New York pioneers a city role in strengthening mental health
As a student at a middle school in the Bronx, a low-income district of New York City, Teresa, the child of Mexican immigrants, struggled in class.
For years, the trauma of growing up in an abusive family had hardened her to outreach efforts from her teachers. But eventually a social worker from El Salvador, who spoke her language and shared her Central American background, was able to break through. With that added boost, Teresa (not her real name) graduated with honours and moved on to high school.
New York City first lady Chirlane McCray shared that success story recently as an example of the benefits of the city’s effort to provide some form of mental-health services in every public school — among dozens of other such initiatives.
In addition to school-based counselors, New York City is training teachers to help students develop what professionals call “emotional resilience”. That includes developing a system to screen and treat 80 percent of new mothers for post-partum depression, and deploying a mental-health corps of 400 professionals to substance-abuse centers and community health clinics.
These initiatives, 54 in total, fall under the banner of ThriveNYC, the city’s USD 850 million strategy to improve mental-health care. Mental health is a cause célèbre for McCray, who has used her platform as wife of Mayor Bill de Blasio to push her signature issue in over 1,000 public appearances at schools, synagogues, churches and community centres.
Last month, she took her campaign to another New York City landmark, the United Nations, to demonstrate how cities are delivering on the U. N.’s Sustainable Development Goals (SDGs). New York City has adopted the U. N.’s global agenda head-on, with a development plan called OneNYC and a public effort by the mayor’s Office for International Affairs to showcase connections between New York policy and the SDGs through a programme called Global Vision | Urban Action.
The SDGs, which went into effect last year, are made up of 17 goals. In that framework, Goal 3 directly addresses health and has two targets on mental health, pledging governments to “promote mental health and well-being” and to combat substance abuse. (A related indicator would mandate that officials track suicide rates more closely.)
Nevertheless, a lingering stigma means that mental health often isn’t treated on par with other health concerns.
“Someone can be suffering from a broken leg, asthma or diabetes, and no one says, ‘Just snap it out of it, pull yourself together,’” McCray said at the U. N.“When someone has a mental illness, it’s just looked at in such a dramatically different way.”
McCray encountered that type of response when her daughter had depression. As an 18-year-old, Chiara de Blasio was legally an adult and on her own to navigate the web of mental-health services in New York City. Even with McCray’s assistance, the family struggled to find appropriate care.
While this experience took place before moving into the mayoral residence, McCray reasoned that if a professional family such as hers was struggling, it must be even harder for the average New Yorker. As a result, McCray said, “We are determined to change the culture on mental health in our city.”
One of New York City’s most successful approaches has been what Kishor Malavade, a psychiatrist at Brooklyn’s Maimonides Medical Center, calls “task shifting.” Given the lack of trained mental-health professionals and the high demand for services, medical professionals believe that trained lay people can offer basic counseling that can help stem the gap.
To that end, New York City and major medical centres such as Maimonides are reaching out to ethnic, faith-based and other community organizations. The idea is to ensure that someone with a mental-health issue can find basic solace from a person who speaks their language, shares their culture or practices their faith. The programme, called Connections to Care, expects to reach 50,000 New Yorkers in five years.
Teresa, the middle-schooler, was fortunate to have access to a licensed clinical social worker. But ThriveNYC advocates believe that even a teacher with some training could have helped intervene. Task shifting allows health experts to “think about the community in a way that we could all be partners together,” Malavade said. “They are just different elements of what we need to do to help individuals out there.”
Not that the approach doesn’t have its critics. Medical scholars are not unanimous in their support for the “lay counselor” approach. “My own community of providers has been some of the most difficult to engage,” Malavade noted.
New York City is cognizant, meanwhile, that its challenges — where 1 in 5 residents will experience a mental-health disorder this year — are not unique, but also that its solutions are cost-effective and scalable. “We know New York City is not the only place with a lack of mental-health services,” McCray said.
Halfway around the world, the Pulitzer Center reported last month, an Indian NGO cultivates lay counselors with 40 hours of training that provides them the tools they need to help some of the country’s poorest, who have the lowest levels of access to health care.
While medical scholars have debated whether the poor suffer from mental-health problems at similar levels and in similar ways as the rich, and whether such lay counselors are effective, Indian lawmakers have taken notice. The parliament is contemplating a proposal to guarantee mental health for all Indians — with lay counselors a key part of meeting that commitment.
City’s ability to thrive
Back in New York, the U. S. financial capital is taking on the issue not only because of McCray’s advocacy. “Mental health affects literally everything,” warned Deputy Mayor Richard Buery, citing setbacks in education, impacts on physical health and threats to public safety. Buery also points to a whopping USD 14 billion in estimated annual productivity losses in the city due to depression, anxiety and substance abuse.
Mental health “truly affects the ability of our city to live and to thrive,” Buery said. He attributed ThriveNYC’s success thus far to committed leadership by the mayor and first lady, as well as to a culture of accountability willing to set metrics and cross-agency partnerships. For example, the city’s health and education departments are now working more closely with each other to deliver on the plan’s expansion of mental-health services in schools.
Globally, the World Health Organization estimates that 450 million people suffer from mental-health concerns and that 1 in 4 worldwide will be affected by mental or neurological disorders at some point in their lives. This week, the agency dubbed depression the “leading cause of disability worldwide”.
To that end, the SDGs include mental health as a global issue to tackle. Dessima Williams, a Grenadian diplomat and U. N. special adviser on the implementation of the SDGs, applauded New York’s efforts thus far. “That is the strategy for success for the SDGs: local ownership, local action,” she said. “New York, you’re on target.”