Our state has a long history as an innovator when it comes to improving the mental well-being of New Yorkers. From establishing the first state-funded psychiatric center to creating the first research institute dedicated to exploring mental health, this spirit of innovation has influenced and driven the important work we do in mental health care, positioning our state as a national leader in the field.
This spirit of innovation continues to push us to find new trauma-informed and family-based treatment approaches to address anxiety and depression – conditions that impact countless individuals across all ages and communities. These cutting-edge treatments and care models provide new strategies to improve outcomes, promote resilience, and positively impact the recovery journeys for New Yorkers impacted by anxiety and depression.
For instance, we are now using Transcranial Magnetic Stimulation (TMS) as an effective method to treat depression. This electroconvulsive therapy uses a magnetic field to generate an electric pulse inside the skull, targeting the left dorsolateral prefrontal cortex. This method is well-tolerated by patients, with mild side effects, including scalp pain, tension-type headaches, dizziness or lightheadedness, fatigue, and insomnia.
High-quality randomized controlled trials and meta-analyses with large numbers of subjects have provided strong evidence for this method, which is especially convenient as it can be used in an office environment without anesthesia. Extensive studies have looked at different factors such as permutations of dose strength, and whether treatments are effective if they are delivered multiple times in a day, with a rest period built in for the patients so they don’t need to travel to the office daily.
There is good evidence this technique can be used to treat depression in individuals with Parkinson’s Disease, and those who have suffered a stroke. Likewise, TMS is also being used to effectively treat Obsessive-Compulsive Disorder (OCD) and tobacco use disorder.
Innovations are also happening with medications – including Ketamine and Esketamine – to effectively address Treatment-Resistant Depression (TRD) and can rapidly improve conditions for patients with suicidal ideation. A single IV infusion of Ketamine has a rapid-onset anti-suicidal effect, but the duration is still short – less than 72 hours – and repeated infusions are needed to preserve effect.
Esketamine, under the brand name ‘Spravato’ is an FDA-approved nasal spray that can be administered by a qualified physician or nurse practitioner and has been more effective than a placebo to counter TRD. In longer continuation trials, individuals receiving Esketamine were at significantly lower risk for relapse or recurrence.
We are also studying effective treatments to counter depression in adults 55 and older. Spearheading partnerships between mental health, substance use, and aging services providers in six communities to address complex, cross-service system needs that put older adults at risk of losing community tenure.
The geriatric service demonstrations show that treating mental health and anxiety inherently involves addressing social determinants of health, including food, housing, transportation, etc., along with loneliness and social isolation, and holistic mind-body needs. Through them, we have discovered three very promising strategies to reduce depression and anxiety if they are provided in tandem with traditional mental health therapy.
Intensive case management links older adults to benefits and other resources to address social determinants of health. In Manhattan, Service Program for Older People is incorporating intensive case management into its intake process to meet the client’s needs before focusing on behavioral health therapy.
We are using peers to share lived experience and promote social connectivity, which has helped outreach to the stigmatized populations hardest hit by the COVID-19 pandemic. Certified mental health peer specialists, certified recovery peer advocates, and older adults with lived experience helping connect with these individuals and are now a required component of all geriatric service demonstrations.
Group wellness classes have also been effective at helping older adults. At Jamaica Hospital in Queens, a group class offering manualized curriculum focusing on mental wellbeing is combined with a Fitbit tracker to help address mild to moderate depression and anxiety in older adults.
Across the geriatric service demonstrations using these strategies, older adults with moderate or above depression who are at risk dropped from 46.4 percent at admission to 34 percent at their most recent follow-up. Additionally, this downward trajectory is seen in older adults with moderate or above anxiety who are at risk, dropping from 43.9 percent at admission to 29.1 percent at follow-up.
We are also using the New York State Trauma-Informed Network and Resource Center to support and implement strategies to reduce anxiety and depression and support wellness in the workplace. The center is partnering with the Breath-Body-Mind Foundation to host free virtual sessions offering a set of gentle exercises to help with stress and improve well-being that can be used at home, work or in public settings.
The center is also close to releasing the Frontline Worker Wellness Toolkit, an all-inclusive guide detailing the impact of stress on the body. Expected to be released this fall, the toolkit includes resources to promote well-being for individuals and specific training and informational resources to help employers create work environments that are trauma-informed and support wellness.
This month, the center is launching its Resilient Leadership pilot to provide a learning experience grounded in wellness, reflective practice, and trauma-responsive values. The goal is to bring together leaders from diverse fields – including behavioral health, healthcare, human services, education, and community-based organizations – to deepen understanding, build community, and sustain wellness-driven leadership practices.
Finally, we are learning that the Collaborative Care model can be used to significantly decrease suicide risk. This model allows patients to be treated in a familiar setting and have access to behavioral health services right away to prevent the lapses in care that sometimes occur with external referrals. One study showed that 76 percent of patients improved their suicide risk when enrolled in a Collaborative Care model for six months or more, and that this approach may be helpful in treating a broader range of diagnoses like Post-Traumatic Stress, Bipolar and substance use disorders.
These unique approaches help to identify new, more effective methods, treatments, and therapies for addressing anxiety and depression, and the impact and complex challenges these conditions present for individuals, their families, and our system of care. By continuing to innovate, we can develop cutting-edge treatments to improve outcomes, promote resilience, and support the recovery journey while New York State remains a leader and establishes best practices in the mental health care field.
Dr. Ann M. Sullivan is Commissioner of the New York State Office of Mental Health.
