My Mental Health Plan

Mental health is the most important element of health, but government delivery is substantially outdated and requires a holistic redesign.  

“Illness” is discussed to exhaustion. But “health” is not, except as an “absence of illness.” It’s easy to point to examples at each extreme. But almost everyone lives in the middle. It’s a fluid gradient and people move from one state to another. Almost everyone experiences lack of mental wellness regularly, especially with the pandemic. 

Despite this, public policy is obsessed with drawing a clear line between health and illness, because that line is all about money and implicit power. On one side, people receive services that cost money. On the other, nada. 

That line also represents social stigma. On one side the lack of services implies that people are “healthy” and “normal.” On the other, the presence of services means people are “sick” and “need help.” This, combined with other cultural and societal prejudices, means that people who need services often do not seek them, and people who receive services can feel ashamed and isolated. 

This bias runs across government social services. But it’s just the opposite with corporate welfare, whose recipients are considered “smart” by taking advantage. But I digress...

The line between healthy and sick is a false dichotomy and should be eliminated. I often say that our problems are interconnected. With mental health, our problems are intersectional. Poverty, violence, cultural norms, the pandemic quarantine, gender and racial bias and other factors all contribute to mental illness. The absence of parks, open space, clean air, safety, supportive schools and other factors stand in the way of health. 

Health deserves our focus. The top priority of my administration will be to address the causes of illness, especially poverty, to promote the presence of health, and to create a more responsive government that puts people first over bureaucracy. 

My plan for mental health reform focuses on restorative justice, robust outpatient treatment, and supportive housing. As Mayor, I will collapse the  $816 million dollar budget for ThriveNYC into the Department of Mental Health & Hygiene. This department would report to a Deputy Mayor for Well-Being, along with the Department of Health and Health & Hospitals. I would salvage and improve maternal depression screenings for young mothers, expand syringe exchange programs at sites where opioid overdose is common, and ensure equitable distribution of Naloxone kits across the city. I would also immediately push for 10,000 new beds in supportive housing and access to outpatient mental health services. Passing the NY Health Act, delivering on Universal Childcare and Mental Health Reform would help address the root causes for illness for generations to come. 

Too many New Yorkers, struggling with mental illness, are sent to jail or left to the streets with no options for care except for the emergency room. This places tremendous financial strain on the city and takes a greater emotional toll on the families of people with serious mental illness. 

We ask our police to do the work of psychologists, social workers, and psychiatrists. They are asked to make up for society’s lack of investment in mental health, education, and economic opportunity. This needs to change. 

TL;DR: Mental Health Policy Priorities 

• Focus on equitable delivery of social support systems and relief for long-term prevention, resilience, and well-being

• Provide safety and immediate relief for the homeless:

  • Create Mental Health Crisis Management Teams led by social workers and mental health professionals as an alternative to armed police response to homelessness issues

  • Create 10,000 beds in supportive housing

• Greatly expand supports in the public schools

  • Make mental health a priority across the entire school system

  • Double the number of guidance counselors and social workers 

  • Greatly increase the number of school nurses, at minimum putting one nurse in every school

• Implement data collection to set a baseline for performance measurement

The Details: Mental Health Plan

Anyone who has struggled with or knows someone who has struggled with mental illness understands how difficult it can be. Rates of overdose, suicide and homelessness are at record highs and life expectancy has gone down in many demographics. 

From Thrive NYC’s records: 

Despite the fact that people of color and those in poverty bear the greatest mental health burden, they are among the least likely to get help. 

• African Americans and Asians are less likely to receive counseling/therapy or take medication for their illness than whites, according to a survey of NYC residents. 

• Receipt of mental health treatment has been found to be lower for African Americans and Latinos compared to whites.

• National studies suggest that African Americans can be half as likely as whites to receive community-based mental health care, but as much as twice as likely to be hospitalized.

Nearly one in every 25 New Yorkers live with a serious mental illness, with around 280,000 adults dealing with diagnoses like major depressive disorder or schizophrenia, city health officials reported last month. The likelihood of someone having a psychiatric hospitalization in New York City varies dramatically by neighborhood and income. People from the city’s lowest income neighborhoods are twice as likely to be hospitalized for mental illness compared to residents from the highest income neighborhoods.

Reported last month, the city’s 311 system recorded over 17,330 calls between March and December 2020 related to mental health issues — nearly 85 times more than the 206 calls recorded during the same time period in 2019, city data shows. Another 5,866 were recorded between January and April 1 of this year.

About 40% of single adults in city shelters say they suffer from a mental illness, according to the Department of Homeless Services. Among city jail inmates 53% of them — 2,965 of about 5,640 total — have repeatedly received mental health treatment, have a known mental health diagnosis, or have attempted suicide during a previous stint behind bars, Correction Department data shows.

Thirty hospitals statewide have repurposed about 600 psychiatric beds for COVID-19 patients, according to the state Office of Mental Health. All told, the state has 5,815 licensed psychiatric beds, including the 600 not currently being used for psych patients — a decrease of about 30 beds statewide since 2019.

This lack of resources leaves homeless adults to suffer the most: they have much higher rates of serious mental illness, addiction disorders, and other severe health problems. The city estimates that about 40 percent of the unsheltered population has a serious mental illness.  The pandemic has only exacerbated these problems, with rates of eviction, homelessness, and overdoses skyrocketing in the past year. 

But it doesn’t have to be this way. We know how to treat mental illness effectively; how to mitigate the effects and allow people to live normal lives. The real problems arise when people with serious mental illness have no access to care or affordable housing, leaving our most vulnerable alone and homeless, pushing folks into violent cycles of homelessness, drug abuse, and repeated interactions with police. 

This needs to change. We need to strengthen healthcare for those who need it most, providing housing to the homeless, making outpatient treatment accessible to all, and eliminating punitive approaches to substance use and possession. 

Divert from Justice Involvement 

People suffering from suicidal ideation, substance abuse disorder, or in a mental health crisis should be met with compassion and treatment, not punitive judgement. Existing models have been effective at improving outcomes in mental health crisis response. The National Alliance on Mental Illness (NAMI)’s plan for Crisis Intervention Team Programs (CIT) has demonstrated positive outcomes. We should structure our mental health crisis management response on the same principles of prioritizing health and well-being first and ensuring the presence of mental health professionals and routine de-escalation training. 

These programs provide evidence that our city, working with professionals and communities, can create competent, evidence-based protocols for open-air drug use, mental health crises, and other non-violent, victimless offenses. 

Coordinating Data 

Implementing this policy will require coordination between mental health service providers, community support networks and city agencies, like DOE, DOH, H&H, and the NYPD. Providing streamlined access to outpatient mental health services in every school, healthcare office, and law enforcement interaction will require intense collaboration between city agencies.

Assisted Outpatient 

We need to strengthen community support and outpatient treatment services before individuals struggling with mental illness go into crisis mode. That means ensuring routine outpatient care, decent housing, and community based supports for medication and treatment. Building these community and outpatient support networks will help stop setbacks escalating into crises, like arrests, emergency rooms visits, and incarceration. 

Mental Health in Schools

Police interventions in mental health crises in schools are on the rise, including instances of 5 and 7-year olds being handcuffed by NYPD officers. This is an entirely inappropriate way to handle kids having mental health crises. We need to take cops out of schools, and instead, staff our schools with enough nurses and guidance counselors/social workers who are trained in mental health responses. If a situation were to escalate where a student is becoming violent, our unarmed, non-NYPD school safety officers will be there to support guidance counselors in ensuring teachers and students don’t get hurt. 

Additionally, adding more guidance counselors and nurses to schools will help identify and treat mental health issues before they become crises. 

Conclusion

As we do the hard work of creating a healthy city, we will need to improve the tools we have, such as Kendra’s Law. It mandates the replacing of inhumane and expensive involuntary inpatient hospitalization and incarceration with less expensive, outpatient care, managed by a community-based support team. And lastly, the Mayor’s office must be a partner in this work, using the City’s marketing capabilities to raise awareness about mental health, and reduce the stigma surrounding seeking out mental health treatment.