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Brian Lehrer: Brian Lehrer on WNYC. Earlier this month, Mayor Adams unveiled his administration's latest agenda for addressing the growing mental health crisis in New York City. This is one of the most important things we could talk about, titled Care, Community, Action, A Mental Health Plan for New York City. The plan focuses on allocating $20 million to help the city's youth as well as those battling addiction and serious mental illness.

There's a lot to unpack in this plan. We're going to get to it with none other than New York City Department of Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan, who continues to make himself very available to the show and to your phone calls. Dr. Vasan, we always appreciate when you come on. Welcome back to WNYC.

Dr. Ashwin Vasan: Great to be back with you, Brian.

Brian Lehrer: In the release of the city's new mental health plan, you refer to mental health needs as the second pandemic, the first obviously being COVID-19. The comparison sounds quite dire. What does the mental health crisis in New York City look like, just to give people a refresher before we dive into policy?

Dr. Ashwin Vasan: Yes. Thanks for the question. We're really in an unprecedented time of need, emerging from the worst public health crisis in over a century. The trauma, the isolation, the pain, the social and economic security, and really the direct impacts on health have led to a series of mental health issues that we're all facing in ways big and small, in ways that are seen and unseen, and in ways that are felt and yet to be felt because we know that when we've been through a big trauma like this, the closer we are to it, the further we are from actually understanding the ripple effects.

The bottom line is, we're in a health crisis. The city is facing the largest drop in life expectancy that it's experienced in over a century. While COVID is a principal driver of that, so too our mental health issues, whether it's rising overdose rates, rising rates of violence and suicide, or indirectly through the impact on serious mental illness and social isolation, the impact on our young people. People are hurting, people are dying too soon, and this is a plan to really meet the moment by focusing on the groups that have the greatest needs.

Brian Lehrer: What's driving it now, as you see it, if we accept that the pandemic is over, more or less, in terms of how young people can go about their lives, what's driving a youth mental health crisis today?

Dr. Ashwin Vasan: As a parent, this is very personal to me. I've watched my three school-aged kids really be impacted by the isolation, the closures of schools, the fear, and the anxiety stoked by the pandemic. That's a trauma that while it may have been present for a short amount of time on the order of a year or two, the impacts are going to be felt for years to come.

When you take that combined with the fact that the isolation forced young people to go inward, look at screens, connect more on social media, and with some of the positive and a lot of the negative that comes along with that, and you're hearing young people say that, "My time online makes me feel worse. I feel worse after using social media platforms, and I'm hurting," which is why youth mental health is such an important pillar of this plan and why we're making a pretty transformative investment to build a digital mental health platform that will meet high school-age New Yorkers where they are.

We know that young people, 13 to 17, are most impacted, and we know groups like teenage girls, in particular, are expressing unprecedented rates of suicidal thoughts, sadness, and hopelessness. It really is a convergence of multiple things happening at once that's impacting our kids, but the pandemic really tipped the scales.

Brian Lehrer: Listeners, what questions do you have for Dr. Vasan, New York City's Department of Health and Mental Hygiene Commissioner? It's worth lingering on your title there for just a second because I think people probably including me in some of your past appearances so easily shorthand your position as health commissioner, but some years back before Mayor Adams, it was renamed the Department of Health and Mental Hygiene. This is really an integral part of the job, and I know you come out of the mental health sector into this job, right?

Dr. Ashwin Vasan: Yes, it really is. Around 25 years ago, the city made a choice to merge our Department of Mental Hygiene and our Department of Health into the Department of Health and Mental Hygiene. It has historically really been one of the few local jurisdictions that has done so, but it comes from a recognition that our brains and our bodies are connected, and the same factors that drive our health and well-being physically are the same things that drive our health and well-being mentally. I'm very proud that our city has realized that long ago and that my job is to bring these systems together.

One of the interesting and important parts of this plan is that it really is centered around public health, and what do I mean by that? It means investing not only on care and treatment because we know that care for many is too hard to access and too complicated and often not culturally competent, but we also have to invest in prevention. We have to go upstream and invest in the drivers of our mental health crisis, which means for youth, we are investing in social media and the toxic impacts of social media, we're building that digital access platform.

For overdose prevention, we are investing in harm reduction and supervised consumption as one pillar of that, as well as things like naloxone. For serious mental illness, we're not just focused on acute care in hospitals, we're trying to focus on ensuring that as few people as possible ever end up in crisis and ever end up needing street outreach or acute care, or hospitalization by investing in the community mental health system that we've always needed, we've always deserved as New Yorkers, but never really had.

Brian Lehrer: Yes. I got sidetracked there on the way to giving our listeners the phone number in talking about your title, but listeners, what questions do you have for Dr. Vasan regarding the city's latest mental health initiative, or stories you want to tell regarding the severity of the crisis at the community level? 212-433-WNYC, 212-433-9692. Do you think you or a family member might benefit from this plan?

The plan has three main goals, increase youth services and study the scope of the need among young New Yorkers. Two, reduce overdose deaths 15% by 2025, and three, double the number of connections for New Yorkers with serious mental illness to community-based treatment over the next four years. Do you think this will help you or anybody you know or what question do you have? 212-433-WNYC, 212-433-9692. I can see our Twitter feed again, so you can also tweet @BrianLehrer, and we can take some questions there. Let's take a phone call right now. Here's Katie in Brooklyn, you're on WNYC. Hi, Katie.

Katie: Oh, my God. Hello. I'm so excited to be on the air. I'm wondering how the commissioner feels about Mayor Adams' original plan to get homeless individuals off the street and force them into psychiatric care and how the mayor's intentions aren't really addressed to systemic levels of mental health treatment. Like I don't think our hospital system has the capacity for these individuals and there's not really any services to connect them to. I'm just wondering how the commissioner's goals fit within the mayor's plan. Thank you.

Brian Lehrer: Thank you, Katie. Commissioner.

Dr. Ashwin Vasan: Thanks, Katie, for the question. When you see our plan, it's a 75-page robust plan, particularly for serious mental illness and mental health crisis, is focused on two things. Number one, ensuring that as few people as possible ever end up in the kind of extreme crisis on the street, in our subways, even in their homes that require crisis response services. That means investment into upstream community-based care, into rehabilitative services, and into supportive housing, in combination with the governor's commitments into mental health supportive housing.

It also means creating a really robust front door to the mental health system that is not simply based on our 911 emergency response, but that is leveraging the NYC Well, our mental health hotline, and building into it the work of 988, the national suicide prevention hotline and to make New York City an exemplar in its implementation because we need to create a front door to our mental health crisis system, in particular for people with severe mental illness that is led by health professionals.

That's what this city is committed to doing, and that's what this plan does. It's really focused on making the comprehensive investments you referred to, Katie, which will ensure that as few people as possible end up in that extreme need and extreme crisis.

Brian Lehrer: I should say that even though the early part of our conversation was about this plan that you're laying out and how it will address the needs of young people, in particular, and we didn't mention that particular piece that got a lot of headlines about hospitalizing people against their will who are perceived to be unable to take care of themselves because of serious mental illness. That's what a lot of our callers are asking about.

I don't want to keep taking calls on basically the same question, but on behalf of them, let me follow up and say that I read that since that policy was announced by the mayor, the NYPD has actually forced hospitalization on fewer people or at a slower rate than before the policy was announced. Is that your understanding?

Dr. Ashwin Vasan: I think we're still working through the data as an interagency group, because really we're working across agencies. This isn't just about the NYPD, it's not just about the Department of Health or public hospital system, it's about multiple agencies including our Department of Homeless Services really working together in a coordinated way, which we announced early on in the Adams' administration as a part of our subway outreach plan.

The bigger picture is that the intention was never to unilaterally increase a particular type of removal. It's really a commitment by the mayor and the city to say we're not going to walk away from anyone we see in need. I think the mayor and, frankly, myself as a doctor, we see need increasing on our streets and have over several years, and during the pandemic also seen that we've become a little almost inured to it.

Then I think that the mayor and the administration has said, "Well, we are going to stay. We're going to engage. We're going to keep engaging. We want to focus on voluntary removals. We want to make sure that that's the focus and that's the optimal outcome, but in a very small subset of cases how do we get a person the help they need when they need it while they're facing really a complex set of health, mental health, and social challenges." It's not surprising to me that the program is rolling out in this comprehensive way because that was always the intention however it was reported or however has been discussed.

Brian Lehrer: The city is also aiming to reduce overdose deaths by 15% through various harm reduction initiatives like expanding access to naloxone, also drug checking services, creating a network of harm reduction hubs, and looking into opening more overdose prevention centers which some people object to politically saying the city is therefore facilitating opioid use, which leads to more risk. Can you talk about that? Not from, "Ooh, gross, they're allowing people to inject themselves," but from a public health harm reduction standpoint, risks, and benefits?

Dr. Ashwin Vasan: As you heard me say publicly, Brian, if it weren't for the COVID pandemic and this infectious crisis we've been dealing with, our rising overdose epidemic would be the number one public health issue on the top of everyone's minds. In 2021, we had nearly 2,700 people die of fatal overdoses. That's a record. In the first half of 2022, almost 1,400 people died, which means we're on a trajectory to have 2022 surpass 2021. A New Yorker is dying every three hours of overdose, and so that's a crisis.

For me, as the city's doctor, it behooves us to do whatever we can to save lives. We're very proud of the work we've done to partner with our harm reduction organizations in the community to open up the first supervised consumption sites or overdose prevention centers in our city because now, after a year of operation or more than a year of operation, we know that more than 800 people have been cared for in those supervised settings who would otherwise be using in silence, and in isolation, and maybe even out on the street and in the community with a much, much greater risk of death.

Across those 800 interventions, 800 instances, we've not seen one death. We haven't even seen a 911 activation needed because skilled, trained, compassionate, and dignified care is being provided indoors and breaking down stigma, breaking down discrimination, and bringing drug use out of the shadows. The only way we're going to bend this curve is by investing in a comprehensive approach, and that has to center meeting people where they are through harm reduction and keeping them alive with the fighting shot to recover because everyone deserves to live.

Brian Lehrer: Are the overdoses mostly from fentanyl, the lab-created opioid?

Dr. Ashwin Vasan: We know that fentanyl is extremely powerful. It can be up to 100 times more powerful than morphine, and that in 2021, 80% of overdose deaths involved fentanyl in some way. When we talk about what we need to do to bend the curve, we're also up against a rapidly shifting illicit drug supply, which is killing people both and causing a much stronger level of opioid dependence and tolerance than we've ever seen. All the more reason why we need to really allow people the time and give people the supports and give people the spaces where they can manage this really powerful disease of addiction and stay alive in the process.

Brian Lehrer: Republicans often say fentanyl is coming largely from Mexico and so that's another reason to seal the border. Is that your understanding? Because I always scratch my head over this idea that something that can be created in a lab, the lab could be in Queens, the lab could be in Rockland, but they say it's being imported from Mexico. How much is that the case?

Dr. Ashwin Vasan: Look, I'm an internal medicine physician by training, and I've used fentanyl for patients at the end of their lives dealing with significant end-stage cancer, end-stage illnesses, and a great deal of pain. Often, it's a drug that's used during hospice care to take away pain and to ensure comfort care and quality of life. To see this proliferating in our communities is obviously extremely disturbing. Can't really speak to the origins of this because-- but we do partner very closely with our agencies from federal, state, and local to really try to stem this tide because it continues to come into our cities, continues to come into our neighborhoods, and it's also why we are investing in drug checking as well.

We have a drug-checking pilot at four sites, and this plan will expand that because we know that it has to also get down to the level of the individual that can make safe choices. Often, people don't even know what's in the substances they're using because it's cut with fentanyl or cut with other substances and we need to ensure that they can stay alive and do so safely.

Brian Lehrer: You're saying you don't know where the fentanyl is coming from that's being shipped to the city?

Dr. Ashwin Vasan: Yes. I think that's a question for law enforcement partners and for-- I know that our federal partners, in particular, our DEA partners are really trying to trace the sources of this, but I'm a doctor, I'm a public health provider, and my job is to keep people alive, to save lives, to prevent suffering. That's exactly what this plan tries to do for people who use drugs, for people with serious mental illness, and for our young people, focusing on the three populations with the greatest urgency and the greatest needs in order to address this most important of public health crisis that is contributing to our life expectancy decline in New York City.

Brian Lehrer: The term that we've used a couple of times now, drug checking, what is that?

Dr. Ashwin Vasan: Drug checking is a program where anyone coming into one of our four harm reduction centers, harm reduction hubs, can actually have the substance that they intend to use tested for its ingredients. It can break down how much fentanyl's in it, how much of another substance is in it, whether there's any unexpected substances in it, and then can get counseling and education, and information about safety. Maybe it will cause a person to not use at that moment. Maybe it will cause them to adjust their use at the moment and to take a smaller dose.

What is clear is that going in blind into these events for people who use drugs is an extremely risky endeavor when we have so much circulating fentanyl and other substances in our drug supply.

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 at wnyc.org. Coming up to eleven o'clock, a few more minutes with New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan, on his and the mayor's new mental health program. Steve in Manhattan, you're on WNYC. Hello.

Steve: Good morning. This is a crisis for families like mine where we have a child or a loved one who is facing a substance use disorder in opioid addiction. I am among the most fortunate because I've had a tremendous amount of support through other parents who have gone through some of this. I am grateful that my son today is in recovery, but I know that this is a crisis for families and we need support for entire families.

I've heard this called a family disease. It's an infectious family disease, and we need programs that support families. We may not be able to cure our kids of this addiction, but we can help preserve our families and be there, available to support attempts that our kids might make towards attaining recovery. We need New York City to step up for family support.

Dr. Ashwin Vasan: Thanks so much, Steve.

Brian Lehrer: Thank you, Steve. Go ahead, Dr. Vasan.

Dr. Ashwin Vasan: Thanks so much for sharing your story. I think you're modeling exactly what we need much more of, which is openness and dialogue about the strain and the pain underneath these issues. I, too, I come from a family where I've lost loved ones to mental health and addiction, where I have loved ones currently who struggle with mental health issues, and that has ripple effects on me, on my family. You're absolutely right. The family unit is so critical to our mental health plan.

That's why for our overdose plan, in particular, we have our whole goal organized around family support, both post overdose as well as in prevention, and really working with both our medical examiner's office as well as prior to a fatal event, getting families social work support, and really connections into supports that they need to support their loved one who's facing a really terrible and powerful disease. For our youth mental health plan, and this is why centering this on public health is so important because we have to intervene early before our children's mental health needs devolve into something that could end up in addiction or substance use.

We know that that doesn't just involve giving care or support to the individual, the individual child and student, or student. It's about involving the school. It's about involving the family unit. This plan outlines a comprehensive approach to supporting children, youth, and families, not just the affected children themselves because we know that a child's life and their ability to manage their own well-being is deeply impacted by the family unit. Thank you so much for raising these issues.

Brian Lehrer: Let's end on this as we run out of time, and maybe as a service to other parents who are in the position now that Steve has found himself in in the past. I see that a hefty chunk of the $20 million allotted for this entire mental health plan has been allocated to funding telehealth services for teens. $12 million is what I've read into this initiative. Explain why telehealth. Is there a plan to provide resources in schools or how does the telehealth work?

Dr. Ashwin Vasan: Let me just zoom out for a second, Brian. I know the focus is on the dollar figure that we announced in the plan, but one of the things that I'm most proud of about this plan is that we really understand how this system works, and it is a building block of local, state, and federal funding of which we're seeing unprecedented levels of new funding, like the governor's commitment for a billion dollars into the mental health continuum. The Biden administration's new commitments into mental health-certified community behavioral health centers, and the 988 crisis hotline.

We have to braid this funding together and make it work together and drive it into our community. There isn't a dollar amount that a local government can throw at the issue of mental health that doesn't need to take account for the way that we pay for our mental healthcare, which is through things like Medicaid and state and federal grants. I just wanted to start there.

Brian Lehrer: It's fair to say that in the city budget, which is $100 billion a year, roughly $20 million is such a drop in the bucket for such a defining problem these days as mental health. You're connecting it to other kinds of funding that go into this same project, right?

Dr. Ashwin Vasan: We've announced $20 million in new funding. We have put already $370 million in year one of the Adams administration into related programs that are contained within this plan. It's going to be year on year building each floor of a mental health system that we've always needed and has never really had the level of investment from any level of government that it's needed. We didn't get here overnight. We're not going to get out of this overnight, but we're going to have to year-on-year, budget cycle after budget cycle build and construct this system.

Now on telehealth, you asked about why telehealth in particular, because in point of fact, young people are saying that's how they prefer to access care. They want to be independent, they want to do it on demand. They want to do it through their digital devices, which they're, obviously, digitally native and feeling comfortable working through their smartphones or their iPads, and they don't want to have an intermediary, an adult, a school administrator, or anyone else standing in between their relationship between themselves and a provider.

The goal of this initial plan is to create the lowest barrier to entry for the greatest number of young people possible and to meet them where they are using platforms that they feel comfortable with. That said, we understand that in the course of that, we're going to identify needs that are either more sustained or more severe and that need tangible connections into site-based care, in-person care, whether it's delivered through school-based health centers or delivered through our network of community mental health centers.

This is about really building that continuum, but the front door of the system for young people has to be a front door that they want to walk through, and that's through their devices. They're saying that very clearly in survey after survey.

Brian Lehrer: New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan. Thanks as always, doctor.

Dr. Ashwin Vasan: Thanks, Brian.

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