The public mental health system is failing those most in need:
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Over half the people who are homeless have a behavioral health condition
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Rikers jail has become New York’s largest psychiatric facility
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Payment models favor hospitals and prescription drugs over housing and social supports
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For community-based providers, staff turnover and vacancy rates are the highest in decades
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Services are most scarce in communities of color, where there is the most need
Overuse of acute psychiatric beds – 45,000 admissions
Jails as “treatment” for 5,000 people with BH needs
Shelter for 11,000 people with BH needs
180,000 ‘911’ crisis BH calls annually
Without person-centered care that focuses on recovery and prevention, people with mental health conditions are trapped in a traumatic cycle of homelessness, jails, and hospitals, which disproportionately impacts people of color, especially young Black and Hispanic men.
A History of Reform Efforts
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Attempts to reform the public mental health system began over 100 years ago, when, on January 12, 1890, the New York state legislature passed the New York State Care Act to create state-run facilities to end the horrendous abuse for people with psychiatric disabilities confined in privately-run poor houses.
In 1954, the legislature enacted another major reform with the NYS Community Mental Health Services Act, which attempted to address the failures of needlessly warehousing of nearly 100,000 people in massive institutions. However, this Act did not provide any meaningful incentives or technical framework for local governments to plan and create a community-based system of care.
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Over the following decades, many commissions, task forces, and legislative committees examined the on-going failures to create a robust community-based system of care. A brief summary of some of the most prominent reports can be found [here.] The common findings highlighted in these studies found the mental health system to be fragmented, wasteful, and lacking accountability for outcomes.
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Why the System is Not Working
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By state law The New York State Office of Mental Health is required to issue a strategic plan. The current “5.07 Plan” (named after the legislation that mandates it) includes a vision and values that embrace an ideal system of care, that it should be “person-centered, resiliency- and recovery-focused,” and promote “community and social environments that reduce the incidence of disorders, eliminate stigma, and foster community inclusion.”
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Unfortunately, translating these values into a highly organized and effective system of care at the local level has never been achieved. Like the 5.07 Plan, local governments are required to prepare plans outlining their mental health priorities and objectives. These rarely, if ever, include a detailed needs assessment as defined by people who use services, providers, or community members; define specific programs or services that will be created; how much they will cost; who is responsible for designing and implementing them; or how systemic racism and poverty could be addressed by promoting solutions that advance racial equity.
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Conclusion
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We will never have an efficient and effective system of care if such a system is not described in a workable plan that includes a vision for what will be achieved and a measurable set of outcomes to evaluate the success of each program and service. Reforming the system needs to begin at the community level with the active engagement of all stakeholders through a participatory planning process. The resulting plans must include a coordinated set of goals and strategies and can be endorsed and financed by the state. This was the intent of the 1954 Act and is the purpose of the 2023 NYS Person-Centered Mental Health Act.
Creating a system of care without a clear vision—and strategies and goals to achieve that vision—is like trying to build a house without a set of plans—nothing would fit together and money would be wasted trying to correct all problems.
