New York Mayor Broadens Mental Health Plan

Monday, March 6, 2023

By Don Sapatkin

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Team care gives youth with psychosis the best shot to recover. Most private insurance won’t pay for it

An estimated 100,000 young adults and adolescents have a psychotic episode every year, often marking the start of a serious mental illness like schizophrenia. A comprehensive team approach has become available in recent years – and when provided early, it is highly effective. It includes medication management, psychotherapy and support services for employment and education, which can help people hold onto jobs and avoid falling apart and ending up on the street. But few people get it, according to an excellent story by KQED radio in Northern California. Some 300 clinics nationwide provide the treatment, but slots are scarce, they are not evenly distributed and not all offer the gold-standard treatment.

Even if a space opens up, however, most private health insurance plans won’t pay for it. Only one state, Illinois, mandates coverage, while Massachusetts and Virginia are considering it; a California bill died in the Senate last year under pressure from the insurance lobby. The result is a reverse disparity: At least in California, lower-income families covered by Medicaid can get the best care available for schizophrenia, while middle-class families with employer-sponsored insurance cannot.

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NYC Mayor announces expanded mental health plan

Mayor Eric Adams has broadened his strategy for addressing the mental health crisis on the city’s streets. In November he announced a policy directing police to force into treatment severely mentally ill people living and often decompensating on the streets. Now he has followed up with a companion plan that focuses entirely on treatment people can access voluntarily, aiming to prevent them from falling apart in the first place, the New York Times reported. An estimated 100,000 adult residents have severe mental illness that is untreated, and thousands more receive slipshod or inconsistent care.

Adams’s mental health agenda targets three distinct populations: children and families, people with serious mental illness, and those at risk of a drug overdose. More a vision than a detailed proposal, most of its initiatives are not yet funded, although Gov. Kathy Hochul’s own $1 billion plan to tackle mental illness in the state will presumably help.

The new plan creates 15 mobile teams to serve more than 800 people – the governor’s would add more – including five “intensive” teams focused on the most challenging patients who often move between shelters, jails, hospitals and streets. It expands a program that sends counselors and medical professionals rather than police officers to respond to mental-health 911 calls. And it invests in “clubhouses” – community centers for people with mental illness that foster friendships, help them connect with education and job opportunities, and are widely regarded as cost-effective. The city’s new health commissioner, Dr. Ashwin Vasan, is the former president and CEO of Fountain House, a New York -based mental-health nonprofit known worldwide for hacing started the clubhouse movement in the 1940s. Today, there are over 300 in 30 countries and 40 states (with several in New York City).

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U.K to cut back on Friday releases for prisoners’ safety. The U.S., not so much.

Prisoners in England and Wales considered vulnerable to addiction, mental health problems or homelessness will no longer be released on Fridays under a bill expected to pass Parliament, the BBC reported. The change (Scotland already has a similar policy) recognizes of the risks faced by newly freed inmates who often are unable to access critical services and benefits on the weekend.

Marc Conway, then 17, was released on a Friday after three months in a young offenders’ institution in London. “I was quite fearful of where I was going to stay that night ─ I didn’t want to stay on the streets,” he told the BBC. With no one left to see him at the housing office, he made a “disastrous mistake” and stayed with a “known associate” ─ violating a condition of his release that sent him back to prison for three months.

The days following release can be dangerous, especially for people with addiction, who are at heightened risk of an overdose. One in three prisoners in the U.K. are released on Friday, and a long-running advocacy campaign led to legislation that would allow Friday release dates for vulnerable prisoners to be moved up 48 hours. There is no similarly committed movement to reduce Friday releases in the U.S., although efforts to limit late-night releases have focused on these same risks. In 2019, California Gov. Gavin Newsom, citing costs, vetoed a measure to allow county jails to let inmates scheduled for late-night release stay in a safe waiting area – but not behind bars – until the next morning. The year before, a woman with a history of addiction was released at 1:30 a.m. and overdosed and died four hours later.

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Three psychedelics walked into a bar …

   SHROOMS: I’m feeling chill, just doing my thing in the forest. But yo, have you guys noticed how humans react to us differently depending on their vibe?
   DMT: Yeah, for sure. Some people are just like, “cool patterns, bro,” while others are like having full-on mystical experiences.
   LSD: It’s like, humans who are chill and open-minded seem to have more fun with us, while the uptight ones just get freaked out.

***

   SHROOMS: You know, I think we should team up more often. It’s been a while since we’ve combined our powers.
DMT: I’m down for that. What did you have in mind?
SHROOMS: Well, I was thinking we could take people on a journey through the forest, and really show them the magic of nature.
   DMT: Oh man, that sounds amazing. And we could throw in a few moments of cosmic revelation along the way, just to keep things interesting.

And we’re laughing our bots off…

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In other news…

TikTok will enforce a 60-minute daily limit for users under 18 in the coming weeks, NPR reported, a response to increasing complaints that social media companies aren’t doing enough to protect young people. Teens can bypass the limit by entering a passcode, “requiring them to make an active decision to extend that time,” the company said in announcing this and related changes. Users under 13 will face the same cutoff but a parent or guardian would have to enter the passcode, enabling 30 more minutes.

Thirty-eight percent of consumers prefer getting behavioral health care virtually rather than in person, Behavioral Health Business reported. While adoption of all telemedicine services continues to grow rapidly, only 28% of consumers said they trust digital health apps with their health information, according to a survey by Rock Health.

Insurers are moving toward “value-based care” models that link part of providers’ reimbursement to patient outcomes as an incentive to improve them. The exception: mental health. In that realm, insurers and providers have largely stuck with traditional fee-for-service schemes that reward volume over effectiveness. “The more sessions a patient has, the more the provider makes, regardless of whether the patient improves,” say two executives of Marvin, a teletherapy company, writing in Harvard Business Review. “It doesn’t have to be that way.”

Online therapy platform BetterHelp agreed to a $7.8 million settlement with the Federal Trade Commission for allegedly sharing customers’ sensitive health data with third parties for advertising purposes despite telling customers it would not, Politico reported. BetterHelp, a division of Teladoc, agreed to change a variety of its business practices and will make partial refunds to affected customers.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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