Congress should follow cities' lead on mental health

Congress should follow cities' lead on mental health
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President John F. Kennedy died 56 years ago last week. The inspiring young president’s last piece of legislation, the Community Mental Health Act, called for states to close mental hospitals and open community health care centers in their place. The bold new idea was that people could get humane and comprehensive treatment for mental health and substance disorders while bolstered by the support of families and communities.

Kennedy’s vision never became reality. Without needed federal dollars, many states closed their institutions without replacing them with community-based supports. More than half of the Act’s proposed centers never opened. Far too many people ended up getting no treatment or services at all, living on the streets, in shelters, or detained in jails and prisons. Some of the nation’s key providers of psychiatric care are not hospitals or clinics, but jails in Los Angeles, Chicago, and New York City.

We are mired in a crisis of our own making because the federal government is missing in action. With no emphasis on prevention — and instead of a national, well-funded behavioral health system — people are largely on their own.


In the spirit of President Kennedy’s vision, our non-partisan Cities Thrive coalition met in New York City last Monday and Tuesday for our annual Mental Health Conference. We are building a national movement for mental health reform and community care. Our panels and workshops brought together mental health professionals, allies, and tribal and government leaders from 80 cities and counties across the country — and from as far as London and Toronto — to share best practices.

As the First Lady of New York City I founded ThriveNYC, which is working to help provide more mental health services for all New Yorkers. I also lead the Cities Thrive coalition. Started in 2016 with 25 member cities, we now include over 200 city and county officials, and thought leaders from all 50 states and both political parties.

We came together because of Dr. Martin Luther King Jr.’s “fierce urgency of now”: in any given year, roughly one in five people faces a mental health challenge. Yet, people wait on average about 10 years before seeking assistance for mental health and behavioral challenges. About half of mental health disorders begin before age 14, and 75 percent begin by age 24. We could avert untold misery and tap untold potential if behavioral health care was as accessible early — just like care for cavities or diabetes.

We call on our federal partners to lead — and all presidential candidates to develop a comprehensive behavioral health platform. In the meantime, we’re looking to the many solutions emerging at the local level to address the needs of our families and neighbors.

In New York City, ThriveNYC has trained over 140,000 New Yorkers in Mental Health First Aid to educate more people about mental health; we provide dozens of employers the tools and resources to make workplaces more supportive of mental health. Our mental health helpline has answered nearly 770,000 calls, texts and chats in the last three years. Social emotional learning is a unique opportunity to build resilience in all our children while they are in school — we can identify and treat disease before it gets more serious and before children lose valuable learning time.


Bartenders in Ventura County, Calif., are being trained to recognize the signs and symptoms of mental health challenges and to refer customers to services and offer support. The aim is to reduce suicide among middle-aged men, who might be reluctant to seek a therapist but might open up to a friendly bartender.

Polk County, Iowa, has a “data-driven justice initiative” to divert high users of emergency services to treatment providers and support programs where they can get long-term help.

In Nashua, N.H., fire stations offer substance misuse treatment with a ring of a bell. At a “Safe Station” one can get medically-cleared by a paramedic and taken to a hospital.

Sharing our stories is something we can all do to de-stigmatize mental health challenges. My conference keynote address talked about the enduring loneliness and anxiety I had from being bullied and shamed as the only black student in all my classes, from kindergarten through high school. I have learned that many people have similar stories of trauma that have triggered mental health challenges.

This work is not easy. But neither was passing the Affordable Care Act or the Americans with Disabilities Act. Medicare and Medicaid became law only after years of failed attempts at national health insurance.

For federal leaders longing for the days when America tuned bold visions into reality, our advice is simple: look local. But we cannot wait. For now — city by city, county by county — we must do what we can.

Chirlane McCray is First Lady of New York City; her husband is Mayor Bill deBlasio. McCray created ThriveNYC. She also spearheads the Cities Thrive Coalition, with more than 200 mayors, county officials and thought leaders from all 50 states. She was named to TIME Magazine’s 50 Most Influential People in Health Care for 2018. Follow her on Twitter @NYCFirstLady