Series: Breaking Point

Breaking Point

Final thoughts and next steps
Jun 24, 2015

My beat at WNYC is covering poverty. And I’ve been doing it for roughly a decade.  At this point, I’ve probably spoken to hundreds of people, many of whom were either in the middle of a crisis or just getting over one.  Whether it was a single mother of four behind on her rent or a teenager who feared getting shot inside his housing project, their stress and anxiety was often palpable.

These are just some of the experiences that motivated me to explore the intersection of poverty, the justice system, and mental health in New York City in my four-part WNYC series, “Breaking Point”.
The tangled relationship between mental illness and incarceration grows worse, even as crime rates and jail populations shrink. In fiscal year 2010, New York City’s jails had an average daily population of about 13,000, 29 percent of whom suffered from a mental health issue. In fiscal year 2014, the jail’s average daily population went down to 11,408, but the number of incarcerated people with a mental health issue increased to 38 percent.  
At the same time, homeless shelters have taken in record numbers of people. In 2014, more than 80,000 people were either living in shelters or on streets in New York State. Nearly 18 percent of them were considered to be severely mentally ill. 
Shelters and jails have become systems of last resort that are expensive and often make mental illness worse, and while hundreds of thousands of adults and children do use the state’s public mental health system each year, estimates indicate that there are many more who need some level of treatment and aren’t receiving it.
Advocates suggest there is a complicated mix of reasons why:  too few clinics, services that don’t engage people, and stigma. I discovered aspects of all three in my reporting.  The crisis team I followed had to wait up to a month to get a kid an appointment with a therapist, and half their job was convincing parents that treatment for their children was both necessary and worthwhile. The adults I interviewed had accepted that they were mentally ill but many were still reluctant to be identified. None agreed to use their full names. Some had not told family or friends the extent of their illness. Others were concerned being identified would ruin their job prospects. And most troubling, several had experienced symptoms for decades but never got help. Some were in outright denial while others chased physical symptoms and sought help from internists instead of psychiatrists. A National Alliance on Mental Illness survey found that there is on average a nine-year gap between when a person first experiences symptoms of schizophrenia and when treatment occurs. By this time, situations can grow dire and windows for intervention can be missed. 
But the system is on the verge of potential transformation. The de Blasio administration has put more resources into reforming the troubled jail system at Rikers Island. And because of financial incentives to lower the cost of treatment, managed care companies may soon make a wider variety of community-based services Medicaid-eligible. In addition, New York State is receiving billions of dollars in federal funds to reduce hospitalizations under the Affordable Care Act—a portion of the money is expected to beef up community-based care. Many that have toiled or advocated in the mental health system see this as an opportunity to create a system they have sought for decades.
There are always hazards on the road to reform, but the opportunity is there to improve the quality of mental healthcare and dramatically reshape how it gets delivered. The stakes are far too high for us not to seize it. 

Vera is pleased to complement the WNYC broadcast, Breaking Point: New York’s Mental Health Crisis, with a blog series that features the voices of experts from a range of fields as they examine how the nexus of poverty, mental health, and the criminal justice system affects nearly every aspect of New York City life.