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Brian Lehrer: Brian Lehrer on WNYC. Now, we're going to turn to a roadmap for navigating New York City's mental health crisis. This came out from city council before the death of Jordan Neely. The New Yorker recently reported that there are over 200,000 New Yorkers living with what they call "severe mental illness." About 13,000 of those New Yorkers, who are experiencing significant mental health issues like schizophrenia or bipolar disorders, are homeless. While the pandemic has likely only exacerbated the crisis, New York City Council believes it has been fueled by decades of neglect and disinvestment for critical services.

At the end of April, the council introduced what it called its Mental Health Roadmap, a continuously evolving plan to improve mental health outcomes. This is one of the biggest, if not the biggest, issue in New York City, how mental health and the housing crisis interact. Joining us now to talk about the plan, including provisions for prevention and support, is New York City Council Member Linda Lee. She represents District 23 in Eastern Queens. She chairs the Committee on Mental Health, Disabilities, and Addiction. Council Member Lee, welcome back to WNYC.

Council Member Linda Lee: Hi, Brian. Thank you so much. It's great to be here. Such a huge fan of you and the show, so it's really wonderful to be here today.

Brian Lehrer: Thank you very much. As I said in the intro, this roadmap was announced in April before the death of Jordan Neely, but his death certainly brought to light, unfortunately, again, how people can fall through the cracks. Can you start with the Jordan Neely case as an example of what needs to be dealt with systemically?

Council Member Linda Lee: Sure. As you just mentioned, the case and the incidence with Jordan Neely almost highlights, unfortunately, more incidences that we're seeing of people who were even identified by certain city agencies but ended up falling through the cracks. The roadmap really does attempt to address some of these issues through four pillars that we've identified.

Just to take a couple of steps back, this roadmap really has been the culmination of years of experience in the non-profit sector that I personally have had in running an outpatient clinic and also the social worker, but really just in working with a lot of our advocates. Something intentional we wanted to do is make sure that the providers and the non-profits that are actually providing these services on the ground, that their voices were actually included in guiding us on a lot of these policy legislative suggestions that are included in this plan.

That's where we came up with these four pillars. Also, as you mentioned, as chair of the Mental Health, Disabilities, and Addictions Committee, we had several oversight hearings last year where many of these topics were discussed. A lot of the ideas reflected in this plan actually are direct results of what we heard on the ground, what we heard from community members and advocates in terms of what they would like to see.

Brian Lehrer: Let me, before I ask you to go into those four pillars, address another thing that got revealed in some of the press to more people than knew it before as a result of the killing of Jordan Neely. According to The New Yorker, he had been arrested more than 40 times, mostly for petty offenses. It came to light in your roadmap notes, Rikers Island is now counted as one of the three largest providers of psychiatric care in the United States. That's mind-blowing, with approximately half of those detained diagnosed with a mental health issue. I mentioned the intersection that's so important to the city right now between the mental health crisis and the housing crisis, but it also intersects in this huge way with the incarceration rates.

Council Member Linda Lee: Yes, it does. Actually, one of the pillars is talking about the intersection with the criminal justice system. As many of us who have been in health care know, housing is one of the largest social determinants of health. We all know that even sometimes before finding a job, housing is the first thing that usually guarantees someone's road to recovery and success, especially if they have a severe mental illness, whether it's supportive housing or someone who needs help getting back on their feet and then is able to find a job.

I think when it comes to the intersection with the criminal justice system, something that we've seen is that, I think more and more so these days, the police and NYPD are being used as almost like a catch-all for a lot of these incidences that we're seeing. I think what this roadmap attempts to do is, and one of the other pillars is, talking about the prevention and supportive services.

What we've seen in the case of Jordan Neely as well as others is that, unfortunately, there are too many cracks and gaps where people can fall through. The question really that this roadmap attempts to address is, how can we make sure that those gaps are getting plugged in and that, for example, if someone is receiving inpatient care, how do we ensure that they're actually getting plugged into services in the community and that they're receiving the care that they need?

Before someone even enters into the criminal justice system, what are the measures that have been in place, whether it's in the school system, whether it's in outpatient care? How is it that we can address these issues before they get to the point where perhaps they do end up in Rikers? The goal is, is that we need to-- We have the resources. Something that we talked about last year is we had a joint oversight hearing with the Veterans Committee as well as the Mental Health Committee.

The veterans treatment courts are a great tool that are just, in my opinion, under-resourced and not being fully utilized and they're understaffed. Same thing with the other mental health treatment courts is, how do we up-resource some of these things that are already in place so that we can prevent situations like having Rikers Island be one of the third highest places where people are getting treated for mental health?

Brian Lehrer: What do you mean by mental health treatment courts? What kind of a court is that and what happens there?

Council Member Linda Lee: For example, one thing with the veterans treatment courts is that if someone, for example, is identified as a veteran and it seems-- There's usually a review or a health assessment or screening that takes place to make sure, "Okay, is this something that is due to a mental illness perhaps?" Because as we know, a lot of veterans do have trauma that they've been through and maybe perhaps have never sought out mental health services because of the stigma. I think what this does is that it places them in treatment. If it shows that through the screening, they actually need services, then it's a way to plug them into the services as opposed to having them go into the jail system or criminal justice system.

Brian Lehrer: Another aspect that relates to the Jordan Neely case last November, Mayor Adams announced his plan of involuntarily removing homeless people with severe-enough mental illness that they're not capable of meeting their basic needs, as he described it, off the streets and subways involuntarily. I've read that in Jordan Neely's case in 2021, he was involuntarily hospitalized at Bellevue and then let back out on the streets to-- From one article that I read, you can involuntarily hospitalize someone, but you can't involuntarily make them stay there, and he just walked out. Is that a problem in your estimation? Is that a hole in the system that needs to be repaired even though it might give the person themselves even less choice?

Council Member Linda Lee: I think two things to that point is, number one, as part of the roadmap, there is a bill that I'm actually sponsoring that is going to collect data and require the city agencies to report on the involuntary commitments. I think the issue is, is that we don't have that data collected in a central location because I'm a huge fan of data. I think the numbers tell you a story.

I think the story that I'm trying to understand in this situation is, what are the circumstances around these involuntary removals? Is it something that may have been avoided if we, for example, had better connections to services and the mental health continuum was stronger? Was it that the person was not aware of all the programs that were available in the community? I think it's just the data that we're collecting, I think, will help inform us about how to pivot and maybe put resources and staffing into other programs that may work.

The other thing I wanted to mention is, is that something that we highlight in this roadmap that, honestly, I don't think many other plans have talked about is the importance of peer-to-peer family services, and the fact that there is so much evidence-based research out there that shows how these services are impactful and how they actually contribute positively to someone's recovery.

I think that's why groups like, for example, Alcoholics Anonymous or Narcotics Anonymous are so successful because it's actually peers who've been through what they're going through that have become mentors for these folks and try to plug them in. I think what we're trying to do with this is use the resources and tools that we know already exist in the community and really just try to map it out in a way that makes sense where we can have, in theory, a continuous, smooth transition between different services and programs based on someone's mental health diagnosis.

Brian Lehrer: What kind of peer-to-peer counseling or mental health service provision could that be? If you're talking about Alcoholics Anonymous as an example, it's a very specific example with people with very specific problems. If we're seeing a lot of the mental health issues, the prevalence of mental health issues that are serious in New York being a consequence, if you agree to put it this way, of socioeconomic conditions, of housing shortages, of chronic poverty, of systemic racism, there's not probably systemic racism victims anonymous or poor people with poor housing choices and food insecurity anonymous. How would peer-to-peer work for the kinds of mental health problems that are sadly prevalent in New York?

Council Member Linda Lee: Sure. Well, I think one example of this, and I know that there are a few organizations that do this, but NAMI, for example, which is a national organization, but NAMI New York City, for example, actually does provide a lot of these peer services. It's a course that they take, which involves a few different types of topics.

I think it really helps people to look at the systems around them, work with peers that have been through what they've been through, the challenges of living with a mental health disorder, for example, and trying to find a job, the challenges of mental health disorder, and dealing with all of the other daily living situations that may be difficult for folks like you and I but are even more stressful for folks that have a mental illness. I think there are programs out there that have been proven to be very effective in work.

Brian Lehrer: Listeners who has a question about the city council's Mental Health Roadmap for City Council Member Linda Lee from Eastern Queens, who is in a leadership role on developing it, she's the chair of the Committee on Mental Health, Disabilities, and Addiction, 212-433-WNYC, 212-433-9692, or you can text a question to that number as well.

I want to let people know that prior to your role as an elected official, you were president and chief executive of the Bayside-based Korean Community Services of Metropolitan New York, a non-profit which, as Koreans put it, provides New Yorkers with mental health care and operates the only state-licensed outpatient mental health clinic in New York run by a Korean-American non-profit. I wonder if you could tell everybody a bit more about unique challenges that you see the Asian-American community, AAPI community, facing when it comes to receiving mental health services because I don't think they tend to be in the news probably as much as they should.

Council Member Linda Lee: Yes, definitely. For example, I think one statistic people probably are not aware of is that one of the highest rates of suicide actually comes from the older adult women in the AAPI community. In the Asian community, we have just as high rates of mental health diagnoses and illness. However, we are the highest percentage of underutilization. We are the population that really underutilizes mental health services.

I think that's due to a few challenges. There's the stigma issue, which is huge and can't be underestimated because a lot of our Asian immigrant communities are very collective. It's not about the individual. It's about the community. The last thing that parents or aunties and uncles want, for example, is to bring shame or any sort of bad reflection to the family or to the community.

I think that has since changed, especially here in the US, but I know that that stigma is very, very prevalent. You see that through some of the suicide rates that we're seeing. I think the stigma's a huge piece. In the recent years where we've seen a lot of increases in upticks in AAPI hate crimes similarly, and I think this speaks to the culture as well, is that a lot of our community members-- because of language barriers, which is huge, a lot of our communities do not speak English as a first language.

The language barrier is huge. There's this culture of like, "Let me just put my head down, not bother anyone, and just keep my head in the sand and not make a ruckus." They're not reporting a lot of these hate crimes. I would actually say that there's a lot more hate crime incidences happening in the AAPI community that are just not being reported. The fact that they have to repeat the trauma that they've experienced over and over again is not something that they're accustomed to.

A lot of times, the community will actually talk about their mental health illness in the form of physical ailments, right? Like, "Oh, I'm feeling super tired. I feel very weak. I'm not really feeling like myself." They'll go to their primary care doctor without realizing that it actually is something related to mental health and stress. I think this goes to one of the other pillars in the Mental Health Roadmap, which is the shortage in the workforce.

This is the number one issue we've been hearing from providers across the board around mental health as well as health care in general is this huge shortage of people in the workforce. I think what we're trying to do is two things, which is, on the front end, build a pipeline for people to get into this sector, especially those who speak multiple languages and are coming from different cultures in a city like New York.

It is very difficult to find, let's just say, a Bengali or Korean-speaking social worker that understands the issues and can help address this problem. That's a large reason why it took me four years, but we opened up this mental health clinic through KCS, and because we saw that the rates of suicide were increasing that the mental health issue was becoming a greater concern in our community, but they had nowhere to go for these services.

Brian Lehrer: How hard is it to get licensed? If people heard you say "social worker," people may have at first thought, "Oh, gee, well, I'd love to help serve my community or other communities by becoming a mental health professional, but I don't know if I have the time or the money to go through being a PhD psychologist or something like that." What's the minimum that people can do? You said social worker. That takes training too. What can people do to be of service in the easiest way?

Council Member Linda Lee: Yes, I think that's why we are trying to-- so the challenge is for a non-profit to get their license to be an outpatient clinic, it is extremely cumbersome for them to go through that licensing process. I think in my conversations with the state because, as a city, we may have funding to give out to these programs, but the state really is the one in charge of overseeing any compliance or regulatory issues around mental health services and how they're delivered in our state.

I've been talking to the folks at the state level. Are there ways to still be respectful of the professional degrees, but also include some maybe certificate programs or other things that can be used? Also, can that be reflected in the reimbursement? I think the other issue that you have there is that through Medicaid and private insurance companies, they will only recognize the 45-minute session that I may receive with my therapist.

What's not reimbursed is all the hours that I have to spend doing outreach in the community, getting the word out, doing workshops for the community. Those things are not reimbursed. I think we need to figure out a way to address this issue on a multi-prong level where we can include other things and services that can be reimbursed, which I think the governor did include in her billion-dollar investment into the mental health system.

Then also from the professional perspective, are there different tiers or levels that we can look at that can be revised in terms of the-- Maybe a peer specialist, for example, can't do the full-on therapy session, but they can be allowed to run group sessions maybe with some other certifications or courses that they go through. I think we're trying to be creative and think of any and all solutions to deal with the fact that we have this huge workforce issue.

Brian Lehrer: This is WNYC FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are New York and New Jersey Public Radio and live-streaming @wnyc.org. Few more minutes with New York City Council Member Linda Lee from Eastern Queens, who chairs the committee on mental health. Let me get it right, Mental Health, Disabilities, and Addiction, and has led the council to a Mental Health Roadmap set of bills for New York City. Francesca in the Bronx, you're on WNYC with Council Member Lee. Hi, Francesca.

Francesca: Hi, Brian. Council Member, thank you so much for your work and your service on this. The attention is really needed. I have one major concern about something that you did discuss earlier, but I didn't feel like we got to a satisfactory answer. I have worked in these as a mental health provider in emergency rooms. One of the most, just the most frustrating thing is somebody having some kind of psychotic episode. Yes, you can hold them for 24, 48, 72 hours, and then you have to release them. There's this very, very tricky, sticky question of mandating treatment.

Is somebody competent enough to say, "I'm refusing treatment," or whatever? Different states have wrestled with this in different ways. Until we come to an actual conclusion about this, about how to handle this, this is why it's a big part of why people are cycling and cycling and cycling because they just bounce in and they bounce out. They, in a non-lucid state, are still saying, "I don't want treatment. I'm good," and they go, and then you can't help them. There's a lot of different ideas about how to address this. Until we do that, I don't see how you're going to solve that part of the problem.

Council Member Linda Lee: Yes, I do think that's a concern. Those are conversations that we're definitely having at the state level because they're the ones that are in charge of a lot of those regulations. One thing I will say to that point though and, again, I know this is not going to solve the whole issue, but the reason why I do think it's important to work on a lot more groups that are able to get their licensing on the outpatient side, for example, is we worked very closely with Elmhurst Hospital in Queens. They do have an inpatient unit. There actually is Korean-speaking LCSWs that are part of that inpatient unit.

I remember having this conversation with them about a couple of years after we opened up our outpatient clinic. One of the things they said was, "Listen, we can't obviously tie this to any clear data, but what we have noticed is that our Korean-speaking clients who have been coming in and out of our hospital as a revolving door, we've seen them less and less after we refer them out to you guys." I think part of what we were talking about is now that they have a place to refer them, they do think that that's something that has been very helpful in addressing this issue because I do agree, it's hard because they may leave the hospital, maybe with some medication.

Maybe they are in a state where they're in a better place. Then once they leave, there's no insurance that they're going to continue on with their treatment and actually go through with a lot of their therapy or medication or whatever it is, depending on their diagnosis. Like you said, it's a complicated issue, but I think that's why we're trying to really focus on plugging folks in and connecting folks as much as we can to the hospital systems because there is so much opportunity for them to fall if there's no clear plan for them or place to transition them to.

Brian Lehrer: Thank you.

[crosstalk]

Council Member Linda Lee: Go ahead, sorry.

Brian Lehrer: Go ahead. You can finish the thought.

Council Member Linda Lee: The other thing I was going to say is, and this is also something else that's included, is that there are nine crisis respite centers across New York City, but it only totals about 50 beds. That's it. Let's just say, for example, someone was experiencing a mental health crisis and on their own said, "Listen, I need to go somewhere. I need help."

I think part of the issue is that the inpatient psychiatric beds at the hospitals have not been fully brought back yet. The crisis respite centers, again, are just another tool and resource in the community that we can utilize. When you think about it, 50 beds across the entire city is really nothing. One of the things that we're attempting to do also is bring more of those beds online and try to invest in that as well because those have been proven to be very effective as well.

Brian Lehrer: Khamenei in Harlem, you're on WNYC with Council Member Linda Lee. Hi, Khamenei.

Khamenei: Hi, Brian. Thank you so much. Thank you, Linda. I knew Jordan Neely. I knew him personally. I attended his funeral. What I shared because I've been speaking at city council hearings as well, what I shared is a tsunami of trauma, that only focusing on the acute issues of like, "Oh, a mental health crisis or people with mental health is also missing the mark." This is not a critique on you. I think this is a critique on larger society about what I call the "trauma class," right?

Especially now after COVID, there's people who are in trauma that is beyond class distinctions. We need to move into a trauma-informed society. When Smokey Bear would say, "Only you can prevent forest fires," it's like, "I would like to start to see public service announcements about how to deal with trauma." How do you as a person deal with trauma? How do you de-escalate someone if someone in your family or your best friend or your roommate, whatever?

I feel like in the curriculum and education, I feel like we need to start to normalize what it is like to see someone be in trauma and have with them which we address that just like we have the Heimlich maneuver. There's ways in society where we have addressed issues that can then literally save lives. I think that needs to happen. I also think when I spoke on the Housing Committee, city council hearing yesterday, there's people that were there talking about, they're bitten by rats, their ceiling are crashing in, there's mold.

I'm like, "That's trauma." It could be someone who "does not have a mental health issue," but because all of our other systems from the HPD, ahem, to the NYPD, and we are taxpaying citizens. We're actually causing people to have mental health issues because our taxation is not represented in terms of actually being preventative as a society. What happens is people don't show up to work or they show up to work and they lash out.

I used to be a teacher for 15 years. Children come to school. They're upset. They bully. All of this domestic violence goes up. All of these things happen not only because "someone has a mental health issue." It's also because when you're dealing with so many different issues and there's no solution and you're still trying to pay your bills, you're trying to get a job, all of that then orchestrates what I call the "trauma tsunami." That's why I'm talking about the trauma class.

Brian Lehrer: Khamenei, thank you for-- and I've got to go because we're coming to the end of the segment, but thank you for such a big-picture take. Council Member Lee, she gets a lot right, right?

Council Member Linda Lee: She does. I think she brings up a lot of really great points. Again, I think people tend to focus on what we see in the news and just focusing a lot on severely mentally-ill folks, but you're absolutely right. There's a lot of things that can cause reactions that, normally, if someone is just going through their day like there's issues. There's things like that in the housing. Like you said, people being bitten by rats. That's something that will impact someone's state of mind for sure.

I think that's why it's something that I am trying to really push at least is we have a couple of hundred or a few hundred, I should say, mental health clinics that are located within schools or clinic-based services that are in our public school system. I'm such a fan of like, "We need to have these services available." It may not even be for someone that's showing any signs and symptoms. It could just be someone like you said who is having a bad day and they're angry about something.

How do you talk about that and de-stigmatize? I think so much of what's around mental health is this stigma. I think a proven method that the previous administration had rolled out was the Mental Health First Aid training. I think that is actually something that worked that a lot of communities and faith-based communities in particular really embraced because it allowed-- I may not seek out mental health services, but I may go to my pastor or I may go to other community leaders and talk about some of the things that I'm going through.

It's really a way to equip them at a very, very high level to at least help identify some of the signs and symptoms that someone may be going through that may not require any sort of inpatient treatment, but maybe they just do need to see a therapist. Maybe they need to seek outpatient care or get plugged in. This is a complicated big-picture issue for sure. I think that's why we need to make sure at every step along the way, we have services that are in place that are able to address, help, identify community members who may be going through something.

Brian Lehrer: There we leave it on the New York City Council's new Mental Health Roadmap with City Council Member Linda Lee from Eastern Queens, chair of the Committee on Mental Health, Disabilities, and Addiction. Thank you so much for this deep dive and for taking calls from our listeners.

Council Member Linda Lee: Thank you so much for having me.

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