This winter there is renewed focus on serious mental illness and discussions about how New Yorkers can best address the health and safety of these residents. As an emergency room psychiatrist, I began my career on the front lines of addressing mental health crises in NYC and saw firsthand the limits that mental health issues have on bringing long-term health and stability to residents living with these health concerns. There are
In a city where an estimated 1 in 25 residents have a serious mental illness, a revolving door of involuntary commitments and emergency department visits has become a permanent stop for those in serious need, yet the root of these residents’ woes There is little to reduce.
Our system is in dire need of basic support to address serious mental illness, to meet all people’s basic needs, integrate and screen for mental health, and increase capacity to care for those who need mental health services . Solutions to New York’s mental health crisis won’t happen overnight — instead, we need to focus on proven, long-term, and multi-pronged solutions.
A population health-centered approach addresses the needs of individuals with more complex mental health care needs by involving community-based organizations, health care systems, primary care providers, mental health specialists, community-based care management, peers, and supportive housing. This allows highly specialized mental health resources to focus on treating individuals with complex issues and coordinate with primary care providers, all while addressing societal needs. It serves the primary care system and community-based organizations to provide vital basic mental health support to the wider population.
More than a decade ago, with state and federal support, we began developing a model that comprehensively addresses these complex needs through coordinated care management. Over the years, we have also incorporated Critical Time Intervention, an intensive and time-limited form of care management that has become a cornerstone of addressing homelessness and severe mental illness. These severe cases receive intensive care management over a period of 9 months, after which we can usually link the patient to other community supports.
Within emergency departments and acute care units, the deployment of mental health and substance use companions has successfully engaged patients with clinical services, linked them to treatment options in their communities, and helped them achieve their goals after discharge. have reduced post- and readmission and higher utilization of acute care services. Community Care of Brooklyn has integrated peers from two community agencies — Baltic Street and Bridge Back to Life — into Brooklyn’s hospitals since 2017, and surveys of emergency departments and providers show that peers reduce morale and utility. Has had a positive impact.
Early help and screening before a certain age is a critical element in addressing the public mental health crisis. Programs such as an immediate assessment service provide a less traumatic assessment setting for children who experience a mental health crisis by sending social workers to schools to train teachers and assistant principals to better handle mental health issues. Huh. Since 2015, such programs have been implemented in 100 middle and high schools throughout NYC.
The collaborative care model provides mental health treatment in primary care through a social worker and backup consulting psychiatrist. This approach treats mild to moderate mental health conditions and has been shown through several randomized controlled trials to be superior to the traditional practice of referring each patient with mental health concerns to a mental health specialist. In addition, implementation of this model has resulted in higher patient satisfaction and decreased emergency room visits and admissions.
In the community at large, we have built a network of community-based organizations that address social needs such as supportive housing, food access, care management, and connect them with health care providers. For example, we have partnered with the Arab American Family Support Center in Brooklyn to reduce stigma around mental health in the broader Arab, Middle Eastern, Muslim and South Asian (AMEMSA) communities in NYC. The office of the mayor and the city’s health department have played a key role in funding the efforts of these community-based organizations.
Taken together, these programs provide a roadmap for combating serious mental illness by creating a comprehensive network of services and organizations working together to support the social and health care needs of individuals. I have seen great success with initiatives like this and continuing proper funding will allow such efforts to expand throughout the city. Jobs will be created through the recruitment and training of additional fellows and care managers, and a focus on reducing preventable acute care readmissions will relieve overburdened emergency departments.
I hope we can improve mental health outcomes by expanding foundational supports and population-centered care initiatives.
Malvade is vice president of Maimonides’ Department of Population Health and chief medical officer of Community Care of Brooklyn.