Mental Health Care: Separate and Unequal

How does a country lose sight of 60 million people? One in five Americans has a mental illness at any given time, yet as a society we do not see them. They suffer discrimination, yet as a society we don't acknowledge it.

Access to mental health care is a civil right. Under federal law, insurers must cover mental health care on the same basis as physical illnesses, but in practice too many sufferers don't have access to the same care as those with physical ills. A 2015 National Alliance on Mental Illness survey found respondents were less likely to find doctors or prescribers who accepted their insurance and more likely to be forced to spend extra out of pocket to receive coverage.

Mental health issues may strike anyone. But we know that the poor, the black and the brown are more vulnerable. Serious mental illness is more than twice as common for adults living with incomes 200% less than the federal poverty level compared to adults with incomes 200% more than the federal poverty level.

Tragically, the ravages of poverty fall on our children's psyches. Approximately nine out of 10 American children suffering from the most common mental disorders live in poverty. A young person who has lived through poverty, neglect or violence, is twice as likely to experience the onset of a mental health disorder as a young person who hasn't had those experiences.

Racism also exacts a terrible psychic toll. A review of almost 300 studies published over 30 years found that those who faced racism suffered, "poorer mental health, including depression, anxiety, psychological stress and various other outcomes."

Yet the same people who most need support are the least likely to get it. African Americans, Asians, and Latinos are less likely than white New Yorkers to receive counseling or medication. African-Americans are less likely than whites to be diagnosed even with the same symptoms and half as likely to receive mental healthcare in their own neighborhoods.

Nationally, African-Americans are 20 percent more likely to have serious mental health disorders than whites, but 40 percent less likely to receive care.

We should consider these facts as the debate on health care continues. For now, Republicans have failed in their efforts to directly gut the ACA. Yet their efforts are ongoing. If the Trump administration ultimately succeeds in killing Obamacare - directly or indirectly - the effect on people with mental illnesses would be devastating.

Not only are insurance companies required to cover mental health on par with physical health, but the ACA also funds preventative services like mental health screenings. Even with the ACA, too many Americans aren't getting the care they need. Remove the ACA and the gains we've made might disappear.

That is why the de Blasio administration is doing all that it can to ensure that the kind of mental health care New Yorkers receive is the same in every zip code. In November of 2015, we launched ThriveNYC, the most comprehensive mental health policy of any city or state in the nation.

Thrive includes 54 initiatives backed by nearly a billion dollars and it is reaching into every corner of the city.

We're providing mental healthcare where the people are in neighborhood clinics, senior centers and schools. We've launched NYC Well, a 24/7 call line that can connect anyone who contacts it to care. We're training 250,000 people in mental health first aid so they know how to help struggling family members, friends and co-workers.

We are focusing on children's mental health by rolling out an "Act Early" strategy to bring help to young New Yorkers. We are putting mental health clinics in schools, training thousands of school staff and teachers to deal with mental health issues, providing a social-emotional learning curriculum to thousands of students and much more.

I am reminded of a story I heard about a licensed clinical social worker named Yajahira who works in a Bronx middle school. There was a student in that school, who I'll call Teresa. Teresa grew up in an abusive home and began harming herself, and she was hospitalized on numerous occasions.

But Teresa's story ended well. Her teachers spotted the problem and instead of ignoring it or sweeping it under the rug, they referred Teresa to the school's social worker, Yajahira. As a fellow Latina, Yajahira was sensitive to Teresa's history and culture, and that understanding led to trust and then to dialogue.

Eventually, Teresa began to work through her trauma, and on the last day of middle school, Teresa didn't just graduate, she graduated with honors.

The lessons of this story are clear. We need to do all we can to create a world where talking about mental health is as easy as talking about asthma; where treatment for mental health issues is as available as treatment for diabetes; where the color of your skin doesn't determine how you are treated for mental health or if you are treated at all.

Only then will we be able to end the tragic consequences that occur because our mentally ill family, friends and neighbors are living lives that are separate and less equal.