The advertisements on public transportation don’t usually warrant a second glance, let alone a conversation. But on the New York subway last week, a new series of banners went up, asking people to start talking. “Depression doesn’t define me,” one reads. Another one: “Addiction can affect anyone and is treatable.” At the bottom of all of them is this line: “Let’s talk openly about mental health issues. Together we can heal.”
These notices come not from a special-interest group or a medical institution, but from the City of New York. ThriveNYC, spearheaded by First Lady Chirlane McCray, is a comprehensive program intended to improve access to mental health care across the city and break down barriers to treatment, including longstanding cultural stigma. ThriveNYC, which officially launched last November, has an $850 million budget and will work with 20 city agencies on 54 initiatives. The subway banners are part of one of them, an awareness campaign called “Today I Thrive,” which brings long-silenced mental health issues out into the open.
The ThriveNYC campaign coincides with a growing worldwide recognition that mental health concerns must be addressed. One in four people will be affected by mental health concerns in their lifetime; at a conference held in Washington, D.C. from April 13-14 of this year, the World Bank and World Health Organization brought together hundreds of doctors, aid groups, and government organizations in an effort to move mental health to the forefront of the global agenda. Speaking to NPR, Dr. Shekhar Saxena, who oversees WHO’s mental health and substance abuse sectors, said that a failure to treat just depression and anxiety costs the world $1 trillion per year. “We believe that all countries need to pay more attention to mental health,” he said.
ThriveNYC was featured at the conference alongside 20 other innovative mental health programs from around the world, like the Africa Mental Health Foundation and Mental Health Beyond Facilities in Nepal, Uganda, and Liberia. But New York “is the only city that is giving mental health this amount of attention—and I mean in terms of staffing, in terms of budget, in terms of resources, and in terms of reach and range,” McCray tells CityLab.
In many ways, it makes sense for New York to do so. The city government is wide-ranging and well-funded; three-quarters of the budget for ThriveNYC derives from city funds. And it’s well-positioned to act as a convener to a number of pre-existing groups and initiatives, including NYC’s Assertive Community Treatment program, which provides low-cost treatment and support to those unable to access more traditional mental health care.
Traditional mental health care is what ThriveNYC aims to revolutionize. Currently, mental health care is often confined to treatment after the emergence of symptoms, and—especially in New York—individual therapy and treatment are often inaccessible and expensive. McCray says it’s common for people to wait almost a decade before seeking help, if they ever do. But ThriveNYC will involve the city in every stage, from prevention to treatment. The Mental Health First Aid program will train citizens about responding to need in their communities; 9,000 public school teachers and administrators will learn how to convey social-emotional knowledge to pre-kindergarteners; NYC Health + Hospitals and Maimonides Medical Center will offer maternal depression screening and treatment to every pregnant woman.
The comprehensive program, McCray says, enables up local government to address mental health as a public, pervasive concern, much in the same way the city stepped up in the 1980s to respond to the HIV/AIDS crisis. That, says Devora Kestel of the Pan American Health Organization, was another instance wherein the issue itself was almost unspeakable. “It wasn’t easy for people to come out and say, ‘I have HIV,’ and it’s not easy for people now to say ‘I am mentally ill,’” Kestel says. By leading the conversation out of a vacuum, Kestel says, city governments can advance solutions.
Later this year, New York City will host the first-ever Mayor’s Conference for Mental Health. That will be an opportunity, McCray says, for city leaders to come together and learn from the various initiatives in place across the country. While ThriveNYC is the most comprehensive, initiatives such as Baltimore’s Don’t Die campaign, rolled out last year in response to the spread of the opioid epidemic, demonstrate the potential for cities to target their initiatives to the specific needs of their communities, says Brendan Saloner, a professor in the department of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
But some needs are even broader. The lack of housing for those affected by mental illness has reached a crisis level, and “we know that, at this point, some of the biggest institutions that have stepped in to house people with mental health problems have been jails,” Saloner says. He and Kestel agree that cities have a responsibility to provide concrete, alternative housing solutions to widespread incarceration. In Denver, the Colorado Coalition for the Homeless and Renaissance Housing Development Corporation collaborated to establish a network of supported living apartments that provide on-site services for those affected by a variety of vulnerabilities. And over the next 15 years, ThriveNYC has committed to opening up 15,000 supportive housing apartments. Still, the initiative’s roadmap reports that this number falls short of meeting the estimated need.
While initiatives like ThriveNYC have made evident the potential for cities to engage with solving this crisis, Saloner cautions against depending on local governments alone. “I worry about the haves and have-nots,” he says. “New York is a wealthier city, and I certainly think that an initiative that has the backing of city hall and the resources to fund it has a better chance of having a real impact than many one-off programs.” But cities without similarly stable finances will struggle to replicate New York’s model. “There’s a real need here—even after the Affordable Care Act, which is doing a lot to improve access—for the federal government to promote and fund regional communities of wellness,” Saloner says. Which hearkens back to Saxena’s sentiment following the recent mental health conference Washington, D.C.: “When it comes to mental health, all countries are developing countries.”