Mayor Bill de Blasio and his wife and mental-wellness czar, Chirlane McCray, recently announced a new goal for ThriveNYC, their $850 million mental-health plan: “reach people with the highest needs.” That should’ve been part of the plan from the start, but in any case, it’s a hollow promise.
A close reading of the 2020-2022 Thrive spending plan and “Progress Report” makes clear that the administration will continue to send money to ineffective programs, while giving short shrift to ones that reduce homelessness, arrests and incarceration of the seriously mentally ill. The mayor and his wife justify the continuing boondoggle by reporting meaningless and misleading statistics.
Clearly, Thrive is failing. In New York City, rates of homelessness, arrest, incarceration, violence, hospitalization and calls to 911 involving the mentally ill are rising. Yet these critical metrics aren’t included in ThriveNYC’s new Progress Report, presumably because they are trending in the wrong direction: Calls to the police for emotionally disturbed persons rose to 179,000 in 2019, from 145,000 in 2018. The number of seriously mentally ill homeless people rose to 12,140 in 2018, up from 9,840 three years earlier.
The elephant in the room: 41 percent of the most seriously mentally ill New Yorkers received no treatment in the past year. The program deserves to be judged on a simple metric: Does it deliver effective treatment to the untreated seriously ill? Properly directed funds could make a difference.
What isn’t in Thrive’s new spending plan is as important as what’s in it. The $235 million annual budget includes only a token $1.2 million for Kendra’s Law, New York’s most effective program for the seriously mentally ill. Kendra’s Law allows mentally ill individuals with a history of criminality to continue to live in their communities, provided they comply with judges’ orders to undergo outpatient treatment.
With the help of Kendra’s Law, families of the mentally ill can keep their loved ones at home, rather than taking out orders of protection against them. In Gotham, Kendra’s Law has reduced incarceration by 65 percent, hospitalization by 61 percent and homelessness by 62 percent for those who participate. But lack of city support makes the program hard to get into for those who could benefit.
Thrive’s new spending plan also fails to fund mental-health courts, which can drop charges against arrested mentally ill individuals if they comply with a judge’s order to stay in treatment for a certain period. Mental-health courts prevent the seriously mentally ill from sliding into recidivism, but the courts can’t accept more cases because of the lack of housing available for the homeless mentally ill who come before them.
Likewise, ThriveNYC doesn’t include funds for “clubhouse” programs like Fountain House, perhaps the best voluntary program for the most seriously ill. Clubhouses provide a physical location where the seriously mentally ill gain a sense of purpose and community through cooking, planning, cleaning, shopping and other necessary daily activities.
The 2021 budget does include $21 million for some useful case-management programs. But it sets aside another $34 million — almost half the total funds dedicated to “Strengthening Crisis Prevention and Response” — for an unspecified “Crisis Prevention and Response Task Force.” The seriously mentally ill don’t need another task force; they need funding for programs that work.
The budget allocates almost as much money for school “consultants,” who don’t treat children ($9.9 million), as for clinicians who do ($10.9 million). Perhaps to make the resources assigned to helping the mentally ill look larger than they are, $14 million assigned to help crime victims was included in the total budget. But being a victim of a crime isn’t a mental illness.
Thrive’s Progress Report includes almost no metrics for progress — only for process. It reveals, for example, how many people completed a training or used a service, but it says nothing about outcomes. And the numbers reported are cumulative from the program’s introduction, making the impact seem greater than if only annual numbers were included.
For instance, 705,000 people have called or texted the NYC WELL Helpline since 2016 — but that’s largely because the city is running ads telling all New Yorkers who feel “under pressure” to call. No ads encourage the seriously mentally ill or their families to call.
Thrive’s new goal to “Reach People with the Highest Need” mostly consists of smoke and mirrors. The City Council needs to get off the sidelines and bring some sanity to the mayor’s mental-health plan.
DJ Jaffe is an adjunct fellow at the Manhattan Institue, executive director of Mental Illness Policy Org., and author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill. This piece was adapted from City Journal.
Photo by Noam Galai/Getty Images