Kids ‘coming apart at the seams’

Young people who are living on the streets of New York City and dealing with mental illness are falling through the cracks of a social services system that doesn’t understand their needs, said nonprofit organizations serving homeless and runaway youth. Part of the problem is a lack of programs tailored to their unique situation. 

“I don’t believe that, as a city, we have seen this population clearly,” said Mary Adams, managing director of mental health programs at Manhattan-based nonprofit University Settlement and its partner youth services organization, The Door. “They are coming apart at the seams for the first time in their lives.” 

Adams and others familiar with the needs of mentally ill youth say they applaud Mayor Bill de Blasio’s recent initiative to recalibrate the city’s mental health system and expand care across city programs. But nonprofits say they hope city officials will engage with them and consider their input as they decide how to spend the relatively small sum set aside for runaway and homeless youth services. 

The mental health initiative provides $54.4 million in fiscal year 2016 and $78.3 million in subsequent years for programs aimed at families, people dealing with substance abuse and survivors of domestic violence, among others, according to the city. The amount that will be made available for runaway and homeless youth programs as of July 1 is $1.57 million, plus additional funding that is currently in the proposal stage, said Susan Haskell, deputy commissioner for youth services at the city’s Department of Youth and Community Development.

Haskell said the agency is going to give the organizations they fund a great deal of flexibility in how they spend the money. For instance, she said some organizations might choose to hire a social worker while others might develop a partnership with a nearby facility that provides health services. 

“We’ve heard from our providers that it’s been tougher and tougher” to meet the mental health needs of young adults, Haskell said. “We’re not only asking for their input—we’re asking them to tell us what they need.”

Staff members at provider organizations say the number of homeless people in their teens and early 20s has gradually increased in the past 10 years, and that the population has become more difficult to serve. There are currently nearly 20,000 homeless people under the age of 24 living in New York City, according to the nonprofit Safe Horizon.

There isn’t just one problem, but “a trifecta of bad things raining down on these kids,” Adams said, describing typical scenarios she has seen in the more than 25 years she has spent working with young adults.

In some cases they’ve graduated from high school—or stopped attending and were taken off the roster—which means they have lost one of their support networks. Maybe they’ve aged out of the foster care system, or maybe a relative they had been living with wants them to support themselves now that they’re out of school. All of this is happening at an age when people usually begin to exhibit early signs of mental illnesses such as schizophrenia or psychosis. 

“It happens pretty quickly and then they’re out on the street … and they’ve literally been disconnected from every system they’ve known in their life,” Adams said. “We need programs where they can go and stay, and they’re safe.”

The Department of Youth and Community Development operates a network of facilities aimed at serving runaway and homeless youth, in many cases partnering with nonprofit organizations in each borough. They include seven drop-in centers, where young people can find a shower, a change of clothing, a meal and employment services; eight crisis shelters, designed for emergency situations, as a place to spend a few nights while finding a long-term solution; and 12 transitional independent living programs where young people can stay for up to 18 months.

But accessing mental health care remains a challenge, said nonprofits, adding that employees at most of the city’s hospitals and clinics are not trained to work with young people experiencing a great deal of trauma. With the exception of several nonprofits that offer on-site psychiatric services, they say it’s difficult for young people to find mental health care where staff members treat them with sensitivity.

“It can be intimidating for a youth to walk into an emergency room in the city,” said Richard Luthy, assistant director for transitional programs at the Brooklyn drop-in shelter operated by the nonprofit SCO Family of Services.

Even when mental health treatment is available, Luthy said many young people’s lack of insurance and proper documentation is another barrier to their receiving treatment quickly. He stressed the importance of streamlining the lengthy process clients now go through before they begin treatment. 

“The main challenge for our staff is ensuring that youth that are undocumented or do not have health insurance, that they can get assessed right away,” Luthy said. “The sooner that we can get someone assessed and possibly on medication, we can start working on moving them forward.”

Organizations that have on-site mental health services specifically targeting their client populations, such as the Ali Forney Center in Harlem, a drop-in center that mainly serves LGBTQ youth, are finding it difficult to keep up with the demand. 

“Our waiting list to see the psychiatrist is kind of long,” said Joey Lopez, outreach coordinator at the center, adding that the staff psychiatrist currently only works two days per week. 

Lopez said he hopes city officials will engage the staff at the center and at other organizations as they determine how to allocate newly available funding.

“We don’t know where the money’s going to go,” Lopez said. “It would be great if they allowed us to sit at the table and give them some kind of guidance.” 

Ideally, Adams said city officials would develop a “continuum of services” for homeless young adults, reducing the likelihood they’ll face problems such as “bouts in and out of jail and ER” later in life. In this case, the treatment they receive early on would translate into cost savings for taxpayers years later.

“Let us create a tool,” Adams said. “People can’t throw up their hands and say, ‘There’s no place to send them.’”