Care, Community, Action: A Mental Health Plan for NYC

New York City is facing a mental health crisis. It is time for a comprehensive mental health plan for NYC to alleviate and prevent emotional suffering, and to save lives.

The City’s new, comprehensive plan for NYC’s mental health focuses on three groups of New Yorkers, for which we see the greatest need:

  1. Children, youth and families
  2. People with serious mental illness (SMI)
  3. People at risk of drug overdose  

This comprehensive plan to address NYC’s mental health takes an innovative public health approach to mental health, focusing on New Yorkers with urgent needs. We must focus on prevention — including addressing the social, economic, racial and cultural drivers that affect mental health — intervention, and convening resources and supports.This plan’s goals will guide our future actions across the city to improve mental health.

Child, Youth and Family Mental Health

When children and youth have good mental health, they are more able to experience well-being, realize their abilities, have fulfilling relationships, learn and work productively, and engage with their communities. However, many children and youth in NYC are reporting symptoms associated with poor mental health. Our children are hurting, as we emerge from one of the most difficult periods in our world’s history.

We envision a city where all children, youth, families and communities have equitable access to the conditions, opportunities, resources and care they need for good mental health. Beyond treating a young person’s mental health needs, we must also holistically support them to help them achieve their goals and live fulfilling lives.

Our Goals And Strategies

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1. Provide children and youth with mental health care that is timely, culturally responsive, accessible and affordable

Our Strategies:
  1. Leverage and increase accessibility of telehealth as part of a continuum of care
  2. Support youth facing a mental health crisis
  3. Increase appropriate care for children and youth impacted by inequities leading to disparate mental health outcomes
  4. Build out school capacity to provide and connect children and youth to care
  5. Guide mental health system improvements informed by the experiences of youth
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2. Improve access to prevention interventions for children and youth exposed to risk factors

Our Strategies:
  1. Provide early identification and prevention services within systems that serve and support children and youth
  2. Expand supports focused on maternal mental health
  3. Create a child and youth mental health “safety net”
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3. Increase awareness and understanding of child and youth mental health and how to care for it

Our Strategies:
  1. Remove the stigma associated with talking about mental health through messaging and outreach developed by youth
  2. Provide trainings for youth, parents and caregivers, and other caring adults on how to help improve children's and youth’s well-being
  3. Make it easier for youth and families to learn about and connect to available services
  4. Collect better data to better understand the current landscape of child and youth mental health
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4. Create environments that equitably support good mental health for children and youth

Our Strategies:
  1. Address potential harms of social media as a toxic exposure, and make sure online spaces are safe for children and youth and do not harm their mental health
  2. Create supportive environments in schools through social-emotional learning and policies focused on children and youth
  3. Make children, youth and families the center of policies that improve their quality of life and prevent chronic stress

Serious Mental Illness

Serious Mental Illness is defined as one or more mental, behavioral or emotional conditions such as major depressive disorder, schizophrenia and bipolar disorder that substantially interfere with major life activities (for example, ability to maintain employment). Similar to national averages, about 4% of adult New Yorkers live with an SMI diagnosis. In addition, 39% of adult New Yorkers with SMI are not engaged in treatment.

The City is committed to taking a public health approach to supporting people with SMI, focusing on prevention and intervention to avoid crisis and providing responsive care with health and social supports that are affordable, accessible, acceptable and free of stigma.

With the right help, all New Yorkers with SMI can thrive. With this approach, we aim to improve health, decrease suffering and social isolation, and improve well-being for people living with SMI.This approach also acknowledges that a focus on health care alone is not enough to foster mental wellness. Home, community and response are just as critical for preventing the progression of mental health issues and ensuring healthy environments for recovery.

Our Goals And Strategies

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1. Improve access to specialty SMI care and primary care that is race-conscious and trauma-informed

Our Strategies:
  1. Ensure coordinated access to the range of specialty care needed, from intensive community-based behavioral health services to appropriate care in a hospital
  2. Enhance reentry services for people impacted by SMI and the criminal legal system
  3. Address racial inequities in health care services and treatment for New Yorkers of color with SMI
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2. Expand the stable housing options available to New Yorkers with SMI

Our Strategy:
  1. Make safe and stable housing more available, affordable and accessible to help improve the quality of life of New Yorkers with SMI
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3. Expand City infrastructure for rehabilitative supports, education and employment for people with SMI and for their families

Our Strategies:
  1. Make sure people with SMI are part of the wider community and supported with education, employment and relationship-building opportunities
  2. Make sure families impacted by mental illness are adequately supported
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4. Serve New Yorkers in mental health crisis through a health-led response

Our Strategies:
  1. Improve the experience of New Yorkers who are facing a mental health crisis through strengthened connections to a range of community-based supports and acute care services
  2. Improve access to and use of crisis stabilization options, including hospitalization and alternatives, for people with SMI in need of intensive and supportive care

Overdose Response

NYC is facing a drug overdose crisis. Every three hours, a New Yorker dies of an overdose, and more New Yorkers died in 2021 from overdoses than from suicides, homicides and automobile accidents combined. 2021 was the deadliest year on record for overdose deaths in NYC with 39.4 deaths per 100,000 people, a 25% increase compared to 2020 and an 80% increase compared to 2019. This crisis cannot be secondary to other emergencies. It is — and must remain — at the forefront of our city’s public health planning, even as we manage other emergencies.

Reducing overdose deaths and improving the lives of people who use drugs and people with substance use disorders is a top priority for NYC. We envision NYC as a place where substance use never leads to death, where all New Yorkers have access to the services they need when they need them, and where a strong and integrated health, mental health and social service system leads to fewer people developing problem substance use.

Our Goals And Strategies

The City’s comprehensive approach will focus on four overarching goals, now and in the coming years:

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1. Reduce the risk of death for people who use drugs, with a focus on neighborhoods with the highest overdose death rates

Our Strategies:
  1. Expand citywide naloxone distribution
  2. Expand and enhance nonfatal overdose response efforts
  3. Optimize and expand overdose prevention services
  4. Understand and respond to the risks of an unregulated drug supply
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2. Make sure people who use drugs have access to high-quality harm reduction, treatment and recovery services

Our Strategies:
  1. Enhance the scope and reach of existing harm reduction services  
  2. Optimize the availability, accessibility and acceptability of evidence-based treatment
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3. Improve quality of life through increased investments in housing, employment and health care in communities

Our Strategies:
  1. Expand housing options for people who use drugs
  2. Support and invest in people returning to the community from jails and prisons
  3. Provide vocational support for people who are chronically excluded from the workforce  
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4. Support children, families and communities affected by the overdose crisis

Our Strategies:
  1. Provide support to families who have lost a loved one to overdose  
  2. Enhance place-based capacity to support and respond to community needs
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5. Reduce the number of people who develop problem substance use

Our Strategies:
  1. Support development of protective factors for youth at risk of problem substance use through funding community coalitions
  2. Intensify support and provide early intervention for youth and families affected by problem substance use

Our Policy and Advocacy Agenda

We recognize that, alone, NYC cannot fully address the mental health challenges it faces. The pressures facing our mental health systems are in part the product of policies set across different levels of government over decades. Support for NYC’s mental health care system comes from a blend of federal, state, city and private dollars, through a combination of grants and insurance reimbursement. These different funders set the rules about how these dollars can be used. That is why it is so important for NYC to work with state, federal, and private partners to make sure we have the support and flexibility we need. This has become critical now that mental health is a national issue, with federal and state leaders prioritizing it in their policy agendas and budgets.  

The process of developing this plan for Child, Youth and Family Mental Health, SMI and Overdose Response revealed common needs to address structural gaps.

Policy and Advocacy Goals for NYC:

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1. We need a robust, diverse and culturally responsive workforce capable of engaging people early.

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2. We need sustainable financing for mental healthcare that equitably incentivizes outcomes that matter to people with lived experience and impacted communities.

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