide and community investments in criminal justice reforms and initiatives to responsibly accelerate the reduction of the city’s jail population.

For city officials, one of the most complex issues they face is ensuring that the new system is less punitive and more rehabilitative, particularly for the 43% of incarcerated individuals who suffer from some form of mental illness. Experts and advocates say the plan is taking an appropriate approach to that issue but also insist that it provides a novel opportunity to rethink how the criminal justice system deals with the mentally ill, especially those suffering from more acute problems.

Given that one of de Blasio’s signature programs as mayor is the ThriveNYC mental health “roadmap” spearheaded by his wife, Chirlane McCray, the mayor’s approach to services for those with severe mental illness, particularly those who wind up involved in the criminal justice system, has been the source of intense scrutiny, again heightened as the new jails plan was crafted.

With most major crimes at or near record lows in the city and recent shifts in law enforcement and prosecutorial policies, particularly around non-violent offenses, the number of people incarcerated in city jails has been consistently declining. That drop has been so sharp that the de Blasio administration projects the average daily jail population to fall to 3,300 by 2026, when Rikers is set to close, down from about 7,000 this year and aided by state bail reform that will go into effect in January.

The Rikers closure plan will involve building four new facilities in every borough except Staten Island, with roughly 885 beds each. The facilities are meant to be fairer and safer than the dilapidated jails on Rikers. Another 250 new beds will be created in existing public hospital facilities for those individuals who require continuing access to specialized medical services.

Mayor Bill de Blasio himself has acknowledged that the city has its work cut out for it when it comes to individuals with mental illness who are locked up in jails. The day after the Council’s vote, the mayor made his weekly appearance on WNYC’s The Brian Lehrer Show and a caller named Winston who was formerly incarcerated on Rikers prodded him on improving access to mental health services. De Blasio emphasized the decarceral aspects of the plan, which include greater investments in alternatives to incarceration, supervised release programs, and mental health initiatives.

“This thing is not in isolation. Six years of changing the approach to criminal justice and it’s all been consistent with reducing crime at the same time and I’m very convinced that this is the right approach,” said the second-term Democrat. “But you’re right, it will take some important adjustments and investments and getting people more access to mental health services, which is the whole concept behind the Thrive[NYC] initiative, is absolutely necessary going forward, and providing better and more consistent mental health for those who do happen to be incarcerated, which is also in this plan.”

One of the key elements of how things unfold will be the dichotomy of mental health services for those with serious mental illness who need treatment while serving jail time versus those who can be removed from or kept out of jail given appropriate treatment options and enrollment in such programming.

City Council Speaker Corey Johnson, in a statement to Gotham Gazette, said, “The time of locking people up because they're mentally ill has to come to an end. This is why we are creating new Intensive Mobile Treatment (IMT) teams to provide intensive treatment to adults with recent and frequent contact with the mental health, substance use, criminal justice, and homeless services systems. It is time to eliminate an unjust system that has criminalized mental illness and destroyed so many of our communities.” 

In a background briefing, an official from the Mayor’s Office of Criminal Justice, which took point on the jails plan, laid out the various pillars of the city’s approach. The official reemphasized what de Blasio said on the radio: that the administration’s focus is to minimize the number of people in jail with behavioral health, mental health, and substance misuse problems, and to prevent reincarceration by providing services that address their needs.

Correctional Health Services, an arm of NYC Health+Hospitals, is charged with providing medical services to the city’s jail system, from pre-arraignment through reentry. According to a H+H spokesperson, roughly one-third of the 43% of detainees who receive a mental illness diagnosis have severe mental illness – schizophrenia, bipolar or depressive disorders, and post-traumatic stress disorder – making up about 16% of the total jail population. For a population of about 7,000 detainees, that means just over 1,100 people with serious mental illnesses at any given time.

Currently, each jail has what H+H says is the equivalent of an outpatient clinic. For detainees with serious mental illness, intellectual disabilities, or who might be more vulnerable in the general jail population, there are 18 so-called mental observation (MO) units across the 10 jails and Horizon Juvenile Center. There are also inpatient psychiatric beds at Bellevue Hospital for men and at Elmhurst Hospital for women, all of whom are considered part of the city’s jail population while being treated.

The community investments package that the City Council and mayor agreed to includes an expansion by Correctional Health Services of two programs that provide discharge and reentry services to the formerly incarcerated, the Community Reentry Assistance Network (CRAN) and Point of Reentry and Transition (PORT) programs.

Though the city is hoping for the best, it is planning for the worst. About 40% of the beds in the new borough jails will be therapeutic housing units to account for the percentage of the jail population that suffers at least some kind of mental illness.

The city plans to reduce the population through various efforts, including implementing recommendations from the city’s Crisis Prevention and Response Task Force announced last month, which will change how police respond to people experiencing mental health crises. The city is putting $23 million in total towards those recommendations by 2023, which includes adding four Health Engagement and Assessment (HEAT) teams of clinicians and peers who have experienced mental illness to handle non-emergency responses, and six more mobile crisis teams (mental health professionals who respond to calls to the NYC-WELL hotline) to conduct home visits and respond to urgent situations.

These programs aim to ensure that people suffering from mental illness do not wind up in jail, or back in jail as the case may be.

Additionally, the city is investing $11.2 million to add 380 beds of “justice-involved supporting housing,” for a total of 500 across the city, and is increasing the number of post-release transitional beds for those with mental health needs and a history of homelessness to 500 with a $25 million investment.

About $27 million in new funding will go to mental health services (for a total of $37 million) through various programs. And the Council also passed the Get Well And Get Out Act, which will allow those with serious mental illness to push for their release from custody if they improve with treatment.

But the official from MOCJ conceded that there will inevitably be individuals with serious mental illnesses in jails, despite the city’s best efforts to reduce that population, which has stubbornly hovered in the 10-15% range even as the overall numbers of detainees have fallen. Almost all of the people held in city jails are either awaiting trial, locked up due to a parole violation, or serving sentences of under one year.

The new borough facilities and the Rikers plan account for the fact that some detainees will suffer from serious mental illnesses by expanding two key programs that address this population: Clinical Alternative to Punitive Segregation (CAPS) and Program to Accelerate Clinical Effectiveness (PACE).

The Council’s agreement with the mayor includes $12.8 million to double the number of existing PACE units by the end of the current fiscal year. The city has yet to decide the breakdown of those units in the borough facilities, the MOCJ official said.

The 250 new Outposted Therapeutic Units outside the jail system, however, will be dedicated to those individuals who have some form of substance abuse disorder, mental health or behavioral health issue as well as a complex need for medical care. The MOCJ official said they had identified a gap in the current continuum of care for these detainees, who don’t necessarily require inpatient hospitalization but benefit from proximity to specialized care. They can spend hours going to and from hospitals for even the shortest of check ups with specialists. 

The city is currently in the process of identifying vacant sites for those units and has contracted Lothrop Associates to conduct a feasibility study that is expected to be concluded by the end of the year, the MOCJ official said. The study will help determine the costs and needs of the new facilities and the city will then put out solicitations for redesigning the new spaces to accommodate incarcerated individuals. The project is separate from the borough-based jails plan and the official said it would likely move much faster since it would not require approval through the city’s land use process.

Insha Rahman, director of Strategy and New Initiatives at the Vera Institute, said a larger goal of the Rikers closure plan should be to minimize the harm that jails do to inmates, not just those with mental illness.

“If we're going to say, ‘We are still going to have incarceration in this city,’ which we are, for the foreseeable future, 5, 10, maybe even 20, 30 years from now, we should be constructing these new facilities as buildings first, and then outfitting them to be places of incarceration so that they're not built with just incarceration and jail design front and center,” she said in a phone interview. 

She cited the example of jails in countries like Germany and Norway. “To the extent that we're thinking about how do we address people's underlying needs and how do we provide therapeutic care and counseling for those who are in custody, anything that looks fundamentally like a jail is going to inflict some amount of harm and trauma,” she added, insisting that the city should look not to prison architects but to behavioral and mental health experts for ideas for the new jails.

Rahman also urged the administration and Council to invest further at the community level in permanent affordable housing, community-based treatment and counselling that can preempt interactions with the criminal justice system.

A stark reality that the city faces is dealing with those individuals with serious mental illness who pose a threat to themselves and others, a concern that was brought to the fore last month when a mentally ill homeless man killed four men sleeping on the street in Chinatown. It prompted the city to review how it implements Kendra’s Law, which allows courts to mandate involuntary “assisted outpatient treatment” for such individuals. That review is meant to be completed by next week. The number of individuals ordered into treatment under the law was 2,476 in fiscal year 2018, down from 2,517 in fiscal year 2017 but up from 2,368 in fiscal year 2016 and 2,176 in fiscal year 2015, according to data provided by the de Blasio administration.

Rahman warned against harsher enforcement of the law. “I think enforcing Kendra's Law more strongly is not necessarily going to get us fewer people in our jails that have serious mental health needs,” she said. “I think the most important initial response is more community-based treatments and figuring out how can we actually resource families and neighbors.”

There is some disagreement on that front, however. D.J. Jaffe, executive director of Mental Illness Policy Org, criticized the city’s ThriveNYC mental health initiative and called for an expansion of Kendra’s Law in an op-ed in the New York Daily News following the Chinatown murders.

Jaffe argues the City Council should require “the city’s Department of Health and Mental Hygiene to start evaluating all seriously mentally ill people being discharged from Rikers; all seriously mentally ill leaving shelters; and all mentally ill patients being discharged from city hospitals after an involuntary commitment. Those are the three highest risk groups; evaluate them all to see if they are eligible for Kendra’s Law and get them into it if they are.”

Minister, Dr. Victoria A. Phillips of the Urban Justice Center Mental Health Project echoed Rahman’s view, but also stressed that the new jails should prioritize interactions between detainees and health care workers, rather than with corrections officers.

“Behind correctional walls, it’s never the health staff that takes the lead, and I think the Department of Corrections has shown itself to be unable to change its culture of violence,” she said, pointing to the most recent report by a federal monitor with oversight of the city’s Department of Correction, which showed that use of force by corrections officers has risen dramatically while the jail population has dropped.

Former New York Chief Judge Jonathan Lippman, who led the independent commission that proposed the leading Rikers closure plan, praised the approach the city is taking, while acknowledging that the overarching objective is to keep people with mental illness out of jails. “If you have people who the system decides to incarcerate, then you have to deal with that,” he said in a phone interview. “In an ideal world...people who have serious problems with mental health should get help and not be incarcerated. But, you know, we don't live in the ideal world.”

[READ: 'No One Should Enter the Criminal Justice System for Something Related to Mental Illness']

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by Samar Khurshid, senior reporter, Gotham Gazette
     

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Note - This article has been updated. 

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How the City's New Jails Plan Accounts for Those with Serious Mental Illness Thu, 07 Nov 2019 05:00:00 +0000
‘Nobody Should Enter the Criminal Justice System for Something Related to Mental Illness’ https://www.gothamgazette.com/state/8705-new-york-criminal-justice-system-mental-illness-thrive-nyc https://www.gothamgazette.com/state/8705-new-york-criminal-justice-system-mental-illness-thrive-nyc first lady chirl mcc first

Chirlane McCray on Rikers Island (photo: Michael Appleton/Mayor's Office)


A rising number of 911 calls to report emotionally disturbed persons, several fatal encounters between police officers and people with serious mental illness, and an increasing percentage of seriously mentally ill people among those detained in city jails have all raised questions about how New York City and State provide care for those suffering from the most serious mental illnesses.

These questions and concerns don’t have easy answers. The city’s public hospital system, NYC Health + Hospitals; the mayor’s mental health care roadmap, ThriveNYC; services from the city’s Department of Health and Mental Hygiene; treatment within the city Department of Correction; private clinics; mental health shelters; and more combine to create a complex and stratified framework for treating those with a serious mental illness (SMI).

For some, much of what is at times called a crisis of treatment for those with serious mental illnesses like schizophrenia can be traced to the trend whereby the state closed down psychiatric hospitals with many thousands of inpatient beds while requisite treatment systems were not put into place to help people who would no longer be institutionalized, many of them cycling through the criminal justice system and inappropriately receiving their best mental health care while in jail.

There is insufficient use of mandatory outpatient treatment, some critics of the city and state say, with significant recent criticism also aimed at Mayor Bill de Blasio and First Lady Chirlane McCray over how resources have been allocated in their signature ThriveNYC program. Meanwhile, others have focused on questioning that police officers with guns are often first responders to people experiencing a serious mental health crisis, and those critics have been successful to some extent in getting protocols changed, though they say there is clearly more to do.

Dr. Mitchell Katz, president and CEO of NYC Health + Hospitals, says he’s troubled by the gaps in treatment and looking for new answers that would require the city and state to work together.

“The problem with the current mental health system, from my point of view, is for people with serious mental illness, the people we most worry about, the people we sometimes see on the subway or sitting on the bench, that right now there is nothing in between acute hospitalization and traditional outpatient care,” he said in April during an appearance hosted by the Citizens Budget Commission (CBC), a nonprofit think tank.

During an interview after the CBC event on the What’s The [Data] Point? podcast from CBC and Gotham Gazette, Katz was asked for more on his view about how to fill that gap.

He said H+H is working with the state on fixing a system that “drops off too precipitously.” Katz said he was in discussions to create programming to increase services for those who don’t qualify or don’t want to be admitted for inpatient care at a hospital but don’t receive enough treatment or care in the current outpatient system.

“We know in New York City there is a group of people with very serious mental health and addiction problems who rotate between the acute hospital, the shelter, and the jail,” he said on the podcast. “They don’t need to be locked up but let’s provide them a positive residential program that they want to stay at because it’s better than shelter and it’s better than the jail when we know that there are people who get arrested in order to be taken care of in jail.”

Over the course of months since Katz’s April comments, Gotham Gazette reached out multiple times to New York City Health + Hospitals and the Mayor’s Office but didn’t receive any further details on Katz’s vision for the program or whether there are ongoing discussions to make it a reality. State law and the state Office of Mental Health (OMH) have near full authority over the types of mental health treatment options allowed throughout the state, and are essential to the discussion, as Katz indicated.

In a statement to Gotham Gazette, a spokesperson for the New York State Office of Mental Health said, “as New York State continues to transform its mental health system to serve more individuals in the least-restrictive setting possible, we are expanding our reach through community-based services. These treatment models allow people to stay in the communities where they are best supported.”

Serious mental illnesses are not the types of mental illnesses and mental health issues that plague a little under 50 million Americans; according to the National Institute of Mental Health, about 4.5% of American adults have a serious mental illness -- meaning roughly 239,000 New Yorkers based on population statistics.

The three most common SMIs are schizophrenia, bipolar disorder, and major depression – less severe depression and anxiety are not categorized as serious mental illnesses although both the National Institute of Mental Health and the Substance Abuse and Mental Health Services Administration (SAMHSA) agree there is some ambiguity in the cut-off line for what’s considered a “serious” mental illness. It’s also important to note that there are complications with the term “serious mental illness”; it is not a diagnosis itself, but a level of disability or a threshold for having a particularly significant and debilitating mental illness.

In asking how New York treats those estimated 239,000 New Yorkers, there are the unavoidable questions of where they can and should be treated, as Katz indicated. Back in the early 20th century, many people with SMIs were admitted into state psychiatric centers, more commonly known as “insane asylums”; however, over the past 80 years there has been a major shift in placing those with serious mentally illness into inpatient treatment.

In the 1950s, New York began deinstitutionalization – a shift from inpatient care (a patient admitted into a hospital full-time) to community-based outpatient care. According to a 2018 report by Manhattan Institute senior fellow Stephen Eide, the process of deinstitutionalization continues to this day but may have gone too far. According to the report, the city’s public hospital and health care system, NYC Health + Hospitals, is the leading provider of inpatient psychiatric care in the city with only 1,218 beds dedicated to adult inpatient psychiatric care, representing 48% of adult inpatient beds in the city. State psychiatric centers in the city account for 1,058 adult inpatient beds.

ThriveNYC, led by McCray, has come under fire on multiple fronts, including general money mismanagement and lack of clear outcome-tracking, but also for how it helps -- or doesn’t help -- those with serious mental illnesses. During a City Council budget and oversight hearing on March 26, McCray was pressed on the issue several times, including pointed questions about how much of the ThriveNYC budget is dedicated toward treatment for those with SMIs.

At one point she said, “All of Thrive is really focused on the seriously mentally ill,” but she and others who testified about the program eventually offered more clarity.

Thrive, which is called a “roadmap” and spends around $200 million per year on programming and coordination, does include services solely focused on those with serious mental illness, but its main objective is to plug gaps of already existing services run by H+H and the city Department of Health and Mental Hygiene (DOHMH), while reorienting health care to always include mental health care and extend awareness and treatment into all of the city’s communities.

“Thrive is dedicated to prevention when possible, early prevention, treating people in crisis, and making sure people are stabilized when they do reach a crisis point,” McCray said. In arguing that all of Thrive is aimed at serious mental illness, she argued that untreated lower-level mental health issues can spiral.

Thrive, in the context of treating those with SMIs, is criticized for focusing more on mental health rather than mental illness; most of its 54 initiatives are focused on combating stigma, the negative factors that can lead to mental illness, and encouraging people to spot mental health issues in others and themselves, and to seek help.

In a May op-ed in the New York Post, DJ Jaffe, the executive director of Mental Illness Policy Org, and Eide of the Manhattan Institute called for the reallocation of ThriveNYC’s entire budget to focus on those with serious mental illness. They offered specific ways in which to redirect funding into different programs, such as enhancing existing crisis intervention teams, creating an office to exclusively manage the use of Kendra’s Law in New York CIty, and promoting supportive housing for homeless people with serious mental illnesses.

“The most serious cases are the ones most likely to become homeless, arrested, incarcerated, hospitalized and violent if they go untreated,” they wrote. “Yet Thrive virtually ignores this group in favor of people with less severe illnesses.”

Susan Herman, the recently-appointed executive director of ThriveNYC, said during the March testimony, “we are filling strategic gaps and piloting innovative programs for the seriously mentally ill to be able to work with people so they can stay in community by connecting them to services, by helping them connect or reconnect to treatment. We’re helping people both before crisis and after crisis.”

For example, McCray said in an op-ed in New York Daily News that Thrive adds $30 million of funding (about 15% of its budget) to the $300 million the Department of Health and Mental Hygiene already spends directly to help people with SMIs.

“Thrive-supported programs are designed to enhance and complement these existing services, not compete with or replace them,” she wrote.

For someone who voluntarily requests care, they can go to a public hospital for informal short-term hospital care as well as traditional outpatient care. The average stay for someone hospitalized for mental illness is 11 days, according to the New York City Department of Health and Mental Hygiene.

Outpatient care -- preferred by many for its community-based nature -- consists of things like meeting with a therapist or a psychiatrist and getting medication prescribed. Influential 1999 Supreme Court case Olmstead v. L.C. ruled public entities must provide community-based services to those with mental illness whenever possible.

“Lots of people have schizophrenia,” says Dr. Gary Belkin, Executive Deputy Commissioner for Health and Mental Hygiene in the city's Health Department and Chief of Policy and Strategy of ThriveNYC, in a phone interview. “The vast majority don’t end up on the street untreated and that’s because there are things that happen earlier, things that Thrive is working on – getting better care connections, having many points of contact, opportunities for family/friends to bring them mobile help."

Thrive has Assertive Community Treatment (ACT) teams dispatched around the city, often in mental health shelters, to treat people with serious mental illness. There are at least 50 ACT teams in New York with the capacity to serve 3,500 people at any time, according to Herman’s March 26 testimony. Thrive also created intensive mobile treatment teams that mostly go to shelters and provide treatment for homeless people. These outreach efforts mostly help people with outpatient care, but can lead to more intensive intervention, though it is very rare for judges to order people into inpatient hospitalization in New York.

Some of these efforts will now be part of ThriveNYC’s recently-announced outcome-tracking procedures, announced in late June.

The key questions, it seems, are whether Thrive’s efforts and the increased emphasis on outpatient programs on the state level -- perhaps including what Katz of H+H said he’d like to see -- can successfully fill gaps left by deinstitutionalization, while creating a more humane care system, and reduce threats posed by those with serious mental illness to themselves and others.

Deinstitutionalization in New York has been drastic. According to Eide’s report, as of November 2018, the average daily number of people in New York state adult psychiatric centers was 2,267. In 1955, there were over 93,000. Even in just the last four years, the number of state inpatient psychiatric beds -- in other words, the capacity for inpatient care -- has dropped by 19% statewide, from 2,866 in 2014 to 2,335 in 2018.

The drop in average daily patients and inpatient beds has coincided with an increase in the number of seriously mentally ill homeless people in New York and the proportion of inmates with a serious mental illness diagnosis in city jails.

According to Eide’s findings, there are more psychiatric beds in New York City mental health shelters than the number of psychiatric beds in state psychiatric centers and Health + Hospitals facilities combined.

Supportive housing, which provides housing and social services for those with serious mental illness, is also seen as a key tool. There are currently 52,000 units of supportive housing statewide, half of which are funded by the state Office of Mental Health (the other half don’t necessarily serve those with mental illness). Supportive housing, which is built and funded by both the city and state, sometimes in conjunction, is typically run by nonprofit providers who provide onsite mental health care, medication delivery systems, and more.

According to testimony given in a May City Council hearing by the Supportive Housing Network of New York, there are around 33,000 units of supportive housing in New York City. Amid calls for more units, both Mayor de Blasio and Governor Andrew Cuomo have made pledges to develop more supportive housing.

In his NYC 15/15 Supportive Housing Initiative announced in November 2015, de Blasio said the city would develop 15,000 additional units of supportive housing over 15 years. Two months later, Governor Cuomo announced his plan to build 20,000 units over the same 15-year timespan. These announcements came after the two were unable to come to an agreement on what have been known for decades as “New York-New York” supportive housing deals whereby the city and state work together to develop thousands of units.

The New York State Senate and Assembly Democratic majorities see a need for more programming aimed at mental health care and housing, too. Earlier this year, the two bodies unanimously passed a bill creating a temporary commission to study what is seen as chronic underfunding for these housing programs. The commission would “provide policy guidance and recommendations relating to the adequacy of funding levels and need for sufficient staffing in all supportive housing under the auspices of the Office of Mental Health.”

According to a June 25 press release from supportive housing provider Bring It Home, “[t]he bill would prompt a study of current funding and staffing levels across the state and investigate ways the state can begin to remedy its years-long failure to adequately fund mental health housing programs.” Advocates are urging Cuomo to sign the bill so the commission can issue its report in time for the next state budget season.

Another discussion that has played out over many years, at the state level especially, is over how to treat individuals who are too sick to seek help.

Per New York State Law, the criteria to involuntarily admit someone due to mental health is fairly strict – the person can’t understand the need for care or presents a substantial harm to self and/or others, among other standards.

According to a 2015 New York City Department of Health and Mental Hygiene report, 40% of adult New Yorkers with serious mental illness didn’t receive medical treatment in the prior year.

Courts can and do order people to outpatient care: assisted outpatient treatment (AOT) is also known in New York as Kendra’s Law. Originally passed in 1999 in New York State (the first law of its kind and emulated in many other states since), Kendra’s Law allows select people close to a mentally ill person to petition the court to mandate a treatment plan for that person. According to OMH’s website, as of Monday (July 29) there were 3,109 people under active court order via Kendra’s Law, 1,377 of them in New York City.

Jaffe of Mental Health Policy Org, a staunch supporter of Kendra’s Law, estimates around 4,000 people should be in mandated treatment under the law. Critics of Kendra’s Law typically accept the principle but say it’s overly strict, such as the need to show an instance of seriously violent behavior in the last four years. Once a petition to mandate care is successfully filed, the chances of the courts granting the petition are extremely high: 90% of Kendra’s Law petitions were granted statewide from July 29, 2018 through Sunday (July 28, 2019), according to OMH’s website.

Kendra’s Law affects a very small population but has shown signs of working: the state Office of Mental Health says for someone who went through an assisted outpatient treatment program, psychiatric hospitalization was reduced by 64% after AOT, incarceration by 72%, and homelessness was reduced by 61%. Jaffe and Eide in their op-ed call for the creation (and funding) of a Kendra’s Law Office to deal solely with helping the city expand its efforts to get more people into Kendra’s Law.

Meanwhile, ThriveNYC offers NYC Well, a mental health helpline that has the ability to dispatch mobile crisis intervention teams to someone experiencing a mental health crisis. The phone line is something that de Blasio and McCray often cite in their public remarks about Thrive and the city’s efforts to improve mental health care.

Another big piece of the current picture of care for those with serious mental illnesses is correctional health services, which have been needed more and more. Although the daily inmate and detainee population in city jails is decreasing, the percentage of those diagnosed with a serious mental illness has gone from 10.2% in city fiscal year 2014 to 14.3% in fiscal year 2018, according to the Mayor’s Management Report.

Dr. Katz  said on What’s the [DATA] Point? that “In the case of correctional health…we know in New York City there is a group of people with very serious mental health and addiction problems who rotate between the acute hospital, the shelter, and the jail.”

One goal of ThriveNYC is to limit the number of people going to jail due to serious mental illness. The city will open two health diversion centers later this year. Announced in late 2018, the diversion centers will provide somewhere for police officers to take someone who has committed a low-level, non-violent crime but they believe is exhibiting behavioral problems due to mental health. The centers will offer mental health treatment and have overnight beds but stays will be capped at five days.

Skeptics of the idea point out that there will only be two diversion centers, one in the Bronx and one in East Harlem, and each center will only serve its specific community. Plus, the centers will have a “no-refusal” policy that could edge out those with serious mental illness if the centers are at capacity. According to Herman at the March City Council hearing, Thrive plans to evaluate the success of the two programs and possibly create more centers next year.

“We want to catch [people] before entry into the criminal justice system,” said Dr. Belkin. “Nobody should enter the criminal justice system for something related to mental illness. We should be able to reach those people so that doesn’t happen, where they can be treated and managed in a health context before they get ensnared in the criminal justice system. I think everyone wants to avoid that path."

Critics argue, as alluded to by Katz and recently brought up during a Council hearing on recidivism of those with mental illness, that mental health services outside of the criminal justice system are less robust than those offered in city jails. According to Katz, “the fact that we make it necessary for some people to commit shoplifting in order to ensure they’re in a safe place, get their meds, get their food, get their house, when we could do that so much less expensively elsewhere is really a condemnation on us.”

Another option, proposed by Jaffe and Eide, is the expansion of mental health courts, which allows judges to divert those with serious mental illness and charged with crimes to treatment instead of jail. They say current mental health courts cannot offer housing to these people, which weakens its effectiveness.

City Council Speaker Corey Johnson is attempting to prevent those with mental illness from going to jail and to ensure they get better treatment instead. In a speech on criminal justice reform on May 16 at John Jay College, he announced the Council will create a program to house 100 people with SMI caught in the criminal justice system and emphasized the 100 beds are a start, but the program will need further investment and focus to add more beds.

Johnson also pointed out how targeting the legal system can keep people with SMI out of jail; he announced the Council will fund a program to connect social workers with defense attorneys to find alternatives to prison. He also previewed the Get Well & Get Out Act, which would require correctional services staff to keep attorneys informed of their clients’ mental health.

The bill was introduced on June 13 by Council Member Margaret Chin of Manhattan and six other Council sponsors, including Speaker Johnson. The Council quickly held a hearing on the bill that was combined with an oversight hearing on recidivism rates for those with mental illness. The bill has not yet received a committee vote.

How the city handles crisis situations including people with serious mental illness has come under increased scrutiny over the last few years. According to the NYPD and an investigation from THE CITY, calls to 911 involving EDP’s, or emotionally disturbed persons, have risen from around 97,000 in 2009 to 180,000 last year. Fourteen people who appeared to be suffering from acute mental illness have been killed by police officers in the past three years.

The extent to which the city’s roughly 37,000-member police force has been trained in crisis prevention is an ongoing issue. THE CITY estimated that only about 11,970 uniformed officers had undergone crisis prevention training at the time of its March reporting.

In April 2018, de Blasio and McCray launched the NYC Crisis Prevention and Response Task Force to create a strategy to better deal with mental health crises in the city. That report was due in January and has not been publicly released. The Task Force consists of leaders from the Department of Health and Mental Hygiene, ThriveNYC, and the NYPD, among others.

McCray in her Daily News op-ed said serious mental illness and EDP calls aren’t as related as they appear.

“Unfortunately, too many people think of serious mental illness as ‘crazy people in the subway,’ or 911 calls involving emotionally disturbed persons. But not everyone sleeping in the subway or on the streets has an illness,” she wrote. “And emotional disturbance describes erratic behavior at a given time — not a chronic disease.”

In an attempt to treat EDPs, Thrive created what it calls co-response teams that proactively send a police officer with a clinician to people who have shown violent tendencies or behavioral problems in the past. The forensic ACT teams, the mobile intervention teams, and the co-response teams are all a part of Thrive’s NYC Safe program.

It’s possible that the program Dr. Katz spoke about in April -- creating a residential program for the seriously mentally ill to fill in the gaps of treatment between outpatient care, inpatient care, and prison -- is what’s called “Intensive Outpatient Treatment,” or IOT, which offers a much higher intensity of services but still in the patient’s community. Patients under IOT would visit a psychiatrist more often and for longer than traditional outpatient programs.

Already existing outpatient programs must apply for a waiver to the state Office of Mental Health for permission to offer an intensive outpatient treatment program. OMH has approved waivers for 35 clinics beginning in August 2017, according to OMH’s website (they are required by state law to publicly release waiver requests and decisions).

Otherwise, the most intensive treatment with the most consistent care can be found in hospitals, prisons, or homeless shelters.

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by Truman Stephens, Gotham Gazette

Read more by this writer.

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‘Nobody Should Enter the Criminal Justice System for Something Related to Mental Illness’ Mon, 29 Jul 2019 04:00:00 +0000
Experts Discuss Diversion and Decarceration for People with Serious Mental Illness https://www.gothamgazette.com/city/8654-experts-discuss-diversion-and-decarceration-for-people-with-serious-mental-illness https://www.gothamgazette.com/city/8654-experts-discuss-diversion-and-decarceration-for-people-with-serious-mental-illness first lady chirlane mccray host convo across

(photo: Ed Reed/Mayoral Photography Office)


Five leaders in criminal justice and mental health discussed wide-ranging options to keep seriously mentally ill people out of the prison system during a panel discussion held by the Greenburger Center for Social and Criminal Justice last week at Baruch College. Two out-of-state panelists, from Arizona and Florida, elaborated on initiatives in their states that have not made it to New York.

The discussion took place just a week after the New York City Council held an oversight hearing on recidivism for those with serious mental illness and what to do about it, and not long ager the New York State Assembly and State Senate unanimously passed legislation to create a commission to explore further state investment in underfunded mental health housing programs.

The panel, moderated by Greenburger Center Executive Director Cheryl Roberts, consisted of: Arizona State Representative Nancy Barto, Florida Circuit Judge Steve Leifman, Judge Matthew D’Emic of the Brooklyn Mental Health Court, co-Director of the Columbia Justice Lab Vincent Schiraldi, and DJ Jaffe, Executive Director of the Mental Illness Policy Group (Bronx District Attorney Darcel Clarke was slated to participate but was replaced on the agenda the day before).

Each panelist was invited to speak on one particular specialty or accomplishment in their career related to diversion or redirection from prison for those with mental illness. The panel was part of a series called “After Rikers,” which the Greenburger Center is organizing to discuss how those with serious mental illness will fare once the jails on Rikers Island eventually close.

Jaffe discussed a way, assisted outpatient treatment, in which the courts can order someone with a serious mental illness to participate in community-based mental health care services before they become violent. AOT, otherwise known as Kendra’s Law in New York, was pioneered by New York in 1999, an effort in which Jaffe was instrumental (Roberts introduced Jaffe as the “Father of Kendra’s Law”).

“Kendra’s Law is simply the single most effective program that the city has or the state has for the seriously mentally ill,” said Jaffe. Serious mental illnesses, which plague an estimated 239,000 New Yorkers and 4% of the U.S. population, are advanced diagnoses, typically schizophrenia, bipolar disorder, or major depressive disorder.

AOT is utilized for those who have rejected treatment or shown violent tendencies in the past but whose loved ones or psychiatrists can petition for a court-ordered treatment program. In essence, Kendra’s Law is aimed at preventing people suffering from serious mental illness from committing violent crime, in the vein of the namesake incident whereby Kendra Webdale died in 1999 after being shoved in front of a New York City subway by a man untreated for his schizophrenia.

The population of people eligible for assisted outpatient treatment is relatively small – currently fewer than 1,400 people are under court-ordered treatment programs, although Jaffe estimates that number should be closer to 4,000 if New York provided more resources and was more appropriately aggressive in the use of Kendra’s Law to keep dangerous people in treatment.

Barto, of Arizona, discussed her recent legislation to create a secure community residential program that provides long-term housing placements for those who have resisted help and failed traditional housing programs.

“The goal is to enable a person to not walk away from treatment due to their illness, which is happening in an unsecure setting so often,” said Barto. The facility will be “secure” as in the patient will be unable to leave the gated facility until his or her program terminates.

Barto agreed with Roberts’ assessment that the facility is “a civil commitment to a community-based locked facility or house rather than an institution.”

Nationwide, the mental health field has shifted away from inpatient care (i.e. psychiatric hospitals or “insane asylums”) and towards community-based outpatient methods.

Currently, New York offers some supportive housing options similar to Barto’s legislation. Both New York City and State have programs to build thousands of additional units of supportive housing in the coming years, allowing more individuals to receive mental health care and other social and medical services where they live.

Leifman, of Florida, discussed two major initiatives: the implementation of Crisis Intervention Teams (CIT) and the creation of a $42.1 million “one-stop shop” mental health facility. The facility -- full of programming, short-term residential beds, crisis intervention teams, and tattoo removal services -- is designed for those with mental illness who may not recognize the severity of their sickness and go through the treatment system many times.

Through the CIT training program, Miami-Dade trained 6,700 police officers representing each department in how to handle an emotionally disturbed person during a crisis. A similar training has been slow to take hold in New York City, where as THE CITY reported, just 11,970 of the NYPD’s 36,753 uniformed cops have been trained to handle EDP calls as those calls have jumped to 180,000 last year.

Furthermore, Miami-Dade recently created CIT 3.0 as a result of the shooting at Stoneman Douglas High School in Parkland on February 14, 2018. The program, called a threat management unit, has detectives daily go through every call to the CIT program and look for indicators for threats of violence which leads to an officer checking in on the caller.

D’Emic, of Brooklyn, deals with mentally ill individuals after they have committed a crime. His court, started in 2002, is referred mentally ill offenders and he decides if they go through a mental health program instead of jail or prison. It’s this type of alternative to incarceration that many believe should be the model, but must be matched with good mental health care and careful oversight.

Schiraldi spoke about what to do with people after they leave prison. He worked closely on the recently failed bill in Albany entitled the “Less is More Act,” which would prohibit New Yorkers on parole from being re-incarcerated for smaller technical violations of parole such as being late for curfew.

A former Commissioner of the New York City Department of Probation, Schiraldi took a largely critical stance on the entire probation system, saying: “there is not a lot of strong evidence that probation and parole has an impact on public safety or rehabilitation. If this was a medicine, doctors would stop prescribing it.”

“The major reason it will exist tomorrow is because it existed yesterday,” he said.

There was one point of disagreement during the panel: Jaffe was much more bearish on the impact of peer groups on mental health than the rest of the panelists. A question from guest moderator Valentina Morales of The Fedcap Group asked how involved people with lived experience should be in the planning of mental health programs. Each panelist took the chance to praise people with mental illness who’ve completed mental health programs and work with ongoing patients, while Jaffe mentioned how that can at times lead to a closed feedback loop.

[READ: City Council Looks at Reducing Recidivism for People with Mental Illness]

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by Truman Stephens, Gotham Gazette

Read more by this writer.

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Experts Discuss Diversion and Decarceration for People with Serious Mental Illness Mon, 01 Jul 2019 04:00:00 +0000
ThriveNYC to Implement New Performance Tracking System Focused on Outcomes https://www.gothamgazette.com/city/8645-thrivenyc-to-implement-new-performance-tracking-system https://www.gothamgazette.com/city/8645-thrivenyc-to-implement-new-performance-tracking-system first lady chirlane mcray deputy mayors comm

Chirlane McCray (photo: Michael Appleton/Mayor's Office)


Following repeated criticism about spending hundreds of millions of dollars with unclear outcomes, ThriveNYC, First Lady Chirlane McCray’s signature mental health initiative, is now publishing nearly 100 metrics to track the performance of dozens of programs that have been launched in the last three years.

The metrics, provided to Gotham Gazette just before their public launch, will show outcomes of programs, not just their reach or the city’s investment into them as has been the case since the inception of ThriveNYC.

Over the last few months, ThriveNYC partnered with the CUNY Institute for State and Local Governance and various city agencies to create 94 performance indicators across the board, and will begin to publish that data on its website starting this fall, with varying timelines depending on individual initiatives.

ThriveNYC will publicly post a detailed description of each initiative, the agency handling the program, and the indicators associated with it. For instance, for NYC Well, the mental health phone helpline run by the Department of Health and Mental Hygiene, ThriveNYC will measure the percentage of callers who say they are satisfied by its services. To measure the Mental Health First Aid training program, the office will look at the percentage of people that say they shared or used the training they received. 

“Now that the programs are implemented and even the ones that are about to launch, we’re putting up the metrics that we’re going to be looking at to see what kind of effect they’re having,” said Susan Herman, ThriveNYC’s director since February, in a phone interview on Thursday. 

Inaugurated in 2015, ThriveNYC was meant as a paradigm shift in how the city handles mental health issues, seeking to tear down stigma around getting mental health care, targeting services at New Yorkers who cannot afford the cost of care or have been long underserved, and ensuring that people of all backgrounds are more attuned to their own mental health needs, as well as those of their friends, family, and colleagues.

With $850 million pledged over four years, the overarching initiative, called a mental health “roadmap,” sought to bring together a range of services, with more than 50 programs (including some that were already running) across a dozen-odd city agencies. McCray has been the face of the program, touting its gospel across the city and in appearances, both with and without Mayor Bill de Blasio, across the country.

But while many have praised the program’s goals, the accountability involved has been vague. In April 2018, McCray said in an interview on the Max & Murphy podcast from Gotham Gazette and City Limits that Thrive would begin a “resetting” phase, including by bringing on its first executive director and tracking more metrics for the various programs. Gotham Gazette reported soon after that many of the ThriveNYC goals were difficult to track and that the budget was opaque.

By February of this year, a second reset began. ThriveNYC became a standalone office housed under the mayor’s office and Susan Herman, a former NYPD deputy commissioner, was named its director and senior advisor to the mayor, with the task of better organizing the effort and ensuring that it had the right structures in place. But several news reports, first in Politico New York and then The New York Times, further pointed out that ThriveNYC was struggling to track and show results despite having spent nearly $600 million.

In March, the New York City Council convened an oversight hearing where they tried to hold McCray and Herman’s feet to the fire, demanding to know if the city was getting the bang for its buck. 

Those answers are now forthcoming, the city says. 

Herman’s first task when she took over ThriveNYC, she said in the interview, was to clarify to the public the scope of ThriveNYC and the services provided under its umbrella. She denied that the metrics were created in response to the criticism the program faced, saying that they couldn’t be established earlier since there was no data to assess and that the various initiatives had to first be up and running.

“First of all we’re measuring the right things at the right time. This is when you start measuring outcomes, when you are fully implemented,” she said. “And I think most researchers would tell you, ‘Yeah this is just exactly when you should be doing exactly what you’re doing.’ And secondly, it’s very important to know that we are also engaged in formal evaluations, many of which are up and running and have been up and running, some of them for over a year, some of them two years, some of them just launched, some of them still to come but we have worked with outside researchers for years to do formal evaluations of Thrive programs and we’ll continue to do that.” 

Michael Jacobson, executive director of the CUNY Institute for State and Local Governance, echoed Herman in a separate interview. “In this kind of work there are generally two kinds of measures for programs and program success: there’s outputs and outcomes,” he said. “Outputs tend to be process-y, like how many meetings did you do, how many contacts, and those are really useful for management. In the end, whether you’re the government or general public, it’s the outcomes that matter. And they’re both more important and usually the trickier thing to measure.”

While McCray and de Blasio have talked extensively about the importance and impact of ThriveNYC, the measures have almost all been outputs, as Jacobson put it, with McCray admitting at the recent Council oversight hearing that limited systems were in place to even try, difficult as it may be, to track outcomes for individuals serviced by Thrive programs.

With the next fiscal year, FY 2020, beginning on Monday, ThriveNYC will also launch new programs, with plans to spend nearly $243 million overall through the course of the year. These programs are expected to have metrics attached, with reports issued quarterly, semi-annually, and annually, depending on the data gathered.

Some are already evident and showing impact. For instance, according to ThriveNYC, 48% of young children receiving mental health treatment for early childhood trauma at seven clinics run by the Department of Health and Mental Hygiene have shown signs of improvement. At 25 Department for the Aging senior centers with on-site mental health clinicians, 56% of seniors receiving treatment have shown improvement in depression symptoms and 65% have shown improvement in anxiety symptoms.

Even the host of new metrics are an “interim” phase, Herman said, which will eventually be followed by broader evaluations of programmatic effects on specific populations -- school students, for example -- and then a holistic review of ThriveNYC’s effect on the entire city. 

Herman couldn’t explain why the city had failed to measure the impact of many of the programs involved that had existed before ThriveNYC, though she said these had not been repackaged but instead enhanced under the de Blasio administration.

“Some of these programs, could some of them have had outcome measures earlier? Perhaps,” she said, “but this is a way of looking at Thrive in total...It’s an important distinction. Because really what people are asking is what’s the impact of Thrive? And at this point what we should be looking at is the impact of each of the initiatives. It’s only later still that we can look at the impact of Thrive on larger populations and eventually on New York as a whole.” 

Jacobson said, “You can start to think about this for any program but you can’t do it until you get some historical data...It couldn’t have been on day one.” 

Part of the failure to show qualitative and quantitative results, Herman said, is because of the nature of ThriveNYC. Akin to other long-term public health programs, it’s hard to gauge in the span of a mayoralty.

“It’s comparable frankly to universal pre-K where you can see the immediate result, you can see that kids are in school, families are happier but, like Headstart, you won’t know the impact on those children’s lives for many years to come,” she said. “And then you see it and it’s very clear. Just like smoking bans, just like trans fats bans, just like universal pre-k. You’re gonna have an impact that you won’t see for years.”

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by Samar Khurshid, senior reporter, Gotham Gazette
     

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ThriveNYC to Implement New Performance Tracking System Focused on Outcomes Fri, 28 Jun 2019 04:00:00 +0000