A New York State of Mind

Mental disorders in their myriad forms have been well documented throughout history and are inextricably linked to the human condition—affecting young and old, male and female, the world over. On the local level, a study by the New York City Department of Health and Mental Hygiene shows that serious mental illness affects thousands of New Yorkers. What’s more, those with serious mental illness are more likely to engage in unhealthy behaviors—such as smoking and substance abuse—that can in turn lead to such physical conditions as hypertension, diabetes and heart disease.

Making great inroads in the way the city is responding to the mental health crisis, CUNY SPH has partnered with the NYC Health Department’s Mental Health Innovation Lab (MHIL) in the creation of the Center for Innovation for Mental Health (CIMH).

According to Dr. Ayman El-Mohandes, dean of the School, “The Center serves to conduct evaluations, provide technical assistance, and serve as liaison among other researchers, investigators, and academic institutions.”

Building on solid foundations

The CIMH has its roots in the expansive ThriveNYC initiative, an unprecedented commitment to change the way the city handles mental health. ThriveNYC is framed by a comprehensive strategic framework built on 6 guiding principles (Act Early, Use Data Better, Change the Culture, Close Treatment Gaps, Partner with Communities, and Strengthen Government’s Ability to Lead) implemented through 54 initiatives managed across many city agencies. The initiative was established two years ago by the First Lady of New York City, Chirlane McCray, who has demonstrated her passion for improving the lives of all New Yorkers, especially for those with mental health issues and their affected family members. ThriveNYC was designed to pilot and create a model for how cities can attend to the mental health needs of their populations.

“All of us know someone struggling with mental health issues. Reducing stigma, increasing access to preventive and treatment services, and improving the quality of treatment are among the essential approaches of ThriveNYC,” Dr. Jennifer Wisdom, professor of Health Policy and Management and director of the CIMH, explains. “Research suggests this will be a very good investment, as mental health issues are associated with lower work productivity, absenteeism and, of course, increased medical costs. This not only applies to people with severe mental illness, but also for friends and family members with generalized depression or anxiety, or other issues.”

Part of what makes these mental health services so challenging is that they are set within a very complex system involving emotional disorders, substance abuse, jails and courts, schools, child welfare, social services, hospitals, city and state systems, and private providers.

“There are so many groups that have the same goals of improving people’s lives and alleviating distress,” Says Dr. Virna Little, Associate Director of Clinical Innovation at CIMH. CIMH is working with ThriveNYC to find ways for us to work better and more efficiently to make that happen.

ThriveNYC’s initiatives address populations of all ages, from depression screening for pregnant and post-partum women, services for young children and their parents, services for school age children, to criminal justice diversion programs and elderly home visit programs. Dr. Gary Belkin, executive deputy commissioner at the NYC Health Department, explains. “The program relies on a strategic framework built on six guiding principles: Act Early, Use Data Better, Change the Culture, Close Treatment Gaps, Partner with Communities, and Strengthen Government’s Ability to Lead. It’s a very comprehensive program and the largest of its kind.”

Big data for bigger change

In addition to the CIMH, the MHIL was also created as a result of ThriveNYC, in order to address the need for more precise and accurate real-time information than is currently available or widely used.

“It is a challenge to collaborate with community-based organizations and networks, set and meet goals to close gaps, support providers to innovate and manage in a changing marketplace, be responsive to those who fall through gaps, focus action on key groups, etc., without more comprehensive, precise data and resources,” Belkin notes. “MHIL works to address this data gap. The establishment of CIMH at CUNY, working in tandem with the Lab helps us engage the academic sector and address these goals through research and evaluation.”

The New York City Mental Health Workforce Summit

The 2017 New York City Mental Health Workforce Summit, held at CUNY SPH on June 22, 2017, brought together stakeholders and a broad range of sectors including government, insurance plans, funders, providers, and academia to drive workforce policy and innovation. Summit participants built on the progress made from the 2016 New York City Mental Health Workforce Summit in diversifying and expanding the mental health workforce, enhancing existing mental health training programs, and creating better pipelines and career ladders for Peers and Community Health Workers. In addition, the Summit developed metrics for improving the mental health workforce in New York City. Participants have plans to continue to collaborate in order to move the work forward.

Universal screening and care for maternal depression

The Greater New York Hospital Association (GNYHA) and NYC Health Department are leading a maternal depression learning collaborative across 30 NYC hospitals and health systems with the goal of screening all pregnant women and new mothers for depression and connecting them to appropriate care. CUNY CIMH plays a key role in leading all quality improvement (QI) activities for the collaborative, including developing and implementing all QI strategy and content.

Interdisciplinary academy for mental health professional development

Held June 2017, this academy provided new mental health graduates in social work, psychology, public health, and other professions with important information for transitioning them from school to their first professional mental health job. Included were such topics as: the latest trends in mental health, planning a career, thinking critically about culture, ethics, social justice, and equity, and how to take care of yourself to prevent burnout, along with skills-building exercises that are essential to successful career development.

Student-fueled effort

In addition to researchers, doctors and academics, CIMH is propelled by the work of CUNY students: two year-round master’s students who are research assistants and two postdoctoral associates. Also involved are summer interns, who last summer worked on evaluating aspects of NYC Well, the city’s 24/7 call/chat/text mental health crisis and service connection program, and the maternal depression initiative, which aims to provide universal prenatal and postpartum depression screening for all women in New York City.

Alison Feuer, a student who came on board as a research assistant in 2016, is currently working on the Maternal Depression Quality Improvement Learning Collaborative as part of her capstone requirement for her master’s program. The effort evaluates policy implementation of maternal depression screening by measuring the impact of quality improvement training and coaching at all clinics participating in the screening of pre- and post-natal patients. Feuer not only finds it a learning experience, but a rewarding one as well.

“Knowing that anyone in the field of public health can make an impact, whether big or small, individual or population level, is rewarding to me because I know that every single one of my classmates will make a positive change, no matter their career interests,” Feuer says. “I feel that CUNY is preparing us for a career in public health by hiring the best possible staff along with a wide range of research projects in which students can get involved.”

Wisdom, a strong advocate for mental health, also seeks to instill that same sense of advocacy in her students, with the hope that they will remember some key takeaways from her class.

“First, mental health is an integrated part of our lives, so we might as well acknowledge it and incorporate it into all aspects of our public health practice,” she says. “Second, the service delivery systems are complex, challenging, and difficult to navigate at times—yet they provide many opportunities to improve people’s lives. Even for our students who are not working specifically in mental health, such as physicians, policy makers, and statisticians, we all have an opportunity to help others. Finally, it’s important to base our decisions on how to use precious resources based on evidence as to what really works, in order to alleviate distress and to help people.”

Urban plight

Studies show that urban living can place extra stress on an individual. Anxiety typically increases with the anticipation of adverse situations, and the fear of not having the adequate resources to respond to them.

“Many immigrants who arrive in New York are coming from homelands where there is war, famine and disease, all of which can take a toll on one’s mental health,” notes El-Mohandes. “New York City is unique in that it is one of the most popular first entry points for people coming to this country. The cultural, social and political acclimation can be enormous, making these new arrivals very susceptible to varying levels of stress. This enhances the importance of focusing on mental health as a pivotal area for this population.”

Providing an umbrella of support, CUNY’s work with the NYC Health Department encompasses all boroughs of the city and takes into consideration the mental health of all New Yorkers. “CUNY is different from other schools in that we are the only accredited school of public health in Manhattan and we find this to be core of who we are in order to serve the population of the city,” says El-Mohandes. “We are indebted to the taxpayers for creating and supporting us. In turn, one of the mandates of our school is to support the functions of NYC Health Department in any way we can, and to train the future workforce. Collaborating with the Department of Health adds to the credibility, veracity and integrity of the work we produce. That defines us as no other comparative school.”

The future is now

Ultimately, the work of the CIMH will help expand the DOH’s ability to make constructive partnerships with researchers and implementation experts.

“We would like to see New York City be a place to test and establish what a comprehensive public health approach to mental health could look like,” says Belkin. “We want to see what works, what needs changing or adding—and create effective strategies for adoption in other cities nationwide.”

It’s a noble goal and one that’s already bearing fruit, as widespread national and international interest in adoption of ThriveNYC approaches is already underway.

Also in the works by the CIMH are a host of initiatives designed to build on their efforts thus far including:

• Extend research partnerships and evaluations of Thrive initiatives and related efforts to areas beyond the New York City area.
• Establish population-based measures to assess the impact of ThriveNYC
• Reports, briefings, and papers describing and synthesizing evidence on innovative strategies, interventions, and population mental health approaches.

“Opportunities with the NYC Health Department such as this one elevate our school to a new level,” says El-Mohandes. “These collaborations offer unique avenues not only to affect positive change in the lives of New Yorkers, but they expose our researchers to real-life challenges and expose our students to real-life intervention environments that greatly enhance the quality of education we can provide. It’s a win/win partnership.”