Smashing the stigma: Deputy Mayor Richard Buery on ThriveNYC and treating mental health

In November 2015, New York City Mayor Bill de Blasio’s office launched a plan to treat mental health issues across the city called ThriveNYC. The plan – estimated to cost $850 million over four years – is being led by first lady Chirlane McCray and Deputy Mayor for Strategic Policy Initiatives Richard Buery. Before coming to city government, Buery was president and CEO of the Children’s Aid Society, and as deputy mayor he helped to usher in the pre-kindergarten expansion that now serves about 70,000 4-year-olds. He has also placed nonprofits in schools to increase access to social and health services, and encouraged the spread of after-school programs.

He spoke with Dan Rosenblum from our sister publication NYN Media about how the city is rolling out the ThriveNYC program and measuring its outcomes. This interview has been edited and condensed for brevity. You can listen to the full interview here. 

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NYN: What did New York City’s mental health landscape look like before 2015?

RB: Our experience with ThriveNYC really started with the first lady and the mayor’s experience as parents in New York City. And I’m sure you’ve heard her tell the story before about how one day her daughter came to her and said that she was struggling with substance misuse and addiction and anxiety. And as a mom, that Chirlane didn’t know what to do, didn’t know where to get help, didn’t know what the next steps were. And feeling like that as a well-connected mother, as a wife of a leader in city government and still not knowing where to start, where to look, who to trust for advice, what must other New Yorkers be facing?

And I think that’s really the story about the way mental health is experienced in New York City. It is, in some ways, not a system. It’s hard to find care; it’s hard to find support. And even deeper than that, it’s our biases, our stigma that we have that we associate with mental illness even stops people from looking to get that support.

One of the things that I learned as we started diving deeper and deeper into this work is how ubiquitous mental illness and substance misuse really are. One in 5 New Yorkers in any given year will experience mental illness. One in 5 New Yorkers, and all those New Yorkers have family members and friends and co-workers and parents and children, which means this affects all of us. It drives the economy: $14 billion in estimated productivity losses every year.

“People who are mentally ill are more likely to be victims of violence than perpetrators of violence.”

NYN: What is ThriveNYC doing to streamline the mental health system?

RB: ThriveNYC is a coordinated system of 54 initiatives, so the short answer is, we’re trying to do a lot. But it’s built around certain themes. One of those is around changing the culture. So part of what we’re trying to do is tackle some of the stigma that keeps people from seeking help, or from offering help. Or educating New Yorkers about what mental illness is and how to support those who are suffering. We’re trying to close treatment gaps. By that, I mean just making it easier to find help, figure out where to go and to do that in ways that are natural and feel comfortable and that are culturally appropriate and accessible. (We’re) very much focused on partnering with communities, by which we mean relying on the experience and the expertise and the knowledge that exists in our communities. We’re very focused on acting early, so focusing on prevention. Very focused on data, which means trying to promote evidence-based practices, but also just making sure that we’re always researching what works and what doesn’t work and trying to get all the different parts of a city to use practices that work for people.

NYN: How much of the work is being done by nonprofits?

RB: One of the things we know is that so many of the people who are suffering from mental illness, they may not go to a psychiatrist, they may not go to a mental health professional, they may not feel comfortable doing that. But they will go to their local church or synagogue and talk to their minister. They will go to their kid’s after-school program if they feel comfortable with the counselor there. They will so often go to the institution that they’re already comfortable with, which (oftentimes) in our city are local nonprofit social service organizations, to get help. And a lot of the initiatives in ThriveNYC are about empowering those institutions to do their work more effectively.

NYN: With ThriveNYC, there’s a lot of emphasis on preventive care and reducing stigma. What about those who are severely mentally ill?

RB: One of the things that we know is that prevention is critically important: Half of people have their first symptom before the age of 14. Another three-quarters exhibit the first symptom by the age of 24. They can take nine years, I think, is the average before someone actually gets connected to treatment from the time they first exhibit a symptom, which means nine years of suffering, nine years for an illness to get worse without treatment, nine years for problems to reinforce themselves. It’s very important we have a public health approach to just focus not only on those who are exhibiting the most crisis, but also that we’re working through a prevention lens and a public health lens to make sure we can support people and get them treatment before they get the most ill.

But that being said, Almost everything in ThriveNYC supports the seriously mentally ill. (NYC Well is) a resource not only for those who are suffering, but it’s a resource for friends and family members who may have a family member or loved one who is experiencing schizophrenia or other serious mental illness to get help and counseling. Another big initiative is NYC Safe, where we’re focused on the small, small, small percentage of the mentally ill who also have been involved in violent behavior. We have a very intensive case management approach where we deploy mental health resources to go out and support them.

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NYN: Can you talk about how the NYPD is rolling out crisis intervention training?

RB: There’s a lot that we’re doing to give police officers an alternative to the traditional law enforcement response of arrests or taking someone to an emergency room to try to support New Yorkers who are suffering. But one of them is our crisis intervention training, which is really powerful stuff. To this point, we have trained 5,800 police officers, which is ahead of our target. It’s a four-day training, which is really about teaching police officers around communication and empathy and awareness so that they have other responses and learn how to de-escalate situations. It involves role-playing. It engages police officers with those who are experiencing serious mental illness and gives them a chance to hear from people suffering from mental illness.

NYN: How do you know if it’s working?

RB: One of the things that we try to communicate to people is that people who are mentally ill are more likely to be victims of violence than perpetrators of violence. But nonetheless there’s a small number of New Yorkers who both experience mental illness and who have a history of criminal or violent behavior. Through NYC Safe, we have about 369 people, I believe, people in that program right now. Over 90 percent of the individuals in that program who are not incarcerated or in the hospital – 94 percent of those clients – have not been charged with a violent offense since they joined the program. It’s a really great example of how, if you take the appropriate response and solution to a program, you can get better outcomes.