CONFRONTING THE “SHADOW PANDEMIC”: MENTAL ILLNESS IN NEW YORK
When I was 15 years old, I was involuntarily admitted to a mental health facility following a number of suicide attempts. Difficult as the experience was, the 30 days of care that I received at Four Winds Hospital saved my life.
It wasn’t until years later that I realized how privileged I was. Most Americans do not have sufficient access to behavioral health care, especially BIPOC Americans, undocumented people, and those living in poverty.
It has been said that we are currently living through two pandemics: the COVID-19 pandemic, and the “shadow pandemic” of mental illness.
As a country, we have failed in our approach to mental health. Our most tragic failure relates to those with serious mental illness. One need look no further than the streets of any large city in America, including New York City. Thousands of our fellow New Yorkers are experiencing unfathomable pain and suffering, right before our eyes. Many of the tragedies that have happened were entirely avoidable with proper care and treatment.
The seeds of this crisis were sown decades ago, when the faulty system of institutionalized mental health care was dismantled and people who had been warehoused in large, inhumane facilities were moved out of those facilities, most of which were subsequently closed. That system was supposed to have been replaced with a comprehensive system of community-based outpatient care and services. That hasn’t happened. Today, the largest providers of mental health services in the United States are prisons and jails.
This issue is personal for me. It is time for our government to take concrete action to help people with mental illness. Below are just a few of the steps that we must take.
I know it is possible to achieve a society that cares for its most vulnerable and ensures the health and safety of all. As a member of the New York City Council, I will take on this fight.
In service,
Erik Bottcher
1. Stop the Closure of Inpatient Psychiatric Beds
According to the New York State Nurses Association (NYSNA), the number of certified inpatient psychiatric beds in New York State dropped 12% between 2000 and 2018, at the same time as the population and the need have mushroomed. New York City accounts for 72% of the decline in inpatient psychiatric beds between 2000 and 2019, a total loss of 459 beds. This loss of clinical space hasn’t been replaced by community-based services. Instead, patients have been funneled into the carceral system and shelter system. New York State needs to stop the decertification of inpatient psychiatric beds. Any closures of beds must be accompanied by an increase in quality services elsewhere that can serve this vulnerable population. Additionally, there must be an infusion of funding for comprehensive hospital discharge planning, which is currently inadequate.
2. Immediately Dispatch Mobile Mental Health Crisis Response Teams on the West Side
In November, Mayor de Blasio announced a pilot program in which health professionals and crisis workers would be dispatched to respond to mental health crises. That program is being piloted in Northern Manhattan beginning this spring. Unfortunately, we do not have time to wait for a lengthy pilot program to be completed before expanding this program. There is an immediate need for these response teams citywide. This program should be accelerated and expanded to other neighborhoods, including those in Council District 3. People experiencing mental health emergencies need to be stabilized, treated and connected to appropriate wrap around services. For too long, armed police officers have been the default first responders to mental health crises, and this must change.
3. Increase Crisis Stabilization Centers
When unhoused New Yorkers experiencing mental health crises are brought to the hospital, they are released after they are medically stabilized. Frequently, they are not sick enough to stay in the hospital, but are too sick to return to a shelter or the streets. Crisis stabilization centers, also known as medical respite beds, fill this critical need, giving people time and space to recuperate. This provides a critical opportunity to connect them with social services. Unfortunately, there are far too few crisis stabilization centers available in New York City. Therefore, many people experiencing mental health crises are taken to the hospital in ambulances, only to be discharged back to the streets hours later. New York City must expand its medical respite program significantly in all five boroughs.
4. Build Supportive Housing with Mental Health Services
We must greatly accelerate the construction of permanent supportive housing for people with mental illness. Supportive housing is affordable housing that offers case management and other supportive services. Extensive evidence has shown that permanent supportive housing is the best way for people with mental health challenges to lead full lives outside of hospital settings, the shelter system or criminal justice system. Unfortunately, New York City has only constructed a fraction of the supportive housing that is needed to meet the growing demand. We must create quality supportive housing in all five boroughs, and this should include the conversion of distressed commercial properties.
5. Embrace and Expand the “Clubhouse Model” of Psychosocial Rehabilitation
The Clubhouse Model, created decades ago by Hell’s Kitchen’s own Fountain House and now used internationally, is a community-based service model that helps people with a history of serious mental illness rejoin society and maintain their place in it. Clubhouses are community centers where people with mental illness can find opportunities for friendship, employment, housing, education and access to medical and psychiatric services in a caring and safe environment. This model is also effective for helping people released from congregate care settings rejoin society and sustain a healthier life within the community. Clubhouse members experience significantly lower rates of hospitalization, incarceration, and suicide compared to others with serious mental illness. Unfortunately, the current need far exceeds the capacity of Fountain House and other Clubhouses. New York City should immediately begin facilitating the creation of at least 10 more Clubhouse locations, distributed across the five boroughs. Clubhouses are sometimes co-located with supportive housing.
6. Revamp Discharge Planning & Services for Formerly Incarcerated New Yorkers - Expand The Fortune Society Model
Thousands of people with serious mental illness have been funneled into the carceral system because of society’s failure to provide adequate behavioral health treatment. Upon release, individuals are discharged with inadequate planning and support services. Those without homes to go to are often released directly into the New York City shelter system, with inadequate case management and few prospects for housing, employment, substance use treatment, and mental health care.
The State should enact A.6458 (Weprin) and S.2792 (Sepulveda), which would require the state to assist people in obtaining housing prior to release from a correctional institution. The bill would also obligate the state to reimburse local social services districts, such as New York City, for each discharge to temporary shelter in that district. These funds could be used to ensure proper supportive services, like behavioral health care.
The Fortune Society and The Osborne Association are examples of community based organizations that work with formerly incarcerated individuals to help them thrive. The city, state, and federal governments should invest more in these programs and help them procure brick-and-mortar transitional housing that will serve as alternatives to the shelter system.
7. Increase School Based Behavioral Health
Serious mental illness often begins to take shape in adolescence. Early diagnosis and treatment are critical, which is why school-based health and social services are essential. At a minimum, schools must have nurses, counselors and social workers on site who are trained to identify warning signs of behavioral health issues and make referrals to behavioral health professionals. The recently passed New York State budget appropriated $37.8 billion in long overdue funding for public schools in New York State, and a portion of this funding should be used for school based counseling and health services.
8. Redirect ThriveNYC Funds to Address Serious Mental Illness
As of 2019, roughly 10 percent of ThriveNYC’s $250 million annual budget was spent on serving those with serious mental illness. Although City Hall has said it would begin diverting more funding to this purpose, hundreds of millions of dollars that could have been spent addressing this issue in recent years were not. This was a big missed opportunity. While some effective programs have been brought under the ThriveNYC umbrella, an overall shift in priorities is needed to address this crisis. The City should redirect ThriveNYC funds to the aforementioned services to help the tens of thousands of New Yorkers who are suffering.
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