Thrive, New York!

Thrive NYC is an $850 million initiative launched by New York City First Lady Chirlane McCray that is a model for the way all communities across America can better address our growing mental health crisis. The core of the effort includes training 250,000 New Yorkers in Mental Health First Aid, which teaches people how to help friends, family members, and co-workers who may be suffering. A public awareness campaign called “Today I Thrive,” consisting of TV, newspaper, and subway ads and social media outreach in 11 languages is another part of the effort that aims to convince New Yorkers that seeking help is a sign of strength not weakness.


McCray, wife of Mayor Bill de Blasio, discussed Thrive NYC in a Q&A with Shefali Luthra in Kaiser Health News published this week. McCray’s experience with mental illness is very personal: her parents as well as her daughter have struggled with depression.

Here’s an extract from the interview:


Kaiser Health News: What role can cities play in bolstering access to mental health care? Are there unique advantages they have?


McCray: Cities can lead because mayors are uniquely positioned in terms of being really close to the people. I attended the U.S. Conference of Mayors. And unlike governors, and unlike members of Congress, mayors are right there, dealing with the everyday struggles of people. They are more sensitive in terms of what people need, on a day-to-day level. Cities can actually mobilize different types of resources: community-based organizations and churches and synagogues and mosques. All of these different first responder type organizations are much more available. Mayors are much more plugged in.


Kaiser Health News: How do New York’s needs and plans compare with that of other cities?


McCray: In New York, we have everybody. We have a large LGBT community, we have the largest Jewish community. We are the United Nations of cities. Whatever we do in New York, if it can be done here, dealing with all of those questions of culture, religion, ethnicity—all of those things—then it can be done anywhere.


Kaiser Health News: One of the big problems regarding the mental health care system is its shortage of providers. In your plan for New York, you talk about how to build that supply and make it more diverse. 


McCray: We are not going to grow the workforce we need overnight. That is clear. But we can look at alternative methods, which have evidence-based proven ways to address the situation. We are doing that by training a quarter of a million New Yorkers in mental health first aid. We are working to raise the level of awareness, educate people, and sort of demystify mental illness and substance abuse so people can help their family members and friends. We are making sure that we actually are reaching into high-need communities, communities that don’t have professionals that look like them. I heard this over and over again, everywhere I went. “I want to talk to somebody who looks like me, who speaks my language, who understands my religion. And it doesn’t exist.” There are a lot of ideas that are burbling about, but this is one of our priorities.


Kaiser Health News: It sounds like one idea you are thinking of is more ‘midlevel’-type providers—someone who is not a psychiatrist but is more knowledgeable than my next-door neighbor.


McCray: When you think about our teachers, members of our clergy—they do this work, even though they may not be trained to. Some of them actually are somewhat trained — some of them have been social workers or doctors—but you don’t necessarily need that. You don’t need a psychiatrist to treat depression, which is the number one cause of disability now in our nation. You don’t need a psychiatrist to help someone with anxiety disorder, necessarily. All these diseases have a range from mild to severe. We are also thinking about training a new class of worker: a community mental health worker, who works with members of the community—whether it be through involvement in a community-based organization or at a church, et cetera—to screen for mental health needs and refer to help as needed. And there are models in other countries of people who do this work and are able to help folks who suffer from things like depression and anxiety.


Kaiser Health News: Might that address some of the diversity concerns you described?


McCray: Absolutely. Because they will come from the neighborhood and be trusted and understand how to talk to people in a way that is sensitive and understands the history and culture of the place.


Kaiser Health News: You have been able to line up nearly $1 billion to fund your initiative. Is that something other cities will need to do, too, in order to meet their mental health care needs?


McCray: Every city will not have that [level] of resources. But then again, every city is not as big as New York City, so they may not need that kind of money. And everything we are doing doesn’t require funding. Something like screening pregnant women and mothers for maternal depression is something that requires a new approach by doctors and pediatricians and OB/GYNs. It just requires them asking a series of questions. But we had to actually gather people together and say, “Look, we can have a huge impact on something that could have lifelong consequences for a child and a family, by just doing work a little differently.” It’s not a change in the funding. It’s just a change in the way they approach the conversation. We’re training our police officers in crisis intervention training. We’ve already saved lives. We’re making naloxone [which treats opioid overdose] available without a prescription. We’ve saved so many lives already with that. It really depends on the needs of the city.


Kaiser Health News: What do you hope to see moving forward?

McCray: The most important thing is changing the culture. We’ve already been taking great strides. It is change in the culture and ability to know there’s always someplace that a New Yorker can go to get help. No matter who you are as a New Yorker, it’s OK. Mental illness and substance abuse disorders are treatable. And, there’s somewhere to go. That’s what success looks like to me. Of course I want to do even more but if we do those things, I think that will be a huge sea change.


Thrive NYC says its initiative is guided by six key principles:

Change the Culture: Make mental health everybody’s business. It’s time for New Yorkers to have an open conversation about mental health.

Act Early: Give New Yorkers more tools to weather challenges and invest in prevention and early intervention.

Close Treatment Gaps: Provide New Yorkers in every neighborhood—including those at greatest risk—with equal access to care that works for them and their communities, when and where they need it.

Partner with Communities: Embrace the wisdom and strengths of local communities by collaborating with them to create effective and culturally competent solutions.

Use Data Better: Work with all stakeholders to address gaps, improve programs, and create a truly equitable and responsive mental health system by collecting, sharing, and using information and data better.

Strengthen Government’s Ability to Lead: Affirm City government’s responsibility to coordinate an unprecedented effort to support the mental health of all New Yorkers.

Read “Thrive NYC: A Roadmap for Mental Health for All,” and a progress report on the initiative, “Thrive NYC 150-Day Update.”