While it plans to be more deliberate in the future, Thrive staff did not provide internal goals or benchmarks by which to judge its progress to this point. | Demetrius Freeman/Mayoral Photography Office With opaque budget and elusive metrics, $850M ThriveNYC program attempts a reset

Since its inception in 2015, ThriveNYC — the city's sprawling $850 million initiative to address a variety of mental health issues — has operated without much scrutiny or accountability.

With few public metrics by which to measure its success so far, and the broad strokes used by city officials to describe its operations, the city has offered little insight into how it has assessed Thrive's efficacy since it began.


And because Thrive encompasses a variety of initiatives — some new, some already in existence — across more than a dozen agencies, it is difficult to establish a central, line-item budget delineating how the city is spending taxpayer dollars on the program.

POLITICO spoke to more than 16 people, including elected officials, advocates, representatives of community organizations, researchers and consultants who said that although it is crucial for the city to invest in mental health resources, they did not know whether Thrive was successful and said the city has an obligation to publicize its numbers and how it compares to the goals it set out to accomplish. Some requested anonymity for fear of retaliation while others were more vocal in their critiques.

Run by the mayor’s wife and closest adviser, Chirlane McCray, ThriveNYC sought to tackle issues like substance use, depression and suicide. It is meant to target low-income individuals who are often priced out of mental health care because those services are typically not covered by insurance. Thrive also is meant to focus on communities — African Americans, Latinos, military veterans — who are less likely to seek care for mental health problems.

POLITICO filed a records request for the program's line-item budget in October 2018, but the city has twice requested an extension. Two budget breakdowns acquired by POLITICO — one from City Hall and one from the Independent Budget Office — show significant differences in spending.

The City Hall budget shows $594 million in spending since ThriveNYC’s inception. The IBO budget shows $816 million. Both City Hall and IBO suspect the Office of Management and Budget included fewer programs in the City Hall version, accounting for the difference. But the budget discrepancies illustrate the difficulty in tracking Thrive.

In recent months the administration moved to change that, creating a centralized office for the program, appointing a senior adviser to oversee it and releasing budget details and data on 472 metrics against which it could weigh the program’s effectiveness.

The 14-page report, acquired by POLITICO this month, seeks to evaluate the program’s performance, but does not provide a clear picture on what it has accomplished thus far.

The data delineates each program within Thrive and tries to measure the initiative's reach within a given timeline. The city has not begun tracking several programs, such as one for outreach to veterans with mental health challenges and another for trauma services for families with young children, according to the metrics.

While it plans to be more deliberate in the future, Thrive staff did not provide internal goals or benchmarks by which to judge its progress to this point.

For instance, Thrive’s metrics show that between July 2016 and October 2018, 189,070 Naloxone kits were distributed throughout hospitals, syringe exchange programs and other sites where opioid overdose is common. But there is no corresponding data on how many were used or how effective the outreach was.

Social media ads promoting Thrive have reached millions of people, according to the metrics, but the data doesn’t show how many people actually used the program after learning about it.

In the case of diversion programs, which aim to keep individuals with mental health and substance use problems in treatment instead of jails, Thrive only tracks the number of people released under supervision and those screened during pre-arraignment — not if or how city-funded intervention worked.

Other measurements seemingly have nothing to do with the mental health of New Yorkers. For instance, Thrive calculates how many mayors attended a national conference on mental health — just seven when New York City hosted it in 2017.

At least one stat the program tracks showed underperformance in an area of particular importance to McCray.

Twenty-nine hospitals responsible for more than 78,000 newborn deliveries each year — representing nearly seven in 10 births in the city — committed to screen all new mothers for maternal depression. Thrive would then refer them to counseling, which is considered an effective way to treat the problem.

The outcome has not come close to reaching the goal.

Only 28,560 new mothers were screened between September 2016 and October 2018, according to Thrive’s data. As a result, the program reached just 570 women who had been diagnosed with postpartum depression — a sliver of the 12,000 to 15,000 McCray estimated are affected each year.

“If we want to reach all these women, we need to start somewhere. We can’t turn on a switch one day and then screen 120,000 women a year,” Gary Belkin, policy and strategy chief of Thrive, said in an interview, referring to how many women he estimated give birth each year.

“It’s a big city, there must be thousands of OB-GYN providers in communities, in isolated offices. We can’t have a universality in this from day one,” he added.

The city would not make McCray available for a recent interview. In an interview with POLITICO in August, she acknowledged Thrive had not yet released data on its performance related to its mental health hotline, NYC Well.

“We do have some outcomes. I don’t know if we have them available yet, but we certainly are tracking what people are calling about, what they’re asking for, and as much demographic information as we can,” McCray said. “People are allowed to call anonymously, and the calls are confidential. We don’t have everything, but we do have quite a bit.”

Thrive has publicized some data through the mayor’s annual management report of all city agencies, beginning in 2016, but it encompassed only a fraction of the program’s scope.

The city also published a 150-day update report in June 2016 that described “key milestones” produced within the first five months of the program — such as bringing educational programming to homeless shelters and community groups — and outlined what it hoped to accomplish in the coming years.

Thrive’s two-year report, released in February 2018, offers cumulative data, like the number of medical professionals trained to prescribe treatment for opioid use. However, it does not show whether programs met or surpassed their goals, and whether New Yorkers are better off for it.

The new focus for the program is the second time the city has attempted to retrain Thrive’s focus.

Thrive entered a “resetting” phase two years after implementation, which focused on getting programs off the ground, McCray said on the Max & Murphy podcast in March 2018. “Now we have to shift into another phase.”

Now, a year later, the city is rejiggering the program once again to include a centralized office and further engrain the initiatives into city agencies to ensure that Thrive outlasts the de Blasio administration.

Belkin maintains the program has been an overall success.

“We’ve actually built the first rational approach to the real scope and breadth of the need. And the depth issue, I don’t know of many city initiatives that have so quickly touched so many New Yorkers in such a short period of time,” Belkin said.

Others disagree.

Representatives from four advocacy and service organizations said that Thrive does not fund greater access to inpatient treatment or intensive outpatient services for those with serious mental illnesses, further burdening the social safety net.

“Thrive NYC is really best understood as a ‘tale of two cities’ initiative,” said Stephen Eide, a senior fellow at the conservative Manhattan Institute and an expert on homelessness and urban policy. “It’s about trying to give people who are socioeconomically disadvantaged access to the same kind of mental health care that people in upper middle income or affluent communities have enjoyed as a matter of course for a very long time.”

But that kind of programming won’t address institutional problems like homelessness and serious mental illness, which are financial and safety burdens to the city, he said.

“If we’re not addressing those two problems, then whatever we are doing is lacking,” Eide said.

McCray acknowledged in October 2018 that the city does not often discuss Thrive’s programming for violent individuals due to stigma.

“It promotes that misconception that too many people have, that people who have mental illness or people suffering from substance use disorders are violent, which is not true,” she said at a health care conference.

There is a program — NYC Safe — that is embedded into the criminal justice and homeless services agencies to connect “high-risk” individuals to outpatient treatment, according to a 2015 city announcement.

The program has made more than 7,800 referrals to outpatient treatment for those individuals between August 2015 and November 2018, according to city numbers. Again, though, no data was available on the number of people referred or the outcomes of the treatment.

One frequent critic of the program said McCray's reticence in discussing violence related to mental health was a cop-out.

“The mayor and first lady have falsely declared ‘stigma’ rather than ‘lack of services’ as being the major barrier faced by the seriously mentally ill thereby justifying the diversion of funds to public relations campaigns rather than services,” DJ Jaffe, executive director of Mental Illness Policy Organization, an advocacy group, wrote in an email.

Of those 7,811 referrals for people with serious mental illness — meaning they can be a risk to themselves or others — Thrive does not track whether those individuals received care or continued with it. Instead, the metrics list the number of individuals in state psychiatric centers — 68 — and individuals incarcerated — 170 — from Nov. 24, 2018 to Nov. 30, 2018.

“When you’re thinking about performance, there’s both outcome and output,” said Ana Champeny, director of city studies at the Citizens Budget Commission. “I think that would be the difference: not simply how many people you’re screening or you’re training, but what impact that actually has on their life.”

Frustration over Thrive's veteran outreach program spilled over into a tense Council hearing just this week. Council Member Chaim Deutsch, chair of the veterans committee, along with two other Council members, said the veterans program had failed to materialize in their districts.

Deutsch said it also took Thrive weeks to get back to him about training his constituents in Mental Health First Aid — a free, eight-hour course that helps individuals identify and respond to mental illness.

"It is crazy and ridiculous when someone gets funded $850 million — and I don't get a response right away," he said, adding later, "If you have a service, you have to respond to that service ... otherwise, close up."

Similar programs like the Mental Illness and Drug Dependence program in King County, Washington, produce reports that illustrate the target number of people it hopes to reach and the actual number served — data that Thrive lacks. The MIDD progress report also explains how well each program was executed, what challenges were faced and the outcomes.

For Thrive, not only is it difficult to measure impact, but it is also hard to tell how much funding each initiative receives.

Budget watchdogs have lamented Thrive’s opacity.

“It’s not easy to track, because Thrive is a multi-agency program that has functions in all sorts of different agencies in the city, so you need someone very detailed with aggregated budget data to sum up the total spending,” Champeny said.

The city said that was a function of the program's design.

“We need all agencies involved in this issue because all agencies touch it,” Belkin said. “Thrive is really corrective to the narrowness with which we approach this issue, which leaves a lot of people without care, a lot of people untouched, a lot of people not getting what they need, and it’s precisely the need to widen it that we’re trying to fix.”