Working to Break the Cycle

On any given weekday, the halls of the Emma L. Bowen Community Service Center Therapeutic Preschool are filled with some of New York City’s most challenged children. In classrooms that line a wing of the Upper Manhattan Mental Health Center in West Harlem, with walls covered in colorful cutout collages and echoing with soothing music, the Bowen Center offers pre-kindergarten services for children who already show signs of mental health challenges and may exhibit violent behavior. 

Compounding these challenges are the harrowing realities of their young lives: the vast majority of the Bowen Center’s students live well below the poverty line. Many come from broken, violent homes and families with histories of drug abuse and incarceration.

“Many of our students have been exposed to serious trauma for their entire lives, including witnessing domestic violence, which exacerbates mental health and learning challenges,” said Trudy Murray, program director of the Bowen Center’s Therapeutic Preschool program. 

The Bowen Center is one of five remaining programs in Manhattan that offers full day preschool services for such children. As a part of the program, the Center’s team of mental health clinicians, teachers, speech therapists, occupational therapists, physical therapists, and one-to-one paraprofessionals work with children in small settings with the goal that students will go on to less restrictive learning environments upon leaving the program.

Necessarily, Murray claims, services for these children must be holistic, including active parental involvement. The Bowen Center stresses filial play therapy, which involves parents engaging in play with their children while a therapist is present. Bowen Center staff also shadow parents with their children, offering techniques on reinforcing positive behavior and defusing challenging situations. 

Murray explained that the Bowen Center strives to educate parents so that they can become advocates for their children throughout their education. This may include helping a parent with an autistic child get signed up for Supplemental Security Income or checking in with the parent of a former student who has gone on to elementary school.

“We call ourselves a village that works with your child,” said Murray.  

Murray, a clinically trained Licensed Mental Health Counselor with decades of experience working with young children who exhibit violent behavior, explained the importance of early childhood mental health intervention.

“Without help at this stage of development, the cycle of each generation in need of a whole host of costly services – shelters, incarceration, mental health services – simply continues unchecked,” said Murray.

Numerous recent academic studies reinforce the need for early intervention programs. One study, “A Multi-Disciplinary Approach to Early Childhood Mental Health Intervention,” led by Wayne State University and University of Michigan Schools of Medicine professors in 2010, found that up to 14% of preschoolers exhibit behavioral patterns that significantly interfere with their learning and development. Of these children, up to 75% will experience significant mental health challenges as adolescents, leading to dramatically increased rates of substance abuse and incarceration.

In a 2007 study, Harvard University’s Center on the Developing Child suggested that early intervention holds the key to dismantling this progression.

“Cost-benefit studies have demonstrated positive returns on high-quality programs for vulnerable children beginning as early as prenatally and as late as age four,” the study’s summary stated. 

For supporters of early intervention, these academic recommendations seem increasingly pertinent in light of the recent attention given to conditions faced by incarcerated individuals with mental health issues. Reports of harsh treatment and increased sentences, compounded with nationwide data showing that mentally ill prisoners far outnumber patients at state psychiatric hospitals, have increased calls for reform from mental health advocates.

Just this month, Human Rights Watch, an international organization based in New York, released a nationwide report chronicling the pervasive physical abuse experienced by mentally ill prisoners. At least one inmate featured in the study, a Michigan man with schizophrenia, died of preventable causes in a prison with no psychiatric staff.

In New York City, the conditions of mentally ill prisoners at Rikers Island have attracted headlines and calls for reform. A 2014 New York Times investigation found that 4,000 of the 11,000 inmates at Rikers have been diagnosed with mental illnesses, as many as all of New York State’s psychiatric hospitals combined.

JoAnne Page, President and CEO of The Fortune Society, a nonprofit that offers mental health services to formerly incarcerated individuals, and a member of Mayor de Blasio’s Mental Health Task Force, hopes that New York City will begin to substantially shift its resources to prevention.

“We know who the kids are who are in trouble; we basically just don’t worry about it until they become a trouble to us as adults. And then we’re willing to spend a lot of money to put them in a cage for a while, and then let them out without their issues being addressed,” said Page.

Advocates such as Murray and Page cite the current mayoral administration’s commitment to universal pre-kindergarten, as well as a recently announced allocation of $100 million over two years to mental health services, as steps in the right direction.

However, agencies that provide early prevention services are still facing a challenging environment. Murray and her staff at the Bowen Center must continue to deliver services to one of New York’s most underserved populations with very limited resources. One of the primary sources of government funding for the Center’s services, New York State Medicaid, provides just $80 per day for each student for full day clinical and classroom services.

In spite of the current challenges, Murray is confident in the transformative nature of the Bowen Center’s work. She described a recent experience with one child who, after months of frequent removal from the classroom due to violent behavior, volunteered to lead his one-to-one aide in deep breathing exercises when she seemed a little stressed.

“It showed that he had really internalized the techniques that we’re teaching. That’s a solution that he will have for the rest of his life,” said Murray.

Her hope remains that more funding and priority will be given to programs that aim to break the current cycle of those who suffer from mental illness.

“There simply need to be more programs. We are a city in crisis,” said Murray.