Transcript: Mayor Adams Unveils Ambitious Mental Health Agenda Focused on Improving Family and Child Mental Health, Addressing Overdose Crisis, and Expanding Serious Mental Illness Support

March 2, 2023

Mayor Eric Adams: My fellow New Yorkers. Today, I want to speak to you about the next phase of our plan to address mental health in this city. A plan which has been long been needed, but is only now being reckoned with. Three years ago, the Covid-19 pandemic began here in our city, killing thousands of New Yorkers, and eventually over a million Americans. The fear and trauma were overwhelming, especially for those on the front lines and those with fewer resources. Overnight, New Yorkers lost their livelihoods, their support networks, and people they loved. Our city was empty and our hospital beds were full. All of us experienced uncertainty, stress, and isolation, and thousands more experienced grief and economic insecurity on a scale unseen in generations. Mental health became part of our everyday conversation. And as we recover and rebuild, we have come to a deeper understanding, that we must focus on the brain as much as the body.

We must address the whole person, the whole system. We saw how the injustices of the past were magnifying the impacts of Covid-19, from unequal health outcomes to addiction, violence, and educational disparities. We realized that this mental health crisis started long before the pandemic, and that we will have to change the way we approach mental health as a city, as a community. That change begins now, with us.

Today, we are releasing a comprehensive report that would outline the second phase of our mental health plan. This report, “Care, Community, Action: A Mental Health Plan for New York City” — this plan is the result of an intensive interagency effort over the last year, one that drew on every part of our city government. From our healthcare experts to our first responders, and our educators, we look for gaps in care, and ways to get people mentally healthy and physically healthy. This report focuses on three main areas. One, actively promoting the mental health of our children and families through prevention and intervention. Two, addressing addiction and the overdose crisis. And three, expanding support for New Yorkers suffering from serious mental illness.

I want to thank everyone who worked so hard to put this plan together, including the public health leadership of Deputy Mayor of Health and Human Services Anne William-Isom; Health Commissioner Dr. Ashwin Vasan; the New York City Department of Health and Mental Hygiene; New York City Health + Hospital President and CEO Dr. Mitch Katz; and the entire H + H team; our dedicated city and state agencies; our valued community partners; and people who lived with experience of mental health needs. The entire text of this plan is available online at nyc.gov/mentalhealthfornyc. I want to highlight some of the approaches we'll be using to support mental health in key areas. So often I talk about addressing problems upstream, instead of trying to solve them downstream. A healthy city begins with equity, good jobs, good schools, and affordable housing.

No one can be expected to thrive mentally and emotionally if they don't know where their next paycheck or next meal will come from. This is an issue that touches every aspect of our lives, and it starts with our youth. We've all seen the isolation and trauma that children have experienced over the past several years, along with the results: disappearing into screens, behavioral issues, and even suicide. Year after year, suicide is increasing as a cause of death for young people. As of 2020, suicide is the second leading cause for adolescents 10 to 14-years-old. Right behind gun violence, the number one killer of our youth. 9.2 percent of New York City public high school students reported attempting suicide in 2021 alone. This is a major crisis that we cannot ignore. We must take action to address youth mental health now. That is why we are going to use our public schools as our first line of defense, expanding school-based mental health clinics, and providing social emotional learning, and screening for interventions.

We're also going to launch a comprehensive and accessible telehealth program for high school students, create a youth suicide prevention pilot program, and increase youth suicide prevention data resources and tracking capacity. We're going to make it easier for young people to get help and healing before it's too late. We are going to let children in crisis and not going to allow them to fall through the cracks of the system. This won't happen. We're also going to examine the potential risk of social media to our children's mental health, and work to make sure tech companies are required to keep online spaces safe for our kids. Our second area of focus, the substance use and the overdose crisis. Across this nation, we see the effects of addiction, from small town America, to the sidewalks of our biggest cities. Opioids use is skyrocketing. Illegal drugs are often contaminated with toxic levels of fentanyl, or other dangerous substances, and overdoses have hit historic levels everywhere, including New York City.

2021 was the worst year on record for overdose deaths in our city. And drug related death is a leading cause or mortality among people experiencing homelessness in our city. We cannot allow this crisis to continue taking lives and destroying communities. We must ramp up our efforts to prevent fatal overdoses, and get treatment to people who need it. This plan would expand proven harm reduction in treatment strategies with the goal of reducing overdose deaths in New York City by 15 percent by 2025. Saving lives, dreams, and families. We're going to increase the availability of overdose reversal drugs, especially in high-risk areas, provide more medication for opioids use disorder, as well as clean syringes and other safety supplies, and reduce the risk of overdose by expanding the distribution of fentanyl test strips, that will alert users to dangerous levels of the drugs, before it's too late.

We also support the opening of more harm reduction hubs and overdose prevention centers. These spaces will provide those in crisis with low barrier assistance, and decrease the chance of overdosing through treatment and recovery options. We will also support and invest, and people return into the community from jails and prisons with more job training and housing support. We want New Yorkers to have access to the services they need, when they need them, including mental health services and drug treatment options. And that includes New Yorkers who may be uninsured or underinsured. Our city must be a place where substance use does not lead to death, but can be treated, and overcome. And we need a mental health and social service system that leads to fewer people developing substance use problems in the first place. Third, we must continue our effort to help New Yorkers suffering from serious mental illness, get the treatment they need, including inpatient care. More than 250,000 New Yorkers live with a diagnosis of serious mental illness, and nearly 40 percent of those affected are not engaged in treatment. This must change, for their health, their families, and our city.

In November, when I laid out my plan to help those with serious mental illness who are living on the street, I said it was just the beginning. This is the next phase of how we are going to help people in need before they fall into crisis, by ensuring everyone has access to healthcare, community and a home. To support people with serious mental illness and their families who are going to improve access to specialty care and primary care regardless of need. New York City Health and Hospitals, which already provides 55 percent of all the mental health beds for New York City, will be expanding capacity in the coming months to meet demand. Who will also increase the city's crisis services, including adding additional peers to mobile crisis teams, and expanding the behavioral health emergency assistance response division, or be heard as we call it.

This means responding to mental health emergencies with mental health professionals and emergency medical technicians, while decreasing unnecessary use of police services. For people with serious mental illness, help doesn't mean a single intervention. Community is critical. We currently have a network of spaces called Clubhouses that assist people with employment, education, and skills building. Most of all, they provide a community. Under this plan, I'm proud to announce we will significantly expand the number of Clubhouse spaces across the city. We will expand stable housing options available to the New Yorkers with serious mental health illnesses and add an additional 8,000 units of supportive housing, as well as more opportunities for education and employment. Finally, we'll increase support to families impacted by those with serious mental illness, many of whom have struggled for far too long with supportive and the support they need for a family member in crisis.

This plan is the next step on a long journey to center mental health and human well-being at the core of our city, and the city that we love. In the near future, we'll also be looking at new research about the impact of diet has on mental health, and making plans to support a healthy lifestyle for our bodies and our minds. The pain of the pandemic was real, and this is one way we return it into purpose. Addressing mental health will allow us to build a better city from the ground up, with more opportunity, housing, and education. Provide a new focus on equity and justice, and create a more responsive and integrated mental health system, that addresses New Yorkers' needs across the spectrum. The New York state of mind has always been resilient, but we intend to make it even stronger going forward. That's getting stuff done, for our bodies, for our minds, and our souls. God bless you all.

(...)

Mayor Adams: They’re not going to report that.

Deputy Mayor Anne Williams-Isom, Health and Human Services: It's not about reporting, it's about what we're feeling in this moment. I keep on trying to remind you. I am Anne Williams-Isom. I'm the deputy mayor for health and human services. And before I begin today, this very exciting announcement about care, community and action, and a comprehensive mental health plan for New York City, I'd like to recognize some of the folks behind me, not all of them, but some of them: the chancellor of New York City, David Banks; Commissioner Sideya Sherman from the Office of Equity; Social Service First Deputy Commissioner Jill Berry; Department of Youth and Community Development Commissioner Keith Howard; Chief Medical Examiner Dr. Jason Graham; Health + Hospitals President and CEO Dr. Mitch Katz; Dr. Omar Fattal, also from Health + Hospitals; executive director of the Office of Community Mental Health, Eva Wong; and of course, the city's doctor, our commissioner for the Department of Health and Human Services, Dr. Ashwin Vasan.

I'd also like to give a shout-out to Assemblywoman Rajkumar who's here, and also to Council Members Lynn Schulman and Linda Lee, who I rely on so much and learn so much from. So thank you so much for being here. Oh, I didn't see you… There are other people here? They did not give me your names. Councilmen Bottcher, Abreu, who else am I forgetting? I'm so sorry. They'll give me your names as we go along. At this time, I'm thinking a lot about what has happened in this city as we think about this most important day, and so many people who have helped to bring us to this moment. But when I think about this moment, I think about being a child advocate and my work at the Administration for Children's Services so many years ago. And as far as I'm concerned, that's what happens when we don't give children and families what they need, that then they end up at the door of the child welfare system.

I was then so happy to be the president and CEO of the Harlem Children's Zone because that was an opportunity to work in a school, to work in a community, to give children and families what they needed. But I was often surprised by the amount of young people that needed mental health support. I used to have second-graders that were drawing pictures that showed suicidal ideation, second-graders. I would have 10-year-olds that were so depressed that they couldn't do their schoolwork. Dr. Lindsay would talk to me about that because we see the suicide rates for African American boys. And then my special group, my high school kids, when I would get those knuckleheaded 16-year-olds to finally decide after months and months that they wanted to talk to somebody because whether you are the victim or the perpetrator of a crime, it affects you.

And so when we were together and I finally get them to connect, they would say, "Ms. Anne, is there a Black therapist that I could talk to? Is there somebody that looks like me?" And so I would run around in Harlem trying to find a black man to be able to talk to these young brothers that wanted to find some care. That's what I think about today when I think about standing here. I think about the statistic that 40 percent of Latino and Black young people report experiencing anxiety, depression, or associated conditions, which are compared to 30 percent of the white people or white children. Nationally, we have witnessed these numbers climbing even higher. Another alarming statistic that I know that you all know, but I decided I wanted to say it today. There are 8,500 young people across the city that lost a parent to Covid. Think about that.

We know much of that was felt in Black and brown communities in areas from Elmhurst, Queens to Brownsville in Brooklyn, and so many places in between. Many of us are working with those families and know those families. I was talking to the first deputy mayor today, and both of us were very emotional about today because we feel personally affected by these issues. But I bet you if I asked you all to raise your hands, we would all raise our hands because we've been affected by the issues of wellness and mental health during way before the pandemic and certainly more during the pandemic. These facts and figures, the pillars in this plan are touching on children and families, or people who have severe mental illness, and those experience substance use issues due to opioids are all focused on New Yorkers, and how can we get support to New Yorkers, our family, our friends, our colleagues, and our neighbors?

We all know that mental health is just like our overall health. I said to somebody today as I am approaching 60, it's not like I could say I could stop working out and I don't need to eat well, it is a lifelong journey. And just like my beloved late pastor Calvin Butts would say, "We all need a checkup from the neck up every once in a while." And so this is something that we have to do all the time and for lifelong. It is why this plan centers on persons, centers on the family, and centers on everyday New Yorkers with love. And yes, I'm going to always start and lead with love, with dignity, care, respect and support, and making sure that we have a long-term commitment to people's wellbeing. Over the past year, we've saved lives with our programs that serve folks with the history of overdose.

We've connected people with severe mental illness to shelter and care they deserve, and we have so much more to do. So thank you Mayor Adams for today, and thank you for your focus on this issue. I'm excited today and I am energized. And the reason I'm energized is because I know that despair is contagious. I also know that hope is contagious. And for me today is about the hope and the promise of what we as a community, as an administration, and as a city together can do for this very important issue. Now I'd like to turn it over to my friend and colleague, Dr. Ashwin Vasan.

Commissioner Ashwin Vasan, Department of Health and Mental Hygiene: I'm not sure I should be standing on a podium for this. We'll work with it. I am tall. This is a great day and I want to recognize the deputy mayor for the way she leads with love and compassion every single day. It creates the space for folks like me, my team, all of the agencies involved in this plan to come together in that spirit to create something good. My name's Dr. Ashwin Vasan. I'm the health commissioner of New York City, and I'm very proud to be here as a part of the announcement of the Adams administration mental health plan. I'm here as the city's doctor, of course, but you don't have to be a doctor to recognize certain symptoms. I see what you're seeing, a crisis in mental health after the worst public health crisis in a century. Historically, mental health has not been at the forefront of our approach to public health.

But today that changes. The problems aren't new, but they are newly urgent. Data from the CDC show that starting in 2019, life expectancy across New York State has declined faster than anywhere in the country. And we know that declining mental health is a major contributor to that. If we are serious about stopping and reversing that drop, we have to be serious about mental health. We have to direct our resources to where they can make the greatest difference. And that means starting with our young people who have suffered through this uniquely damaging few years. In New York City alone, more than 8,000 children have lost a parent to Covid-19. And according to the CDC, nearly one in three teenage girls say they've considered suicide, an increase in over 60 percent in the last decade. As a parent of three small children, including a young daughter who will soon be a teenager, these statistics hit home.

At the same time, overdoses have risen to unacceptable levels. In 2021 overdoses claimed the lives of nearly 2,700 of our fellow New Yorkers, the highest ever total in the City of New York. And each year when the data come in, we expect to set a new record. This is inextricably linked to mental health, and we have to stop this trend in its tracks and we know how to do so. Too many of our friends and our family members and our neighbors suffer from serious mental health issues that have gone untreated or undertreated for too long. People living with serious mental illness have the worst health, social, and economic outcomes, as well as shorter lifespans than any other racial or demographic group in our city. This is the worst of inequities. But while we would never blame our kids for their mental health problems, we have no problem blaming adults, and this has to change.

Let's consider many people's first experience with serious mental illness. Maybe 19 or 20-years-old, a person has a crisis and ends up in the ER. Maybe they're in college or living alone for the first time. They're most vulnerable at the exact moment that we expect them to become independent. Right now, on average, the time between the first symptoms of serious mental illness and treatment is 11 years. 11 years. So it's no wonder that we see the consequences all around us in our homes, our streets, our shelters, our hospitals, and our jails. We can't just lurch from crisis to crisis. We need a strategy that centers recovery, stability, and hope. And that's what this plan offers. We have the focus and the strategies that this unique moment demands, as well as the people who can deliver. We're putting mental health at the forefront of our public health agenda, which starts with the people who need help the most. And we're committing more resources than ever to prevention and early intervention.

Let me give you some examples. We're launching a new telemental health service for high school aged teens, the largest of its kind in the country. With technology that they're used to, teens can connect with a specialist fast. Right when they need it, not after the problem has spun out of control. In the coming months, we'll also field a first of its kind survey to provide an even more complete and detailed picture of the youth mental health challenges in our city and to guide further understanding and planning. And we will come together to address the effects of social media on our young people, exploring pathways to reduce their negative exposure the same way the city has done for other toxins like tobacco or air pollution. When it comes to stopping overdoses, we're following the evidence and building on successes. Since launching the nation's first publicly recognized overdose prevention centers in 2021, hundreds of deaths have been averted. And I want to recognize Sam Rivera here from OnPoint who's joining us here today. Their work has been lifesaving. Transforming. Yes, please give it up for Sam.

We will expand these centers and make them 24/7 while investing even more in harm reduction along with care and treatment. Too many New Yorkers living with serious mental illness lack healthcare, housing, and neighborhood support. The city's plan aims to double the number who are connected to community-based care over the next four years, and as a part of this effort, we will expand mobile treatment capacity over the next year to serve more than 800 additional people with high service needs. And we will also expand access to lifesaving rehabilitative psychosocial clubhouses. And this plan is just the beginning, and I know we can do it because we have the right approach with the right people in place at the right time. The mayor's commitment to mental health is a major reason I agreed to serve. And his commitment to public health is clear every single day.

This administration deeply understands how the mental health crisis has contributed to the unprecedented drop in life expectancy in our city, our state, and this country. We have the strategies and the resources and above all, the will to do something about it. And as the mayor said, we have a better understanding than ever of how interconnected the brain and the body are. It's time our policies and our programs reflect that as well. This is something I have known for most of my life. I lost a beloved uncle to alcohol use and suicide when I was 10. Only as an adult did I begin to grapple with the impact of his death and his life on me. I also saw the emotional pain of parents in my mother's pediatric clinic, primarily immigrants of color who were scared of losing their premature babies. The toll this took on them and on my mother, an immigrant herself (inaudible) felt if not seen.

So today, I'm also seeing this in my own children and in their entire generation facing unprecedented barriers to learning and to relationships. I became a doctor to be a healer. And one of the best things we can do to help New Yorkers heal is to openly and unambiguously focus on mental health. This is what this plan does. It has the support of government colleagues, community leaders, scholars, health providers, activists, so many others have contributed in word, in deed, and in partnership. This is an all hands on deck effort because they know as I do that New Yorkers are healthier when they live in a city that's healthy. And this plan is just the start, but it's the start of something that will change the trajectory we're on. As a city, taking mental health seriously will make all of us healthier for years and for decades to come. Thank you.

And I'll now turn it over to Eva Wong, the director of the mayor's office of community mental health. Thank you.

Eva Wong, Director, Mayor's Office of Community Mental Health: Thank you, Commissioner Vasan, and good afternoon, mayor. Good afternoon everybody. I think I have to adjust this because the doctor's very tall. Okay. Good afternoon again. And I am Eva Wong, director of the Mayor's Office of Community Mental Health. Our city is committed to treating mental health with public health solutions that will bring care and support to New Yorkers in need, right in the communities they live in. And the Adams administration's mental health plan puts that commitment into motion. The three areas of action in this plan bring healing to communities by connecting care to our neighbors, our coworkers, our children, our families. That means all of us.

We might not know it, but all of us know someone who has needed mental health support at some point in their lives. Sometimes the support doesn't come soon enough and it leads to mental health crisis. Through this plan. If anyone anywhere in the city experiences a mental health crisis, they can be confident that the city's response will bring the most appropriate form of help. B-HEARD, where teams of mental health professionals and EMTs respond together to mental health 911 calls will now expand citywide, to help people with emergency mental health needs quickly get appropriate help and health center assessments from trained medical and mental health professionals. Mobile crisis teams, an important part of our city's crisis services, will expand to include additional peers, those who have actual lived experiences, to be part of the teams. The mental health plan also focuses on bringing much needed care to our children and their families. This is especially close to heart for me as a single mother of two little ones and as a therapist who has supported numerous children and the full spectrum of the adults who love and care for them.

With my connections, relative privileges and resourcefulness, I still bump into many obstacles navigating the mental health system, whether personally or professionally. I'm holding in mind the many families, the caregivers are incredible, despite their love and commitment and tireless efforts, still simply could not access resources. They're supposed to support their children's mental health needs. Too many were marginalized. The disparity in their experiences is a reminder that the equity that is in our world, our city still, is still a major barrier to getting care. We need to do better. We will do better.

The burden of finding and receiving mental health support should not rest exclusively with already overwhelmed families. This plan increases access to telehealth services so caregivers don't have to choose between going to work and supporting their children's mental wellbeing. To meet the significant needs of our communities, the mental health system also requires a robust, diverse and culturally responsive workforce ready to meet us where we are. This plan includes the Mayor's Office of Community Mental Health’s efforts in launching interagency collaborations to expand and support our mental health workforce, develop career pathways, and remove institutional barriers that prevent our workforce from operating efficiently and effectively.

Action, community, and care. I'm going to add love because DM said it so beautifully, our DNA of a mission to promote mental health for all New Yorkers. This agenda brings us closer to realizing that mission so everyone in all communities can get the care they deserve and that we can truly turn the tide for our children and generations to come. Thank you.

I'm going to pass the time back to the mayor to answer some questions.

Mayor Adams: Thank you. Before we open up to questions, credentials and professional abilities. One thing, as I was leaning over talking to the chancellor, when this administration is over and people do a real analysis of it, you're going to notice the life experience that we brought. We are not doing this work because we're trying to fill our job descriptions. Many of us have reached into our lives and we see that we have an opportunity now to fix the things that we've witnessed through our lives. The issue of mental health is not something that we are embracing just because it's a popular terminology that people use today. I'll never forget the first time I met Dr. Vasan when I was doing my mayor classes during the time I was running. I just took a note and stated, I got to get this guy on my team somehow, some way. He just understood. He understood the Clubhouse model, he understood the depth of it. He understood every part of it. And when he stated that he was going to join me in pursuing this, it was a very significant part of our administration.

If you don't see why he's playing this important role, then you just will never get it because sometimes we become so jaded as human beings that even when someone authentically care, we find reason to find that they don't care. Well you know what? Just get over it. This guy is the real deal and he produced a real document.

Again, I thank you. And I thank all of you. Thank all of you. Grew up in Harlem, you stopped me on the street. You started talking. You told me to come visit your location. We went around to see your overdose prevention center. Shams DaBaron, we were hanging out in the street together, sleeping out together. And so these are real people. I know what it's like. 22 years, it was clearly my son and my love of my son that allowed me to stabilize after those 22 years of seeing the things that men did to men in this city. And listen, you don't leave 22 years of policing this city and don't feel a part of you has been destroyed.

As we saw today, my heart goes out to that young officer who appeared to have taken his life. His dad was a retired sergeant. The officer was involved in an officer involved shooting, and I spoke with him. Energetic, young, beautiful young man, at the prime of his life, enjoyed saving people. We don't know the impact of what happened, but it's just a real pain for our city to lose a young man of that nature. And we should think about that every day when these officers are placing themselves on the front line, protecting our city. And so this is a huge step. And we stated it then, someone stopped me on the streets and say, "You're not doing enough about mental health. You don't care about people with mental health." And I said, "Ma'am, this is January 3rd, just got here, of 2022." We just got here. And everybody was asking us, "What are y'all going to do? It's January 2nd of 2022, why isn't the crime down yet? Why isn't the subway clean? Why you cleaned up all the homeless?" But we showed discipline and we understood that we couldn't listen to the noise.

And we raise things in levels. You are going to start to see the city, the subway system, crime, mental health issues. You're going to start to see the evolution of the city with a group of disciplined people that are not allowing people to have us just have a knee-jerk reaction to systemic problems. This is the second phase of what we stated we were going to roll out. That's why we are here. And there's more phases. Remember on the campaign trail, some of you covered me and some of you wrote the story, when I started talking about food and mental health. Y'all demonized me and called me names even before looking to see the research. You didn't even bother seeing the research when I did that debate that day and say, food is connected to our mental health. Before even reading to see if Eric was right, you just started writing stories. What is this kook? And now all of these researchers are coming out saying food is connected to mental health because you know why? Because our brain is connected to our body. Duh.

Your brain is connected to your body. So if something harms your kidney, why wouldn't it harm your brain? And we are going to push us into areas of dealing with what food is doing. That is why you're seeing the bad food in economically challenging communities. How much does it have an impact on the behavior of our children? And we are going to explore that. I started talking about social media and what it's doing to our children. We don't realize what social media is doing to our children. Talk to your children. Ask them what they're doing. Ask your young girls how do they feel about themselves based on what they're seeing on social media. Talk to our young people who are stealing Kia cars because they're being told on TikTok that it's a competition. I must be the only one seeing what is happening in this country and what's happening across the globe to our young people. No, I'm not the only one. I got a bunch of people behind me.

So we will open up to the questions, but this is a significant moment in our administration because of this team and what we have brought. Thank you, deputy mayor, on what you're doing, and our chancellor, what you're doing in school and these electeds. Really, thank you. Thank you. Any of them give me and Kate, do your thing.
Question: Yes. Mayor, can you talk about your journey to really firmly connect addiction to mental health in your policy plan and talk about how much additional funding you might want in the Mayor's Office for Mental Health to really support that, and any of those initiatives currently being funded for about 200 million a year go away to make room for this being more of a focus?

Mayor Adams: Hold on. Dr. Vasan, you want to touch that?

Commissioner Vasan: Yeah. Thanks for the question. I think it's hard to look at our overdose crisis and the reasons why people turn to substance use without addressing underlying mental health needs. And Sam Rivera here and Joyce from St. Ann's will tell you that beneath all of the people they help in their harm reduction services is pain. And they're often turning to substances to treat that pain. And at the Health Department, our bureau of substance use or alcohol drug use care and treatment is within our division of mental hygiene. So this city and this administration has had that focus from day one.

A lot of what we're building in the overdose space is things that we've committed to, things that we know work. We have a year of evidence that overdose prevention centers save lives. And what the mayor expressed in his speech, what I expressed in my remarks is a commitment. And what's in this plan is a commitment to saving more lives if we're going to bend that curve because it's moving in the wrong direction right now.

Question: Hi Mayor. So this is an ambitious plan, not to be a Debbie Downer, but how much will it cost and (inaudible)?

Mayor Adams: A combination. Some of the money is new needs, new dollars. When you look at the RFP that's going out for the telemedicine, which I think is brilliant. Dr. Vasan, our children are on phones. We are going to use existing devices to connect with our children. The telemedicine, the money we want to put in the overdose treatment centers. And some of this stuff is we're going to need federal and state dollars. The governor has made it clear she wants to focus on mental health in her budget. So there's some dollars that we are putting in, the vending machines and others that we are putting in. That's within our figures. And then there's other dollars we're going to need help from our state and federal lawmakers. We'll give you exact breakdown of the new dollars we're putting in an expansion of B-HEARD and other items. We'll give you those exact dollars and then we'll show you what we are going to need outside help.

Question: Good afternoon, Mr. Mayor. District Attorney McMahon has been a staunch opponent to the overdose prevention center on Staten Island. Where are you looking to place them and what would that type of community opposition, how would that affect your (inaudible)?

Mayor Adams: Yeah. You said the DA was in the opposition, not community opposition. The DA was. Staten Island is having a real overdose problem. And so we are going to sit down with the DA. I think DA McMahon is an excellent district attorney. We're going to sit down. We are going to show them the numbers. We're going to bring him to see what we're doing in Harlem and other locations because it automatically gives people an image that, oh, this is a bad place. I went up and visited these centers and I saw the resources they're giving to people. When they come in the safe space, you can now talk with them about other items and other issues and give them the holistic care. So we're going to speak with the DA of the issue of overdose is a real issue on Staten Island. He and I have a great relationship and I'm going to continue to show why we believe this is the best way to go.

Question: Yes. Mr. Mayor, you lay out this report, something of generational neglect.

Mayor Adams: Yes.

Question: This has been brewing for an awfully long time.

Mayor Adams: Yes.

Question: On May 11th, the president is expected to issue a declaration that the pandemic emergency is over. There's going to be consequences of that in terms of access to healthcare. Are we not dealing with the fact that we are still in the need of a multi-year response to deal with the underlying issues? Because it appears from all the research I'm seeing — and Dr. Katz might address this — there's a connection between the lack of access to healthcare and the terrible body count in our city.

Mayor Adams: It is. And you're right. And I'm glad you stated that. This is generations of ignoring a problem. Dr. Vasan stated it's almost 11 years before the initial cause to the proper diagnosis. And even when it's diagnosed, we just never really respected it. And in many communities it was a cultural hidden silence. You were not allowed to come out and say, "I'm feeling depressed, I'm going through these feelings." And no one was there to give you that safe space. And I think Deputy Mayor Williams-Isom said something that probably went over all of our heads, that you are not racist because you say, "I want to speak to a Black psychiatrist. I want to speak to a psychiatrist from the AAPI community. I want to speak to..." Because there's something you're bringing in.

There's a tendency to believe that because people want to at least walk in a room and start feeling comfortable, that people tend to say, "Well, okay, you're trying to be racist." No, it's not. And so we know this is a generational problem and we know the lifting up… The pandemic is going to shift costs. We're being hit right now with additional costs that's coming from the state level, but it is more costly to ignore this than to fix it. And that is what this administration, we are an upstream administration, not downstream. When I first said that, while running for office, people didn't know what it meant. But now they understand what it means.

Question: Yes. Mayor, when it comes to these injection sites, have you partnered with the governor? I know right now there are kind of pilot programs here in the city. Have you partnered with the governor to make it more permanent and to expand locations?

Mayor Adams: That's our goal. And there's still some clarity that's needed in the legalities. We still need clarity, but our goal is what we want to do, we have an entire year, as Dr. Vasan stated, of data. We want to now show it to our colleagues in Albany, particularly those from our New York City representatives, some of them we have here. Assemblywoman Rajkumar has been a real partner in pushing these issues in Albany. The goal is to have the governor, her team, her staff, see what we're doing, so that we can get the support that we need, but there's some clarity that we want them to clear up for us so we can move these forward. Yes?

Question: As a parent myself of kids, I know how expensive and difficult it can be to access therapy for children and to find even availability, especially after the pandemic. A lot of therapists, psychiatrist, people who are trained to treat children in particular, have left for private practice because they can earn a lot more money under much less stressful conditions. I'm just curious, how will you ensure that there are enough trained, skilled therapists and doctors who can treat kids that the city can afford to pay?

Mayor Adams: Dr. Vasan, do you want to talk to…

Commissioner Vasan: At the back of this report is a policy agenda that recognizes the fact that this is a system, our mental health system, that's been neglected for far too long. We have more psychiatrists per capita and psychologists per capita in this city than any other city, any other jurisdiction in the country, but we have amongst the lowest percentage that takes Medicaid, that takes even commercial insurance as you're describing. 

This administration really understands how this system works, how interdependent it is, so the work that the state is doing to increase Medicaid payment limits, to increase the upper limit of payment, for instance, for child psychiatry and for mental health, will help us build more programs in schools, for instance. Will help us support our Article 28 and our 31 providers to provide more care. But make no mistake, we have to have some serious discussions around raising the wages for human service workers, for community-based organizations. I think the step that the governor took to raise the COLA was a good first step, but there's so much more that needs to be done. I ran a human service organization prior to becoming commissioner and I know how these salaries are driving people out of the workforce, so it's a priority.

Question: Regarding the injection sites, how many do you hope to open, where and by when? Secondly, regarding folks who have serious mental illness, is anything in here involuntary or by threat with involuntary hospitalization?

Commissioner Vasan: The first question, the goal is to reduce overdose deaths by 15 percent by 2025. We must have more overdose prevention centers in order to reach that goal and I think what's important for readers to understand and the public to understand is that overdose prevention centers are also built around all of the other supportive services that are input into those sites. When you go to OnPoint and many of our other syringe service projects, you'll see a range of social supports, mental healthcare, medication assisted treatment, primary care, basic needs like food and clothing and laundry. The OPC doesn't work unless those things are supported. And so part of the goal here is to invest in our 14 syringe service providers to get them up to snuff, to even be able to consider opening an OPC and we're already doing that today. These syringe service providers are located already in neighborhoods of highest need, for instance, the South Bronx. The reason we built the two first OPCs in upper Manhattan was because these are the neighborhoods that have been hardest hit.

On your other question around involuntary removal. The goal of this plan is to ensure that as few people as possible ever end up in the need for that kind of care. There are 250,000 people living with serious mental illness in our city. 40 percent of those people are not in treatment, 96,000 people. All of those people are at risk if we don't surround them with care, of ending up in crisis and the goal of this plan is for making that number as small as possible.

(Crosstalk.)

Question: Yeah, I wanted to ask specifically about the plan to expand the mobile treatment capacity, the 800 new spots over the next year. I reported last year for Crain’s that the wait list for those is over a thousand. Can you talk about how you've reached that 800 number and how you're going to pay for the new intensive mobile treatment assertive community treatment slots when those programs are already not able to enroll. I'm asking if it's staffing shortages or salaries?

Commissioner Vasan: Yeah, it's a great question. It speaks once again to the interdependence of our system. This is money that the state has already committed to those slots and there's a breakdown between IMT and ACT. ACT as you know is eligible for Medicaid payment and there are rules around that in terms of the number of visits you can have, the amount of time those visits can be. IMT is free from those restrictions and so it serves an even more severely impaired subset of people who have failed multiple rounds of care. That expansion is really driven by state resources coming into the city and out to providers already doing this work who are saying the same thing, is that we can't keep up with demand.

Question: I wanted to follow up on telehealth and that model for children. We know that during the pandemic children didn't learn so well with Zoom. What evidence do we have that they could receive therapy over something like Zoom?

Commissioner Vasan: It's a great question and I will say that this is an area of real innovation. There isn't a deep evidence base except that we know kids are engaging online more than ever and they want to receive care in this way. That's clear. That's very clear and especially through texting. They've said very clearly through the research, we prefer to text, at least as a first step. However, with anything we're building for all New York City high school aged students, we have to create on-ramps into more sustained care or more intensive care, either delivered through video or other forms of telehealth or site-based care through our Article 28s, Article 31s and school-based clinics, which is why you see all of that recognized here and that's really braided funding coming from multiple sources.

Question: Yes. I know that fentanyl test strips are distributed in clubs and other private venues, so when you talk about expanding that, where and who would be distributing those?

Mayor Adams: Dr. Vasan, would do that, but how you doing?

Commissioner Vasan: Yeah. Our fentanyl test strip program has been a real success in keeping people alive and really meeting people where they are and so we'll happily get more details on how we'll roll that out, but we're going to be leaning on the same sorts of sectors that are doing it today. Syringe service providers, bars and clubs, party promoters, even restaurants and small businesses, all places where people have shown that they are at risk of using drugs or actively using drugs on premises. We need to engage everyone in this effort because the drug supply is changing rapidly. 80 percent of overdose fatalities in 2021 involve fentanyl and we need people to know what they're using is safe, if they choose to use.

Question: (Inaudible) redistribution program or is that something they would have to buy into or how would that work?

Commissioner Vasan: Currently it's free to the consumer, but it is a pilot and so what's in this plan is a goal to expand that into a program, but it's always free to the user. It's not eligible for reimbursement through Medicaid or other programs.

Question: Mr. Mayor, I wonder what the research into the role of diet and mental health, how that will inform city policy? Will it affect what you serve in schools and hospitals and senior centers? Will you do campaigns? If you eat candy, it will make you mentally unstable. What will you do?

Mayor Adams: That's a good question and just for the record, you know, you, Juliet, NJ, you know I adore the three of you. It is amazing. We have been communicating with Naveen Jain, who's with an organization called Viome and there's a body of research out there that, when I first became aware of it when I was running for office, that talks about the connectivity with the food we eat and how it impacts on several behavior issues and mental health issues. We are going to lean into that. We're not going move away from it and as Dr. Vasan stated, we are going to follow the science.

Governments should not feed crises. Governments should be preventing crises and because we have been, we have been afraid to go with the science, we have actually been feeding some of the crises. It's not popular what we're doing with plant powered Fridays. It's not popular when we do meatless Mondays, of what we're doing in the hospital with default menus being plant-based food. None of these are popular things, but the science is telling us that we can't continue to feed the healthcare crisis. We're going to look at the science and do a real examination of the food we are supplying New Yorkers, how does it contribute to the mental health issues that they are facing and how does it contribute to brain health.

Question: (Inaudible) policy?

Mayor Adams: Yes, it would. We are going to look at, again… We purchase food to feed people at their greatest level of need. If they're doing that, we should not be giving them food that is causing the healthcare crisis on the other end. I grew up eating that hard ass cheese that I don't even know what it was made of, powdered milk, powdered eggs. Little did I know that years and years of eating contributes to the healthcare crisis that we are facing. How do we tell New Yorkers when they have no other option but to get the food from government, that we are going to feed you food that is going to cause your chronic diseases? That is the greatest level of betrayal. My mother was betrayed by what they gave her to feed her children and we must be honest about that and I'm not going to live a lie.

Question: Thank you. With regard to the suicide prevention pilot programs, where will those be introduced? How many will be introduced and what exactly will be new or different about the approach that they will take?

Dr. Vasan: Thanks for the question. As I laid out in the speech and the mayor laid out, not only are girls displaying suicidal ideations at rates that we haven't seen in a decade, so are youth of color and LGBTQIA youth and so our Caring Transitions program is focused on catching those young people at their moment of greatest vulnerability after a suicide attempt. It's a hospital-based interruption program where a peer counselor, a social worker, can be with them in this immediately extraordinarily vulnerable period. The first 90 days after a suicide attempt is when children are at the highest risk of a repeat attempt and a completed attempt. We're piloting it in hospital based emergency rooms. Happy to get you more details on numbers and when it will start.

Question: (Inaudible.)

Commissioner Vasan: We know that the system we have is incredibly path dependent. If you call 911, historically, your likelihood of being involved in the criminal legal system is significantly higher than getting a health response. B-HEARD is the first step in repairing that and operationally they've created teams to do that in parody zip codes, but let's not forget the culture change that has to come along with that. For 911 operators, it's a very difficult decision to make of when to… There can be a protocol on paper, but the nuance around those calls, I don't know if you've ever listened to a 911 call or been in a 911 dispatch center. It's an extraordinarily difficult job and so there's training, there's education, there's follow up, but this administration is committed to the expansion of B-HEARD, citywide.

Mayor Adams: That's so important, what you said about the cultural change because our 911 operators, they field millions of calls and we can't put them in a punitive setting when they're making the best decision based on the information they have in front of them. If it goes a negative way, we become punitive towards them and that's just unfair. Those 911 operators are dealing with the vicarious trauma. No one is calling 911 to say, "Hey, I want to invite you to a birthday party." They're calling them there when the party was shot up. When you hear that all day, every day, it's a lot of trauma and so that cultural change, that understanding, the training and giving the support to our 911 operators is going to make this transition easier.

Just wanted to say a silent prayer so God can give me the patience to answer these questions.

Question: Mr. Mayor, so the city has agreed to pay $6 million to protesters that were kettled by the NYPD in 2020. What do you make of this settlement? You've been critical of the past of protestors and critics have said, listen, this was a waste of taxpayer dollars for the city has to shell out because the NYPD shouldn't have been using these tactics to begin with. What's your response to that?

Mayor Adams: I am going to reserve my personal opinion. The corporation counsel made a decision, and I respect the corporation counsel, Judge Sylvia Hinds-Radix, and that's the decision they made. I'm going to respect the decision of the corporation counsel.

Question: Mr. Mayor, I know that in your speech you referred to the police officer who committed suicide in Staten Island. I wonder if there's any reason believe it had anything to do with that police involved shooting he was involved in, and if he had left a note, and if you had any conversation with his family, et cetera.

Mayor Adams: His dad is a retired sergeant. I reached out to get his number and I'm going to call him immediately after this conference. I just know the moments after a tragedy like that you just need some space, and you don't want to be bombarded with people right away. So I wanted to give them an opportunity this morning, when I was notified early this morning. And after the shooting, I reached out to the officers who were involved because I just know that after an encounter like that what officers can go through. And so I reached out to them, I communicated with them, and I tried to sort of ease their concerns. Because these are young children, 21, 22-years-old. And when I communicated with them I just told them, you were protecting New Yorkers. And I was hoping to ease the stress. And it just really broke my heart that we lost this young man.

Question: I got a question. I was really interested to hear your church and state comments the other day as a former religion reporter. On school prayer, do you think that teachers in city schools should be leading kids in prayer? I mean, you talked about prayer in schools. How do you think that should be configured if we're going to do that more?

Mayor Adams: No, I didn't talk about… You just need some space and you don't want to be bombarded with people right away. So I wanted to give them an opportunity this morning, when I was notified early this morning. And after the shooting, I reached out to the officers who were involved because I just know that after an encounter like that, what officers can go through. And so I reached out to them, I communicated with them, and I tried to sort of ease their concerns. Because these are young children. 21, 22-years-old. And when I communicated with them, I just told them, you were protecting New Yorkers. And I was hoping to ease the stress. And it just really broke my heart that we lost this young man.

Question: I've got a question. I was really interested to hear your church and state comments the other day as a former religion reporter. On school prayer, do you think that teachers in city schools should be leading kids in prayer? I mean, you talked about prayer in schools. How do you think that should be configured if we're going to do that more?

Mayor Adams: No, I didn't talk about prayers in school. There are clear rules about prayers in school. It had nothing to do, I don't have the power to change that. I just gave you my belief. My belief. This is a country where on our dollar bills we say, "In God We Trust." The last thing I said when I was sworn in as the mayor, I stated, "So help me God." Every event that I start, I start with prayer. Every event that we do, when our congressional state senators, they say, "So help me God." Every president but three, at the end of their swearing in, they say, "So help me God." They all touched a religious book. So I'm not a closet believer in God. I'm a public believer in God. I am who I am because of my belief and faith. And when I speak to my brothers and sisters in synagogues and mosques and baptist temples and Buddhist temples and Sikh temples, they all say the same thing.

You've covered me a long time. I've never made it a secret that my spirituality guides the humanitarian response that I do. And so I think we need to find a way to introduce some form of spirituality in our children because they're not fighting against the seen, they're fighting against the unseen. And these poor children are growing up in an environment that is, it is just so painful for them. And I just see them. I talk to them, I walk with them, I'm experiencing them. If I didn't have that when I was growing up, and if I had to go through what they're going through right now, it's just very challenging.

Question: Sorry…

Mayor Adams: Let him finish, Kate.

Question: Do you think we need to find a way to introduce that more? How do you think we could do that?

Mayor Adams: Oh, there's a number of ways. You could have clubs. We could have children visit other houses of worship, as we are doing with our Breaking Bread, Building Bonds. If you are a child that is never introduced to alternate ways of how do you deal with your pain, we could introduce different groups outside the school setting to have our young people introduced to some form of spirituality. It's very healthy. When I get up and do my prayers and do my breathing and do my meditation, it never dawned on y'all why I'm so patient with all of you? It's because I have the spiritual root and grounding. And I would not be the mayor of the City of New York if it wasn't that God saw something in me. I am the most imperfect, most perfectly imperfect, human being. I am here not because I'm the smartest, not because I'm the brightest. I'm here because in all my heart I believe that it is an Esther 4:14 moment. God made me for such a time like this.

Question: Can we just follow up?

Mayor Adams: Let them toy with this. Because let me tell you something. Normally I get disturbed when what I do is distorted. Nothing gave me more joy than seeing on the front page of the Daily News I was being attacked for protecting my belief in God. To me this is all I live for, to say to God, "Thank you, thank you." And so if I'm demonized for that, then I'll take that every day. I am so happy that there are a small number of people who are saying that Eric's belief in God, he should not be talking about it as the mayor. No, as the mayor, I should be talking about my belief in God. Go ahead.

This drives my team crazy.

Question: Mr. Mayor, just a quick thing. So there's a new Council bill that would require HERRCs to abide by the right to shelter law. Just wanted your reaction to that.

Mayor Adams: We like to work with all of our electeds and we're going to look over what this bill is about and then we're going to make the determination based on that.

Question: Mayor, with respect to the mental health crisis in the city, you addressed a lot of issues, you've proposed a lot of remedies, solutions to address that. One thing that struck me as missing from that was this notion of involuntarily committing dangerously mentally ill people. Is that because that's no longer part of the strategy?

Mayor Adams: No, no, because we rolled it out. This was phase two. We rolled it out already of what we're doing. We were very clear on it. People who are dangerous to the extent that they cannot take care of themselves and they're showing an imminent threat to themselves or others, we already have a plan. And what we wanted to do is to leave people with a clear understanding that was not our only plan. And there's a small number of people that fit that. Dr. Vasan laid out that the overwhelming number of people don't fit that criteria, and we wanted to introduce today, this is how we are going after that large volume of people that don't reach that small number of people. We want to go after them and prevent them from ever getting to that level. You wanted to add something too, doctor?

Commissioner Vasan: No, I think you got it right.

Mayor Adams: Go ahead. Go ahead. Go ahead. Go ahead. Look at you.

Question: We know that your beliefs are maybe yours and I don't know that anyone is questioning your personal beliefs.

Mayor Adams: Yes.

Question: You have a right to hold those. I guess the question I have is that you've also acknowledged you don't have the power to change the constitutional separation of church and state. So what was it the other day that made you feel like you needed to go out there and say you disagree with this separation? What were you trying to say?

Mayor Adams: What I was trying to say is that we need to stop pretending that this is not a country that believes in faith. When you swear in to become a citizen of this country, you say, "So help me God." As I stated, our dollar bill, "In God We Trust." We put our hands on religious books when we swear in. So what I'm saying to New Yorkers and Americans, let's stop being afraid that we are people of faith.

And people don't have to agree with me. If you don't agree with me, that's fine. If you want to be an atheist, that's fine. But those who believe in faith, because I'm calling for all of us to do something I believe we need to do. It's time to pray. And I'm hoping that we start embracing each other, diversity and faith. That's why we are doing the Breaking Bread, Building Bonds. That is why I go to synagogues. That's why I go to mosques. That's why I go to churches. And so I don't know how one walks away, because everybody in that room understood what I said. I don't know how one walks away that I'm trying to force people who don't believe in God to believe in God. I'm telling you what I believe.

Question: Mr. Mayor, if you said mindfulness, would anyone have argued with you?

Mayor Adams: No.

Question: If you had said mindfulness.

Mayor Adams: No, they wouldn't. See why I drive my staff crazy? Right. Right. If I would've said mindfulness, everyone would've been all right. But God forbid I say God . And so can I just say a silent prayer for all of you?

Question: Do you always smile when you're praying, Mr. Mayor?

Mayor Adams: Yes I do.