Delivering on New York’s mental health needs

Dr. Ann Marie Sullivan, commissioner of the state Office of Mental Health, is charged with carrying out Gov. Kathy Hochul’s agenda for transforming the state’s mental health system, along with expanding care to New Yorkers throughout the state. To date, $2 billion has been spent on the expansion of services, supports and capacity across New York.

Sullivan has served as commissioner since 2014. On Oct. 22, she set aside an hour for a fireside chat at City & State’s Mother Cabrini Mental Health Summit with City & State Publisher Tom Allon – and compiled by Editor-in-Chief Ralph R. Ortega – to discuss her department’s progress on meeting the mental health needs of New Yorkers. This interview has been edited for length and clarity.

Can you tell us a bit about the state Office of Mental Health’s mission? What exactly does the office do?

The Office of Mental Health is really responsible for the mental health of New Yorkers. But we have a special focus, though, on individuals with serious mental illness and youth who have serious mental health problems. But we really do have two kinds of major roles. One of the services that we provide directly is state hospital services, outpatient services, community-based services that we actually fund and provide for those with most challenging issues. And then we regulate, work with, fund a whole host of community-based services all across the state. 

We serve the public sector, over 800,000 people every year, and we have a whole (range of) housing services, working with providers that we work with that provide acute services … etc.

How do you interact with New York City?

We work really closely with the New York City Department of Health and with all the county providers. We work very closely in terms of planning, in terms of service delivery and funding.

So the summit emphasizes the intersection of mental health, substance use and homelessness. When you look at the human scale of this crisis, what is the single most inspiring change you have witnessed?

New York currently funds, for individuals, over 50,000 supportive housing units. That’s the biggest in the nation, and with this governor, we have an additional 3,500 added to that, and over the next couple of years, another 6,000 probably in the pipeline. So while it’s not enough, it’s a major emphasis on making sure that (people) have a home. And when I say home, not just the house, because you need the services that enable (people) to thrive in that home, to thrive in the community.

The core of the Mother Cabrini Health Foundation is the intersection of human dignity and recovery. How can all the stakeholders in this room work together better to ensure that the voice and choice of individuals are truly at the center of the care and recovery process and policymaking?

You know, when I started in this, back in those days in Bellevue, there were no peer movements. There was no recovery movement. Now, since the ’90s, the growth of that movement, it’s just incredibly important that we have that voice of lived experience in everything we do. From the point of planning, point of service delivery, what actually happens between a client and service provider. So yes, we need to have peers embedded in all the services we’re doing, (and) that every new service that we’re putting up as a peer component, it’s really critical to have that. 

Also peers need to be supported as a special team. … Peer specialists are not just people who escort people and make appointments. They are there to really do some incredible work with that individual as a partner in their recovery. We’re also growing a lot of training on that working with peers, and we’re also working to develop a supervisory structure over time that will help peers supervise peers, which is what we would love to have eventually throughout the system.

Keeping housing stability is a central theme for today’s discussion. What are some of the most recent investments the state is making into the supply of supportive housing, specifically for individuals with serious mental illness? And what is the role of nonprofits?

We probably have a pipeline in the next five years of 67,000 units of housing that will be coming out. We are also using the housing first model, with some of our serious illness, mentally overwhelmed and unsheltered. Sometimes it’s a little bureaucratic to get through our housing system, but we have the housing first model. We have certain units set aside so that individuals, when they’re ready, can move from maybe living on the streets or keep in the shelters, right into housing without all the other kinds of things that happen, and that’s been very successful. I think it’s over 300 individuals recently who had to go into that (and) almost 80% have stayed stable in housing, many of whom (had) been unsheltered for a long time. 

So there’s an investment, not just in dollars to build the housing, but also in models of housing. For example, we’ve got new models (of) housing, which is called transitional housing, which will be there for individuals leaving emergency rooms and hospitals, and then from the transitional they would move to permanent housing.

What we need from the communities is to work on the stigma about siting housing. One of the delays in getting housing is developers having trouble siting housing. There is still out there a lot of stigma about housing (people with) mental illness. So we really need to support the industry. We need to support everybody to have communities understand that housing individuals who live there are part of the community. They help the community thrive. They contribute to the community and not to be so afraid or frightened that somehow this is going to have some negative impact on their communities.

Developers find it easier, in many ways sometimes, to help other populations that need support housing. So we have to work on the stigma issue, because that’s the real determinant (in) getting enough housing out there. 

Tell us about a specific cross-agency model or initiative that has been particularly successful in ensuring housing.

We work very closely with the MTA and with the Office of Temporary and Disability Assistance with what we’ve called state options support teams, which allow us to work with the unsheltered homeless in New York City. Also, we’ve expanded those teams upstate. About half the teams are upstate. There’s a lot of homeless throughout New York state. These are often individuals who’ve been on the streets for decades. Other outreach teams who do great work have approached and tried to … kind of engage them, but their job is really to engage and then get them to the next level … but then they don’t really see them anymore. These are the individuals who say, “No, no, no, no, I don’t want anything.”

State options support teams have gone out and spent the time to really engage those individuals and then stay with them through their transition to permanent housing. That’s the difference, because this particular subset, the individuals, they learn not to trust us, not to trust the system. So it’s very important that we have that kind of connection, to stay engaged and work with them across the state. We’ve been successful with these teams working really intensely with individuals who people have kind of forgotten about. We’ve been able to house, permanently, 1,400 people. We’re really very excited about that and the model continues to grow and to work, and we just have them first with this. It’s really an engagement model. … The governor funded that three years ago and has continued extension funding across the state.

Young people, especially, are interested in giving back. So, we’ve had less trouble recruiting for these positions than for some of our more traditional positions, because there are people who really want to do this work. They’re very excited about doing the work.

How can we bridge the gap between clinical support, stable housing and sustainable employment, and what are the key performance indicators that your department uses to measure the long-term success and integrated approach?

Employment, if we think about everybody, just to keep ourselves in this, when somebody says, “Who are you?” Then they say, “Well, what do you do?” Employment, the jobs we do, are very important to us. And for far too long, in the history of working with individuals with mental illness, there was this belief that sometimes employment was reaching too far, and that’s dead wrong. Employment is something that everyone should, if they want to, have the opportunity. And so we’ve been doing a lot of work with our psychiatric rehabilitation services … to help people get employment. It’s an evidence-based practice. It’s pretty successful, and we are spreading that across the state in multiple places to help individuals get employed. We monitor the employment numbers. They’re not anywhere where we want them to be. They fluctuate in the mid-teens up to 20%. Between you and me, that’s terrible. We should be up at 60%, 70%. We’re working to get that percentage up. 

Partly we need partnerships to do this. We need people to have faith that they can work with us, that they can meet with these employment outreach programs, that they can hire individuals. They can be successful. They can be productive. 

This is something that we really are focused on. Outcomes? I think two big outcomes, one you want to look at is employment, and the other one is quality of life, and that’s a tough one to measure. We do do surveys. We go out there and ask individuals who are in our systems of care, “How’s your life? Are you happy? Do you feel that you’ve gotten the success you want?” 

You’ve got to constantly measure things beyond just whether someone comes for a visit. You’ve got to try to help measure whether we’re giving the quality of life that individuals deserve and employment is a big piece of that.

What do you think a bit about the evolution of the clubhouse model?

The clubhouses are really terrific. … They support individuals so that they become part of that clubhouse, become part of the community. They work with you also on: “What are your goals and dreams?” That might be employment. That might be volunteering. That might be reconnection with your family. It might be just writing a poem today. ... They connect with that person, and they say, “What do you want? And how can we get there?” And as a community, they work together, which is just tremendous. … And everybody’s welcome. You can come and go. 

Places like Fountain House in New York City, Venture House … these are beautiful programs where individuals can come and spend as much time as they want. They can learn some skills if they want. They can become a part of the community.