Anger
Expanding the Mental Health Workforce
A guest post by Chirlane McCray, the First Lady of New York City.
Posted June 1, 2015

According to the U.S. Department of Health and Human Services, in 2012 there were 1,952 psychiatrists in New York City.
When you dig deeper into the data and compare the city’s five boroughs, it won't come as a surprise that Manhattan is home to the most psychiatrists, with a total of 1,270. Coincidentally, that divides out to approximately one psychiatrist for every 1,270 Manhattan residents.
But what if you live in the Bronx, the poorest county in New York State? The numbers are much different, with approximately one psychiatrist for every 13,100 Bronx residents. In other words, there are 10 times fewer psychiatrists in the Bronx than in Manhattan. And the numbers for other health professionals, psychologists and therapists, are similar.
Sadly, this local example illustrates a broader and troubling reality: The supply of mental health services doesn’t even begin to meet the overwhelming demand, especially in our highest-need communities.
This must change. In order to reach the millions of Americans who struggle with mental illness, we need to vastly increase the number of culturally competent caregivers. We need to expand the power and function of psychiatric nurses. We need to make mental health a bigger part of the curriculum at our schools of social work.
But to accomplish any of this, there’s one more thing we need: your support. Highly trained psychiatrists, psychologists and therapists have been and always will be the backbone of our mental health system. You have committed your life to helping people regain their equilibrium, and the knowledge and experience you bring to the table are invaluable.
I have seen this firsthand. My daughter is in recovery from depression, anxiety, and substance abuse thanks in large part to the support she received from a gifted therapist.
But I have also seen the consequences of a status quo that has turned entire neighborhoods into mental health care deserts. I’ve spent the last six months traveling throughout New York City, meeting with doctors and patients, parents and children, experts and advocates. And if there’s one thing I’ve learned, it is this: Mental illness does not discriminate by income—we are all equally susceptible. But tragically, those who are most likely to be exposed to risk factors like poverty, discrimination, and instability have the least access to convenient, culturally competent mental health services.
This is not an intractable problem. In fact, I have seen the beginning of a solution here in New York City.
A few months ago, I visited a Family Resource Center in Queens. There are nine Centers throughout the city, and they provide free support to the parents and caregivers of young people who are experiencing emotional and behavioral challenges.
The Centers are staffed by Family Advocates. These Advocates often don’t have a college degree in a mental health-related field. What they do have is a child of their own who is in recovery from a mental health condition. Put simply, Family Advocates understand their clients because they’ve been there.
While I was at the Center, I met a woman I will call Leslie, a native of St. Croix and a home health aide who is raising a teenage son I will call Markus.
Last year, Markus got into a fight at school and was arrested. It wasn’t the first time his anger management issues had gotten him in trouble, but it was the most serious.
In the aftermath of the fight, the lives of both Markus and Leslie were thrown into turmoil. They had to get an attorney, and Markus had to find a new high school.
Luckily, Leslie was paired up with a remarkable Family Advocate named Jennifer, an immigrant from Guyana whose own son dealt with behavioral challenges.
Drawing upon both her personal experience and the evidence-based training she received from the City’s Health Department, Jennifer helped Leslie and Markus put their lives back together. She helped them figure out their legal options. She helped Markus find a new school, which he really likes. And she spent hours talking with them about Markus’ struggles with anger and sharing strategies for staying calm.
Of course, there are times when Jennifer encounters challenges she can’t solve. But that doesn’t mean her client is out of luck, because Jennifer is also adept at referring people to more specialized care when needed.
Our mental health system needs many more people like Jennifer. Without them, we simply won’t be able to engage all of the people who need help. My hope is that you will welcome them with open arms and help us expand America’s mental health workforce. I also hope that many of you will play an active role in bringing new colleagues into the fold, which could mean working in partnership with a community-based organization or becoming a master trainer in mental health first aid. And if you have other ideas, I’d like to hear them. With some creativity and some resourcefulness, I believe we can improve the way we bring mental health services to those who are not receiving them.
Chirlane McCray is the First Lady of New York City.