We are committed to finding what works. And when we find it, we ensure it becomes a lasting part of how our City government serves New Yorkers.


WHY WE NEED INNOVATION

Every year, one out of every five adults in New York City experiences mental illness. That’s roughly equivalent to the number of people who live in Manhattan. Yet, for decades, hundreds of thousands of these people have gone without the care they need – sometimes because care costs too much, a therapist’s office is too far away from home, or it’s difficult to find a mental health provider who understands their culture or speaks their language.

We need real, innovative solutions to this long-standing problem.

Before 2016, almost all funding for mental health came from federal and state funds. Since 2016, first through ThriveNYC and now through the Mayor’s Office of Community Mental Health’s Incubator, New York City is investing its own dollars in the mental health of New Yorkers. These funds have supported dozens of innovative approaches, implemented by many City agencies and hundreds of community-based organizations. Explore reach and impact data from current programs here.


FROM INNOVATION TO INTEGRATION

Our office makes sure that this historic investment in mental health services is delivering for New Yorkers. We begin by working with City agencies to build new strategies to close gaps in mental healthcare. We incubate these innovative strategies — helping agencies to launch or change how they deliver services, enhance existing services and maximize the reach and impact of these new approaches. Where needed, we refine our approach or try different strategies entirely. For programs that work well and show proof of concept, they are no longer overseen by our office and are integrated into management by an agency — becoming a lasting part of how that agency serves New Yorkers.

 

 

 

Assertive Community Treatment (ACT)

City implementation partner: Department of Health and Mental Hygiene (DOHMH)

Elmhurst Assertive Community Treatment (ACT) Team

Program description: Assertive Community Treatment (ACT) teams include mental health and substance use professionals and, at times, peer specialists. ACT teams typically meet with clients six times per month in their home or community to provide long-term behavioral health treatment, including medication. In 2016, ThriveNYC added a master’s level Substance Use Specialist to 40 ACT teams, enhancing these teams’ ability to serve people with co-occurring disorders. At any given time, ACT teams that receive partial funding from the Mayor’s Office of Community Mental Health have the capacity to serve 2,720 clients.

Need: About 43% of psychiatric hospitalizations in New York City in 2013 also indicated a co-occurring substance use disorder [Source].

Evidence: A study of one mobile treatment team in New York State that integrates criminal justice, healthcare, and community support services for individuals with severe mental disorders found a number of positive outcomes for participants, including significant reductions in arrests, incarcerations and jail days, and hospitalizations and hospital days [Source]. ACT teams that include substance use specialists have been shown to support significant improvements in mental health symptoms and residential stability among adults with a history of chronic homelessness and co-occurring mental health and substance use disorders [Source].

Reach and impact data highlights

  • Among clients discharged from the program in FY2021 Q2 after receiving ongoing care from a team, 33% had experienced incidents of homelessness in the six months prior to admission. This percentage dropped to 19% in the six months prior to discharge, while being served by a team (Assertive Community Treatment (ACT) Teams/Forensic Assertive Community Treatment (FACT) Teams/Shelter-partnered ACT Teams)
  • Among clients discharged from the program in FY2021 Q2 after receiving ongoing care from a team, 61% had experienced incidents of psychiatric hospitalization in the six months prior to admission. This percentage dropped to 34% in the six months prior to discharge, while being served by a team (Assertive Community Treatment (ACT) Teams/Forensic Assertive Community Treatment (FACT) Teams/Shelter-partnered ACT Teams)

Assisted Outpatient Treatment (AOT) Coordination

City implementation partner: Department of Health and Mental Hygiene

Derrick Brown works as a Peer Specialist on an Intensive Mobile Treatment team. Approximately 80% of people currently on AOT court orders are mandated to receive mobile mental health treatment. 

Program description: Assisted Outpatient Treatment (AOT), commonly referred to as Kendra’s Law, is court-ordered mental health treatment and care coordination for people with a history of lack of compliance with treatment for mental illness. To enhance the City’s capacity to implement this important program, ThriveNYC added 20 staff to the Office of Assisted Outpatient Treatment.

Evidence: A 2009 independent evaluation of New York State’s AOT program found a significant reduction of roughly 25% in hospital admissions during the six months after an AOT court order, as compared to the pre-AOT time period. AOT clients also experienced a number of other improved outcomes, including: reduced hospital length of stay, increased receipt of psychotropic medication, and greater engagement in outpatient services [Source].

Reach and impact data highlights 

  • 1,818 people were monitored by the AOT program in FY2021 Q2
  • 51.4% of individuals no longer needed AOT because they were likely to engage in treatment voluntarily or survive safely in the community without court ordered treatment as evidenced by their adherence during AOT order and their presentation at a psychiatric exam in FY2021 Q2 (Oct 1, 2020-Dec 31, 2020)

Featured announcements:


Behavioral Health Assessment and Support for Young Adults in Detention

City implementation partner: Health + Hospitals / Correctional Health Services

Group mandala created by women in Mental Observation Unit with Merrill Cox, Licensed Creative Arts Therapist/Instructor - Correctional Health Services - 2020 creative arts therapy during COVID-19

Program description: Young adults who experience jail incarceration are disproportionately vulnerable to mental illness, substance misuse, and victimization compared with young adults who do not experience incarceration. To enhance support for these young people, our office supported 30 NYC Health + Hospital/Correctional Health Services (CHS) staff who conduct voluntary behavioral health screenings, substance use engagement, and therapeutic creative arts programming. The data for this program focuses on 18-to-21-year-olds (“young adults”) who are incarcerated on Rikers Island or in a borough-based jail for at least 7 days and are brought by the Department of Correction to CHS for screening. Screening data reported for this program do not include incarcerated young adults already in care of CHS’s mental health service. Prior to October 1, 2020, data for this program also included those 16- and 17-year-olds who were brought by the Administration for Children’s Services (ACS) to CHS for screening; now, ACS is implementing a separate program to address their behavioral health needs.

Need: According to a study by the Vera Institute of Justice, about 85% of young people assessed in secure detention reported at intake at least one traumatic event, including sexual and physical abuse and domestic or intimate partner violence. One in three young people screened positive for PTSD and/or depression [Source].

Evidence: A 2016 review of existing literature found that arts-based programming for justice-involved youth has positive effects on social and emotional development outcomes [Source].

Reach and impact data highlights

  • 6,215 creative arts therapy sessions were conducted through this program between 12/1/16 and 3/31/2021
  • 1,550 youth and young adults were screened for behavioral health needs through this program between 11/01/2018 and 03/31/2021 (data collected FY20 onward includes only those who stayed at least 7 days)
  • 91% of creative arts therapy participants surveyed between 10/01/2020 and 12/31/2020 reported that participating in the program helped them express their feelings

Featured publication: Creative Arts Therapy During COVID-19

Be Well: Mental Health Support for City Employees

City implementation partner: Mayor's Office of Labor Relations (OLR)

Program description: Be Well is a program of the Mayor’s Office of Labor Relations’ WorkWell NYC initiative that offers programs and resources to promote mental health among the 380,000 people employed by New York City. This initiative aims to create work environments that support the mental and emotional well-being of employees and create opportunities for employees to build resilience.

Need: One in five New Yorkers experiences mental illness in a given year [Source]. As the largest employer in New York City with over 380,000 employees [Source], the City has a critical opportunity to promote mental health for its employees.

Evidence: Characteristics of the most effective workplace mental health interventions include providing activities that address both mental and physical health, and support accessing clinical treatment and navigating disability management programs, among others [Source].

Reach and impact data highlights: 13,606 City employees participated in all Be Well activities between 7/01/2019 and 6/30/2020


Connections to Care:
Mental Health Integration in Community-Based Organizations


City implementation partner: Mayor’s Office for Economic Opportunity

Employees of the Arab American Association of New York, part of Connections to Care, support community members in southern Brooklyn


Program description:
Connections to Care (C2C) integrated mental health support into the work of community-based organizations (CBOs) serving at-risk and low-income communities across the City. Through C2C, CBOs that had not been providing mental health services worked with mental health providers who trained and coached staff to screen their clients for mental health needs, offer direct support when appropriate, and link to local health providers for further care if needed. This program was operated in partnership with the Department of Health and Mental Hygiene, with additional funding through the Mayor’s Fund to Advance New York City.

Update: In the summer of 2021, Connections to Care will be integrated into Jobs Plus, a program operated by the NYC Department of Social Services/Human Resources Administration that provides career training and employment services, with the goal of creating pathways to employment for public housing residents. By adding mental health services to the Jobs Plus program via the Connections to Care initiative (C2C), the City aims to increase clients’ ability to overcome barriers to employment that may be the result of unaddressed mental health challenges and achieve other targeted program-specific outcomes in areas such as job placement and financial independence.

In April 2021, the City announced a new partnership with the CUNY School of Professional Studies to create a Community Behavioral Health Academy that will train more than 5,000 City agency staff and social service providers in three years to better support the mental health of the people they serve. Drawing on the framework of task sharing, and building on the promise of Connections to Care (C2C) and other initiatives, the Academy will equip providers and City agencies with tools and resources to address and promote mental health.

Need: About 30% of the total population of New York City (or around 2.6 million people) resides in federally designated mental health professional shortage areas [Source]. Research has robustly and consistently shown that identities with a history of oppression – such as people of color – among others, experience increased negative mental health symptoms related to experiencing discrimination and harassment. [Source]. C2C provides people the opportunity to access mental health services in places where they are already going for other basic needs. Screening data from Connections to Care reveals that about 1/3 of CBO participants experience mental health symptoms, higher than the prevalence of symptoms in the wider population. (Program data collected by DOHMH/NYC Opportunity)

Evidence: The RAND Corporation led an independent evaluation of C2C from 2016 through 2020, which found that CBOs were able to expand the skillsets of their staff to identify and address mental health needs and promote positive mental health. The evaluation also found a positive effect on mental health and social services outcomes for specific groups, including expecting parents and parents of young children and participants in youth development and workforce development programs [Source].

Reach and impact data highlights

  • 1,930 CBO staff have been trained and 49,786 participants received services through this program since this program began in 2016 through December 31, 2020
  • 70.7% of CBO participants experienced a clinically significant improvement in symptoms of depression or anxiety within 12 weeks of an initial positive screen

Featured publications:

Crisis Intervention Training (CIT)

City implementation partner: New York City Police Department (NYPD)Two New York City Police Officers do community outreach on a sunny summer day

Program description: Taught by Police Academy instructors and mental health experts, Crisis Intervention Training (CIT) helps NYPD officers better recognize and respond to the behaviors and symptoms of emotional distress and mental illness. The training includes role-playing, lectures, and conversations with individuals with mental illness who have had both positive and negative encounters with the police. The four-day training aims to increase officers’ skills in de-escalation of crises and improve the safety of both the officer and the individuals encountered.

Need: 10% of all law enforcement responses nationwide involve adults with untreated serious mental illness [Source].

Evidence: A 2017 systematic review of CIT programs has shown that CIT has positive associations with improved officers’ attitudes and knowledge about mental health, as well as on officers’ confidence in their ability to respond to individuals with mental illness [Source].

Reach and impact data highlights:

  • 16,894 NYPD officers and staff were trained in CIT between 06/08/2015 and 3/31/2021
  • 83% of trained officers surveyed in 2019 reported that they use the knowledge and skills gained from CIT

Forensic Assertive Community Treatment (FACT)

City implementation partner: Department of Health and Mental Hygiene (DOHMH)

Program description: Forensic Assertive Community Treatment (FACT) teams provide ongoing, community-based mental health treatment and other supportive services to people living with a serious mental illness who have experienced a recent interaction with the criminal justice system. These multi-disciplinary teams aim to improve the quality of life for clients though treatment, rehabilitation, housing support, and a full range of community services. FACT teams have a capacity to serve 340 clients at any given time.

Need: 33% of women and 15% of men re-entering the community after incarceration have been diagnosed with a mental illness [Source].

Evidence: A 2017 randomized controlled trial of a FACT program in New York State found that, on average, FACT participants had significantly fewer convictions, days in jail, and days in the hospital, and significantly more days in outpatient treatment [Source]. A study of one mobile treatment team in New York State that integrates criminal justice, healthcare, and community support services for individuals with severe mental disorders found a number of positive outcomes for participants, including significant reductions in arrests, incarcerations and jail days, and hospitalizations and hospital days [Source].

Reach and impact data highlights

  • Among clients discharged from the program in FY2021 Q2 after receiving ongoing care from a team, 33% had experienced incidents of homelessness in the six months prior to admission. This percentage dropped to 19% in the six months prior to discharge, while being served by a team (Assertive Community Treatment (ACT) Teams/Forensic Assertive Community Treatment (FACT) Teams/Shelter-partnered ACT Teams)
  • Among clients discharged from the program in FY2021 Q2 after receiving ongoing care from a team, 61% had experienced incidents of psychiatric hospitalization in the six months prior to admission. This percentage dropped to 34% in the six months prior to discharge, while being served by a team (Assertive Community Treatment (ACT) Teams/Forensic Assertive Community Treatment (FACT) Teams/Shelter-partnered ACT Teams)

Featured announcements: A recovery for all of us: Mayor de Blasio announces new programs to support New Yorkers experiencing serious mental illness, April 28, 2021

Mental Health First Aid (MHFA)

City implementation partner: Department of Health and Mental Hygiene (DOHMH)

Program description: Mental Health First Aid (MHFA) is an evidence-driven, free, eight-hour training that, prior to the COVID-19 pandemic, was regularly provided seven days a week in all five boroughs to expand the number of people who can help New Yorkers in need. Conducted in English, Mandarin and Spanish, MHFA helped trainees recognize mental health needs, learn how to talk about them, and learn where to direct people in need to ongoing care.

Update: In June 2020, Mayor Bill de Blasio announced – as part of the Task Force on Racial Inclusion and Equity -  that DOHMH would re-direct Mental Health First Aid (MHFA) staff to communities hit hardest by the pandemic for a Community Conversations initiative focusing on Mental Health, Equity & Resilience. This program holds structured discussions with communities about the impact of the pandemic, including structural racism, providing coping and resiliency skills, and informing residents of available mental health resources. 

Need: The stigma associated with mental health challenges has been shown to have a direct relationship to lower levels of help-seeking behaviors [Source]. Stigma also has a strong relationship to lower levels of hope and self-esteem, increases the severity of psychiatric symptoms, and lowers the likelihood of staying connected to treatment [Source].

Evidence: MHFA has been shown in numerous studies to affect trainees’ knowledge, behaviors and attitudes towards mental health, including recognition of mental disorders, beliefs about effective treatment, and confidence helping others around mental health [Source].

Reach and impact data highlights: 159,952 individuals were trained in MHFA between 12/01/2015 and 06/30/2020

Featured announcements: Mayor de Blasio and Taskforce on Racial Inclusion & Equity Announce Expansion of NYC Care and Mental Health Services to Address Disparate Impact of COVID-19 on People of Color, June 9, 2020

Mental Health Outreach and Support for Veterans

City implementation partner: Department of Veterans' Services (DVS)

Program description: New York City is home to over 210,000 veterans, some of whom experience symptoms of post-traumatic stress disorder or major depression. To enhance mental health support for veterans, dedicated care coordinators worked directly with veterans to connect them to a range of community-based services as they transition home. These teams also engaged and offered support to veterans’ families and caretakers. 

Need: 210,000 veterans live in New York City. 11% of these individuals were deployed after 9/11. [Source] 20% of veteran and service members of the Iraq or Afghanistan wars living in New York State suffer from either PTSD or major depression. About half of those in need of treatment seek help; however only half of those receive minimally adequate care [Source].

Evidence: A 2016 study showed that Washington State veterans who had connected to outreach services were three times more likely to schedule an intake appointment, attend their appointment, and enroll in treatment than those who had not [Source].

Reach and impact data highlights: 11,500+ veterans, military families, and caregivers accessed services and support through this program between 2017 and 2021

Mental health services for high-need schools

City implementation partner: Department of Education, Department of Health and Mental Hygiene

 

Program description: Symptoms of mental health conditions frequently emerge before the age of 14. The Office of School Health implemented new mental health services at 173 high-needs schools serving grades K through 12. Participating schools have on-site clinical services, including group and individual counseling for students, to integrate mental health services in school settings, improve the mental health outcomes of students, and build schools’ capacities to address the mental health needs of their school communities. This program began in fall 2017.

Need: 32% of New York City students report feeling sad or hopeless for at least a two week period in the past twelve months [Source]. Nearly 270,000 five- through 17-year olds in New York City are believed to have a diagnosable mental disorder; 134,000 of whose symptoms are severe enough to impact their daily functioning [Source].

Evidence: A recent study found that students in schools who received on-site mental health clinicians to identify and treat children with mental health needs demonstrated a significantly greater increase in prosocial behavior (as rated by both parents and teachers) than students who did not [Source]. An additional study of four school-based mental health programs that provided on-site clinical services found that all four programs decreased the percentage of youth in the clinical range on a scale of emotional functioning [Source].

Reach and impact data highlights

  • Students participated in 201,298 individual or group supportive counseling sessions since this program began in 2017 through December 31, 2020
  • 16,478 trainings have been provided to teachers, staff, and families since this program began in 2017 through December 31, 2020


Social Emotional Learning (SEL)

City implementation partner: Department of Education (DOE)


Program description:
Social, emotional, and behavioral regulation skills are foundational for learning and well-being. Through a partnership between the Mayor's Office of Community Mental Health and the Department of Education, Pre-K and 3-K programs across New York City provide social-emotional learning support to students, families, program leaders and teaching teams.

Need: 43% of children in New York State (0-17) had experienced adverse childhood events in their lifetime, a 2011-2012 survey found [Source]. Adults who had experienced childhood emotional, physical, or sexual abuse were four to twelve times more likely to experience alcoholism, drug abuse, depression, and suicide attempt, according to the Adverse Childhood Experiences Study (ACE Study) [Source].

Evidence: There is a consensus among scholars that schools provide a powerful opportunity to provide social and emotional learning [Source]. Enhancing school staff’s ability to conduct provide successful social and emotional programming through universal interventions can have significant positive effects on students’ social and emotional skills, attitudes, behavior, and academic performance [Source].

Reach and impact data highlights:

Over 3,000 schoolteachers and program staff participated in at least one professional learning session since the program launched in 2016

  • More than 3,000 parents and caregivers have attended family workshops to learn social emotional development practices since 2016
  • 91.4% of classroom staff reported that they learned one skill or strategy to help children manage their feelings or behaviors between January 1 and March 31, 2021
  • 1,979 parents and caregivers participated in family support workshops or trainings between January 1 and March 31, 2021