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���ϲ����� Note: Yesterday, the NYC Mayor Bill de Blasio’s Administration released a condensed version of what will be the first section of the Roadmap for Mental Health, a project that has been led by an unprecedented level of commitment by First Lady Chirlane McCray. This section aims at providing a background to offer “a full understanding of the depth of the problem” via “the result of months of brand new research commissioned by the ���ϲ����� City Department of Health and Mental Hygiene.” A full report that will include numerous new policy and programmatic recommendations, called ThriveNYC, will be released in the coming months.

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Here are some of the report’s most defining findings (see attached report for annotated data sources):

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Prevalence

• At least one in five adult ���ϲ�����ers is likely to experience a mental health disorder in any given year.
• 8% of NYC public high school students report attempting suicide.
• Consequences of substance misuse are among the leading causes of premature death in every neighborhood in ���ϲ����� City. Each year, 1,800 deaths and upwards of 70,000 emergency room visits among adults aged 18 to 64 can be attributed to alcohol use.
• 73,000 ���ϲ����� City public high school students report feeling sad or hopeless each month.
• Approximately 8% of adult ���ϲ�����ers experience symptoms of depression each year.
• Major depressive disorder is the single greatest source of disability in NYC.�� At any given time over half a million adult New Yorkers are estimated to have depression, yet less than 40% report receiving care for it.

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Cost

• There are $14 billion in estimated annual productivity losses in ���ϲ����� City tied to depression and substance misuse.
• In 2013, more than 630,000 ���ϲ�����ers with health insurance (Medicaid, Medicare or commercial insurance) saw a provider who diagnosed a mental illness. While this group only accounted for 8.3% of the population, the cost of their health care—almost $17 billion—represented approximately 25.6% of total health care expenditures paid by these insurance sources in ���ϲ����� City. This figure does not capture the cost of care for the many ���ϲ�����ers who are uninsured.
• In 2013, the overall health costs for people with a mental illness or substance use-related diagnosis were more than three times the cost for people without these diagnoses. Individuals with any mental illness diagnosis or indication of substance misuse experience three times the number of emergency room visits for physical health care issues, and six times the number of medical inpatient hospital days compared to people without those conditions.

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Impact

• Unintentional drug overdose deaths outnumber both homicide and motor vehicle fatalities. If the impact of alcohol use disorders and other substance use disorders are added together (they are separated in this figure), they would be the second leading contributor to overall disease burden in New York City.

Social Factors

������ Stigma

• The stigma of mental illness has been found to have serious negative effects on hope and an individual’s sense of self-esteem. Stigma also increases the severity of psychiatric symptoms and decreases treatment adherence.

Poverty

• SMI is more than twice as common for adults who live below 200% of the federal poverty level (FPL) compared to those living 200% above it.
• Of all NYC children between the ages of two and five whose parents report their child being diagnosed with at least one of five common mental health disorders, 90% live in poverty.
• People from the city’s lowest income neighborhoods are twice as likely to be hospitalized for mental illness compared to residents from the highest income neighborhoods.

Race and Ethnicity

• Latina adolescents feel disproportionately sad or hopeless and are more likely to attempt suicide.
• African Americans are more likely to be given a diagnosis of schizophrenia and other psychotic disorders, and that is true even when they have the same symptoms as white people.
• People of Puerto Rican descent were 54% more likely to have more severe depressive symptoms than people of Mexican descent.
• African Americans and Asians are less likely to receive counseling/therapy or take medication for their illness than whites, according to a survey of NYC residents.
• Receipt of mental health treatment has been found to be lower for African Americans and Latinos compared to whites.
• National studies suggest that African Americans can be half as likely as whites to receive community-based mental health care, but as much as twice as likely to be hospitalized.

Improper Care

“Much of the care is not delivered properly. Examples of this abound:

• Approximately half of all treatment for major depressive illness in the U.S. does not follow expert-recommended best practices.
• Almost three-quarters of youth insured by Medicaid who receive antipsychotics were prescribed these drugs “off-label”, that is, for conditions not approved by the Food and Drug Administration. While off-label use is common and not illegal, the use of these medications for children in the absence of firm evidence of their efficacy has garnered significant concern and scrutiny.
• A recent national study suggests that increased access to mental health treatment for youth over the last decade may contribute to the overuse of anti-depressant and stimulant medications.”

ThriveNYC White Paper