First Lady McCray Delivers Keynote Address at the American Psychiatric Association Awards Reception

October 6, 2016

The First Lady received the Patient Advocacy Award. The award is presented yearly to a public figure who has made outstanding efforts to promote the improvement of services for people coping with mental disorders and substance abuse, and who has fought stigma by speaking out about experiences with mental illness and psychiatric treatment.

Remarks as Prepared for Delivery

Hello, everyone! Thank you for this wonderful award! It is such an honor to be recognized by the American Psychiatric Association!

And how cool it is to be introduced by Dr. Maria Oquendo! I admire her focus on prevention, her long track record of standing up for communities of color and, of course, her many years of service to the people of New York City. 

Thank you all for the work you have chosen to do. Highly-trained psychiatrists have been and always will be the backbone of our mental health system. You have committed your life to helping people regain their equilibrium, and the knowledge and experience you bring to the table are invaluable. 

I’m excited to be here with you today and to have this opportunity to tell you about ThriveNYC. And I hope you feel my passion because I want to enlist you as allies in our quest to bring mental health and substance misuse services to our communities.

Nearly two years ago, I started traveling throughout the five boroughs of New York City, talking to folks about mental health.

And wherever I went, I asked people, “Can you please raise your hands if you or someone you love has not been touched by mental illness, either directly or indirectly?”

By now, I’ve probably asked thousands of people that question. Not a single person has raised their hand. Not one.

I saw with my own eyes what is backed up by the research: When it comes to mental health, America is facing a major public health crisis.  

Just imagine if one out of every five Americans had Zika right now? It’s all we’d be talking about. Am I right?

As you well know, one in five Americans is suffering from a mental health condition. That means real people connected to families like mine and like yours.

But for so long now, we have looked the other way while this crisis corrodes every sector of our society.

I see it in New York City’s hospitals, which cope with 70,000 alcohol-related emergency room visits every year.

I see it in our jails, where more than one-third of detainees is diagnosed with a mental illness.

And I see it in our schools, where eight percent of our public high school students report attempting suicide. That’s at least 18 thousand young people! And those are only the students who are willing to report their attempts.

The supply of mental health services doesn’t even begin to meet the overwhelming demand, especially in our highest-need communities.

There are many, many examples to illustrate this gap. But here is one I think you will especially appreciate.

According to the U.S. Department of Health and Human Services, in 2012 there were 1,952 psychiatrists in New York City.

If you dig deeper into the data and compare the city’s five boroughs, it doesn’t come as a surprise that Manhattan is home to the most psychiatrists, with a total of 1,270. Coincidentally, that divides out to approximately one psychiatrist for every 1,270 Manhattan residents.

But for the people living in the Bronx, the ratio is very different. There is approximately one psychiatrist for every 13,100 Bronx residents. In other words, the Bronx has ten times fewer psychiatrists than Manhattan. 

And that is just one example of the gaps facing most communities in our nation.

We need your help. We need your help reshaping the entire mental health system.

That means recruiting more psychiatrists to close the gaps.

That means vastly expanding our mental health workforce to include co-workers, peers, staff at community-based organizations, and family members.

That means recruiting more mental health professionals of all types to get out into those neighborhoods, where they are needed most. 

That means establishing a stronger presence in integrated care settings.

That means expanding our mission to include both treating mental illness and promoting mental health.

And that means working together to change how mental health treatment is funded in this country. 

Our Mental Health Moment is now.

Is this an ambitious agenda? Hell yes. But I strongly believe there has never been a better time to dream big.

All across the country, communities large and small are coming together to shatter the stigma of mental illness and develop real solutions. 

We’re seeing it in cities like Tacoma Washington, where a sales tax helps pay for mental health services.

We’re seeing it in Boston, where there’s an entire city agency devoted to recovery.

We’re seeing it in Minneapolis, where it’s getting easier for immigrant and refugee students to seek treatment.

More and more, we’re even seeing it in pop culture, where the discussion about mental illness is taking center stage. On shows like Empire where there’s a character with bipolar disorder who graduates from a prestigious college, and contributes to the family business.

And shows like Ellen, where we hear actresses opening up about their anxiety and depression.

Meanwhile, in New York City, we have launched the most comprehensive mental health plan of any city or state in the nation.

Just a few years ago, it would have been hard to imagine any of this. But our world is changing. And we have the opportunity to further this progress.   
   
But before I get into the details of New York City’s mental health roadmap, Thrive, I want to share some of my own mental health story and why I am so passionate an advocate.

Mental illness has affected me at every stage of my life – directly and indirectly.

When I was growing up, my parents suffered from depression. Which of course affected me. And over the years, people who were close to me – members of my extended family, friends and co-workers – have suffered from alcoholism, bi-polar disorder, schizophrenia, and other untreated conditions. 

I understand the emotional frustration and anxiety of unexplained and erratic behaviors. And I know the haunting, unspoken “whys” people harbor about suicide – the questions that never seem to go away. 

Of course, in the 50s, 60s, and even the 70s, we didn’t have all the different treatments or resources we have now. 

We have come a long way since those days, but we still have a long way to go. 

I saw this for myself just a few years ago when our daughter told us she had been diagnosed with depression, anxiety and addiction.

Here was our child, in terrible pain. And I wished I could love her into wellness. But I didn’t know where to turn. I didn’t understand a lot of the terminology. And it was very difficult to find the appropriate services for our 18-year-old biracial daughter. 

Thankfully, our family got lucky. We connected with wonderfully caring professionals and found enough of what we were looking for. 

I'm proud to say that our daughter is doing well and recently graduated from college.

But even after our own family’s crisis subsided, I could not forget how difficult her journey was, and how difficult it must be for other families.

So when Bill became Mayor and I became First Lady, I knew we had to do everything we could to bring comfort and resources to those who are suffering. And that is how ThriveNYC was born.

As I said earlier, ThriveNYC is the most comprehensive mental health plan of any city or state. It's our roadmap to changing the way people think about mental health, and the way the City and its partners deliver services.

With 54 initiatives backed up by nearly a billion dollars over the next four years, our goal is to change the culture around mental health, and approach it like physical health. Because people need to know that mental illness is treatable, and they can do something about it.

I know that is a foundational truth for everyone here. Of course mental illness is treatable!

But for too many Americans, that simple sentence is a life-changing revelation. 

That is why we are spreading the word through videos like the one you just saw, ads like the one behind me, and palm cards like the one on your seat.

That is why we are building a system to address the mental health risks at every stage of life.

That is why we are making resources available where people live, work, worship and learn— with a special focus on high-need communities.

And that is why we are tearing down the silos that have kept too many promising programs from achieving their full potential.

All of the challenges I saw when I was traveling around the city—young people struggling with depression, the opioid scourge, untreated mental illness in our jails—are part of one, larger crisis.

We need to connect the dots. And that's what we do with ThriveNYC. We have combined all of our efforts into a single, long-term strategy. 

Our time is short, so I am going to focus on just four of the 54 initiatives that I think you will find of particular interest.

In the area of Prevention and Early Intervention,we are making an unprecedented investment and bringing more mental health support—including psychiatrists—into our schools.

Our thinking is simple: Half of all mental health and substance use disorders emerge by age 14, and three-quarters by age 24.

So we are expanding Social-Emotional Learning to all of our pre-K and EarlyLearn Centers over the next three years.

Social-Emotional Learning helps children develop the skills they need to build healthy relationships, handle conflict, and make good choices.

Because children often need help learning how to manage their feelings and relationships—especially children who have experienced trauma.

Too many kids have been scolded by their teachers, sent to the principal’s office, and even suspended because no one has helped them strengthen these skills and build resilience.

That’s not fair or effective. Our youngest students don’t need more punishment—they need more tools. 

And our educators need high-quality support, which is why we’re creating a support network of therapists, psychologists and, of course, psychiatrists to provide technical assistance and training to teachers. They will also treat students with more serious needs. 

But social-emotional learning is just a beginning—our students need help every step of the way. 
That is why we have opened nearly 50 new Mental Health Clinics in high-need schools.

That is why we created new Children’s Mobile Crisis Teams, which respond when teachers are concerned about a student who is experiencing a non-life-threatening behavioral health emergency.

And that is why we will hire 100 School Mental Health Consultants. 

The consultants will work closely with teachers and principals to identify areas of need and forge stronger connections to psychiatric help and local resources.

By the end of this year, every one of the schools in our system of 1.1 million school children will have access to mental health support.

We are also bringing task shifting to scale —changing our assumptions about who can do some of this work, and giving people at the grassroots level the knowledge they need to be part of the mental health solution. 

Because not only is our supply of mental health resources not meeting the demand, we are also facing a massive gap when it comes to cultural competence.

In so many communities, for so many people, it’s virtually impossible to find a mental health professional who speaks their language. Someone who understands their culture. Someone they can trust.

Finding that someone can make all the difference.
  
Connections to Care is one of our efforts to begin closing the gap. 

Here’s how it works: We are connecting trusted community-based organizations with behavioral health providers.  

The behavioral health partners will train and mentor CBO staff in evidence-based skills they can use to help people who are struggling.

So if a mom who suffers from undiagnosed depression comes in to sign her child up for daycare, the CBO staffer will be able see the signs, and connect the mother to treatment. 

Through Connections to Care, we plan to reach nearly 50,000 New Yorkers over five years.

But just imagine how much good we could do—imagine how many lives we could save—if all of our nonprofits were staffed by people with mental health training.

That’s a big dream—but a worthy one. And one we could realize with support from the APA and its members. 

The City of New York is also partnering with high-need communities to break down the wall between physical health and mental health.

Our new Mental Health Corps is made up of physicians and clinicians who have recently received their Master’s or Doctorate degree and are eager to put their education to work.

Most Corps members will be assigned to work in primary care practices—including pediatric settings—in under-served communities. And they will be trained in the evidence-based practices we want to see more of, like Collaborative Care.

We want the Corps, which will grow to about 400 members, to be as diverse as the city itself, which is why we are recruiting far and wide.

They will provide approximately 400,000 additional hours of service. 

And they will also accelerate our push to make integrated, evidence-based mental health care the new normal.

But in order to fully realize that goal, we need help from our leaders here in the nation’s capital, which brings me to the fourth initiative I want to tell you about—our federal advocacy work.

Over the last months, I’ve traveled down to D.C. twice to speak with leaders about the need for federal action. And I’m pleased to note that we’re starting to see progress.

Secretary Hillary Clinton recently released a mental health policy agenda, which reflects many of the principles embedded in ThriveNYC. Needless to say, it is unprecedented for mental health to receive this kind of attention.

There is exciting bipartisan movement in Congress, which is considering two promising pieces of mental health legislation.

Now we need to make sure the bills include funding devoted exclusively to mental health, and more support for bringing mental health services into primary care settings.

Congress also deserves credit for passing the Comprehensive Addiction and Recovery Act, or CARA, which addresses the opioid crisis.

But there is no funding to support it. That has to change.

I am eager to partner with all of you to push Washington to do right by the millions of Americans who have been touched by mental illness and substance misuse.

The APA has a robust advocacy arm, and I'm pleased to note that we share many of the same priorities.

I urge all of you to support APA’s action and advocacy effort.

Send a letter to your local newspaper, your Congress Member, your Mayor and your Governor. 
When it comes to mental health, no one speaks with more credibility than all of you. We all need to act locally, but think nationally.

We Need Your Help.

If you want to learn more about the work we’re doing in New York City, and the six guiding principles outlined in the video you saw earlier, please check out our website at Nyc.gov/thrivenyc. 

But I'm not leaving you before I double down on my call for partnership. In order to bring ThriveNYC fully to scale, we need the APA and its members to have our back.

We need you to join with educators to make sure all of our children get the help they need, when they need it.

We need you to welcome non-professionals into the field with open arms, and help us expand America’s mental health workforce through task-shifting.

We need you to strengthen your existing partnerships with community-based organizations, and build new ones, so they can be anchors for prevention and promotion.

And we need you to join us in urging Washington to make long-term investments in proven solutions.

That’s what it will take to bring this movement to the next level. And it really is a movement. 

People are marching in the streets. People are demanding action from their elected officials. And people are finally starting to speak up.

I heard their voices loud and clear back in May, when we put together a Weekend of Faith for Mental Health.

Between Friday and Sunday, a thousand houses of worship representing a quarter million New Yorkers put mental health at the top of their agenda.

For three days, I was out speaking, participating in the public conversation. I visited a mosque and a synagogue. I visited a Catholic church… a Baptist church… an interdenominational church… and two Seventh Day Adventist churches. 

I heard Spanish. I heard Hebrew. I heard Arabic. And I heard a whole lot of “Amens.” 

But most of all, what I heard, and saw, and felt was a great need for more—more open conversation, more treatment and prevention resources, and more collaboration.

Every single American who understands the gravity of the mental health crisis—which means every single person in this room—has an opportunity to help push the movement forward. Do you feel your power?

And no single group is stronger than all of you. NOW is the moment we’ve been waiting for. Now is the time to come together and take action. So are you with me? Let me hear you!

Thank you!