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Now ‘Resetting,’ Chirlane McCray’s $850 Million Mental Health Program Has A Lot Riding On It


Chirlane McCray Bill de Blasio

Chirlane McCray, with Bill de Blasio looking on (photo: Benjamin Kanter/Mayor's Office)


On a sunny Wednesday morning in November 2015, more than 30 of New York City’s top public officials gathered together in East Harlem. They stood shoulder-to-shoulder and tiered in three rows on the ground floor of the City University of New York’s school of social work. An audience of hospital administrators, business leaders, mental health advocates and journalists watched from folded seats.

Chirlane McCray, wife of New York City Mayor Bill de Blasio, took the lectern. With a sing-song cadence and emphatic smile, she announced what would become her signature initiative:

“It is my great pleasure to announce the release of ThriveNYC: A mental health roadmap for all,” McCray said. The surrounding group, that included de Blasio and their children, Dante and Chiara, applauded. The plan, she said, is one of action. “It includes an investment of $850 million over four years.”

ThriveNYC is not an organization. Led by McCray, who cannot hold a paid position in the administration due to nepotism laws, Thrive is a “mental health roadmap.” It encompasses 54 mental health-related projects that are being housed across 20-plus city agencies. Richard Buery, former deputy mayor for strategic policy initiatives and Mary Bassett, the commissioner for the Department of Health, have helped spearhead many of the broad-ranging projects.  

With each of the projects, 31 of which previously existed before McCray’s 2015 announcement, the aim has been to address the stigma-laced culture around mental health as well as general barriers in accessing mental health care across the city’s five boroughs. In the two-plus years since McCray announced Thrive, her political profile has boomed and the city has published dozens of metrics meant to indicate the initiatives’ successes.

As even McCray and de Blasio admit, the city still has significant mental-health related issues and a long way to go. The Kaiser Family Foundation, a leading non-profit research organization, found that just 42 percent of the city’s mental health needs were being met as of December 2017.

Recently, a host of high-profile incidents between New Yorkers with mental health disorders and city employees, especially police officers, have topped headlines. In the first week of April, NYPD officers shot and killed a black man with bipolar disorder who was standing on a street corner in Brooklyn’s Crown Heights neighborhood. The man was holding a metal pipe as if it were a gun. The incident, one in a series of similar deadly encounters between police officers and New Yorkers suffering from serious mental illness, sparked protests and questions around city officials’ mental health training.

McCray recently said of two such incidents, including the killing of Saheed Vassell in Crown Heights, “neither one of those tragedies had to be,” according to Observer, and pointed to ThriveNYC as the plan to fill a long-standing void and prevent such tragedies.

Meanwhile, weeks before the most recent incident and an announcement of a new “crisis prevention and response task force,” in mid-March, the mayor’s office circulated a press release that the sweeping mental health initiative that is ThriveNYC had hired an executive director: Alexis Confer. Confer, who had been working on the initiative under Buery, is the first person to occupy a full-time administrative role under Thrive. The hire, McCray said in an interview in the following days, is part of Thrive moving into a second, “resetting” phase.

“The resetting is really necessary because the first two years we were really focused on getting everything off the ground, every program didn’t launch at the same time,” McCray said during a recent appearance on the Max & Murphy podcast from Gotham Gazette and City Limits. Now that nearly all of the 54 projects are up and running, the goal is to use the administration’s remaining years in office to ensure each project will reach its goals and live beyond the ticking political timeline. Tracking metrics and success, McCray said, are critical in accomplishing these goals.

“We know we have 3 years and 9 months,” the first lady said. “I want to make sure that all of these programs last beyond this administration, which means that we have to do careful analysis of how well they’re doing, and we have to actually embed them in the agencies.”

Yet as Thrive moves forward, questions linger around its structure, impact, and McCray’s role -- especially since the first lady has recently been toying with the idea of running for political office in the next city election cycle.

With speculation swirling around McCray’s future and a city muddled in what some experts have labeled a mental health crisis, much is at stake. In leading Thrive, McCray took on what she called “ambitious” goals. The result has largely been positive, it appears, in terms of reorienting how city government addresses mental health and the breadth of the services available. People working under Thrive-backed programs sing praise for McCray’s dedication and work ethic. Many people in the city’s mental health sector also commend efforts to address one of the city’s most pervasive issues.

According to McCray, there are about 400 metrics that indicate the various programs’ successes and, in some cases, shortcomings. While city officials working under Thrive are already applauding its impact, some of the metrics that have been published don’t seem to point to concrete improvements or to all of the programs’ being on track to meet their marks.

*****

Before de Blasio took office in 2014, the office of New York City First Lady was vacant for close to 15 years, whereby mayoral partners were not active in politics. During his mayoral campaign and into his transition into office, de Blasio and McCray had made clear that New Yorkers were getting something along the lines of ‘two for one.’ De Blasio regularly called his wife his number one advisor. She did, after all, bring her own political background to the table. The city’s mayoral duo met working under Mayor David Dinkins, the city’s first and only black mayor and last Democrat elected before de Blasio.

Under Dinkins, McCray primarily worked on the speech-writing team. She then worked on-and-off for elected officials and held a brief post at the foreign press service with the work always centered around writing. When de Blasio was first elected, McCray helped appoint top city officials, as she had done before during his political career as public advocate and a member of the City Council, they said.

Unlike some first ladies at various levels of government, McCray has used the role to bring publicity to topics and spearhead initiatives with real money behind them. De Blasio appointed her chair of the nonprofit Mayor’s Fund to Advance New York City, which raises tens of millions of dollars for public-private partnerships, and, of course, she helped develop and oversee the city’s sweeping mental health program.

On the day of the announcement for Thrive, McCray introduced a handful of the 23 new initiatives. For example, a 24/7 hotline would be launched to connect people seeking mental health services with treatment options. Primary care providers would be trained to prescribe buprenorphine, a medication that prevents withdrawal symptoms, to people recovering from opioid addictions.

McCray listed off a number of goals: train 250,000 people in mental health first aid; implement social-emotional learning in all the city’s 1,850 Pre-K for All programs; create a mental health corps that will clock 400,000 hours of outpatient care each year.

The 15-minute introduction the first lady delivered on that brisk 2015  day was the culmination of a handful of meetings, spread out over the course of the previous months, with the commissioners of more than a dozen city agencies. Traveling across the boroughs, McCray asked agency heads—from the Department for the Aging to the Administration for Children’s Services—about mental health services available to the populations they serve. All of the agencies already had some mental health initiatives in place and McCray wanted to know what was working and what wasn’t. Commissioners from at least two departments were impressed by McCray’s commitment and insightful questions early on.

“To me, the first lady has been incredibly active—way more active than I really expected or anticipated,” said Lorelei Vargas, a deputy commissioner for the Administration for Children’s Services who attended the early meetings.

In that first speech, McCray didn’t mention the planning behind Thrive. Instead, the veteran speech writer invoked the personal. She touched upon her family’s own struggles with mental health, from her daughter’s public struggle with addiction to her parents’ depression. She recited statistics about the prevalence of mental health problems in New York City— 8 percent of high schoolers tried to commit suicide, 26 percent of CUNY students reported having anxiety, and 13 percent of elders in care facilities suffered from depression.

McCray called Thrive’s goals ambitious and emphasized the collaborative demands of this type of work. The smile on de Blasio’s face grew as the mayor looked on and clapped with warm approval. The city, in trend with the state and country, was facing a shortage of mental health professionals. Thrive aimed to respond to this by equipping people already working in city agencies and interacting with residents with the ability to screen for mental health issues, and then direct them to adequate services. To accomplish this, McCray said reducing stigma was a necessity.  

“If we work together we can make it as easy to talk about anxiety as it is to talk about allergies,” McCray concluded.

*****

McCray speechTwo-and-a-half years later, nearly all of the 54 initiatives are underway. Hundreds of people have been hired to work on initiatives, old and new, and tens of thousands trained in mental health first aid. More than $818 million has been allocated across more than a dozen agencies’ budgets through fiscal year 2019. Two-thirds of the sum comes from city dollars. A combination of federal grants and private donations fund the $24 million Connections to Care program, also under Thrive, and Medicaid reimbursements back the shelter-based treatment for people who are homeless.

But getting a grasp of how the initiatives that span more than 20 city agencies fare requires looking beyond the official year-two update report that representatives of the mayor’s press office direct inquiries to. Tracking the funds alone demands examining each of the agencies’ budgets that are slated to receive Thrive-related funds. A team at New York City’s Independent Budget Office (IBO) spent months reviewing the budgets and compiled a report on Thrive.

The metrics measuring the programs’ success are similarly spread out. McCray mentioned that there are about 400 metrics being used across the initiatives to track their success. Some are being maintained by the city agencies operating the initiatives, others by the mayor’s and first lady’s offices, and at least one is being monitored and evaluated by the Rand Corporation. During her appearance on the Max & Murphy podcast, McCray said that she reads up on all of them every week.

“You know, we’re watching, we’re watching very carefully,” McCray said. “Every other week, we have a roster, or an implementation chart to show   how we’re making our bench-lines, how our timeline is moving, whether we’re on target, or off target, it's very thorough. We’ve got 400 metrics to measure our programs, and we’re very much focused on making sure that we’re doing a very thorough evaluation and assessment of  how we’re doing.”

Yet, following multiple requests and conversations with the mayor's and first lady’s offices, as well as requests over the course of weeks with 11 agencies working under the auspices of Thrive, metrics have trickled in slowly and sparingly. Spokespeople from the mayor and first lady’s offices have responded to multiple requests for the 400 metrics by sending along the "ThriveNYC Year Two Update" report, which lists 55 projects and associated metrics through October 2017 . Some of the initiatives have exceeded their goals, others underperformed. Some have few metrics, if any, by which to gauge progress.

People have critiqued Thrive overall for not specifically targeting programs toward New York City residents who suffer from more severe psychiatric disorders. The nine-hour mental health first aid trainings, for example, don’t necessarily equip city employees with the necessary skills to assist someone suffering from a severe psychiatric disorder or in the throes of an episode. Employees from three city agencies dismissed those claims, asserting that the varied programs address people across the spectrum.

“It’s simply not true. Thrive addresses the full span,” McCray said. She added that many of the programs are focused on early intervention and prevention because many people suffering from severe psychiatric disorders later in life often have had mental illness go untreated in the past. “This is why you see so many people on the street. That is the result of untreated mental illness, and not just a year or two, this is years and years and years in the making. If we act early, we could actually prevent, or certainly intervene,” she said.

De Blasio himself recently dismissed the criticism, pointing to both NYC Safe and the reasonable use of Kendra's Law, which necessitates a judge mandating treatment for individuals in need.

Yet in response to increasing attention on this subsect of the population, de Blasio and McCray announced the formation of the new task force on Thursday that will focus on some of these concerns.

The task force brings together city officials, mental health researchers and individuals with mental illness over the next 180 days who will identify ways to increase interventions, according to a press release. The group is also slated to address means to improve coordination between public health and safety agencies within the city. McCray along with the leading names on Thrive, including Confer and Bassett, are set to manage the task force. Thrive initiatives, meanwhile, continue onward.

One of the initiatives that’s among the most referenced during press events around Thrive is NYC Well, the hotline for people seeking mental health services. De Blasio and McCray recite the number -- 1-888-NYC-Well -- at public and private events on a regular basis, often asking their audiences to repeat it back or say it with them. Judged by the number of people who have utilized NYC Well, the initiative has been deemed a success.

More than 250,000 people have reached out to the hotline through phone calls, texts or online chats, according to Thrive’s two-year update report. This exceeded initial projections by about 25 percent. Prior to NYC Well, many city agencies, like the Department of Health and Mental Hygiene, ran independent hotlines where people tended to call for mental health services. NYC Well consolidated these numbers into one, where people on the receiving end of the calls would be better equipped to navigate the city’s mental health providers and other services.

The first lady and others involved in thrive said the numbers are a testament to advertising campaigns around the city. Nearly $15 million of Thrive’s overall funds through 2019 are dedicated toward media campaigns. However, some have questioned whether basing the program’s success on the number of people who reach out is most telling as to whether people are actually being connected to the care they are seeking.

Commissioners for the Department for the Aging said they were excited about the impact that Thrive’s funding has already had on the two projects the agency runs in partnership with Thrive. The Friendly Visiting program, which launched July 2017, trains and connects volunteers with homebound elders. In the program’s first four months, Thrive’s year-two update reported, 645 seniors were served. Thrive has also backed initiatives to provide additional mental health services in senior centers.

Some have expressed concern that programs that existed prior to Thrive are being lumped into the umbrella program without much benefit. But representatives from the Department for the Aging disagreed.

“It’s a more the merrier situation. We absolutely need more services than we can provide in our point in time,” said Jackie Berman, the director of research at the department who is closely involved in the administrative-side of the two Thrive initiatives. “Thrive opens up the door, but there’s even still a great need—it’s the tip of the iceberg.”

While initiatives like Friendly Visiting and NYC Well have hit their goals, others have faltered. City officials remain adamant that these initiatives are still on track to meet the targets that were recited in 2015 and echoed in appearances since.

For example, there are seemingly underwhelming metrics about the number of people who have received mental health first aid training. Thrive’s two-year update report, which collected data from 2016 through October 2017, indicated hat nearly 37,000 people had been trained in mental health first aid, which means taking a free nine-hour course offered throughout the city. The course is meant to teach participants how to screen people for possible mental health issues and educate them on the steps to take when concerned about another’s mental health. With the city experiencing a mental health professional shortage, the idea is to give residents the tools to fill some of the gaps left by the shortage.

For Thrive to meet its goal of training 250,000 city residents in mental health first aid by 2020—there would have to be significant growth in the number of people enrolling in mental health first aid programs. At least double the number of people will have to be trained in 2018 and 2019 that were trained in 2016 and in 2017 combined.

Confer, hired to be Thrive’s executive director as of mid-March, did not provide concrete ways that the city would scale up the number of people receiving mental health first aid trainings. She did, however, stress the importance of meeting the goals. The metrics, she said, not only promote benchmarks critical to the programs’ success, but also act as “a magnifying glass on ourselves.”

Yet, some metrics are difficult to ascertain. Though the city outlined a number of benchmarks for 34 initiatives in the year-two update, there are missing links between how lump sums in budgets trace to each of these metrics. For example, NYC Safe, which is run by the Department of Health and Mental Hygiene, is geared toward supporting people with mental illness who are more likely to exhibit violent behavior. The program has $22 million earmarked toward its development.

According to the year-two update, NYC Safe was responsible for adding  40 substance-abuse-disorder specialists to treatment teams across the city. In January 2016, three intensive mobile treatment teams launched and a fourth was added the following year. Overall, Thrive’s year-two update said that 405 New Yorkers were engaged in the NYC Safe program through October 2017. The link between how the $22 million is being employed and how money links to each of these metrics is not available.

Jane Meyer, a spokesperson for the mayor’s office, said that some data was simply not readily available. Some metrics were only available in quarterly update reports, for example. Meyer said the city was working on the weeks-long request for the most up-to-date information on each of the 54 initiatives. However, she said, consolidating all of the 400 metrics that the first lady said she keeps up-to-date with was proving a time-consuming task.

Confer said she’ll be spending 100 percent of her time on Thrive in the new post. Without a specific office or even the semblance of being an organization, Thrive doesn’t publically appear to have full-time staff other than Confer. She said she planned to spend the first few weeks taking stock of the initiatives that she has helped oversee from the deputy mayor’s office since Thrive’s launch. She also plans to touch base with the hundreds of people working on the projects that have been labeled as Thrive-based initiatives.

“The goal is to save lives, and to make sure people have the resources they need—that is the ultimate metric of success,” Confer said.

*****

Before Confer stepped into the executive director role, no single person was tasked with maintaining and organizing the initiatives under Thrive. McCray was as close as it got. She also spends her time heading the Mayor’s Fund.

The Fund, a non-profit organization, facilitates partnerships between the city and private stakeholders to implement programs advantageous to New Yorkers and, at times, experiment with initiatives that could become part of what city government does. McCray’s role has drawn criticism from some concerned that the appointment creates an expectation from private donors that the mayor will treat them with favor. McCray has waved those off.

“It’s not an overriding concern,” McCray said on the Max & Murphy podcast, saying that people donate to the fund because they are devoted to philanthropy, not because they expect political favors. “But we do have lawyers,” she said. “And lawyers are important to sift out the who does what and when, and that’s important.”

Tax filings for the fund between 2014 and 2016 list McCray working one hour a week. A spokesperson for the mayor’s office, responding to an inquiry about this filing, said McCray spends about 10 percent of her time working on the Mayor’s Fund and that the public schedules aren’t reflective of all her time. Thrive, meanwhile, appears to occupy much more time, and there is some crossover.

The most prominent is Connections to Care. The Mayor’s Fund contracts the McSilver Institute for Poverty Policy and Research, part of New York University, to train non-governmental organizations and nonprofits in screening for mental health issues. Connections to Care is based on the premise that very few people go out of their way to seek mental health care. Having city employees recognize mental illnesses when they do interact with the city’s population would provide more entryways to care.

“I would say it’s been a fantastic experience,” said Andrew Cleek, the institute’s chief program officer.

For McCray, the experience may be the first of many more politically-minded work in the future.

In mid-March, McCray packed her bags and boarded a flight to Puerto Rico to travel the region and assess the mental health climate in the territory following hurricane Irma. In the weeks leading up to her trip, McCray was showing up more frequently at public events. The mayor featured her at press conferences, where she often invokes Thrive.

Rumors began to spread that McCray was prepping to expand her future political aspirations. She didn’t dismiss the idea. McCray actually said it was on a list of things she’s considering. But, in order to get there, she said she needs to focus on the work that currently has her name on it—the most prominent being Thrive.

“I’m too focused on doing a really good job, of what I’m doing now—because my future depends on it,” McCray said when asked about whether she was beginning to plan out steps for her own run for office. “It really does.”

***
by Maya Miller for Gotham Gazette
@GothamGazette
The author is a freelance journalist currently earning an M.A. in health and science journalism at Columbia's Graduate School of Journalism.

This article has been corrected to reflect the number of NYC Well is a 1-888 number, not 1-800

This article has also been updated to remove an inaccurate mention of a discrepancy in reported numbers of people given mental health first aid training.

Mayoral Charter Revision Commission Starts Its Work


charter commission first meeting

Charter Revision Commission (photo: Samar Khurshid)


A commission created by Mayor Bill de Blasio to review the City Charter and propose reforms to how city government functions kicked off its work on Thursday with its first public meeting in Downtown Manhattan.

Huddled elbow-to-elbow at tables stretching across an auditorium stage, the members of the Charter Revision Commission -- former public servants, law professors and attorneys, union leaders and community activists -- introduced themselves to the 20-odd members of the public in attendance (and whoever might have been watching the live-stream).

Over roughly an hour, Commission Chair Cesar Perales did most of the talking at what was billed as an initial organizing meeting, discussing the law, rationale, and guiding principles behind the creation of the commission.

“[W]e’ve attempted in forming this commission to cover the geography of all of the boroughs of the city, the ethnicities, and to have everybody represented...We’ve also called up people with tremendous government experience, enormous experience in voting rights, even a [former] member of the City Council,” Perales said. “So I think we are very well represented but in order for us to do our work, we’re gonna need the participation of the people of this city. We want them to learn as much as possible about what is in the City Charter and to come to us with ideas about revising the City Charter, making it better.”

Any Charter Revision Commission is, under the law, an independent body and has the authority to examine the entire charter, though past commissions have been convened by mayors with limited interests in mind, a fact that Perales acknowledged Thursday. De Blasio too charged his commission -- though he cannot control their agenda -- with looking at the city’s campaign finance laws and ways to improve voter participation and access.

“This mayor, much to my delight, is interested in improving democracy and improving the way we elect our leaders,” Perales said. The commission would focus on elections, he insisted, but would also “be looking at the entire City Charter” and the issues presented to them at hearings over the next few months.

Perales also pledged a thoroughly transparent process -- before he spoke, he made sure to check that the hearing was indeed being live-streamed -- that would include ample testimony from the public. “We’re gonna hear from more people than anyone ever imagined,” he said.

Among the first acts of the commission was the nomination and appointment of Matt Gewolb, former legislative director at the New York City Council, as its executive director and Christine Billy, a lawyer from the Department of Sanitation, as general counsel. Candice Cho, deputy chief of staff at the Law Department, will serve as the commission’s chief of staff.

Much of the commission’s staff, which will work out of the David Dinkins Municipal Building, will be borrowed full-time from city agencies, Perales said, though the commission can request funding from the mayor and already has a budget that will allow it to hire consultants. “We’ll have all we need but we’re not gonna be spending a fortune on getting it,” he said.

The commission will hold its first borough hearing on Staten Island, though the full schedule has yet to be decided. At Thursday’s meeting, the commissioners did agree on a few broad ground rules for public outreach: holding multiple hearings in each borough at different times of the day to ensure maximum participation; preventing any barriers to access for immigrants; a robust social media presence and a marketing campaign.

“I think it’s especially important because some of these boroughs are very large,” said Commissioner Angela Fernandez, executive director and supervising attorney of Northern Manhattan Coalition for Immigrant Rights. “For example, folks in East New York or in Washington Heights are unlikely to go to more centrally located...area of the borough.”

“I wanted us to take a look at the demographics of the city because things are changing, and a sense of who is where is going to be important in decisions that we make for our deliberations,” added Commissioner Una Clarke, the former City Council Member from Brooklyn.

In particular, Clarke warned of how the national political scene and the federal government’s policies could depress immigrant input. “I think we ought to be very sensitive to the new immigrant communities. Because of what’s happening in Washington, many people will not come out and speak with us, and we have to be able to bring them out because whatever we do is going to affect their lives,” she said.

Fernandez suggested a “simple but creative marketing campaign” to invite the public into the process.

As the commission does its work, examining the city charter and city government and taking pubic testimony, it will prepare recommendations that then go to voters for approval or disapproval.

Thursday’s meeting marked the latest start for any Charter Revision Commission convened in the recent past, and Perales conceded that they will have to work hard and fast to meet the September 7 deadline to have their recommendations included on the general election ballot in November. “We’ve got some really serious time constraints,” he admitted, though he said he was “optimistic” about getting the work done.

What wasn’t raised at the meeting was the parallel Charter Revision Commission being created by the City Council through legislation that passed last week. The Council’s commission will include appointees of all the city’s top elected officials and will work through this year into the next, to present ballot proposals for the 2019 general election. De Blasio, who appointed all the members of his commission, will have four appointees to the Council-led commission.

***
by Samar Khurshid, senior reporter, Gotham Gazette
     

Read more by this writer.

What's The [Data] Point? $307.45, with Anita Laremont of City Planning


whats the data point


What's The [Data] Point? Episode 37 -- $307.45, with Anita Laremont [You can download What's The [Data] Point? wherever you get your podcasts, including on iTunes]

wtdp anita w maria and benAnita Laremont is the general counsel and chief data officer at the Department of City Planning, where major decisions are made around how land is used in New York City. Laremont joined the podcast to discuss some of the significant projects and changes that City Planning has ushered through over the past several years, including historic changes to the city's land use rules meant to spur affordable housing, neighborhood rezonings, and why the city doesn't have a master plan.

Listen to the conversation and let us know what you think: Ben Max of GG (@TweetBenMax), Maria Doulis of CBC (@MariaDoulis). Listen below or download wherever you get your podcasts!

***
by Ben Max, Gotham Gazette
     

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