ThriveNYC, the groundbreaking mental health campaign launched by New York City's First Lady Chirlane McCray, is quite a remarkable approach to the endemic mental health problems of American cities. In relatively short order, it has advanced making mental health both an approachable subject and a practical mission. The "Today I Thrive" advertising campaign*, itself---with its convincing images of men and women with disorders from schizophrenia to substance abuse proclaiming they have learned to thrive---is a mini-breakthrough that takes us away from the gloomy images that now so strangely dominate public health messages.
The decision to widely involve the public and, especially public employees, in massive training to better handle mental health emergencies addresses the routine civic damage that follows from the fact that those now stationed on the front-lines for mental eruption ---police officers, teachers, firefighters---lack realistic back-up. The Thrive goal to enroll 250,000 New Yorkers in the well-recognized Mental Health First AID Course, a one-day training in responding to mental health emergencies, is just an extraordinary civic goal.
But, after barely a year, Thrive has also hit a major braking point----which is that the workforce to address acute mental health needs in low-income communities, much less for a massive mental health initiative, does not exist. Observing that the provider shortage is a central challenge, Ms. McCray recently told the Kaiser Health News**, "We are not going to grow the workforce we need overnight." She emphasized that, at community meetings, she had heard over and over again, "I want to talk to somebody who looks like me, who speaks my language, who understands my religion. And it doesn't exist."
Actually, an initiative which has already gone so far could reach even further and faster---and indeed create excellent personnel almost overnight, by taking the next step. That step is to fully embrace low-income communities as assets in building their own mental health.
Community Asset Programming, by definition, (or, at least by mine) entirely uses people who live in "high need" communities to implement and deliver programs. This may appear to be a challenge in, say, places like the South Bronx, where half of residents haven't graduated from high school, but actually, New York, with its diverse and innovative community groups can show example after example, where local people, with basic back-up and training, are delivering extraordinary programs--- despite not having high school, much less college degrees. Maternal depression? Doulas, local women who provide pregnant women with kindly support during pregnancy, an encouraging voice during delivery and extra hands to get the baby's needed things in place, demonstrably provide better outcomes for depressed and alone mothers.
Our "justice system involved" young men? Look at the Arches program, started under the Department of Probation, in which older men with a criminal justice background mentor young men on probation. In our experience at Health People, where we have implemented Arches in the South Bronx, half the young men in this remarkable program are back in school or obtain jobs within six months.
The "off the chart" rates of depression and anxiety that accompany the terrible rates of chronic disease, especially diabetes, in low-income communities? Try evidence-based self-care courses delivered by trained peer leaders from the community.
It is important to appreciate that Community Asset programming is very different from community-based programming that, while located in communities, largely brings in social workers and counselors from the outside. Community Asset programming, even as it delivers measurable results, rests on two pillars which inherently build mental---and physical---health across as a range of programming.
First, a community asset approach builds "social capital" even as it delivers evidence-based programming. As Robert Putnam emphasizes in Bowling Alone, his vital book about social connectedness, "Of all the domains in which I have traced the consequences of social capital, in none is the importance of social connectedness so well established as in the case of health and well-being." Massive research shows that simply putting people in groups---disease and substance abuse support groups, community and church groups alike--- is as good for their health as giving up smoking or losing weight! All the programs discussed here bring people together, rebuilding social capital, in a way that is simply not possible in conventional mental health programming. In Arches, for one example, the young men on probation can phone their mentors anytime of the day---or night---for support.
Similarly, by training and hiring local people, even part-time, community asset programming addresses the profound impact of unemployment on mental health---an impact so destructive that research conclusively shows that people unemployed in their teens and twenties---even if they obtain jobs later---still have far higher risks of drinking and depression in middle age
Community asset programming, then, is a vision of programming that, by building social capital and community employment puts any effort at health far ahead from the start---even as it produces real results for participants.
Look at the range of people---new mothers, diabetics, young men already ensnared in the criminal justice system---helped in practical, real, yet profoundly vital ways just through the few examples of community asset programs given here.
The sad problem is that, despite the evidence confirming the outcomes and value of so many programs that communities can readily learn to provide themselves, the regular medical system simply won't pay for them. These programs receive little attention. They remain largely unknown.
Thrive, in its concept, intentions and focus, is perhaps the first major initiative in the United States which could end that awful neglect. At the same time, it could be the national example of how to overcome a national shortage of mental health providers which is so acute that the federal government just allocated almost $45 million for mental health workforce training.***
If Thrive goes the next step by making community asset programming central to its own vision, not only will New York City Thrive more, but the entire national approach to mental health would start to change very much for the better.
*The "Today I Thrive" ads highlight the stories of eight brave men and women of different ages and backgrounds who have struggled with anxiety, depression, bipolar disorder, alcohol misuse and drug addiction. This is the first of a series of campaigns designed to educate New Yorkers about mental illness and drive conversation.
**http://khn.org/news/mental-health-first-aid-chirlane-mccray-on-how-n-y-c-is-fixing-the-system/
***http://www.hhs.gov/about/news/2016/09/22/hhs-awards-more-44.5-million-expand-nation-s-behavioral-health-workforce.html