What are the latest developments on Hochul’s mental health plan?

Gov. Kathy Hochul has made mental health a priority, dedicating $1 billion to improving the state’s mental health infrastructure in 2023. The state Office of Mental Health Commissioner Ann Marie T. Sullivan has the task of putting those funds and plans into action. That includes everything from the expansion of school-based mental health clinics to restoration of inpatient psychiatric beds and the construction of supportive housing units. City & State spoke with Sullivan about the state’s progress in executing the governor’s mental health plan. This interview was edited for length and clarity.

What are the latest developments on how the governor's mental health plan has been unfolding?

Progress has been pretty remarkable, actually. The billion dollars from last year really set up a framework for a transformation of the system. I think it’s important to note that these billion dollars fall into three big buckets, which includes prevention. The second one is really getting access to care, and then the third is working with individuals with the most complicated, most complex needs.

Prevention involves a lot of work with schools, which is continuing into this year. The governor has committed to put a school-based mental health clinic in every school that wants one. Currently, we have over 1,100 school-based clinics, and we’re going to be continuing to expand them.

In access to care, I want to emphasize a couple of things. You may be familiar with something called the Certified Community Behavioral Health Clinics, which is a federal initiative. We had 13 in New York state. With this budget, we grow to 26 and then we get another 13 to go to 39. That’s massive. That is really opening up our entire clinic service system to significant expansion. And what’s so great about the Certified Community Behavioral Health Clinics is that they’re truly integrated care. They integrate mental health, substance use and physical health, and they work very hard to make sure that there’s that comprehensive picture of care for individuals. They serve adults and kids and they also do outreach and some crisis work.

There’s been expansion of other services, an exciting program called Youth ACT, which is youth service, community treatment, which we didn’t have before, which these budgets are supporting. We’ll eventually have 20 Youth ACT teams across the state. We already have 380 kids enrolled in these ACTs, which is really exciting. This one got started kind of early, so we already have enrollment. A lot of these dollars that are coming out are (requests for proposals), and we’ll see these kinds of results later. We’re also growing the adult ACT team services.

The third big bucket was to deal with the most complex individuals with mental health issues. That’s where you see an increase in state hospital beds, where you see a whole major initiative to work with the acute care hospitals and our community providers to make sure that individuals who have to be hospitalized or who go to an emergency room when they are discharged get the services they need. We are connecting wraparound services and access, if needed, to transitional beds, where individuals who are leaving hospitals and leaving emergency rooms get the wraparound services they need. That’s a major initiative which we have sent out all the (requests for proposals) for. Now, all this plus 3,500 units of housing.

This is the biggest expansion of mental health services in the past 50 years. We’ve never seen anything like this. It raises our budget 45% to a total of $4.8 billion in mental health. It’s a 45% increase since 2022.

What aspects of the plan have been able to move a bit faster, where you’re already starting to see impact?

With the Youth ACT teams, we’ve been able to put up several of them, and we have about 380 kids enrolled. That’s already happening. The Safe Options Support teams have had 650 people already out. They’ve been operating for a year and a half to two years. Those are the two big impacts that we’ve seen, because most of it is housing. And even with the (requests for proposals) for services, it takes time because they have to hire up.

Now, you will see an impact, for example, with the first 13 Certified Community Behavioral Health Clinics, they've already gotten their increase in rate as of July 20 this year, so they will begin hiring and expanding their capacity. We have loan repayment programs in this budget. One thousand people have taken on those loan repayments. That means about 250 psychiatrists and nurse practitioners – and the rest are social workers and psychologists etc. – have accepted the loan repayments. That means they will be with us for three years in the system to pay back the loans.

How much have school-based mental health clinics expanded so far and what is being done to reach other school districts that do want to create them?

We have 1,100 now across the state, working with the state (Education Department), with the district superintendents across the state, with the Department of Education in the city and with the city office of health and mental health to get the word out. In order to make it easier for everybody, we now have a rolling thing that you can apply anytime you want. All a school has to do is come to us and say, I’d like to have a school mental health clinic, or if the provider in the neighborhood says, I think I’d like to work with the school, and then we can help coordinate those two things. We also give them startup funds.

One of the issues in school-based clinics being financially viable was depending on your payer mix. If you are largely a Medicaid population, school-based clinics were fine, but if you had a mixed population of commercial payers and Medicaid, it became difficult to make ends meet in the school-based clinics. Legislation was then passed to say commercial payers had to pay for school-based and they had to pay at the Medicaid rate. We also increased the Medicaid rate. The school-based clinics now are really well, financially viable.