From the coverage of Simone Biles’ mental health struggles at the Tokyo 2020/2021 Olympics, to concern about the devastating collective toll of the COVID-19 pandemic on all of us, there is a growing public focus on developing appropriate responses to mental health needs and improving access to care. This focus has spurred a reexamination of how best to respond to mental health crises in communities across the United States. Cities, including San Francisco, Denver, Portland, Oakland, Minneapolis, and Atlanta, are experimenting with new measures that respond to non-violent mental health-related situations in creative ways. New York City remains committed to promoting mental health for all New Yorkers and has made significant investments to improve crisis prevention and response. Among these investments has been increased funding to its mental health helpline, NYC Well. In addition to offering free referrals to ongoing care, NYC Well is a 24/7 resource to New Yorkers experiencing mental and behavioral health crises.
The New York City Mayor’s Office of Community Mental Health (formerly known as ThriveNYC) oversees a large part of NYC’s mental health crisis and prevention work. Public Works recently supported the Office to develop a campaign to make Central and East Harlem residents aware that they have options in a mental health crisis. The campaign encourages New Yorkers to call NYC WELL (1-888-692-9355) for mental health crisis support. By calling the City’s free and confidential mental health hotline, New Yorkers can ask about Mobile Crisis Teams, or to talk to a counselor 24/7 for crisis counseling or suicide prevention. Mobile Crisis Teams are made up of clinicians and peers who provide in-person assessments and refer people experiencing mental and behavioral health crises to care. These teams are deployed about 20,000 times a year by NYC Well, public hospitals, and healthcare providers, responding to urgent situations that require a response in a couple of hours.
What is NYC Well?
NYC Well is the City’s gateway helpline to access the City’s mental health, substance misuse, and suicide prevention services. NYC Well also provides referrals to ongoing care, help with scheduling appointments, peer support, and follow-up. New Yorkers can get connected to appropriate services regardless of insurance or immigration status through NYC Well. Any New Yorker who is in need – or who knows someone in need – can call 888-NYC-WELL (1-888-692-9355), text WELL to 65173, or chat online at nyc.gov/nycwell.
Not all mental health crises are emergencies that require a response within minutes. Some mental health crises require an urgent response or help that can be provided within a couple of hours. In instances where an urgent response will do, New Yorkers have options. In these situations, New Yorkers should contact NYC Well to get connected to a variety of crisis supports, instead of calling 911 for a traditional emergency service or police. Users of NYC Well can call, text, and chat with a mental health professional, who can provide immediate crisis counseling over the phone and, if needed, arrange for a Mobile Crisis Team with trained clinicians to arrive at the person’s location within 2 hours. Once there, the Mobile Crisis Team will provide an in-person assessment and connection to care. If anyone needs emergency in-person help, they should call 911.
“As more New Yorkers become aware of this service and experience it, we hope to see more and more people turning to NYC Well and Mobile Crisis Teams – rather than 911.”
– Susan Herman, Director of the Mayor’s Office of Community Mental Health.
Why focus the campaign in Harlem?
East Harlem and parts of north and central Harlem have experienced a high volume of 911 mental health crisis calls from residents. These neighborhoods had 9,058 mental health 911 calls in 2019; and approximately 8,400 calls in 2020, the most in the City.
In addition to the campaign, NYC is layering more crisis prevention and response help into this neighborhood with the East Harlem Support and Connection Center and the recently launched Behavioral Health Emergency Assistance Response Division (B-HEARD) Teams, which provide a new health-centered response to 911 calls regarding a mental health emergency. Beginning with a pilot in East Harlem and parts of Central and North Harlem, 911 call operators can now deploy B-HEARD Teams—FDNY Emergency Medical Technicians (EMTs)/paramedics teamed with a mental health professional from NYC Health + Hospitals—to people experiencing a mental health emergency that requires a response within minutes.
The new B-HEARD Teams have experience in crisis response and have expertise in de-escalating emergency situations and providing immediate care. These teams are trained to respond to a range of behavioral health problems, such as suicide ideation, substance misuse, and mental illness, including serious mental illness, as well as physical health problems, which can be exacerbated by or mask mental health problems.
This pilot program, like NYC Well and Mobile Crisis Teams, is part of New York City’s commitment to treat mental health crises as public health problems, not public safety issues. An important note – NYC Well callers cannot specifically request a B-HEARD Team as that is reserved as a health-centered approach to 911 mental health crisis calls taking place in Harlem under the City’s pilot program.
According to the Mayor’s Office of Community Mental Health data brief, between June 6 and July 7, crisis teams responded to an average of 4 mental health calls daily in the pilot zone. According to city data, 95 percent of people accepted care from the newly instated crisis teams, much higher than the 82 percent of cases accepting care from traditional response involving the police and EMS. Just 50 percent of people treated by these teams were brought to the hospital, while that figure is 82 percent for typical mental health emergency-related 911 calls.
How did Public Works support the City’s campaign in Central and East Harlem?
The Mayor’s Office engaged Public Works Partners to lead a series of focus groups supporting a public awareness campaign for NYC Well. The pilot campaign, entitled “We Have Options,” launched in July 2021 and informs Central and East Harlem residents of the city resources they have access to through calling NYC Well during a mental health crisis.
Community engagement is key to any effort to create an effective campaign that resonates with neighborhood residents. Public Works recruited participants for a series of five focus groups, drawing feedback from key community groups, including Harlem residents, mental healthcare providers, and those experiencing mental illness in New York City. Participants weighed in on both the effectiveness of the proposed messaging and visuals for the campaign materials. They also provided insights on where campaign materials should be presented throughout the community. These campaign materials were designed by 5Rings Media, a design collaborative of artists, writers, and filmmakers based in Harlem. Throughout our sessions, we heard the following key takeaways:
1. Inclusivity and representation should be reflected in the campaign imagery and language
Participants stressed the importance of crafting a campaign that would resonate with a range of Central and East Harlem residents. To move towards this goal, participants wanted to see subjects whose complex identities varied across cultural background, race, gender identity, sexual orientation, age, as well as dress and occupation.
2. Campaign messaging ought to de-stigmatize mental health struggles and normalize the use of mental health services
Focus group participants expressed that the stigma associated with mental health issues acts as a crucial barrier preventing folks from seeking out help for their loved ones. As a group, participants strategized on forms of messaging that would present NYC Well’s resources as accessible and inviting and that challenges the narratives of shame that accompany discussions of mental health.
3. Mental health must be treated as a collective issue rather than as an individual one.
Residents and providers called for a campaign that would instill a sense of collective support and empathy towards addressing mental health struggles, stressing the sense of isolation many feel at their worst moments. Their ideas for addressing this issue ranged from depicting individuals with a loved one or friend to using the word “we” throughout the campaign.
How did the focus groups translate into action?
Following the discussions, the Public Works team drafted a memo of findings and reviewed the key takeaways with the Mayor’s Office of Community Mental Health and the 5Rings design team. 5Rings then incorporated the focus group findings into a set of final campaign materials that are now in circulation across Central and East Harlem.
The process to develop the campaign through deliberate and genuine engagement with community experts reflects the ethos of the work we do here at Public Works Partners. At our core, Public Works is committed to community-informed solutions and strategies. Empowering residents to participate in their community’s health is why we’re in this business.