New York City is in a mental health crisis. The COVID-19 pandemic exacerbated this crisis both in our city and in communities across the nation. Yet, the crisis predates the pandemic, created by decades of inadequate public investments and ineffective policies. Decades of neglect and disinvestment have left too many New Yorkers without appropriate, holistic mental healthcare and our systems overburdened and ill-equipped to respond to the current crisis.
Addressing and correcting this deeply-rooted challenge requires investments in comprehensive, proven, solutions, particularly within communities that have often lacked adequate resources. Success will also require all levels of government – city, state, and federal – to coordinate solutions to increase access and remove barriers to mental health care and services.
The Council’s Mental Health Roadmap is a continuously evolving plan that recognizes these priorities and incorporates evidence-based solutions, shaped by New Yorkers’ experiences, to improve mental health outcomes. It starts with a focus on increased prevention services, especially at the community level, addressing the mental health workforce shortage, confronting the harmful intersections between mental health and the criminal justice system, and increasing public awareness about available programs while improving interagency coordination to enhance the continuity of care.
The Council’s top priority is to advance the dignity, health, and safety of our communities and of all New Yorkers. The Mental Health Roadmap provides a path toward improving our health and ultimately bringing us out of this crisis.
1. Prevention and Supportive Services
Access to holistic supportive services is essential to treating mental illness and helping individuals maintain mental health, preventing people from entering crisis. This includes supports such as healthcare and medication, housing, food access, technology and internet access, economic and job stability, and supportive community infrastructure. Economic strain and stressful living environments, by contrast, result in poorer mental health outcomes and a higher prevalence of serious psychological distress. The lack of stable housing and lack of access to in-community healthcare, in particular, present challenges to providers in their treatment of patients and those in need of care and support. Under New York State law, hospitals are required to produce discharge plans upon discharging patients. These plans become increasingly complicated when a patient lacks stable housing, access to food, or a supportive community to return to upon discharge. Patients who are discharged from hospitals into unstable, unsupportive conditions in their communities are much more likely to be readmitted to hospitals, to linger in hospitals for longer than necessary, and to fall into an endless cycle of hospital admission, discharge, and possible eventual interaction with the criminal justice system. This puts a strain on hospitals, who must accordingly provide repeated care for patients that could be served within their communities if there were adequate resources and infrastructure. Adequate in-community mental health care and support would benefit both people with serious mental illness.
2. The Council will consider legislation (Council Member Riley) that establishes the City’s commitment to expand “clubhouse”-style community centers for individuals with serious mental illness (SMI), like those already successfully operating. The legislation will ensure such centers are located in at least five of the highest-need areas. Clubhouses are evidence-based models of psychiatric rehabilitation as one-stop places that help people with serious mental illness by providing peer support, access to services, employment and educational opportunities, and socialization and recreation in a safe, restorative and structured setting. Research shows they reduce hospitalization and justice involvement, while improving health and wellness.
3. The Council will ensure that Local Law 35/2023, sponsored by Council Member Bottcher—which requires mental health professionals to be available in the 30 largest families with children shelters to provide on-site or telehealth mental health service—is fully funded and implemented. The Council will work to ensure the City fulfills the law’s requirement for mental health professionals to be available in all shelters for families with children by July 2025.
4. The Council will continue advocating to include adequate funding in the city’s FY24 budget for expanding school-based mental health services, including the additional investment of $28 million to strengthen existing school-based mental health clinics and establish additional sites across all five boroughs. This commitment of funding should be the foundation for the City moving towards the ratio of 1 social worker per 250 students, as recommended by the National Center for School Mental Health and the National Association of School Psychologists.
5. The Council will advocate for the Administration to reevaluate its production goals in the NYC 15/15 supportive housing plan, towards building two-thirds as congregate units and only one-third as scatter-site units, while continuing to advocate for an additional $45 million to meet the funding need for the plan’s remaining supportive housing units.
6. The Council will urge the Administration to baseline $5 million in funding for the Mental Health Continuum, a cross-agency partnership between the Department of Education (DOE), NYC Health + Hospitals (H+H), and the Department of Health and Mental Hygiene (DOHMH) to provide mental health support to all students, as outlined in its FY24 Preliminary Budget Response. This provides wrap-around support through various approaches, including mental health clinics run by H+H, equipping school staff with the knowledge to address mental health issues in the school environment through the NYC Well hotline, providing crisis intervention for students 20 years old and younger through the Children’s Mobile Crisis Teams, and training school staff to manage behavioral challenges through Collaborative Problem Solving.
7. The Council will advocate for adequate funding in the city’s FY24 budget through its $1.7 million Children Under Five Initiative that provides mental health services for children five years old and younger.
8. The Council will advocate for adequate funding in the city’s FY24 budget for the Mental Health Youth Council Initiative to provide flexible mental health services for youth programs run by community-based organizations. It would help to meet youth mental health needs and support youth workers to proactively advance mental health wellness and effectively respond to mental health crises.
9. The Council will advocate to include adequate funding in the city’s FY24 budget for family support and educational programs that help families learn to navigate relationships with loved ones experiencing a mental health disorder, which would include funding peer-led and family support groups, as well as family therapy and counseling programs.
10. The Council will develop a plan to provide Mental Health First Aid training for Council staff that teaches the skills to provide initial help and support to someone who may be developing a mental health problem or experiencing a crisis. This would help equip staff to be Mental Health First Aiders, who are vital links between people experiencing a mental health challenge and appropriate support.
2. The Council will continue advocating that the State compel state-licensed hospitals in the city to fully reopen closed and/or repurposed inpatient psychiatric beds, and that the State build 150 new beds in state-run hospitals located in the city. The Council will also advocate that the State pass legislation that would increase fines to up to $2,000 per day for hospitals that fail to reopen such beds, as outlined by the Governor.
3. The Council will advocate for the State to follow through on its commitment to continue prioritizing the Certified Community Behavioral Health Clinics (CCBHC) model after the federal Demonstration Program ends on September 23, 2023, and to add additional such programs.
4. The Council will call on the State and City to reinitiate a NY/NY Supportive Housing program to ensure city and state coordination to increase supportive housing development and contracting (Resolution – Majority Leader Powers).
5. The Council will advocate for the State to: (i) increase NYS Supportive Housing Program (NYSSHP) rates to the same level as the Empire State Supportive Housing Initiative (ESSHI) service rates; (ii) create a flexible preservation fund to allow the modernization and preservation of decades-old units; and (iii) increase ESSHI rates to $35,000 per unit.
2. Mental Health Workforce Shortage
The deepening workforce shortage of mental health providers over the past several years has compounded the City’s current mental health emergency. The lack of recruitment and retention of mental health providers has reached a crisis level, with some sectors claiming 30 to 40 percent vacancy rates post-COVID. This workforce shortage is a direct result of decades of disinvestment in the mental healthcare system, which caused salaries that are non-competitive, insurance policies that do not adequately cover services, educational and training programs that fail to recruit and retain sufficient talent, and bureaucracies that prevent ease of practice for clinicians. An investment in the mental healthcare workforce is an essential component to the provision of culturally competent, high quality behavioral health services for all New Yorkers.
2. The Council will fund and help establish a Social Work Fellows Program at one or more CUNY schools, which would subsidize the cost of mental health education, degrees, and licensing, particularly for students who commit to working in public interest mental health professions, which historically experience high turnover rates and staffing shortages. The Council will also consider a resolution (Council Member Joseph) that urges CUNY and the State to support such programming.
3. The Council will continue to advocate for adequate funding and in contracts to achieve pay parity for workers across the mental health workforce within city government and the non-profit sector providing similar services.
2. The Council will call on Federal and State agencies to increase enforcement and penalties against practices that are contrary to insurance coverage parity laws, so insurance discrimination does not impede access to mental health care (Resolutions – Speaker Adams and Majority Leader Powers).
3. The Council will work to ensure that the State funds retention bonuses for mental health providers and adequate COLA increases for programs and services licensed, funded, and certified by the NYS Office of Mental Health, Office of People with Developmental Disabilities, Office of Addiction Services and Supports, among others. It will also remain a priority of the Council’s to advocate for State and Federal support of our goals to achieve pay parity across different parts of the mental health workforce.
4. The Council will work to ensure that the State follows through on the Executive Budget proposal to increase Medicaid payment and reimbursement rates for school-based clinics and services.
5. The Council will also call on the State to enter the Interstate Medical Licensure Compact, the Nurse Licensure Compact and the Psychology Interjurisdictional Compact (PSYPACT) to enhance the portability of mental health providers to become licensed in multiple participating states (Resolution – Council Member Lee).
3. Intersection with the Criminal Justice System
Over the last 50 years, New York State has sought to deinstitutionalize individuals with mental illness, aiming to provide community-based services to individuals in need of mental health treatment in clinically-supported community environments, in lieu of traditional inpatient hospital settings. The implementation of this approach, however, has never been successful; deinstitutionalization has instead resulted in the criminalization of mental illness. Individuals with mental illness are far more likely to be incarcerated or arrested than they are to receive treatment. In fact, Rikers Island is now counted as one of the three largest providers of psychiatric care in the United States, with approximately half of those detained diagnosed with a mental health issue. The other two facilities are also jails – the LA County Jail in Los Angeles and the Cook County Jail in Chicago. An estimated 12% of New York State’s prison population has a serious mental illness – about five times as many people as there are beds in the correctional hospital system. The criminal justice system and incarceration are evidenced to worsen health outcomes, with dangerous and devastating impacts on those with mental health challenges. Our current crisis has demonstrated how this approach undermines public health and safety. Without adequate capacity of more intensive psychiatric care at hospitals and access to in-community holistic care, individuals with mental illness are unlikely to break free of the hospitalization-discharge-arrest-incarceration cycle.
2. The Council will advocate for the City’s FY24 budget to include adequate funding for street outreach teams that utilize the Center for the Justice Innovation’s “Community First” model currently operating in Times Square. The non-law enforcement model focuses on building trusting relationships with people living in public spaces by meeting them “where they’re at” through community navigators providing essential resources (i.e. clothing, food, etc.) while engaging in conversations about help and needs, as defined by the individual. By providing access to services that would be difficult for people to access without a navigator’s support, trust is built to help facilitate connections to health and social services. The holistic community response that does not employ or rely upon policing facilitates long-term success and prevents people from ending up in the justice system.
3. The Council will advocate for the City’s FY24 budget to include adequate funding for the expansion of DOHMH’s Intensive Mobile Treatment teams, which provide intensive and continuous support and treatment to individuals within their communities where and when they need it. The Council will also advocate for additional investments to expand city-funded Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment teams to provide mobile, intensive case management to people with serious mental illness, including those with involvement in the justice system, through treatment, rehabilitation, and community integration services.
4. The Council will advocate for the City’s FY24 budget to include $12.8 million more to meet the funding need for 380 units of Justice Involved Supportive Housing targeted at the small group of people with the highest level of need, who cycle between jail, prison, hospitalization and shelter the most. These units were committed as part of the Close Rikers points of agreement.
5. The Council will advocate for the City to create education and training programs targeted at attorneys and judges regarding available mental health diversion options, while also strengthening their connections to the City’s mental health providers in support of coordinated care and responses for clients who may end up in the courts and justice system.
6. The Council will also support expansion of Support and Connection Centers, which offer short-term clinical and non-clinical services to people with mental health and substance use needs, and promotes community-based and person-centered engagement, stabilization and connection to services. They are an alternative to avoidable emergency room visits and criminal justice interventions for first responders.
7. The Council will hold an oversight hearing on the B-Heard program to address the significant challenges and concerns with the ways the program is currently being implemented.
2. The Council will advocate for the State to increase funding for and to expand the number of Assertive Community Treatment (ACT) teams operating in the five boroughs.
3. The Council will advocate that the State strengthen the connection between mental health care teams and defense teams regarding justice-involved individuals living with mental illness, and advocate for the State to provide enhanced education to judges, district attorneys, and other court personnel on the importance of and opportunities for diversion, such as the use of Mental Health Courts and “release on reconsideration.”
4. Public Awareness & Interagency Communication/Coordination
The provision of mental health services occurs through a complicated web of public and private providers and insurers, intersecting with Federal, State, and local regulations and funding. While New York is resource-rich compared to many other states and cities, this intersection of governmental entities and regulations can create bureaucratic and logistical barriers in the access and provision of mental health services. Community-based mental healthcare is only accessible when there is public awareness of the resources available. Additionally, the large size of New York’s governmental, community nonprofit, and healthcare sectors make it especially difficult to coordinate care and services for individuals in need of mental healthcare. Achieving a comprehensive, efficient, and culturally-competent mental healthcare infrastructure requires the coordination of private, nonprofit, and public actors in the provision of mental healthcare and services, and public awareness.
2. The Council will consider legislation (Council Member Lee) that requires the creation of a user-friendly comprehensive data set of the locations of all outpatient mental health services in the city.
2. The Council will advocate that the State facilitate access at the city-level to hospitalization records for individuals involved in Assisted Outpatient Treatment (AOT) pursuant to Kendra’s Law to help improve continuity of care.
3. The Council will advocate that the State allow broader access at the City level to the PSYCKES database to help improve continuity of care.