Track Results
New York’s first failure on mental health
AS Mayor Adams tackles soaring felony crime, up 28% compared with 2019, he does so in an environment that didn’t exist in the 1980s or even the 1990s: one in which we have a greater awareness of the prevalence of mental illness among both suspects and victims and the need to address such ailments to prevent aggression in the first place.
It’s good that New York wants to explore preventing crime through public health rather than respond after the fact. But the city has to entirely redesign the “performance metrics,” as the consultants like to say, of its mental-health services, to see if what we’re doing is working.
The city’s main way of judging its own performance through data is the annual “mayor’s management report.” This year’s 506-page document contains data-based “outcomes” on everything from picking up the trash to teaching kids to read.
In most areas of government, the responsibility, the goal and the outcome are clear. For example: The Department of Sanitation is supposed to keep the streets clean, pick up the trash and encourage recycling. Hence sanitation “metrics” include what percentage of the streets are clean and what percentage of trash is recycled.
The FDNY is supposed to prevent fires, limit damage when fires happen and respond to other emergencies. Thus the city reports how many fires burned, how many people died and how long it takes to respond to ambulance calls. The NYPD’s goal is to reduce crime. So its first “metric” is the number of felony crimes. And on and on.
We’ll know if the streets are dirtier, if crime goes up or if the number of fires soars — and we will know who is responsible. By contrast, every single goal having to do with improving mental health isn’t an outcome —like the death toll from fires, the number of robberies — but an input.
Consider the city’s “blueprint to end gun violence.” It lists five separate agencies as in charge — meaning no one is in charge.
Every single mental-health goal listed as part of the program is an input, not an outcome. Take “violence interruption” — a counseling alternative to policing. The idea is to teach people how to accept the harm done to them without retaliating against the perpetrator.
The program lists as its performance metric the “number of eligible hospitalbased violence intervention program patients who received conflict mediation services,” usually as they recover from an assault.
But such counseling shouldn’t be a goal in itself; that is the means to the goal.
Nowhere does the mayor’s management report list an outcome. What percentage of recipients of “violence interruption” counseling commit a violent felony crime within the next three years? That should be how we measure success, not how many people participate.
This is also true of the Department of Correction’s mentalhealth goals. It duly lists how many Rikers inmates have serious mental-health diagnoses: 16%.
But the goals related to these diagnoses are, again, not outcomes but inputs: How many times did people visit clinics? How long did they wait? How many sessions did release-readiness counselors hold?
The goals, instead, should be whether access to mental-health care, limited as it is, reduced self-harm and harm to others.
Does access to mental-health treatment at Rikers make any difference to future criminal involvement? We have no idea.
Same thing with mental-health services provided to underage teens in detention: The report lists how many received mentalhealth screening but offers no indicator of whether such screening improved their behavior in any way.
This is true, too, of the city’s most ambitious mental-health programs: the Department of Health and Mental Hygiene’s goal to “prevent and address mental illness.” Great goal, but the only outcomes are how many people participate. There’s no metric to assess how likely the participants are to go on to commit or be victims of felony crime, compared with people who didn’t participate.
These soft goals are partly due to the nature of mental-health care itself. Psychiatry and psychology aren’t exact science, sometimes not science at all. Affluent, nonviolent stable adults go to therapy for decades, never declaring themselves cured.
Nothing wrong with that. But if the city wants to promote mental-health care to a leading role in cutting violent felony crime, right now, then Adams’ next management report will have to offer evidence that it is actually doing so.