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Commentary By Stephen Eide

NYC's Mental-Health Drive Ignores Those Who Need the Most Help

Cities, Health New York City, Serious Mental Illness

Mayor de Blasio has made improving New Yorkers’ mental health a priority, but his Thrive NYC program will deliver too little assistance to the people who really need it.

Promising a “comprehensive solution to a pervasive problem,” Thrive NYC relies on an overly expansive definition of “mental health” and lacks focus. While de Blasio claims that public confusion about the nature of mental health makes matters worse, his plan will increase that confusion by blurring the lines between mild and serious mental illness, and emphasizing prevention over treatment.

De Blasio has committed more than $800 million to Thrive NYC, but these resources are spread too thin, across too many priorities. A better approach would focus more on helping the seriously mentally ill.

Thrive NYC is a combination of new and existing programs. Following the model of the Bloomberg administration’s anti-smoking efforts, it takes a public-health approach toward mental illness, with an emphasis on prevention and public education.

It’s pitched as a mental-health plan for “vulnerable” New Yorkers, but vulnerable is defined more in socioeconomic than psychological terms. The initiative is centrally concerned with increasing access to mental-health care for poor and minority New Yorkers — and their kids.

Thrive NYC elevates promoting mental health over remediating serious mental illness. It proposes to alleviate a broad range of mental illnesses, not just the serious varieties that afflict less than 5 percent of the population.

Thrive NYC’s administrators want to ramp up mental-health services for children attending low-performing public schools, with an eye toward addressing the “root causes” of mental illness. The “Talk to Your Baby” campaign, which “urges caretakers to talk, read and sing to their babies,” will promote more emotional well-being for children in low-income areas. As Thrive NYC’s advocates see it, more mental-health services for children is a preventive strategy.

Prioritizing prevention over treatment may sound savvy, but it is, in fact, an old idea that has never shown much promise, particularly with regard to the most severe thought and mood disorders. Firsthand accounts of dealing with a psychotic or deeply depressed family member often report seeing little advance warning of their illness prior to its emergence in the late-teen / early-adult years.

The sad truth is that there is no way to prevent serious mental illness, because the “root causes” are largely unknown.

Thrive NYC is insufficiently attentive to the needs of the hardest cases — namely, chronically disturbed New Yorkers who’ve burned their bridges and thus lack family supports, and who resist most offers of treatment. A segment of the seriously mentally ill won’t seek voluntary care and must somehow be coerced into treatment.

Figuring out how to do that involves negotiating legal and moral dilemmas that are much more complex than delivering more mental-health services to schoolchildren in poor neighborhoods.

That a progressive administration’s mental-health plan will fail to target maximum resources toward New Yorkers with the greatest mental-health needs may sound surprising — but only for those unfamiliar with the broader de Blasio agenda. Thrive NYC is like the administration’s affordable-housing and universal pre-K programs: It aims at the whole target instead of the bull’s-eye.

By definition, universal pre-K funds services for families who could pay the full freight and don’t need government assistance to prepare their 4-year-old for kindergarten. Eleven percent of the “affordable” units projected to come online over the next decade will be made available to middle-income households (those in the $100,000–$139,000 income band).

Thrive NYC reflects that outlook — a broad-based attempt to expand the reach of government, rather than a plan to ensure that the most vulnerable get what they need.

This piece originally appeared in the New York Post


Stephen Eide is a senior fellow at the Manhattan Institute and author of a recent report, Assisted Outpatient Treatment in New York State: The Case for Making Kendra's Law Permanent.

This piece originally appeared in New York Post