NYAPRS Note: NYC Mayor Bill De Blasio unveiled a multifaceted initiative aimed at enhanced outreach to homeless New Yorkers with serious mental health conditions and greater coordination across City homeless and mental health services and the NYPD.
There’s a lot good here. The plan will allow for enhanced, real-time responses from a variety of promising programs, including 4 forensic ACT teams that appear to be based on the exemplary CASES model and 3 intensive mobile treatment teams that appear to draw from the acclaimed Parachute program. Mental health staffers will also be available at shelters that specialize in temporarily housing those with mental health conditions. And the initiatives will create a specialized NYPD-DOHMH co-response team in each borough comprised of DOHMH clinicians with specially trained NYPD officers to more effectively respond to and triage individuals in need.
But, as the fact sheet below points out, treatment is not a silver bullet and so, mandating more individuals into services that have already failed them will not get the job done. At the same time, housing is the gold standard as is a way out of poverty. Accordingly we look forward to the Mayor’s fall housing initiative and hope that there is some attention, as individuals stabilize their conditions, to help them get back to work. Identifying individuals for greater cross agency coordination of response needs to be done very carefully and there needs to be a clear way as to how one gets on and, as important, off of such a list.
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City Moves to Monitor Violent Mentally Ill
by Cindy Rodriguez WNYC August 7, 2015
As part of a larger plan to restructure and improve the city’s flawed mental health system, the de Blasio administration said Thursday it would spend $22 million to identify and monitor people who have a history of violence and who don’t comply with treatment for an existing mental illness.
The plan includes the creation of a central hub to be run by the Mayor’s Office of Criminal Justice that will gather information from city workers who have regular contact with the mentally ill. Mayor Bill de Blasio said the information could come from different places, such as the police who encounter someone on the street, a shelter worker or a healthcare provider at a public hospital.
Once someone is identified, teams of NYPD officers and clinicians will find them, assess them and get them treatment.
The city said right now various agencies are encountering this vulnerable population but they aren’t communicating with each other, and people are falling through the cracks.
“We have two systems, the criminal justice system, the mental health system that until now have really not had a regular and real-time way to communicate with one another, and there are consequences to that,” said Liz Glazer who heads the Mayor’s Office of Criminal Justice.
The city said the information that’s gathered on people would help clinicians make better informed decisions about whether to commit someone or not.
First Lady Chirlane McCray said that several hundred people would likely need to be monitored. When asked what the bar would be for a violent history, the city said it was still working out the fine details of the protocol, but that someone who had been breaking furniture or assaulting people at shelters would be considered to have a violent history, and so would someone with assault or harassment convictions.
“When someone meets those criteria they are not ignored which sadly has been the history for decades in this city, ” de Blasio said.
Some mental health advocates said the plan had some positive aspects but more housing for the mentally ill and homeless was missing. Harvey Rosenthal, Director of the New York Association of Rehabilitation Services, said people also should not be forced to back into treatments that don’t work or returned to shelters that may be causing them to get worse.
“Something new and specialized is needed here,” Rosenthal said.
The city said it would address housing issues for the homeless mentally ill in the fall when the city lays out its more comprehensive mental health initiative. It would also expand the use of already existing mobile crisis teams that respond to individuals in distress, as well as teams of medical and mental health professionals that monitor people already in the criminal justice system.
http://www.wnyc.org/story/city-moves-monitor-violent-mentally-i
THE CITY OF NEW YORK
OFFICE OF THE MAYOR
NEW YORK, NY 10007
FOR IMMEDIATE RELEASE: August 6, 2015
CONTACT: pressoffice@cityhall.nyc.gov, (212) 788-2958
Fact Sheet: NYC Safe
The City’s mental health system has been neglected for decades. People are endangering themselves and others because they are not getting the treatment they need. NYC Safe is an unprecedented partnership between law enforcement and health care agencies that will completely change how the City intervenes to stop and respond to violence by the seriously mentally ill. NYC Safe will reach a historically marginalized population, connecting them to consistent care to avoid crises and violence.
The de Blasio Administration had already committed $323 million in additional funding over three years to mental health programs, including a $134 million plan to continue to drive down crime while also reducing the number of people with behavioral health issues needlessly cycling through the criminal justice system. In total, today’s announcement invests $22.4 million annually to continue the Administration’s efforts to make this a safer city and provide better care for people whose mental illness may place others at risk.
This approach supports public safety by:
- Expanding treatment options and helping City agencies identify those mentally ill individuals that pose the highest concern for violent behavior and directing resources appropriately, ensuring they have access to treatment. While treatment isn’t a silver bullet, creating new programs to allow for consistent involvement with services and treatment can reduce the risk of violence.
- Increasing coordination, including the first citywide entity for coordinating interventions to address the mental health and criminal justice concerns for these individuals. Responses will prioritize diversion to therapeutic settings.
More information
Treatment Options: This initiative creates a number of new clinical care options for this population. These clinical interventions are designed to fill gaps in the City’s existing continuum of mental health care. ($17 million annually)
- Funding for four new Forensic Assertive Community Treatment Teams (Forensic ACT), which will provide intensive, high quality treatment to additional 272 individuals assessed at higher concern for violent behavior. These teams require approval for state Medicaid reimbursement.
- Three new Intensive Mobile Treatment Teams, which will provide 75 high concern individuals with intensive, high quality treatment. The teams are designed to keep people in treatment, even if they are in and out of jail or face housing instability.
- Additional clinical staff at the City’s homeless shelters that see the highest number of seriously mentally ill people.
- Resources to increase existing City ACT Teams’ effectiveness to treat co-occurring substance use and mental illness. Uncontrolled substance use among the seriously mentally ill increases the concern for violent behavior.
Increased Coordination: A new hub will enhance and expand capacity to share information among City agencies. This will allow agencies to more easily and effectively find people and connect them to treatment. ($4.8 million annually)
- The new NYC Safe Hub will share appropriate information about high concern individuals to more effectively connect them with enhanced services.
- Hub staff will convene inter-agency teams to follow each case and implement timely interventions. The Hub data will be housed at the Mayor’s Office of Criminal Justice and will report progress on the initiative to the Behavioral Health and Criminal Justice Task Force.
- A new case monitoring team at DOHMH to facilitate the process of connecting individuals of high concern to appropriate and effective treatment options. This team will also stay in contact with their providers to offer additional assistance and resources to make sure these individuals don’t fall out of treatment.
- Resources to better leverage and more effectively use Kendra’s Law, which allows a judge to mandate outpatient treatment for some people with serious mental illness.
- Five new NYPD-DOHMH co-response teams that embed DOHMH clinicians with specially trained NYPD officers to more effectively respond to and triage individuals who are at a great concern for violent behavior and have a serious mental illness.
Improved Security: Targeted investment to improve safety in and around homeless shelters. ($5 million in FY2016)
- The NYPD is providing additional officers to police the area around high priority shelters.
- Increase of DHS peace officers inside highest-need shelters.