NYC Council Testimony: “Access to Mental Health Care in Black and Brown Communities”

On April 6th, CASES’ Tysen White (Program Director, Health Home Care Management program and Forensic Homeless Intensive Case Management program) testified in front of the NYC Council Committee on Mental Health, Disabilities, and Addictions on behalf of CASES. The meeting focused on “Access to Mental Health Care in Black and Brown Communities.” Below is a transcript of his testimony.

Good morning. I’d like to thank Chair Louis and the members of the Committee on Mental Health, Disabilities, and Addictions for holding this hearing today and providing the opportunity to testify.

My name is Tysen White, and I work as a Program Director at the Center for Alternative Sentencing & Employment Services, also known as CASES. CASES is a nonprofit that provides services for people impacted by the criminal legal system, including alternatives to incarceration; youth programs that emphasize education, employment, and family services; and mental health programs. Our mental health services include intensive mobile treatment teams working in Black and Brown communities citywide to serve individuals living with serious mental illness. CASES also operates an outpatient mental health clinic in Central Harlem. I lead two programs based out of CASES’ Harlem office, a Health Home Care Management program and our Forensic Homeless Intensive Case Management program. Both use mobile services in the community to support people living with serious mental illness and past criminal legal system involvement, including some making the transition from State prison back to the community. My clients have needs including medical issues, behavioral health, and substance use, and often have a lack of positive support from family and friends, access to healthy food, clothing, hygiene products, and adequate housing, to name a few. The goal of my teams’ work is to help these individuals connect to appropriate services in the community, achieve recovery and healing, and create a mentally and physically healthy life.

CASES’ 30 programs serve more than 7,000 people annually across the five boroughs. With our programming, CASES focuses on breaking unjust cycles of arrest and incarceration, which as all of us here today know disproportionately impact the Black and Brown communities of our city. In addition to mobile and clinic treatment programs, CASES also works in courthouses throughout the city to provide alternatives to incarceration and detention. These programs allow youth and adults who would otherwise be headed to jail or prison to stay in the community and get connected with the services they need to address challenges while building skills and accessing meaningful opportunities for success. CASES’ jail and prison alternatives have consistently shown to help our clients avoid recidivism.

Because of the kind of work we do, CASES’ clients reflect the racial disparities endemic in New York City’s criminal legal system. In a city in which about 45% of citizens identify as Black or Latinx, in the first half of the current fiscal year about 90% of CASES’ clients identified as Black or Latinx, a rate comparable to the more than 87% of those detained in City jails who identify as such. Similarly alarming, more than 43% of people in City jails have some sort of mental health need, including 15-20% experiencing serious mental illness. While CASES staff work hard to connect our clients to jobs and housing, we also recognize that without access to appropriate mental health services, their ability to achieve their full potential may be limited. There are a few lessons CASES has learned to make sure we create this access.

First, employ psychiatrists, clinicians, peers, and program directors who identify as people of color. Having staff who have lived insight into some of the challenges routinely navigated by our Black and Brown clients—and who understand the stigma around seeking mental health services they may face at home—is the first step to overcoming the taboo of accepting help. The people who understand the culture of the community will be the ones who know how to navigate effectively providing services.

Second, provide community-based mental health programs directly in Black and Brown communities. Every year, more than 40,000 people enter the NYC jail system from seven neighborhoods including Harlem, the South Bronx, and Jamaica, Queens—that’s 81% of the total New York City jail admissions in 2018. CASES’ Nathaniel Clinic, a State-licensed outpatient mental clinic, is co-located with my programs in CASES’ Central Harlem office. CASES’ clinic serves all community members 13 and older and specializes in working with people who have been impacted by the criminal legal system. More than half of Nathaniel Clinic clients reside in or near Harlem; 80% identify as Black or multiracial and 35% as Latinx. We know there are many reasons that the clients served by CASES can experience challenges in accessing services: work and parenting schedules, lack of transportation, stigma around mental health, previous negative experiences in treatment, providers who have their own stigma about working with people with criminal legal histories. We are committed to promoting access by being as flexible as possible in our service approaches. At our Nathaniel Clinic in Central Harlem, this means offering walk-in hours, evening and Saturday appointments, robust telehealth services, and delivering a full suite of treatment and support services at the clinic offices. We want to be ready when someone makes that often very difficult choice to come into our office, whether they are seeking mental health, primary care, addiction, family, peer support, crisis services, or all of the above.

The clinic, like my program offices, is located just off 125th Street on Adam Clayton Powell Jr. Boulevard. Having offices easily accessible in the community often helps clients take that first step, and CASES additionally operates program offices in Downtown Brooklyn, the South Bronx, and Jamaica. Many of our programs—like mine—also provide mobile services in the community, meeting clients in their homes, shelters, or wherever they reside to provide care. This is very important to engage our clients. By coming to them, it shows how important their needs are. We can bridge the gap of transportation, stigma, or location. Providers are accustomed to people coming to them to receive a service. That is not always an option for most people seeking services. There are medical and behavioral health deserts in many areas of NYC where there are no services located within walking distance. There are many people of all ages from these communities who are not able to travel or utilize technology to receive services due to medical and financial barriers. Meeting them where they’re at provides our clients with safety and reduces the fear around the stigma of “going” to the mental health clinic. The option to have services provided in their home along with telehealth services gives some control back to our clients with privacy, comfort, and dignity. One thing we can take from this pandemic is how effective services—services that not only come to the community but are located in the community—can have a great impact on that community’s sustainability.

Third, empower clients by helping them be their own best advocate as they navigate an often-complicated web of system involvement. We have to ask them, “What do you want your life to be?” We have to ask them what they want and help them get there. This means addressing basic needs like hunger, clothing, and housing. This means assessing their transferrable skills, figuring out what goals they want to work toward, and learning how to navigate the legal, entitlements, and medical systems. This means collaborative agreements with probation officers, medical professionals, and mental healthcare workers so everyone’s on the same page and working toward the same goal. Too often, we see clients on different medications for physical and mental health that don’t work well together, or we see probation officers scheduling mandatory check-ins during doctor’s appointments. We need a more holistic approach, a more humane and ethical approach.

In the wake of COVID-19, the need for accessible mental health services is greater than ever. In October 2020, nearly 40% of New Yorkers reported symptoms of anxiety and/or depression. And, as in so many other ways during this pandemic, Black and Brown New Yorkers are disproportionately affected by this mental health crisis—a CDC study found the highest rates of anxiety and depression in May 2020 were among people of color, people ages 13-24, and people who qualify as low income. CASES’ Nathaniel Clinic has seen significant increases in need and demand for mental health services during the pandemic: from February 2020 to January 2021, the clinic saw a 77% increase in monthly active clients and 78% increase in average weekly services. Having services available in the communities most impacted is the only way we as a city will recover from the collective trauma we have experienced over the past year, trauma that will continue to play out in our streets, subways, and homes in the months and years to come.

Speaking on behalf of CASES, we appreciate the time, attention, and funds the City Council has directed toward improving access to mental healthcare in Black and Brown communities. As an organization, we’ve been working for decades to provide holistic care for people involved in a criminal legal system where policing and sentencing practices have brutally harmed communities of color. Ensuring access to robust, effective mental health services in our communities is a critical step toward healing and equity.  CASES is ready to support this effort, and I look forward to seeing how the Committee will invest in and lead this work. Thank you for this opportunity to testify.


Photo credit: Momos/Wikimedia Commons