As we recover from the COVID Pandemic, we must look forward to the future and the critical issues our behavioral health care system will need to address. We know that over 40% of New Yorkers will have a mental health impact from this pandemic and we are seeing over twice the number of our youth dealing with anxiety and depression. We have to transform our system to provide access to prevention, treatment, and wellness across the lifespan, meeting the needs of all New Yorkers as we move forward.
In this article we will discuss these three urgent goals: 1) prevention; 2) ready access to treatment and support systems; 3) ongoing wellness for all ages. As the New York State Office of Mental Health (OMH) considers the development of new programs and investment of funding in our ongoing services, these three goals are in the forefront.
However, they cannot be accomplished without assuring equity, inclusiveness, and focused integrated care in all that we do. Our focus must be on timely access to integrated treatment which is culturally appropriate and is responsive to the voice of the people we serve. We must also ensure that residents of New York State are able to engage in treatment when and where it is needed and that it is available to our most vulnerable populations. And while we have begun this very important work, we have much more to do, and need our communities and providers to join with us.
Finally, we will begin to tackle the profound impact that our workforce shortage has had on all our programs and services. We simply must inspire current and future generations to join us in this incredibly rewarding work.
Focus on Prevention and Wellness
Early and effective prevention begins in a pediatrician’s office and in the neighborhood school. New York State Governor Hochul’s funding support has expanded Healthy Steps, a primary prevention program that places a mental health worker in a pediatrician’s office to work directly with families and youth who are at risk or having emotional issues. We are also expanding the NYS Trauma-Informed Network to recognize and address the range of experiences that may be trauma-inducing for young children and their families, including the pandemic. On the adult side, the Collaborative Care Program seeks to identify and treat commonly occurring mental health conditions such as depression and anxiety in the primary care setting.
OMH has also significantly increased investments made to school districts across the state. We license nearly 1,100 school-based satellite clinics to help address the mental health needs of children and improve the learning environment and will soon announce funding awards totaling $3.4 million that will help create an additional 136 satellites locations. We have also issued awards to 26 schools in high needs school districts to develop and implement comprehensive prevention and mental health plans.
The Mental Health Association of New York State was also awarded $2.5 million this year to further develop the Mental Health Resource and Training Technical Assistance Center. The Center is focused on assisting New York State schools to incorporate mental health in the K-12 health curriculum, enabling future generations of youth to understand mental health as a critical part of their total health and wellbeing.
Over 1,700 New Yorkers still tragically die by suicide each year. OMH’s Suicide Prevention Center of New York (SPCNY) continues to provide school and community-based trainings that educate on suicide risk, warning signs, and response. SPCNY has recently launched initiatives to improve wellness and resiliency for veterans and first responders and will soon be awarding funding to non-profit agencies or tribal organizations serving at-risk youth and/or young adults across the state.
And finally, Project Hope is a statewide response to the trauma of the pandemic and has reached over a million New Yorkers with outreach and counseling focused on healing and resiliency from the impact of the pandemic. It is the largest ever mental health crisis counseling across the state, focused on helping New Yorkers through the pandemic and beyond.
Focus on Access to Treatment: Helping Those in Crisis
The implementation of 988 was a watershed moment in the history of crisis and behavioral health care in the United States. It is an opportunity to rapidly reach millions in emotional distress while de-stigmatizing help-seeking. Through our innovative crisis initiatives, New York State has begun paving the way as a national leader in the statewide development of a coordinated crisis response system during this pivotal point in time Over the past two years, we have been working closely with a diverse stakeholder group of individuals with lived experience, advocates, county mental health agencies, law enforcement, state agency partners, and others who have informed the development of our crisis system. OMH has prioritized the statewide development of crisis services and is dedicated to ensuring equity, access, and inclusion for all individuals and at-risk groups, including youth, rural populations, BIPOC communities, and LGBTQIA+ individuals.
The vision for these initiatives safeguards the individuals’ choice to receive crisis services according to their own preferences and in the communities in which they live. Crisis care offers the opportunity for stabilization and wellness at the level of intervention a person feels they need in that moment. With the 24/7 telephonic triage and crisis counseling available by the 13 NYS 988 Contact Centers, Mobile Crisis Response Teams, development of 12 Intensive Crisis Stabilization Centers and 12 Supportive Crisis Stabilization Centers, Crisis Residential Programs, Comprehensive Psychiatric Emergency Programs (CPEPs), and other community services and supports, individuals will be able to access the help they need quickly and in a supportive and caring environment.
Each crisis stabilization center for example will provide fully integrated substance use and mental health treatment and support and will have intensive involvement of peer services. Throughout the crisis system, staff will be trained in equity, inclusion, and engagement of each individual and family. We will also be strengthening our clinics and certified community behavioral health centers to provide ongoing care as needed, and reopening community hospital beds that were temporarily off-line during the pandemic.
But we cannot forget the most vulnerable individuals living with mental illness on the streets across our state. Governor Hochul has initiated the creation of new Safe Options Support (SOS) teams to work closely with these individuals and meet their needs. This year’s state budget includes more than $11 million, which will increase to $21.5 million full annual to develop 20 new SOS teams with a multi-disciplinary team of 10 staff to reach thousands of homeless individuals. These teams remain engaged with an individual as they access treatment, support services, and permanent housing. Addressing the very challenging time of transition and ensuring that people have the support of professionals with whom they have formed a relationship can make all the difference.
Access to Care: Supporting Children, Youth and Families
Families need access to intensive services in the community, focused on helping families and youth grow and thrive. OMH has recently created the first-in-the-nation Assertive Community Treatment (ACT) teams specially designed for youth, building on the success of the traditional ACT team in which adults who have been unable to engage in traditional forms of mental health treatment are served by a multi-disciplinary team of professionals who meet with clients in community settings We have adapted the ACT treatment model to serve children between the ages of 10 and 21 and their families. The teams will provide services and support in the home and community settings and allow young people who are at risk of entering residential or inpatient psychiatric treatment to receive services while remaining with their families and in their communities. We are developing 20 Youth ACT teams statewide, which covers 29 counties and will serve approximately 835 children and their families.
Increasing numbers of youth and families are in serious, crisis post pandemic. Expanding Intensive Outpatient Programs and Partial Hospitalization Programs serving children provides additional opportunities for community-based treatment, so children remain in their homes and with their families while receiving a higher level of care. We have funded Family Peer Support Services to ensure that the needs of families are met at any stage in their journey whether they are first identifying mental health needs or experiencing significant challenges.
Additional support for children and families allowed for significant expansion of the Home-Based Crisis Intervention programs for children which provide short-term, intensive, in-home crisis intervention services to a family in crisis. We are expanding these teams to serve 2,640 families each year, doubling the current volume.
Finally, statewide expansion of OnTrack NY, our state’s First Episode Psychosis Program focuses on assisting young adults who have a recent onset of psychosis to continue their educational and vocational goals and live their hopes and dreams.
Access to Care: Developing Our Workforce
Throughout the pandemic our mental health workforce healed New Yorkers with skill, compassion, and incredible dedication. With the growth in need for mental health services we are facing an unprecedented workforce shortage.
With the help of our Governor and federal funding we were able to provide bonuses and other incentives to mental health workers, and urgent recruitment and retention initiatives. This year’s Governor’s budget also included a 5.4 % cost of living adjustment (COLA) for our not-for-profit workforce that was critically needed. The budget also included funding for the development and expansion of peer services throughout our system of care.
The Budget also includes $9 million for a new Psychiatrist and Nurse Practitioner loan repayment program, and we are working with SUNY and other Universities on a pipeline for engaging students in our work including fellowships, traineeships, and specialized certificate programs in our community colleges.
We are also working to grow the diversity of our workforce in all the above initiatives and are developing programs to help individuals advance in their learning and professions.
We need to work together to attract, engage and retain our future workforce for the long term.
Looking to the Future
Innovation, new ideas and new services, plays a critically important role in healthcare and our ability to reach, engage, and help people. Post the pandemic we are focusing on prevention, integrated wellness, and rapid access to quality services. We need to ensure that these services are equitable and inclusive and serve all New Yorkers and especially our most vulnerable populations. Our new Vital Signs Dashboard which uses Medicaid data broken down by race, ethnicity, gender, and region is one tool to assist us in understanding and responding to the healthcare disparities experienced by different groups
There are many critical services we have not focused on in this article such as safe and supportive housing, employment and education, intensive rehabilitation, and recovery services, expanded peer and family advocacy, and many more that OMH focuses on daily to ensure that individuals living with mental illness can lead full and productive lives.
As we emerge from this pandemic, we have learned a great deal and we also know we have much to do throughout our healthcare system. Together with our dedicated workforce and the individuals, families, and youth we serve we can accomplish great things!
Ann Sullivan, MD, is Commissioner of the NYS Office of Mental Health (OMH).