We seem to talk about mental health only following a massive tragedy, like the community shootings we’ve all grown too accustomed to seeing—and even then, we only talk about it for a day or so. And doesn’t it seem like you never hear about any changes following the media frenzy about behavioral health needs? Yet for all this silence, around one in five Americans experiences a mental health problem in a given year. That’s a big number—more than 43 million people.
Thankfully, in New York City, conversation—and action—about mental health is going to carry on. Last summer, Mayor Bill de Blasio and First Lady Chirlane McCray unveiled the Connections to Care program, a $30 million public-private partnership to evaluate the integration of mental health support at community-based organizations serving low-income populations. Connections to Care is part of ThriveNYC: A Mental Health Roadmap for All, a plan of action to support the mental well-being of New Yorkers.
In March, the Mayor’s Fund for New York City selected 14 community organizations to receive grants to partner with mental health providers, train staff, and improve access to mental health care in their communities through the Connections to Care program. These organizations are known and trusted in their respective communities and, importantly, do not currently provide mental health services; they offer a range of services from daycare to workforce development. I am glad the Mayor’s Fund chose such organizations because even in 2016, it is difficult to walk into a building with a big sign that says, “Mental Health Clinic” or “Substance Abuse Treatment Center.” Connecting mental health providers with the staff at organizations already rooted in the community is a positive and strategic move.
It’s similar to the health and wellness centers we are working to establish at The Child Center of NY, which will offer various integrated services under one roof—and also address stigma. Physical and behavioral health have been divided for as long as I can remember. I hope community members will start to recognize that it’s okay to go to health and wellness centers to get a vaccination for their child, as well as to see a therapist to help with some life transition.
The focus on expanding access to care and reducing stigma is an important step toward equalizing mental and physical health care, but there is more work ahead. Through Connections to Care, more staff will learn to identify and treat mental health conditions like depression and anxiety, which is great—but we also need to fund behavioral health programs in a way that reflects the importance of the services they provide. Historically, funding streams, regulations, and state and local entities charged with oversight and accountability of health services have focused minimally on behavioral health needs—and with funding that does not reflect parity with physical health. For example, workers providing counseling and substance use treatment are not paid well at all, especially compared with their physical healthcare counterparts, yet the service they provide is of critical importance. Just over 40 percent of people with a mental health condition received treatment in the past year, and serious mental illness costs America more than $193 billion in lost earnings per year. A major step toward valuing behavioral health services is to better compensate the individuals who choose to go into this very demanding field so they can make a decent living and provide for their own families. The current health reform efforts in New York, particularly the transition to Medicaid managed care, are finally involving talk of parity—and perhaps will allocate funds that follow the principles of parity due to the acknowledgment that behavioral health impacts health care costs.
Another step to address unmet mental health needs will be to reach even more groups of people. Connections to Care targets three populations: expectant parents and/or parents of children up to the age of four; out-of-school, out-of-work young adults ages 16 to 24; and/or unemployed or underemployed adults ages 18 and over. Where to target limited resources is a very difficult decision, and I agree that these groups are important priority populations to support. But there are other groups we should keep on the radar and short list—children and families involved with the child welfare system, immigrant children and families, children of military parents who have endured years of deployment, LGBT youth and adolescents—and this list is not comprehensive.
While there is a lot of work ahead of us, I would not underestimate the significance of the Mayor and First Lady of New York City starting the conversation about mental health by sharing their own family’s stories. Whenever I have been in an audience where someone who has struggled with mental illness or substance use tells his or her story, I have seen genuine empathy, concern, tears, and a commitment to wanting to help. It is hard to hear firsthand of such struggles and not believe that behavioral health services need to be there. Bill de Blasio and Chirlane McCray’s stories of their family members’ experiences with depression and addiction are not unique. But when you see someone in the public eye divulge the same truth that you have felt you needed to keep a secret, it propels you forward in thinking it might be okay to reach out for assistance.
Working with communities to turn that conversation into action will change the lives of many individuals and families. But the results of these efforts will reach a much greater scale if they come hand-in-hand with health care reform and a real dedication to achieving mental health parity.
Associate Executive Director for Behavioral Health Services
The Child Center of NY