I am grateful to Behavioral Health News for focusing attention and showcasing efforts and innovation to tackle the opioid epidemic. In behavioral health, we talk a lot about addressing silos and integrating across providers, community members, and peers. Behavioral Health News is therefore an especially important place for this focus as it reaches an array of providers and disciplines. The gravity of the opioid crisis in New York points to the urgency of addressing continuing silos across behavioral health, as well as broader health, providers, as well as community members, peers, and other sectors, certainly does.
Such integration is sorely needed and deserves to be the new normal. But to do that, we need a truly public health strategy to align with and infuse all our work as a community. As we address the urgent issues of the moment, let’s build solutions that grow a foundation which supports this integrated, broad, public health thinking and related resources to be more routinely available and applied. To apply it to opioids means to include more stakeholders, more of government, more of communities, and all parts of the health care system, as well as acting beyond that system.
Whether measured in terms of Years Lived with Disability (YLDs) or by combined disability and mortality impact in Disability Adjusted Life Years (DALYs), substance disorders and mental illness are among the leading contributors to poor health in this country. Yet our responses don’t live up to that need. There is no shared or driving public health vision that adequately rises up to this challenge or that knits together a fragmented system and diverse set of stakeholders. The systematic public health thinking that drove other health successes – like tobacco and HIV – needs to also be applied to the current opioid emergency. That means looking at ways to more aggressively and creatively reach people that address risk and minimize harms. It means challenging our treatment system to adapt in ways that more proactively and creatively provides low-barrier access to care, and that supports earlier, preventive and self-care interventions, as well as needed and proven treatments. In a separate article in this issue by Assistant Commissioner Dr. Hillary Kunins, we outline some of the steps New York City is taking through its HealingNYC effort that in many ways builds on this approach.
That thinking and approach should be visible in all we do, which means building new structures and strategies. That is the crux of ThriveNYC, launched in November 2015, to provide such a vision, and describe the anchors for such an approach. This groundbreaking effort pushes the envelope of what city government can do to improve outcomes, address gaps, and reduce harms for mental illness and substance use.
ThriveNYC rests on key strategic building blocks specified in six principles that can align action on behavioral health: Act Early, Change the Culture, Close Treatment Gaps, Partner with Communities, Use Data Better, and Strengthen Government’s Ability to Lead. All of them apply to the opioid epidemic, as they do to other challenges, and they anchor where the fiscal commitment of $850 million over the first four years for the 54 ThriveNYC initiatives, and where to continuously aim moving forward. These initiatives are not only programs in their own right, but are intended as new structures that can last and grow integrated action to scale moving forward.
One of those new structures is NYC Well, a one-click, one-call connection to counseling, crisis intervention, peer support and referrals to ongoing treatment services serving all five boroughs. NYC Well builds on the City’s previous call line, LifeNet, by having peer specialists on staff and training on the array of services available to people with opioid use disorder, from buprenorphine and methadone to free naloxone. NYC Well will do real-time warm hand-offs to appointments and do multi-session short-term counseling by phone. NYC Well is available 24/7, accessible in more than 200 languages and staffed by professional mental health counselors at the NYC Well Call Center. The program is administered by the Mental Health Association of New York City (MHA-NYC) and funded through the NYC Health Department. In its first eight months in operation, NYC Well received more than 215,000 calls, texts and chats.
ThriveNYC also heavily invests in expanded roles for treatment providers to better partner with and enhance those “outside” stakeholders – from schools and churches, to CBOs and primary care practices. An example of this is the Thrive Weekend of Faith for Mental Health, an event led by First Lady Chirlane McCray and the nation’s largest effort to engage faith leaders in a single effort around mental health. In May of this year, 2,000 NYC houses of worship and more than 40 cities took part in the event to speak to their congregations about addiction and treatment options, reaching half a million New Yorkers and thousands more in cities like Houston, Philadelphia, and San Jose. As trusted leaders of their community, clergy have an important role to play in offering advice and encouraging members of their community to seek care.
ThriveNYC rests on new building blocks specified in six key principles that can align action on behavioral health: Act Early, Change the Culture, Close Treatment Gaps, Partner with Communities, Use Data Better, and Strengthen Government’s Ability to Lead. All of them apply to the opioid epidemic, as they do to other challenges, and they anchor where the fiscal commitment of $850 million over the first four years for the 54 ThriveNYC initiatives, and where to continuously aim moving forward.
We are excited to see in this issue of Behavioral Health News the breadth of interest and the innovation that is emerging to take on this epidemic. They reflect on and contribute to advance many of these key driving principles. Organizing and innovating around them should help drive change forward for all of our efforts in behavioral health. Track our progress on ThriveNYC at the Health Department’s site, www.nyc.gov/health.
