New York City THRIVE Mental Health Initiative Presented at the United Nations
Date: Wednesday 25 January 2017
Location: United Nations Headquarters, Economic and Social Council Chamber, 1st Avenue and 45th Street, New York, NY 10017
Speakers: Chirlane McCray, First Lady of NYC; Ambassador Dessima Williams, Special Adviser, Implementation of the SDGs, Office of the President of the General Assembly (PGA); H.E. Caleb Otto, Ambassador of the Permanent Mission of Palau, Richard Buery, NYC Deputy Mayor for Strategic Policy Initiatives
Panelists: Dr. Gary Belkin, NYC Executive Deputy Commissioner for Mental Health, Ana Bermúdez, Commissioner, NYC Department of Probation, Dr. Sidney Hankerson, Columbia University, Anna Ortega-Williams, Red Hook Initiative, and Dr. Kishor Malvade, Maimonides Medical Center.
New York City THRIVE Mental Health Initiative Presented at the United Nations
In response to the 2030 Agenda for Sustainable Development, the New York City Mayor’s Office for International Affairs convened a panel discussion entitled, “Global Vision | Urban Action: Mental Health for All: Local Strategies,” on Wednesday 25 January 2017 at United Nations Headquarters in New York City.
The theme was to introduce the city’s new program about access to mental health care, that can also serve as a model for other communities. The event convened UN leaders and NYC government as well as community leaders and practitioners for a critical discussion about mental health.
Introductory remarks were made by distinguished guests, including the First Lady of NYC and founder of ThriveNYC Chirlane McCray; Ambassador Dessima Williams, the Special Advisor on Implementation of the SDGs from the Office of the President of the General Assembly; Ambassador of the Mission of Palau Caleb Otto; and Richard Burey, NYC Deputy Mayor for Strategic Policies Initiatives.
Addressing the topic, “ThriveNYC: Local Roadmap to Mental Health,” speakers represented governmental and community-based organizations tasked with implementing local strategies for the dissemination of mental health care services within the NYC community. The panel,included moderator Dr. Gary Belkin, NYC Executive Deputy Commissioner for Mental Health; Ana Bermúdez, Commissioner of the NYC Department of Probation; Dr. Sidney Hankerson, Columbia University; Anna Ortega-Williams from the Red Hook Initiative, and Dr. Kishor Malvade of the Maimonides Medical Center.
In her keynote remarks, First Lady of NYC Chirlane McCray contextualized the origin and significance of ThriveNYC to help families address mental, neurological, and substance use disorders and access mental health services by first sharing her personal story. Both her parents suffered from depression and her daughter struggled with substance abuse. Acknowledging the emotional frustration and anxiety that accompanies untreated mental disorders, and relating the barriers her own family faced in locating the right mental health care providers for her daughter’s condition, she emphasized how families without privilege bear a much greater burden accessing resources and social networks. This situation makes the service provided by ThriveNYC crucial for New Yorkers.
Guiding Principles for Change
The ThriveNYC program presents a roadmap to reduce the burden that mental, neurological, and substance use disorders place on under-resourced communities. The government-initiated program presents “Six Guiding Principles for Change,” to help change the way people think about mental health to reduce stigma and to make treatment accessible:
(1) Change the Culture
(2) Act Early
(3) Close Treatment Gaps
(4) Partner with Communities
(5) Use Data Better
(6) Position Government to Lead.
First Lady McCray said, “Mental illness has no boundaries and does not discriminate. Will you sit on the sidelines or join us and fight? There are simple and powerful steps to take in communities to help those who are suffering.” Her approach that facilitates accessible, quality mental health care in low-resource communities is: Task shifting.
Task shifting is a process of delegation where health services and resources are moved, where appropriate, from specialized care to less specialized lay heath workers. Clergy, teachers, coworkers, peers, and family members can be trained to recognize signs and symptoms of mental, neurological, and substance use disorders, provide relief, or get people to the necessary treatment and care.
This approach is similar to the technique emphasized in other low-resource settings where laypersons can be trained to delver very preliminary assistance.
Community-based interventions such as “Connections to Care” emphasize task shifting as a fundamental strategy for closing the treatment gap in under-resourced areas. Through the Connections to Care program, community organizations that already provide a variety of social services integrate mental health partners to train staff in basic mental health care and psycho-education skills. These community organizations see better outcomes for the other services they provide, because their constituents are better supported socially and emotionally.
Ambassador Dessima Williams remarked that the global community must, “Explore our ability to thrive as healthy human beings in a healthy climate, which is the essence of the sustainable development goals.” She praised the city of New York for emphasizing a program that facilitates accessible mental health treatment through partnership with community and governmental organizations.
H.E. Ambassador Otto addressed the importance of reducing stigma around mental illness, specifically around severe mental illness such as schizophrenia. In a comment that elicited an appreciated response from the audience, he noted that the city has many “hot spots” for Internet access, and what is needed is more “hope spots.”
Deputy Mayor Richard Buery quoted mental health statistics concerning the impact of untreated mental illness on 4 dimensions:
(1) Students’ ability to learn: “Over a quarter of students report feeling sad and hopeless regularly every day
(2) Physical health: “People with mental health issues live eight years fewer than those without”
(3) Public safety: “40 per cent of people on Rikers Island have mental health conditions”
(4) Economic costs associated with untreated mental illness: “the city sees 40 billion dollars in annual productivity losses.”
Deputy Mayor Buery emphasized how untreated mental illness “truly effects the ability of this city to live and thrive,” asserting that “we are in a public health crisis. ThriveNYC takes a comprehensive public health approach to dealing with the crisis by educating New Yorkers about mental health and stigma associated with mental illness, making services available, and working with local partners to build on resources and knowledge embedded in NYC communities.
Closing the Treatment Gaps
Mental health is a driver of many vital social and health outcomes. Dr. Gary Belkin introduced the panel discussion saying, “The breadth and logic of these initiatives deal with this as one of the leading public health challenges of the 21st century. ThriveNYC seeks to bring a very large health system to act very differently on this issue. The thrust of Thrive to is to focus on task shifting, and on delivering the skills of action and ownership to the community.
“How can we move the health system to be a partner, to place resources and expertise at the forefront of solutions?” he asked.
He turned to Dr. Malvade, asking, “What are the obstacles you face in terms of moving the health care system – including workforce challenges and human challenges – in this task shifting direction?”
Dr. Malvade responded, “We help lead a large network of federal, New York State and city agencies working to redesign and transform public healthcare system.” The obstacles can be ameliorated through individual engagement. Large system issues require engaging the community and providers in particular. This kind of multi-sectorial engagement recognizes how “providers and government need to work tougher and differently. Behavioral health and mental health need to be addressed together.” One way to manage workforce obstacles is to “thoughtfully deploy resources” using community-based partnerships and providers such as clergy and teachers. Finally, task shifting requires collaboration to bring together social services and physical health care services.
Changing the Culture
The ability to act effectively in response to the current public health crisis of untreated mental illness requires changes to government and other sectors. These changes require resources and re-engineering the workforce to deal directly with these issues.
Commissioner Bermúdez of the Department of Probation conceded that though the justice system “has not been a system that promotes good mental health,” it is currently undergoing a “global shift,” which involves making probation a “stage of opportunity to focus on well being outcomes, not on arrest outcomes or criminal justice outcomes.”
This global shift necessitates a comprehensive program of task shifting and perspective shifting, as well as officer training regimens on mental health, and restorative justice within criminal justice intuitions.
Bermúdez stressed, “You can be therapeutic without needing to be clinical,” predicated on the idea that “regular people can have an impact” and “mental illness does not predict criminality, it is a responsivity issue. If we are working with you, [psychoeducation] is part of any intervention we make and cannot be divorced from that, but it is not automatically a predictor of criminality.”
Bermúdez presented a two-fold impact of ThriveNYC programming for the city’s department of probation:
- Behavioral Health Unit. ThriveNYC provided funding to start a behavioral health unit within the Department of Probation. An onsite clinician helps probation officers in the behavioral health unit triage mental health cases.
- Psychological First Aid Training. Through ThriveNYC, the Department of Probation was able to train 200 staff members on psychological first aid. The training focuses on identifying stages of change in someone and uses motivational interviewing to establish good working relationships with people. Bermúdez emphasizes that not working with someone effectively can lead to loss of liberty, an unacceptable and avoidable outcome.
Partnering with Communities
Dr. Hankerson contextualized the vital role of communities and faith-based organizations in effectively addressing mental health.
“Major depression is the number one cause of disability in the world,” he said. “More people are suffering from depression than any other mental illness. These individuals are more likely to seek help from a faith leader than they are to seek care from medical doctors or psychiatrists. Clergy are frontline leaders in confronting mental health. The Department of Health partners with clergy members to disseminate a basic counseling intervention called Mental Health First Aid, identify people at risk for depression, provide support and utilize resources in the community to treat mental illness efficiently and collaboratively.”
Dr. Hankerson advocated for the importance of assessing the needs of specific communities, identifying leaders who can support effective interventions, and using the local government as a partner to build on and enhance cultural strengths already embedded in the community.
“Connections to Care,” with a seed fund of $30 million USD over five years, provides a model for connecting behavioral partners with community organizations that deal primarily with social services in order to build capacity in the provision of mental health care.
Anna Ortega-Williams of the Red Hook Initiative described that, “Participating in Connections to Care trained staff members to gain capacity to provide mental health services onsite in a way that ensures that they are making mental health common—what is common about mental health for young people, and accessible to young people, in a language they can understand. This allows them to be a translator, to make connection to allow young people to access resources and become resources by asking questions like, ‘How have they survived so far?’”
“Young people are more likely to listen to a credible messenger,” she said. “The mental health partnership is about learning psycho-education tools to support young people to become ambassadress for other youth, to take on mental health as part of social health.”
Q&A
Delegates from Canada, Costa Rica, Belgium, Chile, and World Health Organization made comments and asked questions, addressing the economic and social of burden untreated mental, neurological and substance use disorders.
(note- these were all high level ambassadors so it is important to have their names- they are likely on the UN webcast on that site or in THRIVE’s report)
Question 1: The Deputy Ambassador of the Mission of Canada, H.E. Michael Grant, emphasized, “We want to ensure mental health is talked about the way it needs to be.” He posed the question to moderator Dr. Bekin, “How is [ThriveNYC] measuring the effectiveness of these programs?”
Response 1: Dr. Belkin acknowledged that measurement challenges “have forced ThriveNYC to rethink how they measure, what tools they use.” He and his colleagues at the Mental Health Innovation Lab put together a task force to look at measuring ThriveNYC outcomes and “get a sense of its overall impact.” They have had to create new ways of measuring in order to create better community engagement strategies, strategies that necessitate more “nimble” measures.
Q2: The delegate from Costa Rica addressed the question of efficacy of alternative sentencing within the community-based mental health care model.
R2: Commissioner Bermúdez responded, “Anecdotally, people in community do a lot better with alternative sentencing. We can stay with them throughout and really work with them to connect them to the right places and people in their community.” She stated the importance of avoiding the “revolving door” phenomena, where individuals with mental illness are processed within the criminal justice system, go untreated, and are pulled back into the system. She acknowledged the difficulty in adhering to mandates that require the city to provide mental health and discharge services in jails. “In terms of the prison situation, this also exacerbates mental health issues and creates more of a challenge. We want to keep people in the community getting the services that they need.”
The commissioner named several initiatives that align criminal justice and mental health: (1) Staff trained in mental health first aid; (2) Risk assessments instituted within the NYC Department of Probation that target specifically behavioral health and substance misuse. These risk assessments help probation officers to figure out what road maps to use to serve their population; (3) The use of restorative justice principles in the work that, “Maintains the humanity of the people and separates what they do, from who they are.” Furthermore, a restorative justice framework “creates a culture of non-judgementalism in the officers and will ultimately change the culture of the institution.”
Q3: The Chilean delegate asked the panelists to contextualize mental health within a human rights framework. “Do you have information for how you see how governments are dealing with mental health from a human rights approach?”
R3: Dr. Belkin said, “The challenge with Thrive is to make community-based mental health be less about four walls of the mental health provider and capacity and centered more on community.” ThriveNYC presents a service dissemination model where the “provider is redesigned to be much more accessible and also much more of a partner to the community, to users, to help promote mental health, to find their way to resilience and self care efforts.”
Dr. Maldave spoke to the value of adopting a systemic understanding of mental health issues. “Mental health plays a critical role in the functional status of individuals’ lives.” He advocated for integrating mental health specialists into primary care and community social services that would help people access appropriate care.
Q4: The delegate from Belgium asked the panel to reflect on “lessons learned in [the NYC] community around community-based mental health care.
R4: Anna Ortega-Williams said, “At Red Hook Initiative, we think often about who and what has value, who has influence. The power of peer education, the power of starting from a very young age with messaging about the commonality of social, emotional, and mental health. We are thinking about how it is integrated into our everyday work. Not separate or distinct from getting a high school diploma, but thinking of it as integral as doing a job search.” One goal directed toward young adults is to bridge the digital divide, connecting information technology and social networking with mental health and social wellbeing. “As a community based organization, we meet people where they are at and integrate mental health care within the processes of those organizations.”
Dr. Hankerson added that he and his team work to train teachers at schools, and clergy members at churches, to identify signs and symptoms of emotional issues and problems. The biggest success so far has been at a church in Harlem, which has “just opened a public health free clinic, offering services at a site adjacent to the church, which has increased access to mental health services for members and non-members of the faith-based community.”
Q5: The Deputy Executive Director of the World Health Organization, and representative to the UN, Werner Obermeyer, asked the panel to reflect on how they use community outreach to ensure greater access to services.
R5: Dr. Hankerson responded, “Research shows the most effect way to reduce stigma is to show contact with someone who has mental illness and show effective pathways to treatment.” He emphasizes the importance of sharing publically personal narratives of mental illness as a powerful way to reduce stigma. Pointing out the important role of culture, he added, “Culture uniquely impacts mental health problems. How we integrate cultural aspects within personal story is one of best ways to reduce stigma.”
Just as the meeting was coming to a close, a member of the audience passionately interrupted the proceeding, to present her point. She gave testimony of her experience and challenges as a caregiver, posing the question of access to services for caregivers of families experiencing mental illness.
Dr. Belkin acknowledged that, “This is a huge issue.” The community and governmental partners at ThriveNYC see families as a “real partner in care.” He mentioned NYC Well, a free, confidential 24/7 phone service, designed to help home and community based caregivers navigate the health care system.
- Report by Rachel Hyman, graduate student at Columbia University Teachers College in Dr. Judy Kuriansky’s fieldwork course “Psychology at the United Nations”
