Like much of the United States, New York City is facing a crisis when it comes to mental health, including addiction. One in five adult New Yorkers is estimated to experience a mental health disorder annually, a figure similar to national estimates. And in New York City, unintentional drug overdose deaths outnumber both homicide and motor vehicle fatalities.
Despite these troubling statistics, what we have now is a culture of silence and stigma around mental illness and substance use disorders, a fragmented array of services and little attention to prevention. New York City, which has been at the forefront of a number of public health battles in the past, hopes to lead a national movement to elevate mental health as a top public health priority. To achieve this, we will have to look to lessons learned from one of the greatest public health successes in recent years: tobacco.
We learned from the fight against tobacco that public health responses require long-term investment, sustained attention, strong collaboration and ongoing political will in order to see results. After decades of incremental progress in the fight against tobacco, lawmakers raised taxes in New York City and banned smoking in bars and restaurants.
Then, city officials blanketed the airwaves, newspapers and subway cars with information about the harms of smoking. And the health department deployed new treatment tools, setting up a quit-line with the offer of free nicotine patches.
It worked. The adult smoking rate declined by 35% between 2002 and 2014, and the youth smoking rate fell by a stunning 53% from 2001 to 2013. We need that kind of a dramatic improvement when it comes to mental health.
New calculations show that mental health and substance use disorders are among the top contributors to shortening the healthy years of life for New Yorkers. Mental illnesses rank right up there with heart disease, diabetes and stroke as causes of poor health when we take into account both what kills us too soon and what reduces the quality of life because of suffering and disability. Major depressive disorder is the single greatest source of disability in the city, and second only to heart disease in terms of overall disease burden.
Our failure to address mental illness isn’t just felt by individuals or by their families. When mental health challenges lead to job loss, dropping out of school or losing one’s housing, it can cost a city the size of New York billions of dollars. Alcohol misuse alone is estimated to cost New York City nearly $6bn in citywide economic productivity losses every year. Depression costs the city $2.4bn in losses.
But we’re starting to take cues from our tobacco successes, and we’ve started the same march forward on mental health. In 2011, after an intense focus on reducing opioid analgesic overdoses in Staten Island, deaths from opioid misuse fell by nearly a third between 2011 and 2013.
The city has invested $130m to reform our criminal justice response to mental health, developed a program to support some of our most at-need New Yorkers and keep them connected to treatment, expanded mental health services in schools and shelters and more.
Too many New Yorkers have fallen through the cracks, because navigating the system is virtually impossible for people who lack the resources or time to make sense of the uncoordinated maze of programs.
It is time for bold action to start a sea change for mental health. The good news is that as a city we know how to take on challenging public health problems – from tobacco to tuberculosis, we have witnessed great victories.
That’s why, in the coming weeks, New York City will launch a roadmap for action to help chart a new path for improving the mental health of all who live in the city. All parts of government – the school system, the police department, the department of homeless services and parks and recreation and many more agencies, are committing to be part of the solution. This represents a real shift from the past – one we believe will result in a healthier and stronger city and a model for the country.