New York City is easily one of the biggest and most diverse cities in the nation. Home to over 8.5 million residents, New Yorkers reside among the city’s five boroughs: Manhattan, Brooklyn, Queens, the Bronx, and Staten Island.
One in five adult New Yorkers experiences a mental health issue in any given year. For the city’s children and adolescents, the high rate of predictors for mental health issues—traumatic events, persistent feelings of sadness, and parental mental illness—are just as alarming. While mental illness does not discriminate among ages, it occurs with much higher prevalence in low-income and less educated individuals, the uninsured, and those receiving public insurance.
Frontline staff members at community based organizations (CBOs) have frequent and meaningful contact with low-income New Yorkers – working with them to address issues ranging from early childhood development, employment and education. Case managers and service providers consistently report that many of their clients appear depressed or anxious and suspect that these challenges interfere with clients’ abilities to achieve their programmatic goals. Yet while social service staff members often receive some training in mental health issues, they typically do not have the ongoing coaching and support from mental health experts necessary to effectively sustain and integrate this knowledge in their work, nor the needed substantive partnerships with mental health providers to successfully make the necessary referrals. Without expertise in mental health, CBO staff often become aware of underlying mental health issues only after a client performs poorly – whether on a job training site, in caring for their children or in attaining educational goals.
The Mayor’s Office coordinated among the NYC Department of Health and Mental Hygiene, the Mayor’s Office for Economic Opportunity, and the Mayor’s Fund to Advance NYC create Connections to Care (C2C) — an approach that builds the mental health care capacity of CBOs serving low-income communities, especially where people may not know they need help, or are reluctant to access care. The C2C model allows non-clinicians to administer evidenced-based mental health practices, in settings that meet New Yorkers where they are in their daily lives. At the time of its inception, C2C invited non-mental health providers that offer services to jobseekers, youth who are not in school and not working, and parents of children ages 0-4 to partner up with local mental health clinical providers and be trained in the C2C model. By engaging non-clinicians in addressing mental health, NYC is expanding the concept of care to include prevention and wellness promotion, rather than only treatment. Those identified through C2C to need clinical treatment are referred to the appropriate clinical partner.
C2C is one of 54 initiatives under ThriveNYC, a comprehensive effort to improve the mental health system and promote the wellness of New Yorkers. Launched by First Lady of NYC Chirlane McCray in 2015 to address the city’s silent mental health crisis, ThriveNYC is guided by six core principles: change the culture, act early, close treatment gaps, partner with communities, use data better, and strengthen government’s ability to lead.
THE BRIGHT SPOT
What happens when community organizations and clinicians develop previously untapped capabilities and take on new roles to collaborate in addressing mental health? Goals are blown out of the water. Launched in 2015 as a five-year demonstration, C2C aimed to train 1,000 staff but three years in providers have trained over 1,200. The number of clients served by C2C has also surpassed initial targets, with over 16,000 New Yorkers receiving the mental health screenings and services. And leadership at the community-based organizations is already reporting that increased mental health support is helping to improve outcomes in employment, education, and family stability. RAND Corporation is conducting an evaluation of C2C’s implementation, impact, and cost and will release an interim report in fall 2018.
Comprehensive mental health services are the future for New York City. Every staff member, every healthcare provider, and every participant has a role to play in helping someone. That’s the future for C2C. Acknowledging that it takes every person along the journey to connect New Yorkers to services to help them live their best lives is a major driver for C2C and ThriveNYC. New York City is fostering hope necessary to lean into a culture of resilience. Identifying needs early on and connecting people to care sooner will lead to better outcomes for generations to come.