Dr Robert London

ThriveNYC could help treat and destigmatize mental, behavioral disorders

Clinical Psychiatry News - February 12, 2016

Can a broad public health campaign have an impact on addressing stigma, and getting people with mental health and substance use problems the help they need? New York City First Lady Chirlane McCray thinks it can.

Late last year, Ms. McCray spearheaded an ambitious public health initiative that Mayor Bill de Blasio’s administration hopes will be used as a model for other cities across the country. It’s called ThriveNYC: A Mental Health Roadmap for All. The roadmap is guided by six core principles: Change the culture, act early, close treatment gaps, partner with communities, use data better, and strengthen the government’s ability to lead.

Chirlane McCray

Chirlane McCray

“We want to change the way we deliver services in this system,” Ms. McCray, chair of the Mayor’s Fund to Advance New York City, told me in a recent interview. The effort involves more than 20 city agencies, 54 initiatives grounded in best practices, and $850 million allocated over the next 4 years.

A key element of ThriveNYC is its plan to train 250,000 New Yorkers “to better recognize the signs, symptoms, and risk factors of mental illness and addiction, and more effectively provide support,” according to the release announcing the initiative. The training component will be based on Mental Health First Aid, a program disseminated by the National Council for Behavioral Health and Missouri Department of Mental Health. More than 6,000 New Yorkers have been trained over the last several years to administer Mental Health First Aid under the city’s Department of Health and Mental Hygiene, and an additional 10,000 people will be trained by the end of ThriveNYC’s first year, Ms. McCray said in recent testimony before the New York City Council’s Committee on Mental Health.

The roadmap also encompasses teaching emotional skills to children in early childhood programs, and increasing screening and treatment for maternal depression as well as an expansion of supportive housing.

In addition, a core of 400 physicians will be recruited to work in mental health and substance use clinics. “We need 400,000 additional hours of outpatient services,” she told me. Another important step in the roadmap, particularly in light of the Cultural Formulation guidelines in the DSM-5, is the recognition that the mental health workforce needs to be culturally and linguistically diverse.

Ms. McCray said her interest in mental health goes back many years. “My parents suffered from depression,” she said. “Later, our daughter came to us and said she had been diagnosed with anxiety and depression. I could not figure out why this was not being talked about.”

Before she and her team came up with the plan, Ms. McCray said, she traveled to all of the boroughs and talked with New Yorkers to discover just how prevalent mental illness is. About 20% of adult New Yorkers will have a mental disorder in any given year, she said. This correlates well with national statistics. “How can so many people be suffering from something that is treatable?” she asked. “If someone has a sprained ankle, people know what to do.”

Dr. Robert T. London

Dr. Robert T. London

She is so right. I have told many people in denial that if you have broken leg you know what to do and do it, or if you get a piece of dirt in your eye and can’t get it out, you find an eye specialist. The list goes on. With mental illness, all too many people remain in the darkness of denial.

This plan also could help people with serious and chronic mental illness beyond depression. As I wrote recently, improving the quality of life for patients with serious and chronic mental illness requires commitment on the part of the mental health community to exert influence on policymakers and business leaders “so that outpatient care is brought up to the standards envisioned decades ago” when psychiatric hospitals were emptied (“Better treatment is long overdue,” Clinical Psychiatry News, August 2015, p. 10). “Psychiatric patients, who are among the most vulnerable people in our society, deserve this.”

Better treatment for people with serious and chronic mental illness also creates an environment in which they can get treatment for medical conditions such as cardiovascular disease, diabetes, and hypertension, which are often ignored. Statistically, people with serious and chronic mental illness live about 20 fewer years than do those without mental illness.

We know that we are in the midst of a shortage of psychiatrists. Primary care physicians often step in to help us treat illnesses such as depression, but the demand for care also is overwhelming their ranks. Meanwhile, about 350,000 psychiatric patients are housed in our prison system, many for minor crimes related to their illnesses, and an additional 250,000 people are in homeless shelters because of the lack of psychiatrically supervised safe housing, according to data from the Treatment Advocacy Center and the National Institute of Corrections. When that scenario is juxtaposed to the number of psychiatric beds available 50 years ago – 650,000 compared with 65,000 today, it quickly becomes clear that this is a crisis.

Ms. McCray’s roadmap is a bold experiment that could be the start of fundamental changes to the landscape for people with mental illness – not only in New York. It also could prove to be a national blueprint. One of its greatest strengths is its potential to help destigmatize mental illness and truly bring mental health care into the mainstream of health care delivery. Implementing the roadmap slowly and with a small group of people, however, would give it the best chance of success.

Those of us who advocate on behalf of people with mental illness, including the American Psychiatric Association, should take a look at what’s going on in New York City and see how we can help. In fact, perhaps the APA should call on Ms. McCray as a keynote speaker. In the meantime, we’ll find out more when ThriveNYC holds a workforce summit that Ms. McCray told me will be held to discuss some of these issues.

Dr. London is a psychiatrist who trained at NYU Langone Medical Center and Bellevue Hospital, both in New York, and developed and ran a short-term psychotherapy program at the medical center from 1975 through 1995. He has been a newspaper columnist for more than 30 years. He has no conflicts of interest.

Providing information properly and lowering the “epidemics of anxiety” to prevent unnecessary suffering in people with full-blown or subclinical GAD should be at the forefront of public health policy.

Let me know your thoughts about this topic and how we might treat anxiety individually—and nationally—and I will try to pass them along to my readers.

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