Advance equity by addressing the health and mental health needs of all communities
People and communities have different health needs. We will ensure all New Yorkers, regardless of race and ethnicity, gender identity, or sexuality, are well served by our public health care system. We will continue to address racial and ethnic inequities in premature mortality and will confront the stark inequities between white women and women of color in maternal morbidity and mortality, and in infant mortality, paving the way for greater equity around childbirth. We will continue to close gaps in our mental health system, connecting people with support and treatment options and reverse the opioid overdose epidemic in our communities.
The leading causes of premature mortality citywide are cancer, heart disease, accidental drug overdose, and diabetes. The City is continuing to advance programs to prevent and control high blood pressure and reduce related health inequities, as well as reduce adult and adolescent obesity—a risk factor for diabetes. Ensuring safety is also an important way that the City works to reduce inequities in premature mortality—for example, reducing traffic fatalities through Vision Zero and reducing gun violence using evidence-based, community-driven strategies.
- Improve heart health especially among black New Yorkers
While heart disease and stroke affect New Yorkers of all races and ethnicities across the socioeconomic spectrum, black New Yorkers and those living in low-income neighborhoods are disproportionately affected. The premature mortality rate due to heart disease among those living in very high-poverty neighborhoods was 2.4 times higher than among those living in low-poverty neighborhoods. Further, black New Yorkers have a premature mortality rate for heart disease that is 1.8 times higher than for white New Yorkers and 3.3 times higher for stroke. We will continue to make targeted investments to address these disparities.
- Encourage heart-healthy choices
Sugary drinks are a risk factor for heart disease alone, but also through the development of obesity and type 2 diabetes. The City has supported legislation to replace sugary drinks as the default beverage option for children’s meals offered at certain food service establishments. In addition, tobacco is the leading contributor to the development of, and complications from, heart disease. The City will expand its ban on the sale of flavored tobacco products to include menthol cigarettes, e-cigarettes, and other tobacco products, in addition to all other flavored e-cigarettes.
Heart disease especially impacts black New Yorkers.
With at least one in five adult New Yorkers experiencing mental health disorders, ThriveNYC is working to ensure every New Yorker who needs mental health support has access to it, where and when they need it. Launched in 2015, ThriveNYC pilots innovative strategies to address needs that have gone unmet by traditional services. This includes implementing new services for historically underserved populations, expanding the range of mental health care and support available to all New Yorkers, and improving mental health equity across the city. The City will deepen this work in the years ahead.
- Expand Services for Particularly Vulnerable Populations
Before ThriveNYC, the Department of Youth and Community Development’s (DYCD) youth shelters and drop-in centers, which predominantly serve LGBTQ young people, had few on-site mental health resources. Now, clinicians are on site in all 33 DYCD-funded runaway and homeless youth shelters. In the last three years, these clinicians have helped more than 10,000 young people. Additionally, through ThriveNYC, 147 shelters — those for youth, single adults, and families — have new on-site clinical services they did not have before.
- Reach people in new and innovative ways
Before ThriveNYC, health care professionals were visiting low-income, new parents in their homes to offer support during what is a stressful time under any circumstances. Now, through ThriveNYC, health care workers are also visiting every new parent living in a shelter. This program has served more than 3,800 families in shelters since 2015.
- Integrate mental health support and social services through Connections to Care (c2c)
By partnering with community-based organizations to reach people who are unlikely to seek care on their own, we are building the capacity of trusted neighborhood organizations — such as community day cares, job training programs, and immigrant service providers — who are often closest to those in need. C2C enables these organizations to act as frontline responders, screening their clients for mental health needs, offering direct support, and linking them to local health providers for further care.
75 percent of ThriveNYC-funded clinicians are working in mental health care shortage area.
- Enhance clinical care in senior centers
Through the Department for the Aging (DFTA), the City has added on-site mental health services to 25 senior centers within the agency’s network. In the coming year, more licensed clinicians will be placed in centers across the city to provide older adults with access to mental health services and help them overcome the stigma attached to mental health. Mental health professionals will treat the range of mental health conditions — with services provided by bilingual and culturally-competent social workers.
- Increase access to care for young New Yorkers
Now, every student in every public school in New York City has access to clinical mental health support. Before ThriveNYC, a fraction of the City’s public schools had a clinician onsite. Now, over 1,000 public schools have access to a clinician, onsite or offsite. And through ThriveNYC, 380 pre-K sites across the city also have access to clinical mental health support.
- Provide new services for people with serious mental health needs
New Yorkers with serious mental illness have complex needs and hospitalization isn’t always the answer. To complement the many services that the City already provides for these individuals, ThriveNYC created and expanded mobile treatment teams to serve people with serious needs. These teams work to intervene before crisis and stabilize people afterwards, helping people stay in their communities. They often connect clients to housing and treatment, re-connect clients to family members and offer help with medication if they have stopped taking it. There are currently over 50 mobile teams in the city with the capacity to serve more than 3,500 people at any given time.
THRIVENYC: ACCESS TO MENTAL HEALTH SUPPORT FOR ALL NEW YORKERS
ThriveNYC is an unprecedented commitment by New York City to ensure that every New Yorker who needs mental health support has access to it, where and when they need it. Launched in 2015, it is a bold response to a challenging reality: one in five adult New Yorkers faces a mental health disorder each year. Eight percent of high school students report attempting suicide, and one in four report feeling persistently sad or hopeless. At any given time, half a million adult New Yorkers are estimated to have depression, yet less than 40 percent report receiving care. If we can build more resilience, mitigate trauma, and address mental health needs, we will have a stronger, safer, and healthier city.
ThriveNYC works in three key ways:
- Thrive innovates, piloting evidence-driven strategies to address needs that have gone unmet by traditional mental health services.
- Thrive enhances equity with a focus in underserved neighborhoods by increasing access to mental health support outside of traditional clinical settings in locations such as shelters, senior centers, schools, and community-based organizations.
- Thrive promotes inclusion by reducing cultural barriers to care and partnering with communities to ensure that particularly vulnerable populations know about and have access to services.
All ThriveNYC programs are informed by six principles for achieving sustainable innovation: change the culture; act early; close treatment gaps; partner with communities; use data better; and strengthen government’s ability to lead.
ThriveNYC in Action
The Mayor’s Office of ThriveNYC, along with partner agencies and mayoral offices, leverages the full expertise and reach of the City government to improve the lives of New Yorkers in need. ThriveNYC:
- Changes the culture by reducing cultural barriers to care.
More than 100,000 New Yorkers have been trained in Mental Health First Aid— 48,000 are front-line City workers such as shelter staff, police officers, or parks employees, while 52,000 are residents who have made the commitment to take this training on their own time. These New Yorkers are now more comfortable talking about mental health, recognizing signs and symptoms of mental illness, and helping connect people in need to relevant services.
- Broadens the range of mental health support available to New Yorkers, because we know help can come in many forms.
NYCWell is now the most comprehensive mental health helpline in the country, available to anyone with any level of mental health need. NYCWell has answered more than 560,000 calls, texts, and chats since it launched in fall 2016. Thrive is also meeting people where they live, work and learn by embedding clinicians in community-based organizations across the city.
- Expands access to mental health services to New Yorkers who are particularly vulnerable to mental illness — and have been historically underserved.
As one example, the Crime Victim Assistance Program is now available in all 77 police precincts and nine police service areas in the city, and has helped more than 110,000 victims navigate the emotional, physical and financial aftermath of crime.
- Deepens community-based early intervention and ongoing treatment options available to those with serious mental health needs.
As an example of the more than 50 mobile teams the City has in place to serve people with serious needs in the community, Co-Response Teams, staffed by one clinician and two police officers, have served more than 900 people. Ninety-five percent of their contacts with clients have been successful, leading to many fewer interactions with police and increased stability in clients’ lives. These clients are not only mentally ill, but also have demonstrated escalating violent behavior.
- Enhances mental health care equity.
There are currently 21 federally designated mental health care shortage areas in New York City. As we have built our ThriveNYC programs, we have paid particular attention to adding resources to these underserved neighborhoods: 75 percent of Thrive-funded clinicians are based in mental health care shortage areas.
The first three years of ThriveNYC focused on getting new services and strategies up and running and expanding our reach to New Yorkers in need. As we move forward, ThriveNYC is focused on effectively implementing Thrive programs, maximizing their impact, and ensuring their sustainability.
In 2017, the City launched HealingNYC, a $38 million initiative to reduce opioid overdose deaths citywide. In 2018, funding increased to $60 million to bolster naloxone kit distribution and overdose prevention trainings; expand peer services in hospital emergency departments; and establish the Health Engagement and Assessment Teams (HEAT), which serves as an alternative response for people with mental health and substance misuse needs who encounter police and other first responders. The City will target implementation of these resources in communities with the highest rates of overdose, such as the Bronx.
- Increase naloxone distribution
The City will continue to equip frontline staff and community members with naloxone, the overdose reversal drug, and the Fire Department of New York Emergency Medical Services will leave behind 5,000 naloxone kits every year when responding to 911 calls for overdoses. In addition, the City will train New Yorkers, including frontline City workers, to administer and distribute naloxone.
- Expand programs for justice-involved New Yorkers
To support the diversion of people arrested on low-level drug offenses from the criminal justice system, the City will continue to support HOPE programs in Staten Island and the Bronx that refer individuals to resources and other services including medication-assisted treatment (MAT), which combines withdrawal medications, therapy, and counseling.
- Expand peer services in hospital emergency departments
H+H will expand its peer advocate program to all of its 11 emergency departments, with the goal of embedding peers with substance misuse lived experience and social workers with addiction specialization directly into emergency department units, so that their expertise is woven through emergency response. DOHMH will expand its peer-response initiative, Relay, to 15 private hospitals by June 2020. With the expansion of these two programs, New Yorkers with an opioid misuse disorder will have access to peer support at the 26 hospitals that provide nearly 75 percent of all emergency services for overdose.
- Implement the Bronx Action Plan
The City will implement the Bronx Action Plan to reverse the opioid overdose epidemic in the borough, where rates of fatal drug overdoses outpace those citywide. With a focus on place-based programs, the City will connect Bronx residents who misuse substances to treatment, care, and community support. The plan directs resources to assist first responders, increase naloxone-kit distribution, run a public awareness campaign to educate New Yorkers about the dangers of the powerful synthetic opioid fentanyl, and expand harm-reduction outreach and services.
New York City has a comprehensive approach to addressing the root causes of persistent, intolerable, and preventable racial and ethnic inequities in maternal mortality, severe maternal morbidity (life-threatening complications in childbirth), and infant mortality. Achieving birth equity requires coordinated activities across government agencies, health care systems, and community partners. Our strategy will transform women’s health care by addressing implicit bias, enhancing maternity care, increasing surveillance, and expanding public education.
- Implement a quality improvement initiative with maternity hospitals
DOHMH will work with a network of 24 public and private maternity hospitals to implement hospital-specific recommendations to reduce the number of life-threatening complications during and after childbirth. Working in neighborhoods with the highest rates of pregnancy-related complications, hospitals will review severe maternal morbidity data to identify problem areas in care and design improvements, including adopting trauma and resilience-informed care training, to better serve women of color.
- Provide comprehensive maternity care at NYC Health + Hospitals
New York City’s public hospitals will continue to provide comprehensive care to women through simulation training for providers to identify and respond to the three leading causes of pregnancy-related deaths: pulmonary embolism, bleeding and severe hypertensive disease; and by offering high-risk patients a medical home model that provides clinical, mental health, and other social supports and linkages to care. We will also make it easier for women to receive postpartum care by co-locating postpartum and newborn appointments and establishing pre-pregnancy planning in primary care.
- Enhance data quality and timeliness
Reviewing population data on the treatment of mothers in childbirth is essential to developing policies and interventions that can improve patient outcomes. The City will enhance data quality through the NYC Maternal Mortality and Morbidity Review Committee, and will also reduce the two- to three-year data lag in mortality estimates.
- Launch a public awareness campaign around safe and respectful child birth and pregnancy-related health risks
This campaign will include educating community residents and health care providers on the NYC Standards for Respectful Care at Birth, which were developed in collaboration with the Sexual and Reproductive Justice Community Engagement Group (SRJ CEG).