/ September 21, 2021

Testimony of Susan Herman on the City’s investment in expanding services for New Yorkers with serious mental illness

Committee on Mental Health, Disabilities, and Addictions

September 17, 2021

Good morning, Chair Louis and members of the Committee on Mental Health, Disabilities, and Addictions. My name is Susan Herman and I am a Senior Advisor to the Mayor and Director of the Mayor’s Office of Community Mental Health. I am joined by several colleagues: Dr. Torian Easterling, First Deputy Commissioner and Chief Equity Officer, and Dr. Chinazo Cunningham, Executive Deputy Commissioner of the Division of Mental Hygiene at the Department of Health and Mental Hygiene; Dr. Charles Barron, Deputy Chief Medical Officer, and Dr. Rebecca Linn-Walton, Senior Assistant Vice President in the Office of Behavioral Health at ‎NYC Health + Hospitals; and Laura Kavanagh, First Deputy Commissioner at the NYC Fire Department. Thank you for the opportunity to testify.

Four percent of all adults in New York City – around 240,000 people – have serious mental illness, or SMI. SMI includes illnesses such as bipolar disorder, schizophrenia and major depressive disorder resulting in serious functional impairment. This means that the illness is severe enough to substantially interfere with one or more major life activities.

These New Yorkers have a wide range of needs. Addressing these needs requires dedicated and coordinated assistance from many different parts of City government. When we talk about serving New Yorkers with serious mental illness, we mean reaching:

  • The 80-year-old who lives alone and has been homebound during the pandemic;
  • The high school junior experiencing the first symptoms of psychosis;
  • The gun violence victim whose symptoms of PTSD and significant depression have lingered for months;
  • The person struggling with chronic street homelessness and bipolar disorder; and
  • The person who, after multiple psychiatric hospitalizations, is now connected to a mobile treatment team that brings clinical care to him or her.

 

 

SEVEN YEARS OF FILLING GAPS IN CARE

In the past seven years, Mayor de Blasio in partnership with the City Council has significantly expanded services for New Yorkers with serious mental illness. Here are just a few examples:

Before 2015, there were 41 City-funded mobile treatment teams. Currently, there are 57. And now we are adding another 25 teams, totaling 82 City-funded teams. With these new teams, the total number of clients who can be served by a mobile treatment team, both those funded by the City and the State, will grow from just over 3,900 people in 2015 to over 5,300 people.

Mobile treatment teams provide ongoing, clinical care to people in their neighborhoods – people who have had difficulty staying connected to more traditional forms of clinic-based mental healthcare. There are several different mobile treatment team models, some of which offer more intensive support for people with recent justice involvement or escalating violent behavior.

Mobile treatment has made a profound difference: For example, around 90% of people served by Intensive Mobile Treatment teams – known as IMTs – remain in treatment consistently for at least 12 months. This is a remarkable success rate, given that one of the reasons clients are assigned to an IMT is because they have been inconsistently engaged in more traditional forms of care in the past.

A high percentage of clients are experiencing homelessness when they begin treatment with an IMT. Since 2015, 41% of all clients who were homeless at the outset of IMT treatment have secured permanent, non-shelter housing through their IMT. We have also expanded the number of supportive housing units for people with serious mental illness from 7,400 in 2015 to 9,600 at the beginning of 2021. As you know, housing is one of the most important determinants of someone’s stability and mental health.

Allow me to mention a few more examples:

Three years ago, people experiencing a behavioral health crisis — an urgent need, but not an emergency — waited on average 17 hours for a mobile crisis team to come to their home, conduct an assessment, and provide care. We recently added six more mobile crisis teams, for a total of 24 for adults now operating citywide. These are teams of psychiatrists, social workers, peers, and nurses – and they arrive in around two hours, seven days a week, between 8am and 8pm, citywide.

This administration also created Co-Response Teams — two police officers and one social worker. These teams offer a pre- and post-crisis intervention for people with mental illness and substance use disorders who may be at an elevated risk of harm to themselves or others. They connect people to care, including medical and mental healthcare, legal, housing and other social services. Four years ago, New York City did not have Co-Response Teams. There was no comparable pro-active intervention for people who had been violent and whose mental health seemed to be worsening. In the last four years, these teams have assisted over 2,200 people across the City, often meeting with them several times over a period of many months.

We have also added capacity to the Assisted Outpatient Treatment (AOT) program, which provides mental health services to individuals who need court-mandated treatment (this is also known as Kendra’s Law). In fiscal year 2013, there were 1,289 people monitored by the AOT program. By last year, we had nearly doubled that number to over 2,400 people on AOT.

We are also now fundamentally redesigning our response to 911 mental health crisis calls. Beginning in Harlem and East Harlem – the neighborhoods that had the highest level of 911 mental health crisis calls last year – teams of EMTs or paramedics and social workers are responding to 911 mental health calls. So far, the results of this pilot are promising. During the first three months, these teams responded to over 280 mental health emergencies. We saw that clients were accepting medical assistance at higher rates than with a traditional – or NYPD/EMS – response. And people were transported to the hospital at a lower rate. Instead, whenever possible, these new teams provided physical and behavioral healthcare onsite or transported people to community-based care. Increasingly, we are helping people where they are and not activating our emergency departments, our ambulances, and our police resources unnecessarily. As we learn from the pilot phase of the program, we are already planning expansion to other zones.

In addition, to continue to enhance our focus on people with serious mental illness, in the spring of 2021, we announced $45 million in new intensive services for people with SMI, including $4 million for clubhouses.

Clubhouses are places where people experiencing serious mental illness can build social connections, access resources, and find a supportive community. This recent investment will support a 25% expansion of membership in clubhouses for people with serious mental illness — from the current 3,000 to 3,750 by January 2022. Funding will also help clubhouses increase their outreach to more places where they can encounter people who may want to join a clubhouse – such as soup kitchens, shelters, hospitals, parks, and subway stations. 

This new investment also supports a new program, called CONNECT, that will provide intensive behavioral healthcare to 850 clients with serious mental illness with a new model of integrating mobile and brick-and-mortar treatment. For the first time, some clients will be accessing services both in the field and at clinics.

Prior to the de Blasio administration, the City’s mental health infrastructure was primarily funded by the State and Federal government. Over the last 7 years, our City has invested in closing gaps in care – beyond what the State and Federal funding will support.

Because of these strategic investments, New York City now provides far more mental health services for many more New Yorkers with serious mental illness – in more places, and in more ways – than ever before.

 

AN ALL GOVERNMENT APPROACH

These new initiatives add to considerable work already underway across City government. Let me briefly explain the role of each of the key City agencies that serve New Yorkers with serious mental illness, and the connections between them.

The Department of Health spends over $500 million annually for people with mental health needs, substance misuse, and intellectual and developmental disabilities. DOHMH’s services include supportive housing; mobile treatment teams; the Single Point of Access program, a centralized referral system that connects adults and children with serious mental illness to appropriate services and providers; the Office of Assisted Outpatient Treatment, which coordinates court-mandated care; and NYC Well, the City’s 24/7 behavioral health helpline.

NYC H+H invests about $800 million every year in acute inpatient and outpatient behavioral health services. These services are provided at 11 acute care hospitals, 4 psychiatric emergency departments, 7 Comprehensive Psychiatric Emergency Programs, and 13 behavioral health outpatient clinics. H+H also manages Correctional Health Services, which provides behavioral healthcare to people incarcerated in NYC.

The Fire Department’s Emergency Medical Services (EMS) responds, alongside officers from the Police Department, to around 150,000 911 mental health emergencies every year. When necessary, EMS also transports those in need to hospitals for additional care.

Many other agencies also play critical roles in serving New Yorkers with serious mental illness.

The Department of Homeless Services has street engagement teams, and onsite mental health services in shelters and in safe havens.

The Department for the Aging serves New Yorkers with serious mental illness through clinicians embedded into dozens of senior centers throughout the City.

The Department for Youth and Community Development serves young people with serious mental health needs at all runaway and homeless youth residences and drop-in centers.

And the Administration for Children’s Services serves young New Yorkers with serious mental illness by connecting parents, children and youth in its child protection, prevention and foster care programs to a range of behavioral health services. ACS also partners with H+H to provide mental health assessments and services in child welfare and detention facilities.

Our Office oversees a small fraction of the overall mental healthcare spending in New York City. The programs we work with were not intended to supplant the larger mental health system in New York City. Instead, they are meant to fill gaps in care through innovation. We also think of our partnerships with agencies as an incubation period. We work with City agencies to test new ways to serve under-served New Yorkers. Where an approach works, it is fully integrated into an agency and becomes a lasting way City government serves New Yorkers. And as programs leave our incubator, we identify new strategies to test.

Currently, we support 28 innovative mental health programs implemented by City agencies, with over 58% of our programmatic budget devoted to serving New Yorkers with serious mental illness and strengthening crisis prevention and response.

 

PROMOTING CROSS-AGENCY COLLABORATION

In addition, we promote cross-agency collaboration. A few recent examples:

First, as I mentioned, we partnered with H+H, FDNY EMS, DOHMH, and NYPD to shape and launch the new 911 mental health calls response pilot, called B-HEARD. We worked closely with these four agencies throughout the spring of 2021 to reimagine 911 mental health emergency response. Together we developed new operational protocols and data-sharing systems. We designed and delivered five weeks of training. Each agency contributed to the training along with several outside experts. And since June, we have all worked together to implement this new approach.

We worked with DOE and H+H to structure a new partnership, called Pathways to Care. In neighborhoods hardest hit by COVID-19, students with acute and ongoing mental health needs are now able to quickly connect to H+H’s outpatient adolescent clinics. We are currently in 5 school districts and as H+H staffs up its Child and Adolescent Clinics, we will expand to more school districts.

We have also supported a new collaboration between FDNY/EMS and DOHMH. This effort focuses on individuals who contact 911 for mental health crises frequently – for many, it’s several times a month. If they are interested in more assistance, we connect them to teams of peers and social workers. These teams can connect people to care in order to prevent the next 911 emergency call.

And, in order to create Mission: VetCheck, we worked with the Department of Veterans’ Services, the IDNYC program at HRA, the City’s GetFood Initiative, and several veteran-serving organizations. VetCheck trained members of the veteran community to make supportive check-in calls to veterans during the pandemic. Since April 2020, over 30,000 calls have been made. These calls have reduced social isolation and provided veterans with critical information on food assistance, housing and unemployment support, and COVID-19 testing.

We also promote interagency collaboration by convening the Mental Health Council, which includes the leadership of 30 City agencies working together in common cause to promote the mental health of City employees and the public at large.

 

THE MAYOR’S OFFICE OF COMMUNITY MENTAL HEALTH

The Mayor’s Office of Community Mental Health builds on the ground-breaking work of ThriveNYC — which began as an initiative spearheaded by First Lady Chirlane McCray to create new — and enhance pre-existing — mental health programs spread across City government. In 2019, the management of this initiative was consolidated in the Office of ThriveNYC based in City Hall. Over the past two years it became increasingly clear that there was a long-term need for a dedicated office within City Hall to lead high-level policy development and promote inter-agency collaboration. Accordingly, the Mayor issued an Executive Order which took effect in May. Our office then took on these functions formally, and continued our oversight of innovative mental health programs as well.

The agencies with me today, as well as dozens of others, provide mental health services to thousands of New Yorkers every year. We work together to serve New Yorkers with mental illness – and to address the often more complex needs of those with serious mental illness.

This is as it should be. With COVID-19 exacerbating challenges for people with serious mental illness, it is more important than ever that City agencies bring their strengths and expertise to the table. This is the intentional, first principle of the de Blasio administration’s approach to this issue: activate every part of City government to promote mental health.

 

POPULATION-LEVEL CHANGE

Let me be clear–it is not enough to just deliver more care. We also want to ensure we are improving the mental health of our City. And, science is guiding our way. In 2019, our office convened a Science Advisory Group of national and international experts in epidemiology, treatment, and the social determinants of mental health — co-chaired by Dr. Vikram Patel of the Harvard Medical School.

Their charge was to help us understand the population-level effects of our programs. For years, we have been tracking and publishing outcome data for every single program we oversee. The question we posed to the Science Advisory Group was broader: how is closing gaps in mental healthcare affecting New York City on a population-level?

Together, we came up with two population-level metrics to help us determine our focus and chart the path ahead. First, we want to see more people with mental health needs get connected to care.

We can see some progress on this metric by looking at serious psychological distress. About 7% of adult New Yorkers experience serious psychological distress, defined as a mental health problem that results in functional impairment and requires treatment. Most adults with serious mental illness are included in this category.

In 2015, 45.9% of adults with suspected serious psychological distress reported that they received counseling or prescription medication in the past year. That’s less than half of New Yorkers with serious needs getting treatment.

By 2019, that measure had shot up 13 percentage points to 58% – an increase that’s not only statistically significant, but – according to health experts – it’s rare in epidemiology. Fifty-eight percent of adults in serious distress getting the help they need is not nearly enough–but it is real progress.

We’re also seeing measurable progress on our second indicator – that fewer mental health needs become crises. Our theory here is that when we invest in prevention, early intervention, better crisis response, and post-crisis stabilization, fewer crises will develop. When more people are connected to care they are not only healthier, but fewer experience emergencies. They don’t need to go to an Emergency Room or call 911, and fewer families will have to worry about a loved one.

There is great urgency to this goal in New York City. From 2008 to 2018, the number of 911 mental health calls nearly doubled from 98,000 calls in 2008 to 170,000 calls in 2018. Now, the tide is turning. In 2019, 911 mental health calls went down by 4% for the first time in a decade to 163,000 calls. And in 2020, they went down even more by another 6% to 153,000 calls. So far this year — even as we know the mental health of the City has worsened — calls are relatively flat.

 

WHERE WE GO FROM HERE

As much as it’s important to note the progress, and the great work that got us here, we cannot make the mistake of slowing down. Especially when the wide-ranging mental health effects of the pandemic are likely to linger for years.

We also cannot be satisfied by any progress that isn’t shared by all. That’s why for both population-level indicators, we are also looking to see less disparity in outcomes. This is where we have the most work to do.

The decline in mental health emergencies occurred throughout the city, with calls declining in precincts from Brownsville to the Upper East Side. However, the significant jump in connections to treatment was almost entirely driven by increases among White adults. The percentages for Black, Latinx, and AAPI New Yorkers were largely unchanged. For the most part, people of color experiencing serious psychological distress have not experienced the greater connections to care that now exists in New York City.

We can’t accept this. More than anything, this is the challenge that must guide our work – now and in the years ahead.

About 70 percent of the new mental health services our office supports are located in federally designated mental healthcare shortage areas. Like food deserts, these are neighborhoods without sufficient access to mental healthcare. We are also reaching deeper into high-need communities – specifically the 33 neighborhoods with a history of health inequities designated by the City’s Task Force on Racial Inequities. Over the past year, many of our programs – along with others across the City – have shifted or expanded to further align resources with these 33 communities. Two examples: The School Mental Health Specialist program now offers onsite, trauma-informed group mental health services to hundreds of schools in these neighborhoods. We are also actively working with the Department for the Aging to expand onsite mental health services in senior centers in the 33 neighborhoods hardest hit by the pandemic.

This Committee can help. The mental health system, and the various services I mentioned today, can be difficult to navigate. This summer, our office sent to every Council Member a guide to mental health resources in your districts. We invited you to request printed copies of these brochures, translated into the languages spoken by your constituents. And we asked for your help in distributing these so New Yorkers across the City can connect to free support right in their neighborhoods.

We also sent each of you multiple copies of our guide that lets New Yorkers know how they can help someone who needs mental healthcare. Published with the Health Department and H+H, this guide walks through how to get mental health support for anyone, at any level of need – including what to know, where to look, and who to call. With this one resource, New Yorkers can learn how to:

  • Find a counselor,
  • Get in-person help for a behavioral health crisis,
  • Help someone with serious needs who is having trouble staying connected to care,
  • And determine if hospitalization should be considered.

 

 

The guide also describes how to access support from peers, as well as support for families. There is a digital version on our site, but we’ve also distributed over 33,000 printed copies to community sites across the City, including libraries, police precincts, hospital waiting rooms, and many others. We welcome orders from you so this guide can be distributed to your constituents as well.

I thank this Committee for your ongoing partnership and commitment to serving New Yorkers with serious mental illness. We are happy to answer any questions you have.

  

The Mayor’s Office of Community Mental Health Partners with Community-Based Organizations



Our services are delivered by almost 200 non-profits through contracts with City agencies. These partners are listed below with the programs they implement.
 

PROMOTING MENTAL HEALTH FOR THE YOUNGEST NEW YORKERS 

Mental Health Services for High-Needs Schools

A Fair Shake for Youth
Arts CSS
ASPIRA
Association to Benefit Children
Astor Services for Children & Families
Bent on Learning
Beyond Counseling
Biofeedback
Breathe Move Rest
Bronx Works
Brooklyn Center for Psychotherapy
CAMBA
Catholic Charities
Center for Professional Education of Teachers
Center for Supportive Schools
Central Queens YMCA
Chelsea Piers
Child Center of New York (CCNY)
Children’s Aid Society
Columbia University School of Social Work
Committee for Hispanic Children & Families
Community Association for Progressive Dominicans
Community Counseling and Mediation
Comunilife
Counseling in Schools
Community Services Society
Cypress Hills Local Development Corporation
Dominican Women’s Development Center
DreamYard
East Side Settlement House
Educational Alliance
El Puente
Footprintz
Fordham University
Franklin Covey
Fund for the City of New York
Global Kids
Global Kids ASPIRA
Good Shepherd
Graham Windham
Grand Street Settlement
Harlem Children’s Zone
Henry Street Settlement
Hey There Beautiful
Hunter College
Interborough Developmental & Consultation Center
Jewish Board of Family & Children’s Services
Johns Hopkins
Johns Hopkins Talent Development Secondary
KariOm Sound Healing
Lineage Project
Little Flower Yoga
Lives of Men
Make the Road by Walking
Mental Health Association of NYC
Mental Health Providers of Western Queens
Montefiore
Morningside Center
Morris Heights Health Center
Northwell Health
New York Foundling Hospital
New York Center for Interpersonal Development
Oceans and Rivers, LLC
Omega Institute
Partnership with Children
Pathways to Leadership
Phipps Houses Inc.
Phipps Neighborhood
Powertools
Project Gametime
Queens Geniuses
Ramapo
Replications Incorporated
Rhinoceros Presentations
Rising Ground (formerly Leake & Watts)
Sheltering Arms Children & Family Services
South Asian Youth Action (SAYA)
Southern Queens Parks Association
Spirit of a Woman Leadership Development Institute
Sports and Arts in Schools Foundation
St. Nick’s Alliance
Staten Island Mental Health Society
Teacher’s College, Columbia University
The Children’s Aid Society
The Door – A Center for Alternatives
TRIAD Consulting
United Federation of Teachers – New York City Community Learning Schools Initiative
Union Settlement
United Way of New York
University Settlement
Urban Arts Partnership
Visiting Nurse Service of New York
Wediko Children’s Services
Westhab, Inc.
YMCA Frost Valley
YMCA GreenKill
YMCA of Greater New York 


Social-Emotional Learning (SEL): Early Childhood Mental Health Network

Association to Benefit Children
Jewish Board of Family & Children’s Services
New York Center for Child Development
Northside Center for Child Development
OHEL Children’s Home and Family Services
Staten Island Mental Health Society

Social-Emotional Learning (SEL): Trauma Smart

St. Luke’s of Kansas City

ELIMINATING BARRIERS TO CARE 

NYC Well

Vibrant

Mental Health First Aid

National Council for Behavioral Health

Connections to Care (C2C): Mental Health Integration in Community Based Organizations

Arab American Association of New York (AAANY)
Bedford Stuyvesant Restoration Corporation (BSRC)
Brookdale Hospital Center
CAMBA
Center for Alternative Sentencing and Employment Services (CASES)
Center for Employment Opportunities (CEO)
Dean Hope Center, Teachers College, Columbia University
Hetrick-Martin Institute (HMI)
Hudson Guild
Hunter College Silberman School of Social Work
Institute for Family Health
Jewish Board of Family & Children’s Services
Northern Manhattan Improvement Corporation (NMIC)
New York University Langone-Brooklyn
Red Hook Initiative (RHI)
Safe Horizon
Safe Space
Sheltering Arms Children & Family Services
STRIVE International (STRIVE)
The Committee for Hispanic Children and Families (CHCF)
The Door – A Center for Alternatives
The Family Center
The HOPE Program (HOPE)
The RAND Corporation
Union Settlement
University Settlement
Urban Health Plan
Voces Latinas

Be Well: Mental Health Support for City Employees

Bodies by Borwownie
Creative Source
Gibbons Family Fitness
Viney Group

 

REACHING PEOPLE WITH THE HIGHEST NEED

People harmed by crime, violence or abuse

Crime Victim Assistance Program

Safe Horizon

Vulnerable young people

Mental Health Services in Runaway and Homeless Youth Residences and Drop-In Centers

Ali Forney Center
Cardinal McCloskey School and Home for Children
CORE Services Group
Diaspora Community Services
Girls Educational and Mentoring Services
Imeinu
Project Hospitality
Safe Horizon
SCO Family of Services
Sheltering Arms Children & Family Services
The Children’s Village
The Door – A Center for Alternatives
Under 21 (Covenant House New York)


Older adults


Clinicians in Senior Centers


JASA
Samuel Field
Service Program for Older People
Weill Cornell


Visiting Program for Homebound Seniors

Catholic Charities
CITYMEALS-ON-WHEELS
Community Agency for Senior Citizens
Lenox Hill Neighborhood House
Neighborhood Self-Help by Older Persons Project
Queens Community
Riseboro Partnership
SelfHelp Community Services
Weill Cornell

Families experiencing homelessness

Mental Health Services in Family Shelters

ACACIA Network Housing
Aguila/Housing Solutions
Bowery Residents’ Committee
Bronx Parent Housing Network
Bronx Works
Brooklyn Community Housing & Services
Brooklyn Neighborhood Improvement
CAMBA
Care for the Homeless
Children’s Community Services
Children’s Rescue Fund
Concourse Housing Development Fund
CORE Services Group
Family Support Systems Unlimited
Harlem United
HELP USA
Henry Street Settlement
Highland Park Community Development
Home/Life Services, Inc.
Homes for the Homeless
Institute for Community Living
Msgr. Robert Fox Memorial Shelter
Nazareth Housing, Inc.
Phipps Houses Inc.
Praxis Housing Initiatives
Project Hospitality
Project Renewal
Providence House
Salvation Army
Samaritan Daytop Village
SCO Family of Services
SEBCO Development
Settlement Housing Fund
South Bronx Overall Economic Development
Tolentine Zeiser Community Life Ctr.
Urban Resource Institute
Urban Strategies
Volunteers of America
West End Intergenerational Residence
Women In Need
Women’s Prison Association
 

STRENGTHENING CRISIS PREVENTION AND RESPONSE

Intensive Mobile Treatment (IMT) Teams

Center for Alternative Sentencing and Employment Services (CASES)
Center for Urban Community Services
Community Access
Institute for Community Living
Visiting Nurse Service of New York 

Assertive Community Treatment (ACT) Teams

Beth Israel Medical Center
Center for Alternative Sentencing and Employment Services (CASES)
Center for Urban Community Services
Federation of Organizations
Goddard Riverside Community Center
Institute for Community Living
Post Graduate Center for Mental Health
Services for the Underserved
St. Joseph’s Hospital
The Bridge
Visiting Nurse Service of New York
Welllife Network Inc.

Forensic Assertive Community Treatment (FACT) Teams

Center for Alternative Sentencing and Employment Services (CASES)
Federation of Organizations
The Bridge


Crisis Intervention Training (CIT)


Center for Urban Community Services


Support and Connection Centers (formerly Diversion Centers)


Project Renewal
Samaritan Daytop Village