New York spends millions on mental health street teams. Do they work?

New York City has poured tens of millions of dollars into a program to treat seriously mentally ill people on the streets and subways for nearly a decade without ensuring it was functioning effectively, according to an audit made public Wednesday by the city comptroller. .

The program, known as intensive mobile treatment or IMT, was intended to help hundreds of the city's most vulnerable residents by providing them with medications, psychiatric treatment and connections to housing and other services.

But fewer than a third of people whose cases were reviewed by auditors were regularly taking their prescribed medications. The audit showed that one in four people have never met a psychiatrist or nurse from a treatment team. And it showed that the city agency that oversees the program, the Department of Health and Mental Hygiene, had not set clear standards to measure its effectiveness, despite spending more than $37 million on the initiative last year alone .

“We need the IMT program to work – to help mentally ill and homeless New Yorkers get the treatment they urgently need,” said Comptroller Brad Lander. “Unfortunately, poor management and coordination are reducing the program's success in helping participants get off the streets and into stable housing – and we don't know whether or not it is working to keep IMT clients and other New Yorkers safe. ”

The audit also documented an inability by the city to properly oversee the nonprofits it contracts with to run the treatment teams, showing that officials had done little to hold the teams accountable for serious errors. City officials have been aware of more than 130 such problems in recent years, ranging from insufficient staffing to failure to complete customer assessments. But officials waited months to follow up, the audit found, and when they did, they didn't always ensure problems were resolved.

One team was allowed to continue operating and even expand its business with the city, despite failing to fill a key behavioral health specialist position for more than three years.

The deficiencies detailed by the audit occurred in what was widely considered one of the city's most important programs for treating homeless, mentally ill people, in years when New York's homeless population was growing and a series of subway shocks and other Random attacks put the city on edge. .

A city health department spokeswoman, Rachel Vick, said the agency was examining how it measures the program's success, but added that some of the audit's findings failed to capture the breadth of the initiative.

“The treatment model does whatever it takes to find, engage, treat and support clients who are in extremely complex situations,” Ms Vick said. “All future goals, including housing, services and reduced justice involvement, are only possible through that sustained involvement.”

Agency officials also said the audit focused on whether clients met with psychiatrists but did not consider interactions with other team members, such as social workers or fellow specialists, who often also provide support.

The audit's findings were released in the wake of a New York Times investigation that revealed widespread failures in the city's homeless mental health system, including in a network of specialized treatment teams.

The Times found that some teams had lost contact with participants for months, and others had failed to spot signs that people were deteriorating before committing random acts of violence.

In one case reviewed by The Times, a homeless man named Rashid Brimmage was under the care of an intensive mobile treatment team when the team lost track of him during the coronavirus pandemic. Mr. Brimmage, prone to psychotic episodes, was still enrolled in the program in 2020 when he pushed a 92-year-old woman in Gramercy Park, causing her to hit her head on a fire hydrant. He was charged with assault; after he was released from prison, his team lost him again — then reunited with him after a Times reporter spotted him on the subway last spring.

A primary goal of the intensive treatment program is to reduce the incarceration rate among mentally ill people, but the city does not regularly track how it has fared on this front, the audit found. The latest study, which analyzed the program's participants in 2018, found that the incarceration rate among them was reduced by 22 percent.

The Times review documented ready-made examples of people under IMT and other treatment programs who deteriorated and ended up in prison.

By the time a homeless man named Dejanay Canteen was assigned to IMT in 2016, he had spent much of his life cycling through psychiatric institutions and emergency rooms, being treated for schizoaffective disorder.

The man, who goes by the name King, was assigned to an intensive treatment team at the Center for Urban Community Services but was still arrested repeatedly, records show.

He once told a psychiatrist who provides care to IMT participants that he needed more support, saying, “I need help. I'm talking to the wall. I can't be in the community,” his medical records show.

In 2019, he went missing for months, and in September a psychiatrist noticed him wandering around without shoes. Months later, after he was accused of robbing a Manhattan street vendor at knifepoint, he threatened a Staten Island restaurant owner with a knife while trying to steal a tip jar in a separate incident, police said. He pleaded guilty to attempted theft in both cases and was sentenced to seven years in prison.

Roshni Misra, deputy program chief for the intensive treatment team at the Center for Urban Community Services, said the team had provided “consistent and meaningful” support to the man, but declined to elaborate, citing patient privacy.

“Building these relationships is not a linear path,” Ms. Misra said. “We cannot force results, but we can do our best to create opportunities.”

The city started intensive mobile treatment teams in 2016 to provide psychiatric care to people who often had a history of homelessness and violence. These teams have a smaller caseload than other treatment teams, are more flexible and can provide care tailored to a person's needs. The city has 31 such teams, run by five nonprofits, that meet people on street corners, shelters and train stations. They now serve more than 800 at-risk New Yorkers.

The teams have become a cornerstone of Mayor Eric Adams' plans to reduce crime and expand services to seriously mentally ill people. He announced last year that the city would expand the number of intensive mobile treatment teams to put more “New Yorkers on the path to stability” and help prevent them from hurting themselves or others.

The audit faulted the city for failing to establish concrete performance measures for the program and for failing to track the progress of individual participants. The city has no set expectations for the treatment people should receive and no goals for how often teams should meet with clients.

“As a result,” the audit said, the city “cannot determine whether the program is actually helping clients make progress in their treatment.”

The Department of Health told auditors that the “complex nature” of the issues faced by those in the program made setting specific care requirements “unrealistic,” the audit said. Nevertheless, the department agreed to develop metrics to track participants' progress – but not until 2025.