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More Care, More Support: City Unveils Public Safety and Public Health Reforms

December 23, 2019

Recommendations set forth by the Health Department and NYPD will provide new ways for City agencies to reach the narrow population of New Yorkers with untreated mental illness who may pose a danger to themselves or others

NEW YORK—The de Blasio administration announced today that it will strengthen and expand its approach to supporting the narrow population of New Yorkers with untreated serious mental illness who pose a risk for violent behavior. City agencies will work together to refer more New Yorkers to treatment and keep them engaged in the right level of care—ensuring that no person in need falls through the cracks. This commitment stems from a 30-day review led by the Health Department and the NYPD.

“We have an obligation to address our broken mental health system and do all we can to connect people who are struggling to treatment,” said Mayor Bill de Blasio. “That includes the small percentage of those with mental illness that, left untreated, are at risk of committing violence against themselves or others. These reforms will keep our neighborhoods and city streets safe, ensuring that no New Yorker in need falls through the cracks.”

To address the broken state of our mental health system at the state and federal level, the de Blasio Administration has pledged historic investments in programs and services. Hundreds of thousands of New Yorkers who have mental health needs are successfully treated in the community each year. Over the last few years the City has created new programs to connect even more New Yorkers in need to treatment. Additionally, to reach the narrow population of New Yorkers with untreated serious mental illness who also pose a concern for violent behavior, the City created NYC Safe in 2015. NYC Safe a network of intensive mental health intervention programs for people with untreated serious mental illness who pose a risk of violence and whose care requires close coordination between City services. The program is overseen by a team at the Department of Health and Mental Hygiene that triages cases and connects high-risk individuals with treatment and follow up.

In 2016, the City launched new mobile mental health treatment teams, which provide intensive, ongoing clinical care to people in their communities, in addition to Co-Response Teams, which are comprised of a mental health professional and police officers who proactively engage clients with serious mental health needs and demonstrated violence, connecting them to care and other stabilizing supports such as housing or family.

Through a new, $21 million investment, the City will fund $9.4 million for the Health Department to expand its mobile treatment teams with the goal of connecting more New Yorkers to intensive mental health services and resources. In addition to offering intensive mental health services through the mobile treatment teams, the increased funding will permit the hiring of additional social workers, housing specialists, and legal assistance services to ensure those who are currently undergoing intensive mental health treatment receive comprehensive support.

The Administration will also invest $11 million in Health + Hospitals to create hospital-based outreach teams to coordinate care for people who frequent emergency rooms and other acute care settings. Through this effort, it is estimated that emergency room visits made by this population would decrease by 10%.

As a result of the Review, the City will make the following reforms to reach the narrow population of New Yorkers with untreated mental illness who may pose a danger to themselves or others:

Improve communication between agencies and the process of referring New Yorkers to treatment:

  • Train more city agency staff that come into contact with people who have serious mental illness – such as the Department of Homeless Services and Health + Hospitals – to refer these individuals for intensive mobile treatment.
  • Deploy NYPD resources to increase referrals to the Triage Desk, which sends both Co-Response Teams and Health Engagement and Assessment Teams (HEAT) to assist those in need of mental health interventions.
  • The city will share data related to high-risk individuals to enhance PSYCKES, a web based application developed by the NYS Office of Mental Health (OMH) and widely used by hospitals and outpatient providers. The city and OMH will also collaborate on the development of new PSYCKES features for providers to support identification and care coordination for vulnerable high risk individuals. 

Connect more New Yorkers to the right level of treatment:

  • Create an interagency coordination team between the Department of Homeless Services and Health + Hospitals to ensure smooth transfer between agencies for people who are experiencing homelessness. The coordination begins prior to hospitalization and continues throughout the hospital stay.
  • Immediately hire additional staff at the Health Department to process the 20% expected increase in mental health referrals as a result of the strategies announced today and make assignments to appropriate level of care.  This will result in approximately 900 additional people each year receiving the treatment they need.
  • Make it easier for intensive treatment teams to visit clients in correctional facilities.

Actively engage New Yorkers who drop out of treatment to keep them in care:

  • Provide NYPD Officers with notice of individuals with AOT orders who have dropped out of court mandated treatment so that when an officer encounters them, they will be brought to a hospital. Additionally, NYPD will develop a protocol to transport people with AOT warrants to hospitals, as required by law, so they can be assessed and reconnected to treatment.  
  • Convene care conferences to ensure individuals in homeless shelters stay connected to treatment.
  • The Health Department will review information with the Department of Homeless Services, NYPD, Health + Hospitals, and the Department of Correction to determine whether anyone who has been missing from treatment has had contact with any of those agencies to help reconnect them to care.
  • Revise the Riker’s release process to increase successful connections to a treatment team at time of release.

Increase Kendra’s Law applications to courts for review, and explore critical, legislative changes to state law to maximize the use of Assisted Outpatient Treatment (AOT):

  • Nearly 2,500 individuals were mandated to Assisted Outpatient Treatment (AOT under Kendra’s Law) last year, a 27% increase since the beginning of this administration. The proposed changes would build on this approach, and ensure that the narrow population of individuals who may pose a threat to themselves or others remain connected to treatment. 

The agencies involved in the initial review – DOHMH, NYPD, H+H, DHS, FDNY, NYPD and the Mayor’s Office of ThriveNYC– will continue exploring ways to improve how people with serious mental illness are connected to care. 

“Our commitment to mental health for all demands that we reach New Yorkers living with the most serious mental illness to ensure they are meaningfully connected to care and treatment,” said Deputy Mayor for Health and Human Services Dr. Raul Perea-Henze. “This approach takes deeper collaboration across City government and strategic investments to ensure access to care for all those who need it.”

“People with serious mental illness are our neighbors, friends, and family and they deserve support instead of stigma,” said Health Commissioner Dr. Oxiris Barbot. “We want New Yorkers in need to be able to easily connect to the right level of treatment in their communities where they can remain connected to their families and other support networks.”

“NYPD officers ensure the safety of every New Yorker in every neighborhood across the five boroughs,” said Chief of Department Terence Monahan. “They are well trained and equipped to connect people with mental illness to the proper services they deserve. Working alongside our partner agencies we remain committed to our mission of helping every person we proudly serve.” 

“Our City is committed to connecting our neighbors experiencing significant challenges with the help and support they need to find stability,” said Social Services Commissioner Steven Banks. “Through close partnerships, innovative approaches, and new proactive interventions, we will continually enhance our efforts to support New Yorkers in need, from addressing housing crises to resolving mental health challenges through a holistic range of services. As we all work together to close gaps in programs and strengthen our safety net for all, we are determined to keep doing better by those we serve, as well as those who may need our services, but may not be ready to accept assistance yet.”

“As we strengthen our support and safety net system for people with serious mental illness, a coordinated approach to behavioral health care is critical,” said Mitchell Katz, MD, President and CEO of NYC Health + Hospitals. “Constant communication between all agencies who serve this population, will ensure that they receive the necessary care and services they need and deserve.”

“The 30-day review highlights the need for greater inter-agency coordination,” said Susan Herman, Director of the Mayor’s Office of ThriveNYC. “I look forward to closing the gaps we identified through implementation of these new strategies.”

 “We have to use every tool in our toolbox to address the mental health crisis in our city, and we need to do more to reach people with the greatest level of need. Mobile outreach has proven to be an effective tool in reaching vulnerable populations who may not seek out help on their own, which is why we have championed similar initiatives, such as funding a mobile shower service for our borough’s homeless population. The 30-day review has highlighted the areas we are currently falling short, but it is also pointing the way forward to a better city where all residents receive the treatment and care they deserve. I thank Mayor de Blasio, Commissioner Barbot, Commissioner Shea, and all our public servants for changing the conversation around mental health in our city,” said Brooklyn Borough President Eric Adams.  

“The tragedy that claimed the lives of innocent homeless New Yorkers in Chinatown in October has forced a moral reckoning across the City – and an overdue dialogue about who is and who is not getting the mental health services they need,” said Council Member Margaret S. Chin. “When a New Yorker is in crisis, our government must step in to provide lifesaving treatment and resources as early as possible, and I thank the Mayor for enhancing interagency coordination to ensure that no one slips through the cracks.”

“These commitments will help expand our City’s behavioral health safety net, which will ultimately result in more people with serious mental illnesses getting the care they need and deserve,” said Council Member Diana Ayala. “As Chair of the City Council’s Committee on Mental Health, Disabilities, and Addiction, I thank the Administration for cultivating this comprehensive approach and maximizing their resources to serve this population.”

These new commitments are an important step towards addressing the behavioral health challenges that homeless New Yorkers are experiencing every day on our streets. I look forward to working further with the City on solutions to the wide swath of issues that are effecting our homeless community and ensuring they can access the resources they need,” said Council Member Carlina Rivera.

“CUCS has operated Intensive Mobile Treatment Teams since 2015 that are staffed with a full range of mental health professionals. Our teams work across the city with individuals who are oftentimes homeless and have experienced high rates of incarceration and psychiatric hospitalizations but have otherwise disconnected from the larger system of care, except for us.  We have seen remarkable transformations among these individuals during the past four years, helping them to reconnect, gain stability, reunite with family, and obtain housing. Additional resources from the city in these types of services would be a great investment,” said Tony Hannigan, President & CEO, Center for Urban Services.

“Engaging the resources and mobilizing the expertise of key city agencies in a coordinated team response will insure that New Yorkers experiencing serious mental illness get the attention and treatment they deserve. The increased availability of site based, mobile and street-based treatment that takes services to people in need should reduce crisis response by the police, trips to the hospital and result in more adherence and continuity of care,” said Gail Nayowith, Principal of 1digit and Chair of the Community Services Board, which advises the NYC Health Department on its behavioral health policy.

“Although research shows that people with mental illness are far more likely to be victims of violence than the cause, we know from our own work across the city that outreach to people with serious mental illness -- in their communities, outside of the clinical setting -- is critical to helping them get better and live more fulfilling lives,” said David Woodlock, President and CEO of ICL, a premier behavioral health agency that helps more than 10,000 New Yorkers each year. “We strongly support this significant increase in funding for mobile treatment teams, which provide treatment and social support for people who suffer from multiple mental health and substance misuse issues and are often homeless or on the verge of homelessness.”

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