Mental health plans (photo: Ed Reed/Mayoral Photography Office)

The New York City Council is seeking greater investment in the behavioral health workforce as leaders at all levels of government grapple with the longstanding crisis of untreated severe mental illness.

The Council and Mayor Eric Adams are negotiating the mayor's $106.7 billion executive budget for the next fiscal year, which begins July 1. On the table is tens of millions of dollars to help boost staffing levels for a range of needed services – some new and some depleted by the pandemic — both in and out of city government.

The Council, led by Speaker Adrienne Adams, is seeking to double the $60 million cost of living increase for human services workers included in the current city budget, along with greater funding for nonprofit providers, a social work fellowship at CUNY, and other priorities.

Industry-wide staffing shortages caused by burnout and uncompetitive wages have stretched behavioral health services too thin, city health officials and providers say, threatening the city and state response to gaps in the social safety net. Mobile intervention, inpatient commitment, and outpatient services — the so-called continuum of care for those with serious mental illness — have become a defining focus for Mayor Eric Adams and Governor Kathy Hochul, both Democrats. They have sought to respond to the subway killing of Jordan Neely this month and other attacks in recent years on or by people experiencing acute psychiatric episodes and homelessness.

The Council's response to the mayor's preliminary budget for next fiscal year and its Mental Health Roadmap released shortly thereafter called for $117.4 million more in mental health care funding along with pay parity for the publicly-funded behavioral health workforce.

Two days after release of the Council’s wide-ranging Roadmap, Mayor Adams released his $106.7 billion executive budget proposal, which contained an additional $40 million for the crisis response program B-HEARD, youth telehealth services, peer-led clubhouses, and a digital services access hub, according to his office’s summary of the plan.

The mayor's latest budget proposal includes none of the city-level workforce development elements in the Council's Mental Health Roadmap, one of the central pillars of the plan. The Roadmap includes various Council bills, city spending priorities, requests of mayoral administration action, and state and federal policy changes aimed at bolstering mental health services and limiting the intersection with the criminal legal system.

Asked whether the mayor supports any of the Roadmap's workforce-related proposals, an Adams spokesperson pointed to the mayor's own mental health blueprint, issued earlier this year, but no specific funding lines in the executive budget.

“The ongoing mental health crisis in our city demands a strong response from all levels of government," the spokesperson wrote in a statement to Gotham Gazette after the executive budget was released. “We applaud the speaker for unveiling this agenda and thank her and the Council for their partnership,” the spokesperson added.

Workforce pipeline issues have led to bottlenecks in mental health programs throughout the state, frustrating proposals by the mayor and governor, including a marquee plan to restore hundreds of shuttered psychiatric beds.

The Council's Roadmap calls for more funding for nonprofit organizations providing culturally competent behavioral health services. The plan, which Speaker Adrienne Adams emphasized was an "ongoing roadmap" and a "pivotal start" as budget talks unfold, lacks specific funding targets. Last year, the Council allocated roughly $25 million in discretionary spending to mental health services, including autism awareness, programs for court-involved and LGBTQ youth, seniors, and other vulnerable populations, opioid treatment, and trauma recovery centers.

Coalition for Behavioral Health represents over 250 local mental health and substance use providers. In testimony before the City Council in March, CBH representatives called for a 8.5% cost of living increase for publicly-contracted mental health workers to match a parallel push in the state budget (that was passed early this month).

The money would help retain and recruit the psychiatrists, counselors, and social workers needed for Adams' various emergency and preventative programs, professionals often leaving for higher pay in other settings. The state included a 4% cost of living adjustment this year, which was less than the 8.5% advocates pushed for but more than the 2.5% Hochul initially proposed.

Cara Berkowitz, acting director of the CBH and Association for Substance Abuse Providers Association of Alcoholism and Substance Abuse Providers' Policy Center, said the cost of living increase is a matter of equal access to health care as much as it is a fair pay issue. "When social service providers, especially those helping those most vulnerable, cannot find workers it is the clients who suffer the most with little or no access to care," she wrote by email. "Facilitating access starts with paying city-contracted workers on par with the state, federal and private sectors."

Dr. Ashwin Vasan, the city health commissioner appointed by Mayor Adams, called a cost of living increase for human services agencies "long overdue" in testimony before the City Council finance and health committees at a May 15 budget hearing. "As a former operator of a human service and community health organization this hits home," he said.

"It is not an agency by agency decision on whether to fill those funding gaps," Vasan added. "It is a citywide decision in part because we're all working with human services agencies and often multiple [city] agencies are working with the same human service agencies, so that's really handled centrally by [the Mayor's Office of Management and Budget] to ensure consistency and equity."

Hiring for the city's outreach teams has been particularly difficult because of the nature of the work and major shortages in social workers and doctors.

"There is a huge problem right now for all mental health professionals across the city, across the country. COVID has really disrupted the mental health market," said Dr. Mitchell Katz, president and CEO of New York City Health + Hospitals (H+H), the city's public hospital network and largest behavioral health provider, in his own budget testimony on May 16.

One of the city’s signature programs, B-HEARD, a non-police mental health crisis response pilot using H+H clinicians and FDNY EMTs to answer non-violent 911 calls, can't expand in part because of a shortage of social workers, Katz told the Council. B-HEARD is getting an additional $27 million in the mayor's executive budget proposal to bring it to the remainder of the Bronx and other parts of the city. The program, which only operates from 9 a.m. to 1 a.m. in a limited number of police precincts, has been criticized for failing to respond to calls often leading to the deployment of police officers.

"We are in favor of 24-hour coverage but we would need to be able to hire more people in order to do that," Katz told the Council. "The city has committed that if we are able to hire, they would provide the funding. The current funding we have is sufficient for the number of social workers that we are employing."

"So it's a question of, can we recruit enough to go to nights?" he added.

The Council Roadmap calls for subsidies for CUNY social work candidates, part of the speaker's State of the City agenda this year. Rendy Desamours, a spokesperson for Speaker Adams, said the body didn't have a specific dollar figure in mind but would be pushing for its inclusion in the final budget deal. Council Member Rita Joseph, a Brooklyn Democrat, introduced a resolution calling on the state to pay for the education and licensing fees of CUNY students who commit to working in the public sector in a mental health field. The resolution is sponsored by 13 City Council and Brooklyn Borough President Antonio Reynoso.

In a recent podcast interview with Gotham Gazette on the City Council Mental Health Roadmap, the Council's mental health committee chair, Linda Lee, said pay parity and subsidized education were key to priming the pipeline of mental health workers. But to fill vacancies in the immediate term, Lee pointed to action the state could take to authorize out-of-state clinicians to practice in New York. Doing so would inevitably increase the reliance on remote service delivery by phone or teleconference, she said. Whether and how telehealth could be used for street outreach remains an open question.

"What we're asking is, can we increase the workforce pool, by actually allowing these folks from out of state to come. And we see that being tremendously helpful when it comes to telehealth," she told Gotham Gazette.

The mayor’s executive budget also includes $66 million for other outreach and crisis response teams run by the city Department of Health and Mental Hygiene, according to officials at the May 15 budget hearing. Recruiting for those positions has also been a challenge.

"Building trust, engaging people over time, coming back and coming back and coming back, never leaving, is extraordinarily difficult work," Vasan told the committee. "It requires extraordinarily special people who want to do that every single day. We're lucky in this city to have hundreds of people who want to do this work, if not more."