NYAPRS Note: NYC Mayor Adams and his Department of Health and Mental Hygiene Commissioner Ashwin Vasan rolled out an ambitious plan today to improve family and children’s health, reduce overdoses and expand support to people with major mental health and related challenges.
The long awaited plan offer some promise and progress here: this plan changes the focuses from public safety to public health, from a major focus on involuntary commitments to a variety of voluntary engagement strategies and from a reliance on the NYPD to the leadership of the Department of Health and Mental Hygiene (DOHMH).
It focuses on crisis prevention and intervention, increased access to responsive health and social supports. It moves the focus from identifying and isolating people to welcoming them into communities: “home, community and response are just as critical for preventing the progression of mental health issues and ensuring healthy environments for recovery.” And, very importantly, it moves us away from a view of confining what the tabloids like to call ‘the deranged’ to our core belief that “all New Yorkers with SMI can thrive.”
Before we get into more detail, none of these progressive initiatives can be carried out without an adequate funding base and workforce:
The Governor, Legislature and the Mayor must go all out to see that we see an 8.5% COLA this year!
There’s a
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very welcome focus on values like centering on equity, anti-racism and human rights, incorporating input from those with lived experience and community voices, supporting the workforce, trauma informed approaches and on innovation.
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a broad view beyond a focus on treating illness and symptoms via involuntary medication and hospitalization and instead, a deeper look at the social determinant of health-related causal factors including stable housing and healthy food, poverty, racism and community safety for all. The previous emphasis seemed to be on dealing with the ‘dangerous mentally ill’…this approach moves away from seeing our mental health community as a common victim of violence and not the major purveyor of it.
When you get past all of the promising value statements, here are some major elements of the plan:
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Increased collaboration with New or Expanded State Initiatives including Certified Community Behavioral Health Clinics, Critical Time Interventions Teams, Assertive Community Treatment Teams and the first episode OnTrack program.
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Some limited expanded use of peers, e.g expansion of peer-driven connections to primary and mental health care and prison/jail reentry services (more details needed) and adding 2 peers to every mobile crisis team and on peer led community engagement (more details needed here). While there’re references to making B-Heard alternative to police first responder teams Citywide, there’s no reference to a central role for peers here, per the CCIT-NYC model NYAPRS has been supporting.
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There’s a very welcome expansion of clubhouses to foster connection to community, employment, health and criminal justice alternatives. We hope that NYS government will do the same in this year’s budget! OMH pulled back funding and support for clubhouses when PROS was established instead of bolstering the most progressive ones and seeking to improve others. As a director of Albany’s club program in the 1980’s, I still see the great impact that the loss of those intentional communities has had on people I’ve stayed connected to over the last 30 years.
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We remain fully opposed to the expanded use of involuntary inpatient and outpatient treatment: while there’re references to alternatives, we don’t see enough specificity here.
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We were thrilled to see the Governor’s support for new peer INSET outreach and engagement teams in her budget proposal and urge the City to invest in additional teams across the boroughs.
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Policy wise, we fully support the greater emphasis on parity enforcement, the focus on making sure CCBHCS have a strong rehabilitation focus and on more training to expand the use of psychiatric advance directives (NYAPRS does such training now and looks forward to collaborating with OMH and DOHMH in this area).
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We remain strongly opposed to the Mayor’s legislative agenda’s heavy focus on bolstering the use of coercion.
There’s a lot more to unpack here, especially on housing….we’ll have more analysis tomorrow.
NYAPRS is working hard to see increased state and City funding for peer diversionary crisis respite programs,
innovative peer bridger initiatives and housing first programs in this year’s NYS Budget.
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Mayor Adams Unveils Ambitious Mental Health Agenda Focused On Improving Family And Child Mental Health,
Addressing Overdose Crisis, And Expanding Serious Mental Illness Support
March 2, 2023
Watch the video here at https://www.youtube.com/live/Hg69k5xWw4w?feature=share
Family and Child Mental Health: City to Launch Pioneering Telehealth Program for High School-Age Teens, Youth Suicide Prevention Pilot Programs
Overdose Prevention: As Overdose Deaths Hit Historic Levels, City Aims to Reduce Overdose Deaths 15 Percent by 2025, Explore Opening Additional OPCs
Serious Mental Illness Support: City Will Double Number of Connections for New Yorkers with SMI to Community Based Treatment Over Next Four Years, Increase ACT and IMT Capacity by 800 Over Coming Year
Mayor Announces $20 Million in Additional Investments Toward Healthier City
NEW YORK – New York City Mayor Eric Adams and New York City Department of Health and Mental Hygiene (DOHMH) Commissioner Dr. Ashwin Vasan today announced “Care, Community, Action: A Mental Health Plan for New York City,” a sweeping mental health agenda — with over $20 million in new commitments — that will invest in child and family mental health, addressing the overdose crisis, and supporting New Yorkers living with serious mental illness (SMI). Over the coming months, the city will roll out a pioneering telehealth program for New York City high school-aged teens that will both provide ongoing support and serve as an entry point to higher levels of care. The city will also launch suicide prevention pilots aimed at youth in crisis. With overdose deaths continuing to climb nationwide and in New York City, Mayor Adams also announced the city’s goal to reduce overdose deaths by 15 percent by 2025. Finally, building on efforts to support New Yorkers living with SMI, Mayor Adams announced plans to expand clubhouse capacity, double the number of New Yorkers living with SMI that get connected to community care, and expand the Behavioral Health Emergency Assistance Response Division (B-HEARD) program citywide. This agenda builds on $370 million in other investments by the Adams administration in New York City’s care continuum and crisis response.
The mental health agenda additionally outlines the city’s policy and advocacy agenda to effectively work with state and federal partners on these important issues. By addressing these three urgent, major challenges, this agenda will save lives and build a healthier New York City for working families and those most in need of care.
“The COVID-19 pandemic — with the stress, isolation, and anxiety it brought so many of us — pushed mental health to the forefront of the conversation,” said Mayor Adams. “When it comes to health, we can no longer ignore the brain and focus just on the body any longer; we must address the whole person, and the whole system. By investing in family and child mental health, addressing the overdose crisis, and supporting New Yorkers with serious mental illness, this plan focuses on where our need is greatest, going upstream to build a healthier city for all New Yorkers.”
“The city has experienced a once in a century pandemic, record high overdose deaths, and growing mental health needs for our young people. Therefore, a comprehensive mental health plan for New York City is more critical today than ever before,” said Deputy Mayor for Health and Human Services Anne Williams-Isom. “This plan centers people, care, and compassion at the core of each of its strategies, and focuses on those who have been previously left behind. From child and family mental health to those struggling with substance use issues to those with more severe conditions needing specialized supports, it sets forth new and sustainable ways to support every New Yorker who needs it.”
“This plan represents the city’s commitment to tackling the second pandemic of mental health needs in the wake of COVID-19, and it outlines a vision and a framework of a culture-shifting response for New York City,” said DOHMH Commissioner Dr. Vasan. “We must treat mental health as foundational to our society’s collective future, the same way we would our economy or the environment. We must act intentionally and ambitiously now, to shore up the system’s foundations and to innovate. By grounding this strategy in public health, focusing on populations with the greatest needs, as well as by working across levels of government and across stakeholders groups, we are showing how to bring all hands on deck to transform our mental health system, to save lives, prevent suffering and improve quality to life.”
Improving Child and Family Mental Health
Increasing access to mental health care for youth and their families and improving access to mental health care that is timely, culturally responsive, accessible, and affordable is critical to New York’s overall wellbeing.
While few models of a holistic youth mental health system exist, the long-term benefits of early intervention are potentially greater than with any other group. The need is also becoming clearer, with rates of depression among youth rising. As announced in Mayor Adams’ State of the City address in January, the city will invest $12 million to launch an expansive telehealth program for New York City high school aged teens, connecting them with mental health care. The city will also launch suicide prevention pilot programming at NYC Health + Hospitals for youth entering emergency departments for suicide attempts and community-based suicide prevention programming to specifically serve Black and Brown youth.
To further understand risk factors to a young person’s mental health better, the city will also bring together youth, families, and community partners to assess the impacts of social media on youth and develop strategies to address potential harms.
Addressing the Drug Overdose Crisis
The year 2021 was the deadliest year on record for overdose deaths in New York City, with racial and geographic disparities worsening — reflecting trends of the national crisis. To tackle the opioid epidemic, the mental health agenda outlines how the city will expand access to high-quality harm reduction services and sets a goal of reducing overdose deaths by 15 percent by 2025.
To meet this goal, Mayor Adams announced the city will expand non-fatal overdose response efforts to at least three additional hospital emergency departments and strengthen the 14 syringe service providers into a network of Harm Reduction Hubs with comprehensive services like a place to rest, addiction services, and medical and mental health services. The city will also expand drug-checking services and implement at least four Public Health Vending Machines that dispense naloxone to increase access in neighborhoods with high rates of overdoses — the first of its kind in New York City. New York will additionally increase support for children, families, and communities affected by the overdose crisis and work to reduce the number of people who develop problematic substance use.
Finally, the city will explore opportunities to expand overdose prevention centers (OPCs) to areas of the city with the highest rates of overdose death, continue to support the two existing OPCs with the goal of allowing them to operate 24 hours per day, and also continue to advocate for legal pathways to fund and operate OPCs.
Expanding Serious Mental Illness Support
This plan focuses on connecting New Yorkers with SMI with four pillars of care: health care, housing, community, and crisis response. The city aims to double the number of connections of New Yorkers living with SMI with community-based care over the next four years, putting thousands more New Yorkers on a path to stability. As part of this effort, the city will also expand mobile treatment capacity over the next year to serve 800 more people with high service needs through Intensive Mobile Treatment (IMT) and Assertive Community Treatment (ACT). To expand housing options for people with SMI, the city will add an additional 8,000 units of supportive housing, and invest $7 million more to significantly increase Clubhouse capacity over the next four years.
The mental health agenda additionally outlines how the city will strengthen the crisis response systems, expanding the B-HEARD pilot program citywide to respond to more mental health-related crises with a health-led response and adding two peers to every mobile crisis team to divert people in crisis from unnecessary hospitalizations. Finally, the city will work in partnership with state partners to develop a streamlined referral system to care, expediting referrals from hospitals, jails, and shelters.
See for long list of quoted supporters at https://www.nyc.gov/office-of-the-mayor/news/140-23/mayor-adams-ambitious-mental-health-agenda-focused-improving-family-child-mental
Up Closer
Serious Mental Illness
Serious Mental Illness is defined as one or more mental, behavioral or emotional conditions such as major depressive disorder, schizophrenia and bipolar disorder that substantially interfere with major life activities (for example, ability to maintain employment). Similar to national averages, about 4% of adult New Yorkers live with an SMI diagnosis. In addition, 39% of adult New Yorkers with SMI are not engaged in treatment.
The City is committed to taking a public health approach to supporting people with SMI, focusing on prevention and intervention to avoid crisis and providing responsive care with health and social supports that are affordable, accessible, acceptable and free of stigma.
With the right help, all New Yorkers with SMI can thrive. With this approach, we aim to improve health, decrease suffering and social isolation, and improve well-being for people living with SMI. This approach also acknowledges that a focus on health care alone is not enough to foster mental wellness. Home, community and response are just as critical for preventing the progression of mental health issues and ensuring healthy environments for recovery.
Our Goals And Strategies
Items bolded by NYAPRS
1. Improve access to specialty SMI care and primary care that is race-conscious and trauma-informed
Our Strategies:
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Ensure coordinated access to the range of specialty care needed, from intensive community-based behavioral health services to appropriate care in a hospital
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Enhance reentry services for people impacted by SMI and the criminal legal system
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Address racial inequities in health care services and treatment for New Yorkers of color with SMI
2. Expand the stable housing options available to New Yorkers with SMI
Our Strategy:
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Make safe and stable housing more available, affordable and accessible to help improve the quality of life of New Yorkers with SMI
3. Expand City infrastructure for rehabilitative supports, education and employment for people with SMI and for their families
Our Strategies:
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Make sure people with SMI are part of the wider community and supported with education, employment and relationship-building opportunities
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Make sure families impacted by mental illness are adequately supported
4. Serve New Yorkers in mental health crisis through a health-led response
Our Strategies:
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Improve the experience of New Yorkers who are facing a mental health crisis through strengthened connections to a range of community-based supports and acute care services
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Improve access to and use of crisis stabilization options, including hospitalization and alternatives, for people with SMI in need of intensive and supportive care