Gary Belkin: Improving population mental health: Thrive NYC


So this is where we launched what we call
Thrive NYC. At that point it was just a report. Now we have 54 initiatives up and running,
a first four year of course of about a billion dollars. You can’t solidify the workplace, secure
neighbourhoods, figure out your prison problems, graduate everyone you want to graduate, reduce
your healthcare burden if you’re not taking on mental health in its fullness. Maybe one out of five Americans who have major
depression will get evidence based care for it. So there are two realities we wanted to take
on. The mismatch between the size of the problem
and the approach, and the mismatch between our reliance on a treatment system that just
wasn’t reaching people and living up to the challenge. There was the diligence to with widespread
community input to decide what were our North Stars? What were our guiding principles? Change the culture included everything from
training a quarter of million New Yorkers mental health first aid, to training half
the New York Police Department in how to manage behavioural emergencies on the street. Act early, with whole new investments in social
emotion learning of course are public pre K and day care centres that touch 100,000
kids every year and social emotion learning skills, close treatment gaps and we identified
some key gaps we wanted to close such as universalising, screening and treatment for pre and postpartum
depression. Partnering with communities, doing pace based
work for this ensemble of stuff to really work and to really be sustained and permanent
and to see their impact, use data better. Created a whole new thing called the Milhove
Innovation Lab in our health department to come with new sources of data and we’re
exploring crowd sourcing and learning about gaps and needs through push surveys and pooling
data sets that never talk to each other and then finally position government to lead. For government to do these 54 new initiatives
and to do this approach, it has to change. In the skill sets it has, and the structures
it has and the data it has, in the way it engages with the communities that it oversees,
that it governs. And so we created new structures. We’ve created a mental health planning council
that brings multiple city agencies together, so you have parks department, probation, police,
child welfare, economic development all talking about how they are all working toward shared
aims around mental health. So what I just described to you is sort of
where we started with the commitment for a principle-driven, public health approach to
mental health. By public health I mean what also informed
the initiatives were looking across the population; who is affected, where are our key risk opportunities
to intervene, but there are three other things I just want to briefly mention that we learned
as cross-cutting ways of implementing this stuff. They are Explode the Work or Explode the Workforce. To do those initiatives we have to totally
rethink the workforce; who’s in it, what skills they have, how they relate to each
other. We need to Engage the City and I mean that
in a very deep way and I’ll talk a little bit more what I mean by that, and we have
to Learn. It’s not the external party coming to do
the three year evaluation that’s get reported at the end, that’s not where learning happens. Learning happens in the day to day effort
to make this work and that’s where we lose most of the really precious data about how
to do this. So we have to equip our frontlines to be laboratories,
through improvement practices, through other embedded and facilitated supports for them
to do that and we saw that as a mission of the city. It’s engaging the city into this work at
all levels. It’s not just the business of the health
department and it’s not just the business of government. Most of the Thrive initiatives that are funded,
the 54 initiatives actually are owned or co-owned by agencies other than the health department,
and we found in New York that also if you go, if you travel, if you step out you start
to find what the healthcare system is not finding. So, the data at the bottom right is from a
colleague of mine who did a convenience sample of churchgoers one day in a black church in
Manhattan and used the PHQ9 and found these depression rates which are higher than you
find in primary care, about three times what you find in the general population. So if I’m a public health planner, if I’m
coming in from a public health perspective, my priority is making sure priests know what
to do, is to go to churches to find, to find the people that we’re missing and so if
you put all these things together, you really have a very different topography of how you
are thinking about your mental health system. It’s not in your centres, it’s partly
in your centres, but they have a different role. They’re in task shifting mostly to skill
build, coach and mentor others to be frontlines as well as to get more serious folks who need
specialised care. My last message to you is if you’re going
to think about to think at a population level is to have permission, to speak exceptionally
about the completeness of the work that you need to do to succeed and the strategic anchors
you have to be honest to, if you’re going to succeed before things get unleashed. It’s proven very helpful to us, it’s kept
us honest as sprawling and as nerve racking and I can tell as many crises every day we
have on each of these 54 initiatives to keep track of, but it keeps us on a strategic direction
and a hope of strategic fidelity to these kinds of transformative possibilities. Thank you.

One thought on “Gary Belkin: Improving population mental health: Thrive NYC

  1. You won't improve an invented idea by applying another idea, you are clutching at straws; validate your post modern neo marxist ideologies prior to you launching them and destroying lives.

    You can't claim mental health as an ideology when it is all so connected into the bigger picture and our individual genetics. Until you teach all that's needed to understand their individual health then it is pointless spending public funds on ideas that you already know are fabricated as you haven't told them how they are let alone showed them the way to find what's relative to the Gestalt..

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