Assessing mental health problems often requires two diagnoses: one to determine the problem afflicting the patient, and another to determine which of the many and varied options between social workers, counselors, psychologists, intervention programs or other providers best fit their needs. 

In the spring of 2001, Northern Manhattan Community Voices issued a comprehensive report assessing both the mental health problems afflicting its communities in the Central Harlem and Washington Heights-Inwood neighborhoods of New York City and the services that are available to treat them.  On May 22, 2001, the Community Voices site invited members of the Northern Manhattan community to a Mental Health Roundtable to discuss the findings of the report.

More than 80 stakeholders in the mental health community of Northern Manhattan, including consumers, community activists, caseworkers, providers, and policymakers representing both New York City and New York State participated in four separate discussion groups.  Each discussion group was run by a moderator and a note-taker and was conducted in a classroom setting to encourage free discussion. 

Each discussion expanded on one of the four main findings of the report.  The sessions were titled: 1) Building Capacity: Assessing the Financing of Mental Health Services; 2) Prevention and Awareness: An In-depth Discussion on Stigma; 3) Service Coordination: Bridging the Gaps on the Road to Treatment; and 4) Cultural Competency: Treating the Individual in Its Context. 

“The report was developed with input from all the people from the community, not one perspective.  We wanted to find out what mental health issues were circulating among people in the community,” said Dr. Allan Formicola, former dean of the Columbia University School of Dental and Oral Surgery and advisor to the Northern Manhattan Community Voices Learning Laboratory.  “The purpose of the roundtable was to synthesize different reactions from all groups.” 

The original report determined the resources dedicated to address the mental health needs of Northern Manhattan were both insufficient to meet the community’s needs and inequitably distributed compared to other New York City neighborhoods.  The primary faults of the system were the under-funding of mental health programs and insufficient attention given to the special needs of mental health patients, especially misperceptions arising due to the cultural diversity of New York City residents. 

With an eye toward presenting their findings to policymakers, the groups dissected a diverse array of topics.  The Building Capacity group explored how city and state funding of mental health care facilities impacts the availability of services in Northern Manhattan.  Cost of Living Allowances or COLAs, the annual rate increases permitted to providers for treating publicly funded patients, vary annually and are often insufficient to encourage providers to accept new patients.

“The groups reinforced the needs found in the report,” said Dr. Formicola.  “The system is not as cohesive as it needs to be.  There is a need for more culturally sensitive providers and a need for more resources.  There are a variety of places where these resources could be placed—school-based clinics, community organizations, social service organizations.  There are a variety of clergy in Harlem who would like to do more referrals, but do not know if or where the capacity exists.  The community is not uniform and a variety of sources are necessary [to provide sound treatment].” 

Also, many facilities in Northern Manhattan have long waiting lists.  As a result, many people are forced to seek treatment in area emergency rooms.  The report found a 40% rise in psychiatric visits in area ERs. 

Topics discussed by the Prevention and Awareness panel included an evaluation of a New York City Department of Health campaign designed to address the stigmas associated with mental illness and the creation of a venue in which community providers could provide feedback to assess the progress of such programs.  Participants also discussed replicating a mental health care network for children, which is currently operating in Lower Manhattan. 

The Service Coordination group examined methods to develop bridges between mental health providers and the community groups and services, which are often the initial point of contact for many mental health patients.  “The first task was defining the system.  Now we need a preventive network that links with the provider network,” said Dr. Formicola. 

“There is a need for more trained professionals and providers, who are willing to settle in the community and work with community-based organizations and back up what they are doing in mental health care,” said Dr. Formicola. 

The Cultural Competency group analyzed both the language barriers, which prevent many individuals from receiving adequate care, and the cultural mechanisms, which often cause friction between patients and providers.  “The relationships between persons vary greatly between cultures,” said Lourdes Hernandez of Northern Manhattan Community Voices.  “A person may describe a reminiscence of his deceased mother as ‘talking to her,’ which can lead to misunderstandings with providers.” 

“One African American patient said he had never seen a black psychiatrist,” said Hernandez. “He felt there were things he could not discuss with a white psychiatrist because the psychiatrist could not understand.  There are concerns about the level of comfort of the consumer.”  According to Dr. Formicola, “One problem in looking at mental health issues is often the cultural differences.  There are varying perceptions of mental health.”

Northern Manhattan Community Voices intended to update the report using the information produced during the discussion groups and ultimately to present their findings to policymakers.  The site will share its findings with the New York City Psychiatric Institute to further its advocacy. 

The Northern Manhattan site “is trying to work closely with providers and the Northern Manhattan Mental Health Council,” according to Dr. Formicola.  “We are trying to support their efforts with the report.”  The final summation of the findings of both the report and the roundtable will be submitted to the Northern Manhattan Mental Health Council, who will then present the findings in its annual report to the New York City Department of Health.  “Our goal was to identify populations most in need and to identify the needs of those persons,” says Hernandez. 

The diversity of the neighborhoods served by Northern Manhattan Community Voices complicates solutions to community problems.  African Americans and growing numbers of African and Central American immigrants populate Central Harlem.  Washington Heights has a large Dominican population and is seeing growing numbers of Central and South American, as well as Asian immigrants.  The economic make-up of the area is also changing.  Areas of Harlem and Inwood are experiencing economic booms. 

This mixture of both cultures and economic conditions demands a variety of solutions to community needs.  “It is important for providers to leave their own understanding of things behind,” said Hernandez.  “The needs of the client are more important.  There are people who have to choose between paying the rent and paying for treatment.  Other patients forego their medications because they fear the side-effects will affect their ability to work.”