[NYAPRS Enews] New NYC Mental Health Agenda will Triple Clubhouse Capacity and Focus on Harm Reduction

[Luke Sikinyi]

NYAPRS Note: New York City Mayor Adams and DOHMH Commissioner Vasan recently unveiled their new mental health agenda which focuses on expanding Clubhouses in the city, a digital hub of resources for those who use services, harm reduction, and school-based prevention services. Although we are still waiting to see the financial details of the plan, we are encouraged by the focus on community-based services, especially tripling Clubhouse capacity in the city. I was lucky enough to work in two great Clubhouses and have seen firsthand how transformative the work done in these programs is for those of us in recovery. See below for more information about Adams' mental health agenda and to read a recent article by Ken Zimmerman, the current CEO of Fountain House.

Adams' Mental Health Agenda To Focus On Harm Reduction And Nontraditional Approaches
By Maya Kauffman  Politico  February 23, 2023

NEW YORK - Mayor Eric Adams is poised to roll out a wide-ranging mental health plan that would triple the capacity of so-called clubhouses for people with severe mental illness, launch a virtual mental health care platform for teens and bolster harm reduction services in neighborhoods like the South Bronx and upper Manhattan.

Health Commissioner Ashwin Vasan shared details of the plan during a briefing Wednesday for city and state lawmakers.

The agenda will consist of three plans: one to reduce overdose deaths and help people with substance use disorders, another for people with severe mental illness and a third to address the mental health needs of children and families.

It will also set a "north star" goal of reducing overdose deaths by 15 percent over the next four years, Vasan said. New York City marked its highest rate of overdose deaths in 2021 since reporting began just over two decades ago, at nearly 2,700, according to the most recent available data.

While he offered no details on how much the city will invest in the proposals, to the frustration of several lawmakers who participated in the briefing, Vasan sketched a broad outline of how the Adams administration plans to approach the city's intersecting mental health and substance abuse crises.

Adams previewed several of the proposals last month in his State of the City address.

"Prevention and intervention need to be in adequate balance," Vasan said during the briefing. "There is no way out of this with white coats and clinics alone. We are not going to treat our way out of the mental health crisis."

City Councilwoman Tiffany Cabán (D-Queens) was among the officials who pressed unsuccessfully for budgetary details, asking, "Do the desires have numbers attached?"

A spokesperson for the city Health Department declined to answer questions on the budget for the forthcoming agenda but provided a written statement calling it "the most ambitious mental health plan in this city's history."

"We look forward to sharing more information with the public in the weeks to come," the spokesperson said. "It will take all of us to tackle this issue and it won't be adequately addressed unless we are flexible, pragmatic, and nimble."

A flagship part of the agenda will be a major expansion of clubhouses, which connect New Yorkers with severe mental illnesses to employment and educational opportunities and provide a structured environment for socialization and recreation. The model was pioneered by the mental health nonprofit Fountain House, where Vasan served as CEO before Adams tapped him to be commissioner.

Over 5,200 people were clubhouse members as of November, according to city data. Adams' agenda aims to triple the number of people served by clubhouses by expanding current sites and opening new ones in neighborhoods with high numbers of mental health crisis calls.

To help New Yorkers with severe mental illness navigate the full range of available resources, the city will develop a digital hub in collaboration with state officials. It will serve as a single point of access for consumers, their families and providers.

The city's existing single-point-of-access program targets providers, not consumers, and is not comprehensive.

"Right now it's a very siloed and frankly pretty confusing environment for anyone to navigate, even providers," Vasan said.

Another focal point will be harm reduction, including a substantial expansion of the city's syringe service programs, which were originally established to help prevent HIV transmission by providing drug users with sterile injection equipment. The programs also offer access to the overdose reversal drug naloxone, hepatitis C testing and treatment, education on safer drug use and referrals to other services.

Vasan said the city plans to build out the programs even further by making primary care and basic services, such as food distribution and laundry, available onsite. The agenda also calls for new investments in drug-checking technology.

The new overdose plan will draw on more than $150 million in opioid settlement funds available to the city. It is designed to build on the foundation laid by HealingNYC, which former Mayor Bill de Blasio launched in 2017 to reduce overdose deaths.

The plan for children, youth and families will focus on the early identification and prevention of mental health concerns by training school teachers, administrators and nurses to recognize warning signs. Specific initiatives will include a virtual mental health care platform for high schoolers, which is expected to launch in the upcoming academic year, and a program for suicide prevention.

Additionally, a task force will assess the impacts of social media on young people and develop public awareness campaigns and other interventions, Vasan said during the briefing.

On the advocacy side, the forthcoming agenda will call for policies to enable graduates of health programs in other countries to work in New York City and facilitate the coverage of mental health services for patients who do not have a specific diagnosis - a common hurdle to preventative care.

Vasan said the city remains supportive of overdose prevention centers, also known as supervised injection sites, but needs the state or federal government to legally authorize them so more can open. The city has two privately-run overdose prevention centers, which have been struggling to stay afloat without government funding.

Adams' mental health agenda to focus on harm reduction and nontraditional approaches - POLITICO<https://www.politico.com/news/2023/02/23/adams-mental-health-agenda-00084085>

The Key To Tackling Our Mental Health Crisis: Community-Based Care
Fountain House fosters an intentional, rehabilitative community for people living with serious mental illness that has been shown to spur recovery and improve outcomes.
Written by Ken Zimmerman, CEO, Fountain House

In my career as a civil rights lawyer, federal and state official, philanthropic leader, and nonprofit executive, the throughline has always been equity, with a large emphasis on housing and homelessness, and on criminal justice reform.

As I reflect back on it, what is striking is that mental health was so closely aligned to the work I was doing, yet it was never the focus. That changed when our oldest child, Jared, developed a serious mental illness that led to his death a bit over six years ago.

Jared was a wonderful child: bright, idiosyncratic, a deeply loving son and big brother.

In the hellish journey he took over the four years before he died - through hospitalizations, a Kafkaesque run-in with the criminal legal system, and an astonishingly brave entry into college available only because of the number of AP courses he had taken before he became ill - what stood out most was how little he and we could figure out about how to move forward, and how to do so in a way that included community, promise and - above all - hope. I say this even though we had some wonderful professionals support him and us. And I want to emphasize that I relate this story not because our experience was unique, but the opposite: it is all too common.

This led me, when I left my post running the domestic program at the Open Society Foundations, to spend a year traveling the country to understand why our nation's approach to mental health seemed so broken and what could be done about it. A preeminent takeaway was, for all the challenges, there was much promise in approaches and efforts that were not widely recognized or were just emerging. And it became clear to me that with the same kind of sustained attention that has been deployed in other domains, catalytic change was possible. Not easy, but possible.

So let me tell you a second story: this one about a man named Country, one of the many people I'm fortunate enough to encounter every day since joining Fountain House<https://www.fountainhouse.org/about>, a 75-year-old mental health nonprofit, as its new CEO<https://www.fountainhouse.org/news/ken-zimmerman-named-ceo-of-mental-health-nonprofit-fountain-house>. Until about a year ago, Country was unhoused and living with substance use issues. He was the first guest at our Recharge Station<https://www.pps.org/projects/recharge-station> - an outreach kiosk in the heart of Times Square where staff and peers engage people who are homeless, live with serious mental health conditions, substance use issues, or all the above, and provide a respite.

As Country came to know, Fountain House and the model it has spawned in clubhouses<https://www.fountainhouse.org/about/clubhouse-model> across the country - what's called "social practice<https://www.fountainhouse.org/about/social-practice>" - starts with something that on the most basic level is common sense: that community is a critical form of therapy. And that is what Fountain House offers Country and others whose lives have been disrupted by their serious mental illness - a community that starts with individual dignity, rebuilds agency and trust, and leads not just to recovery but to thriving for upwards of 2,000 members in New York City.

This is a fundamentally different starting point from most other mental health approaches, such as medication or time-limited programmatic intervention. While these are critical pieces of the puzzle, they are not sufficient in and of themselves. The Fountain House model instead addresses the crippling negative symptoms of serious mental illness that drive loneliness<https://www.fountainhouse.org/news/the-devastating-cost-of-loneliness>, increase stigma, and impede success of other interventions. Social practice helps create a "stickiness." It enables our members to go through the ups and downs associated with their mental illness in a community and, by doing so, remain engaged - in school, jobs, and housing - while staying out of the justice system and hospitals.

The evidence is powerful: Fountain House members have twice the rate of employment, better educational advancement, and are more likely to be stably housed than others living with serious mental illness. As reflected in an independent NYU study<https://www.fountainhouse.org/assets/052017-Project-to-Evaluate-the-Impact-of-Fountain-House-Programs-on-Medicaid-Utilization-and-Expenditures.pdf>, it is also cost-effective: Fountain House members see a 21% reduction in Medicaid costs compared to their peers, largely due to the holistic benefits of this model. And, of course, the most powerful evidence is in the experiences of those like Country.

That's why the model Fountain House created has been replicated in 200 clubhouses around the nation.

Country is now housed and employed. More critically, he is in a community where he is respected. The research shows<https://www.fountainhouse.org/assets/Brief-Summary-of-Evidence-for-Clubhouses_2022.pdf> that his likely trajectory is one that will continue to involve being stably housed and employed while receiving psychiatric services and health care. For the budget counters amongst us, this allows the other public and private systems that Country might engage to be more effective at what they do, improving outcomes and using resources more appropriately. In other words, this is a concrete manifestation that addresses the social determinants of mental health.

Fountain House represents the kind of innovative and emerging approach that has huge potential, not only for the 60,000 clubhouse members across the U.S. but for the way that our country can enable those with serious mental health conditions to recover and thrive. And I want to be absolutely clear that this should be our north star: Recovery And Thriving And Not The Bigotry Of Low Expectations that result in homelessness, incarceration, and hospitalizations. This type of intervention can and should be a fundamental building block in our nation's approach to serious mental health challenges.

Something's fundamentally wrong when the largest institutions<https://www.npr.org/sections/health-shots/2018/04/25/605666107/insane-americas-3-largest-psychiatric-facilities-are-jails> housing people with serious mental health conditions are the jails in New York City, Los Angeles, and Chicago; when 63% of health care costs come from the 20% of our community with behavioral health challenges; and when communities of color and rural communities are particularly hard hit by these system failures.

Something's fundamentally right when we go back to common sense and reaffirm dignity, community, and empowerment as starting points - lifting up approaches that advance mental health transformation and the catalytic change that is so desperately needed.

https://www.forbes.com/sites/forbeseq/2023/02/27/the-key-to-tackling-our-mental-health-crisis-community-based-care/amp/





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