Our communities are in crisis.
Mental health and substance use disorders are affecting communities nationwide from all levels of society, without regard for political affiliation, economic status, age, cultural origin, or educational level. Furthermore, the impact of the crisis is particularly acute for the impoverished and people of color.
Behavioral health disorders are common, recurrent, and often devastating to families and communities. It is estimated that half of the individuals who experience a substance use disorder have a co-occurring mental health disorder – and vice versa (National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, 2018).
The Growth of Co-Occurring Substance Use Disorder and Mental Health Issues
The Centers for Disease Control and Prevention estimates that in 2021, there were more than 107,000 opioid overdose deaths, a nearly 15% increase from 2020, which previously held the record for overdose deaths in a 12-month period.
Among the afflicted were health professionals who provided the services and treatments they in turn would require. In a recent Morbidity and Mortality Weekly Report, 8% of American public health personnel reported at least one mental health issue.
Other surveys reveal a similar rise of behavioral health issues among New York State’s approximately 20.2 million residents. According to the New York State Office of Mental Health:
- More than 1 in 5 New Yorkers have a mental disorder
- 1 in 10 adults and children have serious mental health challenges that affect work, family, and school life
- The total cost of mental illness is more than all cancers
The issue has been a financial burden on the social services sector and criminal justice system.
In New York, unhoused persons living with mental health costs the city over $58,000 in health care, corrections, and shelter services.
Mental health and substance use disorders often run in families, suggesting that these conditions may be inherent and that specific genes can be identified as risks. Additionally, environmental factors, such as stress or trauma, can cause genetic changes passed down through generations and may contribute to the development of a mental health or substance use disorder (University of Southern California (USC) Schaeffer, 2018).
A 2018 study by USC Schaeffer showed that individuals living with mental health disorders are more likely to be jailed than treated. The impact has had a heavy financial burden on the State’s correctional system. Incarcerating individuals (instead of treating them) is costly – at a price tag of more than $500 million.
Fortunately, these two behavioral health disorders are treatable – and many recover. Behavioral health service providers can attest to the fact that it is far better to treat both disorders together rather than separately.
Effective evidence-based treatment often includes both medication-assisted treatment and behavioral therapy. However, experience shows that treatment needs to be individualized based on age, substance misuse, and other co-factors.
No two individuals are alike and the same holds true for their treatment plans. But with skyrocketing numbers of people requiring care, there is a growing number who believe their behavioral health needs are not being met.
Consequences of Not Receiving Care
More than 20 million people are dependent on alcohol and/or drugs, yet only one in ten is accessing treatment (National Institute on Drug Abuse (NIDA), 2010). Often, individuals desperate for treatment must wait days, weeks, and even months for an appointment. The consequences are often dire when the window of opportunity is missed.
According to NIDA over 33% of adults report having a mental health or substance use disorder. However, less than half receive treatment. The main drivers for this phenomenon are:
- Shortages of providers
- Access to facilities offering services
- Gaps in reimbursement
- Cost of care
- Lack of housing
- Fractured families
- Poorly integrated system
According to the National Alliance on Mental Illness, more than 50% of people with at least one mental health disorder have not received treatment in 2020. Without treatment, mental illness may continue to be significantly debilitating, potentially leading to adverse consequences, and diminishing the individual’s quality of life.
Delays can endanger the chances that a person denied treatment will access a pathway to recovery. And too often, the result of delayed treatment is overdose and death.
The primary reasons individuals do not seek treatment are fear and shame. Stigma is real for those suffering from mental health and substance use diagnosis, and it needs to be addressed from a Federal, State and City level. Failure to address stigma and the resulting shame will delay successful outcomes.
The devastation caused by the mental health and substance use crises has taken its toll. Now more than ever, we need creative and innovative strategies to make an impact.
In recent years, New York State and City providers, communities and government officials have joined together to create new behavioral health models that individualize treatment for varying patient types. These new models operate on a grassroots level with partners from the community.
City-Backed Short-Stay Treatment Model
New York City pioneered Support and Connection Centers, an entirely new behavioral health model. Support and Connection Centers provide an alternative to avoidable emergency room visits or criminal justice interventions. The patient receives an introduction to available treatment options while having their immediate health needs addressed.
Each of these community-based Centers offer short-term clinical and non-clinical services for people with mental health and substance use needs. Stays are voluntary for individuals – who we refer to as “guests” – and last no more than five days.
Support and Connection Centers promote individualized, person-centered engagement and stabilization, and offers community-based linkages to follow-up care. The goal is to provide immediate treatment and support and offer appropriate long-term or outpatient care. For many guests, the Support and Connection Center is their first experience with healthcare, social services, and recovery professionals.
Each Center has an interdisciplinary staff of mental health, substance use, peer recovery, and social service experts who provide:
- Screening and assessments
- Counseling services
- Short-term case management
- Links to ongoing health and social care
- Medically supervised substance use withdrawal services
- Access to naloxone
- Support from certified Peer Recovery Specialists
In addition, guests can access other on-site services to fill basic needs such as food, showers, laundry, and overnight shelter.
The facility does not operate as a walk-in clinic, shelter, or treatment program. All guests who arrive at the local Support and Connection Center are referred by a community outreach team run by the New York Police Department and B-HEARD.
In New York City, B-Heard teams consist of criminal justice, medical, and mental health professionals from the NYC Police Department, Fire Department’s Emergency Medical Services, and NYC Health + Hospitals. Team members determine whether the individual should be escorted to the Support and Connection Center or if the case requires a different direction.
The Health Department developed the Support and Connection Center program model in consultation with NYC-based behavioral health service providers Samaritan Daytop Village and Project Renewal, along with feedback from community members and experts.
This innovative program model is currently being operated at two locations:
- Bronx Support and Connection Center
Operated by: Samaritan Daytop Village
Location: 3050 White Plains Road, Bronx, NY 10467
Partnering with the 47th Police Precinct
- East Harlem Support and Connection Center
Operated by: Project Renewal
Location: 179 East 116th Street, Harlem, NY 10029
Partnering with the 25th Police Precinct
Each Center has the capacity to serve up to 25 people per day – a projected total of 2,400 people per year at a cost of $10 million annually over 10 years.
State-Funded 24-Hour-Stay Crisis Clinics
In July 2022, New York State Governor Kathy Hochul announced $75 million in funding to open nine new Crisis Stabilization Centers throughout New York State as part of the State’s comprehensive crisis response plan. The award was a collaboration grant from the New York State Office of Mental Health (OMH) and the Office of Addiction Services and Supports (OASAS).
As 24/7 operations, Crisis Stabilization Centers provide evaluations, care and treatment to any adult, child or adolescent experiencing a behavioral health crisis. In this model, community members can voluntarily enter the Center and request immediate medical attention for an acute mental health and/or substance use crisis.
Unlike the Support and Connection Center, patient stays are limited to 24 hours. However, during that time, an interdisciplinary team tends to patients’ varying behavioral health needs, connects them to a peer recovery volunteer, and provides linkages to community services.
Currently, there are plans to create two distinct types of Crisis Stabilization Centers: Supportive and Intensive.
- Supportive centers target patients at risk of a mental health or substance use crisis that cannot be managed without onsite support. In these cases, the center provides voluntary peer recovery support and 24/7 stabilization services.
- Intensive centers focus on patients with more acute behavioral health symptoms who require urgent treatment. Staff offer all services including medication treatment, peer recovery support, and 24/7 stabilization.
These Centers will be jointly licensed by OMH and OASAS under Article 36 of the Mental Hygiene Law. Samaritan Daytop Village was awarded $1.4 million per year for five years to implement and operate a Center in Rockland County. Currently, the State is working to add a total of three Crisis Intervention Centers in New York City and the Capital Region.
Next Steps: Educating, Training and Funding
We can find inspiration by New York City and State’s targeted action plans. However, we should consider further expanding on their examples. By thinking outside of the box, we can uncover new ways to treat the untreated and prevent the preventable.
In the early 1980’s, the HIV epidemic demanded creative ideas to promote awareness and educate communities at every level in every community. In response, a new treatment model was developed and implemented called the ETF (Education, Training, and Funding) Model.
As a result of the ETF model, communities across the state began to see and hear massive numbers of public service announcements. Funds were funneled toward training and education, including billboards and TV/radio/transit advertising. Both health providers and medical payments were increased through enhanced health insurance reimbursement rates.
A more recent success story demonstrates a feat once thought impossible: We reined in Medicaid costs, thanks in part to the ETF Model, through the creation of the Health Homes model. Health Homes eased providers’ ability to deliver and coordinate care. More patients received care, and costs were reduced.
Just two and a half years ago, the pandemic was another example of the ETF Model in action. Free vaccines, numerous vaccine clinics in partnership with local healthcare institutions and governments, online scheduling of vaccines, frequent print and broadcast PSAs, and webinars were several examples. Where would we be today if we did not educate the public and offer free testing and vaccines?
Finally, we are embracing the ETF Model to curb today’s behavioral health crisis. Program models such as the Support and Connection Centers and Crisis Stabilization Centers are perfect examples of this. These programs will allow us to expand access, integrate care, diversify services, strengthen the workforce, and reduce unnecessary costs overall.
Much has been done but we still need to fund for additional Prevention, Treatment, and Recovery Support and Management. We must also continue to embed innovative health centers within communities and do so with the support and financial backing of State, City, and local governments.
As we embrace our future, we can make an impact if we continue to work together to overcome the current mental health and substance use crisis.
Charles Madray is VP for Health Systems and Community Programs at Samaritan Daytop Village.
“Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health,” Substance Abuse and Mental Health Services Administration, August 2019.
“Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic – United States, March-April 2021,” Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, July 2, 2021/70(26); 947-952.