Compassionate Interventions for the Homeless: The NYC Plan (ep 61)

Guest:  Brian Stettin,  senior advisor to NYC Mayor Eric Adams administration on severe mental illness.

Brian  drafted the legislation that became Kendra's Law when he was an assistant attorney general in 1999, after a young journalist, Kendra Webdale, was shoved into an oncoming train by a young man from Queens with a long history of mental illness.

The  Adams administration's new push is to have more severely mentally ill people brought to hospitals for psychiatric evaluation with or without their consent, and to change the state laws about the length of the stays.

This law is designed to apply to those who can't recognize their mental condition or take care of themselves, not just those who present an immediate threat to themselves or others.

Questions:

• Can you explain the plan in brief, and why it’s different from what has been happening in the past?
• What has been in support of this?
• What has been the opposition to this?
• Is there a plan in place to address the lack of hospital beds, supportive housing options, or other forms of long term care available for those people in need of help?

https://www.latimes.com/world-nation/story/2022-11-29/mayor-eric-adams-says-nyc-will-treat-mentally-ill-even-if-they-refuse

“These New Yorkers and hundreds of others like them are in urgent need of treatment, yet often refuse it when offered,” Mayor Eric Adams said at a news conference, noting that the pervasive problem of mental illness has long been out in the open. “No more walking by or looking away,” the mayor said, calling it “a moral obligation to act.”

more on Clubhouses:
https://www.startribune.com/mental-health-system-must-be-able-to-help-those-who-dont-know-they-need-it/600256700/
Mindy and her book: https://mindygreiling.com/

Randye and her book: https://benbehindhisvoices.com/

Miriam and her book: https://www.miriam-feldman.com/

Hosts:

Who:

Randye Kaye - was a morning Radio Personality bringing humor to CT families when her own son was diagnosed with schizophrenia. Now she is still a Broadcaster, Actress, Voice Talent, Speaker, and Author (Ben Behind his Voices, Happier Made Simple)

Miriam Feldman -  is an artist, writer, and the mother of an adult son with schizophrenia. Her book, He Came in With It chronicles her family's story and was released to rave reviews on July 21st, 2020.

Mindy Greiling - Mindy Greiling was a member of the Minnesota House of Representatives for twenty years. She helped found the nation's first state mental health caucus, which successfully lobbied for a significant increase in Minnesota's mental health funding Her acclaimed memoir is Fix What You Can.

Transcript

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SPEAKER_01 0:00

I can tell you that we do have people who have been in the hospital now for you know weeks, who are reconnecting with family, who are engaged with the the the mobile crisis teams who are coming to visit them, who they had been kind of estranged from and are now talking to again, and um you know who have hope that that that their lives are getting to a better place. They're gonna need a significantly longer period of hospital care and to get the meds exactly right before we can transition them to housing, but that's what we're absolutely committed to with each and every one of them.

SPEAKER_04 0:29

That's our guest today, Brian Stetton. Brian is the City Hall Senior Advisor on Severe Mental Illness in New York City, and he'll be talking about compassionate interventions for the homeless. Welcome to our podcast, Schizophrenia: Three Moms in the Trenches. From the place where schizophrenia and real life collide. East Coast, West Coast, Middle America. With Miriam Feldman, Mindy Gryling, and Randy Kaye. This is our 61st episode of Schizophrenia Three Moms in the Trenches. And this is in response to episode 59, which was just a month ago, but it's a very important episode, and thank you for joining us today. This is called Compassionate Interventions for New York City Homeless, Mayor Adams' Plan in New York City. And our guest today, if you're watching on YouTube, you can see him this way, Brian. We'll bring you in in a second, is Brian Sdeton, who's the New York City City Hall's Senior Advisor on Severe Mental Illness. Before we get into that introduction, I personally want to thank our listeners who wrote to me or commented on our Facebook page their concern and empathy for a crisis we were having with my own son, Ben, last episode, episode 60, at which point he had concocted a plan to leave his group housing and rough it, as he calls it, which I call decide to be homeless. The reason he wanted to do that is so he would have the freedom to go off medication and smoke hot. And I used my best motherly, okay, it's your life. I respect your life to do what you want to do. However, this is what's going to happen on my end, negotiation skills. And then I had a couple of sleepless nights and fortunately woke up to a text from my son saying, hmm, I think I've changed my mind. So I was very grateful to hear that. It doesn't mean he might not change his mind back tomorrow. However, we take the good days as they come. And I want to tell you that at the moment he has returned all the camping equipment a little bit with my help. He managed to pay his rent in his group home and he has been transferred to another one where he'll have a little more independence and he feels like it's a step up. So at the moment, we're in an okay place. And I'm grateful and I'm grateful to you, our listeners, for caring. And I also want to share extreme gratitude for the caregivers at the group home where Ben was and is. Like teachers, I know social workers aren't paid incredibly well. And your hearts are big and your workload is huge. And when I wrote, I won't share her name, but I wrote to the person who was in charge of Ben for the last two years. And just right before the transfer, I just said, I can't thank you and your team enough for navigating this. It has been a roller coaster, but my son sounds hopeful for the first time. I'm laying low because this is better without mom. But thanks so much for not giving up on him. And she wrote back and said, Of course I didn't give up on him. That's my job. Thank you for being such a caring mom. So that made me cry. And just wanted to share that with you. So at the moment, the roller coaster can continue to go. I also want to thank some of the listeners who are kind enough to leave comments on our podcast pages and our Facebook page. And one particularly from someone named Sue who just says, I can't thank the three of you moms enough. She talks about her daughter being diagnosed. She's nine months into the process. The fact that you can all still speak in complete sentences 20 years plus is amazing. And have the energy to help little people like me. You are what heroes look like. Thank you. Keep up the amazing work and thanks for being a guide. So, Sue, thank you for joining our family of listeners and thank you for sharing your thoughts with us. So, by the way, who are the three moms? We are three moms with three families and three sons with severe schizophrenia. We've been up and down and all around that roller coaster, and we know you have too. So we're sharing information and support right here on Schizophrenia, Three Moms in the Trenches. I'm Randy Kaye, and my co-moms are Mindy Gryling and Mimi Feldman. And our books are Ben Behind His Voices, Fix What You Can, and he came in with it. You can check them all out on Amazon and elsewhere. Meanwhile, I do want to let you know about an exciting new podcast from the Treatment Advocacy Center called Make Them Hear You. Here's a message all about it.

SPEAKER_00 5:35

10 million diagnosed, $3 billion, thousands of lives lost. You know the numbers. You've read the headlines, you've said their names, but you haven't heard their stories. The experiences of families of color are a powerful and missing element of our national narrative around our failed mental health system. As the oldest national nonprofit dedicated to eliminating barriers to treatment of severe mental illness, the Treatment Advocacy Center invites you to join us and listen to our new podcast, Make Them Hear You, where we uplift voices of some of our most vulnerable members of society. Individuals of color with a diagnosis of severe mental illness. Make them hear you. Available February 28th, wherever you get your podcast.

SPEAKER_04 6:26

So back to our episode 61. Mimi, Mindy, you guys okay? Anything new and exciting? Or we're status quo right now?

SPEAKER_02 6:34

Everything's fine with me. I, you know, I came back after being away quite a while, and uh Nick seems good. So that makes me happy.

SPEAKER_05 6:44

Me too, Mindy. And Jim is fantastic. He's um a joy to be around, and so I am happy. Our happiness is determined by our sons.

SPEAKER_04 6:57

Well, we have other factors that determine our happiness. I do need to add that, but it certainly does help when our sons are doing well. As much as uh intellectually, I like to be okay when my son is not okay. I like to try to compartmentalize it. Our mother's heart can't really do that. So I totally hear you. So a bit of background on our guest and why he's here. On episode 59, we had Michelle Hammer as a guest. Feel free to listen to that episode. She's a wonderful guest. She's a schizophrenia activist, and she had a few thoughts about a New York City plan to help the homeless. And today we have the privilege of interviewing Brian Stetton, who, as I said, is now the senior advisor to New York City Mayor Eric Adams Administration on Severe Mental Illness. He's going to clarify many of the issues. So welcome, Brian.

SPEAKER_01 7:47

Thank you so much, Randy. Great to be with you all.

SPEAKER_04 7:50

We're delighted to have you here. Now, just in researching your background, you drafted the legislation that became Kendra's Law in New York back when you were an assistant attorney general. That's a few decades ago, 1999. And in case you don't know what Kendra's Law is, uh it was after a young journalist named Kenro was shoved onto an oncoming train by a young man from Queens who had a long history of mental illness. Maybe you can tell us a little more about that. But to he, uh we're here to talk about the Adams administration new push to have, and tell me if I have this right, more severely mentally ill people brought to hospitals for psychiatric evaluation with or without their consent, and trying to change the state laws about how long they can stay at the hospital. And I I would love to talk about the law and any opposition that you've had. So, first of all, welcome. And let's just begin if you can explain Mayor Adams' plan better than I did. Yeah, brief and why it's different from what's been happening in the past.

SPEAKER_01 8:57

I'd be happy to. Thanks so much for the opportunity and great again to be with you all. So, one thing I think that really has to be emphasized is that nothing the mayor has suggested we're going to do now before any change to the law is made, um, is really pushing the envelope beyond what has really long been well established is the state of the law in New York. The problem that with and the frustration that we've really been dealing with is that there is so much misunderstanding uh about the law on involuntary interventions. Under our mental hygiene law, it is possible, as in every state, to provide care to somebody who is in acute psychiatric crisis and is unable to recognize their own need for treatment. And so, as a last resort, when you you reach the point where it's uh apparent that the person is not uh going to be amenable to accepting uh care on a voluntary basis. Um, like every state, we have a law that allows uh, in some cases police and in some cases uh clinicians to intervene and bring that person to a hospital for evaluation and potentially, once at the hospital, admit them uh for care. And the standard as it is everywhere is essentially the person is exhibiting mental illness symptoms and this is a danger to themselves or others. But the meaning of that second part of it, what it means to be a danger to, particularly the danger to oneself, um, has been broadly misunderstood. And so uh we have a statute that is not as explicit as some other states in in making clear that there is a broad range of conduct that could potentially lead to someone being found a danger to themselves. Um so we don't really have the legislative guidance so much on what that means, but we what we do have is case law, right? Because laws are made in in different ways. It's not just what the way the law is articulated by the legislature in passing a statute, but when that law is uh leaves some kind of room for interpretation, we rely on our courts to tell us further what it means to articulate that in greater detail. And we have had case law in New York that makes clear that a person who is failing to meet their basic human needs as a result of their mental illness. And it has to be clear those two things must be tied together. It's not just simply that the person's not meeting their basic needs, but when they're exhibiting mental illness symptoms, and we can see that as a result of that, they are failing or I should say unable to meet their basic needs for food, clothing, shelter, andor medical care. That's a form of being a danger to oneself. And our courts have been very clear about that, but for various reasons, that message has not really filtered down so much on the ground level. And so the really the core of the mayor's plan is to say that we're not gonna kind of hide behind a misinterpretation of the law, the way I think we we have in many tragic cases, where we say, well, this person is not violent, they're not suicidal, they're not presenting a risk of imminent harm, therefore, as much as I'd like to help this person, we can't. Um because the courts have articulated that we have more authority to help people than that, we want to make that widely understood. And so that's really the core of the plan. The mayor has put out a directive that lets our police and mobile crisis clinicians know that the standard does include people who cannot meet their basic needs. And we're um kind of amplifying that message in the training we provide uh to our police and mobile crisis clinicians because we want that to be widely understood. Um, there's some other things that we're doing that are related to really just getting more as much clinical um uh input to this decision making as possible. And it's been frustrating to me that this has sometimes been characterized as uh a plan that puts the police on the front lines of dealing with this issue. In fact, I think this universal recognition, including among our police, that when we have interactions with people in on the street, it's always better to have a clinician taking the lead in both in assessing the person and in trying to coax them to accept care voluntarily. It's obviously much less frightening and triggering for a person to interact with someone who is coming to them as a clinician rather than a police officer. Um and so we we're doing a couple of things on that front that that I think are exciting. One is that we are increasing the number of um joint uh response teams that we have on the ground, right? Where we are pairing clinicians with police officers uh so that interactions that might previously had been led by police now have a clinician involved. And we still want a police officer there because if it comes to the point where we do have to do an involuntary removal, it's obviously not something you can reasonably ask uh of a nurse or a social worker, right, to actually get someone who doesn't want to go onto an ambulance. You need a police officer there, and and and the officers who are part of these teams are are really kind of experts and specialists in the art of getting someone onto and off of the ambulance using the least amount of force as possible. Um, but the the the the main interactions they are going to be handled to the extent possible by clinicians. But also just recognizing that we're not always gonna be able to have a clinician on the scene when these instances present themselves, right? Because police officers in the course of their ordinary patrols sometimes encounter people in psychiatric crisis. Uh and so recognizing that we can't always have a clinician there, we still want to bring as much clinical input to bear to these situations as possible. And so we have created a uh support line where our police officers can call to a clinician. We this is staffed by clinicians from our uh health and hospital system, um, who will advise the officer. It's still ultimately going to be the police officer's decision there, because we can't really have the clinician making that call remotely, but they can at least advise the officer on, first of all, whether they think there is grounds to do uh uh transport if if absolutely necessary. And this can be a video call where the officer can kind of turn the phone around and share visual information. But I think just as importantly, help the officer uh exhaust other possibilities. You know, we also have support and connection centers, which are uh less daunting to people than the idea of going to a hospital. And so we're gonna have uh, you know, the suggestion made to the officer maybe this person would accept a voluntary transport if it was to someplace else that might be able to meet their needs. Um, if this is a person who is uh presenting in a way that doesn't present an imminent risk of harm, but still meets the standard and their whereabouts are reasonably predictable, the clinician might suggest, hey, maybe this is someone we can come back and visit tomorrow. Maybe we can send a mobile crisis team out to deal with this, and we don't have to bring them in now, even though you have legal authority to do it. It may not be clinically the best course of action at this point. So, you know, we're we're really just trying to get these calls right. And, you know, some have gotten the idea that we that the mayor is calling for sweeps of the streets, that we're putting lots more police out there to look for for for folks who who might meet the standard and try and kind of fill our emergency rooms with more of these individuals. There's just nothing that we have proposed or that we're actually doing that's even remotely like that. Uh, this is really just about getting the calls right in the work that we are already doing, that we've been doing for years, um in the just kind of ordinary outreach that we do in the subways and with with our contractors who work with homeless people in the street and parks. Um, and also, as I say, just in the responding to incidents that may kind of unexpectedly arise where officers arrive at a scene and have to make decisions about what they can do to potentially help a person.

SPEAKER_05 16:52

Brian, I am really excited, I have to say, about what you're doing in New York. And one thing uh Randy did not include in your introduction, but I think it's important that you were the policy director at the Treatment Advocacy Center before you ended up in New York. And the way I have heard it is Mayor Adams saw one of your articles that you wrote for when you were there as policy director and almost hired you on the spot. And so to me, when I had known that, I thought his heart is in the right place if the mayor, if he knew enough to hire Brian Stetten, who's uh famous within the Treatment Advocacy Center world. Brian and I were both at the San Diego or San Antonio conference uh last summer on the same panel, and uh he was received like a rock star when he was introduced on that panel. I want to ask you is uh, you know, as you know, I was in the legislature for a while and he had this saying that if you're splaining, you're not gaining. And um, so to me, I wonder what did what did the press, did the media not cover this until, you know, all these other this other misinformation got out there? Or did you fail to get the information out there ahead of time to head off some of this stuff?

SPEAKER_01 18:18

Yeah, well, you know, hindsight being 2020, of course, there are always moments where you think maybe uh it could have been messaged a little differently. I will say that we tried very hard to get the mayor's speech right. Uh so this really came to the public's attention because we had the mayor do uh you know speech from the Blue Room and we we treated it as a pretty big deal. We think it is. Which, as the mayor said, trying to create a culture of engagement. We're truly trying to change the culture um within our our treatment system to kind of stop this tragic um practice of uh of walking away from people in crisis. And so we felt it kind of required uh a bold moment and a statement to make that clear. Um and so, you know, we had the mayor give a speech where we made all the points I made my my uh explanation to you all just a few minutes ago, um, and and had lines in there to kind of anticipate that some might get the idea that this was about sweeps or this was about putting the problem in the hands of the police or or um think uh you know, in some way suggesting that this doing this one thing was the answer to the larger crisis of how we fix our public mental health system. Um and yeah, maybe we could have been a little more repetitive and said those things over and over. You know, when you're writing a speech, sometimes you're trying to cut out the fat and say, well, okay, we've made this point. Uh, you know, I I do kind of wish we had really leaned into some of the moments in the speech where the the mayor made very clear what we were not doing here. Um, but if you go back and watch it, it's all there. He said everything that the press just sort of um uh blew right by. And uh, you know, the stories came out the next day that gave a lot of folks the impression that this was about sweeping the streets and that this was the mayor's answer to the larger mental health crisis, as if we thought we could just hospitalize our way out of the larger problem. And uh, you know, we've had to do a lot of damage control since to make clear to people that that's not the case. And I'm gonna do that.

SPEAKER_04 20:24

And it sounds like you're like you're you're still doing it right now almost.

SPEAKER_01 20:28

For sure.

SPEAKER_04 20:28

And I appreciate every opportunity because we you know, we I asked you to explain it and it felt like you went right into defensiveness mode, which I can understand why, because you know, we just did an episode two episodes ago where there, I believe, a misunderstanding about what the plan is. And you know, we talked before we started this episode about what an appropriate title would be for this. And I think that there it's very important. So the idea of compassionate intervention. So I just want to make sure I understand before I give Mimi a chance to chime in here. And so this, you're not really changing a law, you're changing an interpretation of what it means to be a harm to yourself, correct? You're kind of expanding that definition. So there's no law change necessary. It was just a different implementation, correct?

SPEAKER_01 21:22

Well, so I'll I'll I'll put a little bit of a spin on that. We we have called for some changes to the law, but on this particular question, what we're trying to do is codify what the courts have already said about the law, right? So we are not trying to change the existing standard in New York. We are trying to make it clearer. Um, so by putting that language of what's in those court opinions explicitly into the statute, the way it is in 47 other states, right? New York is one of only four states that don't explicitly say that inability to um meet your basic needs of food, clothing, shelter, and some states medical care is a form of being. Dangerous to yourself. By putting that in the law, we feel like we're going to have an easier time in making it well understood. But at the end of the day, it's just codifying what already is the law through court precedent.

SPEAKER_04 22:14

Got you. And I believe, Mindy, in your book, Fix What You Can, that is a battle you fought in your state legislature for quite some time.

SPEAKER_05 22:23

I definitely did. And I worked with the Treatment Advocacy Center in their infancy. I think I didn't realize it at the time, but they were almost brand new. And I got to be one of the first ones to work with them. It's a phenomenal organization for legislators. And right now in 2023, Minnesota is trying to do similar things to what you're doing in New York, Ryan. And that is we have, unlike what you described in the New York statute, in Minnesota, we have an A plus statute from the Treatment Advocacy Center. So we have the right words. We don't need to go to case law, but we don't use them either. So we're, I'm working with some legislators now about implementing Minnesota's civil commitment law. So that's exactly what you're doing. You can have all the good laws in the world, but if the people on the ground don't know about them, don't follow them, you don't get to have the benefit of them. So it is a problem. And the people on the ground are really just looking for dangerous to self or others. That's been drummed into them. And they are afraid to help people, even with really good laws like we have in Minnesota, who are a danger to themselves or others, gravely disabled, unable to get their own food, will not accept medication, don't dress properly in the cold weather that we have here in Minnesota. We people are just uh floundering out on the streets at times, and the groundworkers do not intervene because they don't understand the laws that we have.

SPEAKER_04 24:05

So there's so there's training that that you mentioned in your in your opening explanation, changing the training, having practitioners on the ground if possible, or available by video if possible, and having better training for police and all of that. So this is already happening. This isn't proposed, this is already happening.

SPEAKER_01 24:25

It is.

SPEAKER_04 24:26

Okay. So I'm gonna throw it to Mimi to ask the question on our mind about what happens after this uh compassionate intervention.

SPEAKER_02 24:38

Yeah, I just want to say, you know, when when the mayor got up and made this speech, and it was all announced right away on social media, I posted something saying, you know, sort of it's about time or this is great. And I was hit with such a virulent deluge of angry people. Uh, and I think people are just really afraid of sweeps. And um, and also I think that people need this delineation between um serious mental illness and mental illness, because a lot of people jump to the conclusion that depressed people or somebody who's wearing a weird hat is gonna get swept up and taken to jail. And I even uh, and that's what they think too, is they're going to jail. And I even, you know, try to talk to people, and people were so closed-minded about this, friends of mine who are in this world and and just have a very narrow view of it. So I think as much PR as we can all do, it will help. So, my question for you though, is I really support this um change or this uh further um um explaining what gravely disabled means, because that's the thing I think all us moms run into is you're at the hospital or you're at the police station, you're begging for help, and they don't even want to listen to the gravely disabled aspect of it. But I'm just wondering when these people are taken in for compassionate care, are there beds for them? All we hear about is there are no beds.

SPEAKER_01 26:14

Yeah. So it's an overstatement, of course, to say there are no beds. There are people who we are uh helping and and and and and uh healing through inpatient psychiatric care across New York City. I don't think we should um you know buy into the idea that the system is that the cupboard is completely barren. There is no question we we don't have as many beds as we need. Um and the COVID pandemic exacerbated that quite a bit, um, particularly in our our private uh hospitals that that uh had an immediate need to repurpose um beds for COVID and got permission from the state to do that, and we're now still leaning on them and waiting for them to bring those uh inpatient psych beds back. And uh, we're gonna get some help from the state, I'm happy to say, in making that happen. And it's gonna make it possible when we do to uh alleviate our challenge in assuring that people get enough inpatient psych care um to meet their needs. I I will say that with respect to the particular population that this plan is addressed at, right, which is people who are unsheltered and failing to meet their basic human needs in a way that they have really been kind of ravaged by uh the the way they've been living. These are individuals who need a significantly longer period generally of hospitalization uh than others. And commensurate to the actual need for that kind of extended inpatient care, um, we're we're actually accomplishing some things. Uh the state um recently made available to us 50 extended care inpatient beds within New York City. That these are in state hospitals, but they're in uh facilities within located within the city. Um 50 is a meaningful number, again, relative to the size of this population that this plan um is addressed to. It's not, it doesn't get us all the way there, but I'm also happy to say that the governor and her state of the state, uh, in announcing her budget uh last month, um, and this got a standing ovation, so I'm pretty confident it's gonna happen, um, announced the plans to bring another 150 extended care beds to New York City, which is gonna make a huge difference. We also need um acute care beds. Uh, there's no question about that. And then we have a ways to go, and we have some things that are happening. We have our own city hospital system that is committed to getting a couple of hundred beds that it's lost in the last few years back online by the end of this year. So, you know, good things are happening on that front. And um, you know, I guess about all I'd say is that what we do in the meantime is really the question, right? While we are doing all this kind of work behind the scenes and getting those beds back online, we're still in the meantime faced with the reality that there are people in acute psychiatric crisis on our streets right in front of us. And, you know, if we're gonna just walk away from them and say, we can't do anything for you now, we're just gonna leave you uh to have your crisis fester and hope it doesn't lead to tragedy because we just aren't confident enough that we have the beds to take care of you. I mean, what a cop-out that is, right? I uh to me, when you're encountering somebody in a crisis, we really have no choice but to get them into the hospital. Any possibility that we're that they're gonna heal and recover has to start with stabilizing them psychiatrically, right? So we have to start that process and do the best we can with the resources we have now. And you know, I'll also say with respect to the real kind of small population that that that this plan is focused on, um, you know, we have been able to kind of all pull together in a way where we're kind of coordinating our our response and planning interventions thoughtfully and getting our health and hospital system um on board with that. And we've been, I think, doing a really good job of making sure that we're keeping not not streeting people um when we bring them in when they're in this kind of condition that we've been describing. And and we've been successful in moving um some of these folks into those new state beds, and um, you know, it's going pretty well. So uh, you know, there is this larger need that has to be solved for us to have a truly functional mental health system. There's no there's no getting away from that.

SPEAKER_04 30:36

Obviously, and I and I think many of us can get stuck in this. Well, the plan's not perfect, so let's not do anything until it's perfect, which you can apply to anything. The problem of drunk driving, the problem, yeah. So I I heard this, it was new to me, but maybe you've heard it before. It I promise it's not about oxygen masks on a plane. Uh, somebody was was saying to me that if you want to do something, just take the first step and figure it out as you go. Because um if you're on a bicycle, you can't steer the bicycle unless you're in motion. Right. And I thought that was sort of a fabulous um analogy for just like, okay, so you're clearly your plan's not perfect because we don't know that after they get in that hospital stay for 72 hours or nine days or whatever you get. I think we can all agree that a plan needs to get into place for the care that happens after they're stabilized. So that by no means can take away from your plan to at least get the get it started. Like I'm applauding that. I'm wondering two, I'm actually wondering three things. It's a lot of questions. So one is if you can share if there's been any success since this has been implemented, a success story or something of someone that has been helped that might not have been helped. And I guess at some point, if if you have something in the works for the aftercare. But I also I I'm wondering what brought you to this field. Do you have a personal story that sparked your interest uh to advocate for the severely mentally ill? So that's a lot of questions, and I apologize. I'm just fielding a mention from uh Mimi, who has to leave us in 15 minutes, but we'll, you know, we'll be done by then, I think.

SPEAKER_01 32:37

Sure. So yeah, that's a diverse set of questions. Which one do you want me to start with? Sorry, I talk a lot. Pick one for me to start with, and I'll be happy to hit them all.

SPEAKER_04 32:46

All right. Um, have you had any success with this so far?

SPEAKER_01 32:50

Yeah. So obviously, I'm I'm limited in how much detail I can go into about any particular individual's case. You know, it's not they're not my stories to tell.

SPEAKER_04 33:00

Yes.

SPEAKER_01 33:00

Um but I can say that there are individuals, you know, we have regular meetings with um various city agencies led by our Department of Homeless Services, um, where we talk about particular cases of individuals who have just been heartbreaking, and the system has been really kind of frustrated by its inability to help over the years. People who've racked up numerous short-term hospitalizations that just keep winding up back on the street, and we're just seeing, you know, terrible uh impacts upon them. And, you know, in many of these cases, uh I think before we had this new approach in place, there was lots of hand-wringing about how there's just really not much we can do to if we can get them into the hospital to keep them there long enough to heal. And, you know, I can say that there are a number of individuals and really heartwarming stories. Look, they're not complete stories yet. We don't have people who uh have yet re returned to the community and uh are in housing and have stabilized the their lives. You know, that that remains uh to be written, and I think we're gonna get there. But I can tell you that we do have people who have been in the hospital now for uh you know weeks, um, who are reconnecting with family, um, who are engaged with the mobile crisis teams who are coming to visit them, who they had been kind of estranged from and are now talking to again, and um, you know, who have hope that that their lives are getting to a better place. They're gonna need a significantly longer period of hospital care and to get the meds exactly right before we can transition them um to housing. But that's what we're absolutely committed to with each and every one of them, um, to get them uh you know back to to leading the their best lives in the least restrictive environment possible. So uh, you know, we're just a couple of chapters into to to what's going to be a long story, but uh, but but yeah, I've been very um I've been very encouraged by it.

SPEAKER_04 34:59

That that's awesome. And that kind of answers two questions in one. So I'll just ask you what's your personal story? Why do you do what you do?

SPEAKER_01 35:06

Yeah, so you know, um Mindy mentioned earlier that uh I had been involved 24 years ago now in the drafting of Kendra's law. And that was really my initiation into this area of law and this world. You know, I was a brand new assistant attorney general uh here in New York just a couple of years out of law school, and there was this tragic uh subway pushing of Kendra Webdale. The evening before I came in with this new team um into office uh with the attorney general and my first day on the job before I even had a desk. Um, you know, this was the covers of all the tabloids that day, and uh everyone was horrified by it. And I was asked to um see if I can figure out what flaws in in New York law um made it even possible that someone who was so well known to the public mental health system um was kind of roaming the streets without treatment and without any kind of uh kind of monitoring to make something really as predictable, sadly predictable as this uh happen. And um I knew nothing about the subject matter. Uh I was able to connect with uh an advocate by the name of DJ Jaffey, who I know you all know well, um, who became a great friend of mine. I had just had some very cursory dealings with him prior to that, but um, he had just been involved in creating the Treatment Advocacy Center, and so he put me in touch um with the gang there, and uh they were uh extremely helpful to me in crafting what became Kendra's Law, which went on to become a model for lots of states and it wasn't the first AOT law, as some people think, but it you know, we did some innovative things. And uh, you know, when we put that proposal out, I was kind of naively expecting to be uh, you know, greeted with universal applause from the mental health advocacy community. I was truly taken aback by the fact that there were mental health advocates, people with I know really great intentions, um, who thought this was an awful idea, um, who thought about the right to refuse treatment for somebody with a psychotic disorder, the same way you would think about, you know, a cancer patient's decision to refuse chemotherapy, right? As if there wasn't an obvious difference in the the illness itself interfering with the person's decision-making capacity, such that it's actually quite cruel to leave a person to the consequences of their quote-unquote choices. Um, you know, the fact that this was as controversial as it was, I think really kind of bonded me emotionally to the issue and just the injustice of it. And so um, you know, I went on this, I guess, just became my life's work through that. I I went on to a 10-year career in state government where I did a few other things and worked on lots of other issues, but it was never anything that meant as much to me as the that work I had done over those initial eight months in the AG's office on Kendra's law. And um, you know, when I got to a point where I was really kind of demoralized with my government career, um, an opportunity arose to go to work for Treatment Advocacy Center. I had stayed in touch with them over the years. And uh they threw me a lifeline. I came down to DC and um, you know, at that point it really did become my life's work. And I, you know, I'll say that I'm one of the few people who I, of all the colleagues I had at attack over the years who did not have an immediate family member with with severe mental illness. Um, so I did come into this work a little a little differently through a different path than most. Um but um it uh to this day I I'm continue to be fired by this kind of sense of right and wrong. And how can we possibly abandon people um who are not really making choices? They have an illness that they didn't choose. Right. And you know, the just that that that that issue at the crux of it, I think, is what is what continues to kind of fuel me.

SPEAKER_05 39:01

I feel the same way, and you know, I I've never heard it expressed the way you just did, but you said you bonded with the issue because of all the opposition and you the inexplicable uh anger over getting care for people that don't know they're sick. Um, I felt that way when I worked on this. It was the first significant mental health legislation I worked on in the Minnesota legislature, and I continue to feel bonded with that issue. I'm gonna remember that term.

SPEAKER_04 39:30

Okay, so we have about eight minutes left in the podcast. And I just want to, I've had my multiple questions answered. I want to give it to you. Miriam, I want to give you a, you know, Miriam is also Mimi, by the way, give you a chance to uh to ask, you know, throw it out to you. Anything else you guys want to know?

SPEAKER_05 39:49

I want to compliment you on, and I'd like Brian to talk about um the Clubhouse Initiative. We had on the show Joe Cochrane from Clubhouse International quite a while back. And so as a result of that, he challenged all of us to work on clubhouses in our community. So I'm chairing an effort in uh my county, and we're getting close to getting a clubhouse. But man, you guys just came out with a proposal for what, 25 new clubhouses or something? Could you talk about that in about three minutes?

SPEAKER_01 40:23

Sure. Yeah, no, it is super exciting. And thanks, thanks for mentioning it. And that that's an effort that's really being led by our uh health uh and mental hygiene commissioner Dr. Ashwin Vaslan, who came to us from Fountainhouse. He was the the leader of Fountainhouse. And uh, you know, it was uh the mayor's visit to Fountainhouse during the campaign, where I think he connected with Oshwan and um came to see for himself just how powerful the Clubhouse model is, how important it is uh for people to have a sense of community, um, to belong to something, to have their days filled with activities that are meaningful, um, as a way to you know keep people from slipping into despair and and keep people um to have motivation to stay engaged with their their mental health treatment. Uh so this is a best practice that has been uh conclusively established around the country is something that really helps people and needs to be in place uh such that everybody who could stand to benefit and wants to be part of a clubhouse can be in one. So uh, you know, we're in a city of eight million people and we don't have nearly enough clubhouses. Fountainhouse can't possibly fill the need on its own. We do have a few others scattered in in the boroughs, but uh, you know, we've talked about tripling the capacity of our uh of uh clubhouses across the city, and uh, you know, that's something that uh we're committed to making happen.

SPEAKER_03 41:46

Awesome. Mimi, do you have any anything you want to throw out at Brian?

SPEAKER_02 41:51

I don't have a question. I just want to say thank you. It's so heartwarming to hear somebody who doesn't have a family member or a close person in their lives with serious mental illness who's grabbed the gauntlet like this, you know. Um, it reminds me of Carrie Morrison who we had on, who has Heart Forward LA. She was working for the mayor on homelessness. And when she saw the situation with mental health, she completely changed her whole career. And that's what she's doing now. And it's it's heartwarming to hear. And I also think it it's encouraging because I think that the more people are going to hear the situation and understand it, whether or not they have a person close to them with mental illness, they're gonna want the change. So thank you. It it were it just means so much.

unknown 42:44

Okay.

SPEAKER_02 42:45

Thank you.

SPEAKER_04 42:46

Brian, anything we haven't asked you that you want to say?

SPEAKER_01 42:50

Um, I think we've covered a lot. Um, I hope that this gives people an understanding that the the um policy initiative that we announced a couple of months ago was not in itself the plan, right? And we and I encourage folks to um take a look at the the the major announcement we made just last week, where we did kind of lay out our kind of bold vision for how we fix the the public mental health system. And it's gonna take a lot of work to actually get all those things into place. Um, but we've kind of laid out uh for for folks where we hope to go. And uh, you know, it's it's uh a set of ideals that I think we can be judged on uh a couple of years down the road. And it's not gonna be instant that we can actually um reverse years of neglect of a system. But uh, you know, the idea that we're not gonna walk away from people in psychiatric crisis is an important component of that larger strategy. But uh we want everyone to know that uh there are lots of things that we need to do to have the great public mental health system that people um with severe mental illness deserve.

SPEAKER_04 43:59

I think we can all agree on that. As three moms with three families, including three sons with severe schizophrenia, and I believe all of us have faced homelessness and our sons or the fear of homelessness. I, for one, I don't live in New York anymore, but I have. And I, for one, would be thrilled to know that if my son were roughing it and in trouble and unable to care for himself, that compassionate care could be an option. And if Mayor Adams ever wants three moms to come and advocate and talk on a panel, we will present the mother's point of view. For you to say that there are people because of this shift who are getting back in touch with their families, that made me cry. So thank you for explaining this initiative. And we hope that this has shed some light for our listeners. And our three books, by the way, if you don't know, are fix what you can. He came in with it and been behind his voices, and we continue to do what we can in our way, as you are too, Brian, in your way. So thank you so much, schizophrenia three moms in the trenches, and a very good-hearted, action-oriented expert. Thank you for joining us today.

SPEAKER_01 45:26

Thank you all so much. Great to be with you.

SPEAKER_04 45:28

Hey, thanks for joining us for this episode of Schizophrenia Three Moms in the Trenches with Randy Kay, Mindy Gryling, and Miriam Feldman. To get in touch with us or to learn more about our books, please visit our websites at MiriamHyfenfeldman.com, mindygryling.com, or randyk.com,