Opinion: New York’s Mental Health Crisis Demands We Invest in Programs That Work – City Limits

“The issue is not whether these programs work, it’s whether we are willing to scale and coordinate them to create an effective continuum of care.”

For decades, New York City has struggled to meet the needs of people living with the most serious behavioral health challenges. We see the consequences on our subways and in shelters, emergency rooms, and prisons. But in the past few years, city, state and nonprofit providers have developed more effective programs—including Intensive Mobile Care (IMT)Assertive Community Treatment (ACT), medical respite, and Step-down Treatment Ensures Personal Success (STEPS) – we started to see improvement.

Despite progress, thousands of people continue to suffer, and New Yorkers see this play out every day on our streets and subways. The issue is not whether these programs work, but whether we are willing to scale and coordinate them to create an effective continuum of care.

Currently, approximately 1,500 New Yorkers are on the waiting list for IMT and ACT, a highly intensive and effective intervention designed for the most difficult to reach and treat individuals who often experience years or decades of homelessness, hospitals, and prisons. The challenge is that when people are stable, there are no programs to go down to those that provide the care they need on a less intensive—and cheaper—scale.

STEPS, a program of my organization, Institute for Living Communities, created with the support of The Leona M. and Harry B. Helmsley Charitable Trust, is designed to fill this gap. It provides a crucial step-down service between IMT and existing community services, helping people live independently and reducing IMT waitlist-a clear win for both the individual and the city budget. Yet STEPS is now running out of money.

In the Fiscal Year 2026 budget, the city allocated $4.5 million to replicate and expand STEPS. To date, that funding has not been released, delaying the program’s ability to help more New Yorkers and reduce pressure on the broader system.

A recent analysis of the STEPS program found that it is highly effective and supports people in building stability, with the ultimate goal of moving them into less intense community service. Our analysis of STEPS participants found that:

• 97 percent is housed

• 89 percent avoided hospital

• 86 percent avoided emergency room visits

• 100 percent were not arrested or incarcerated during their time in the program.

STEPS also contributed to an estimated 5 percent reduction in waiting lists for IMT and ACT, thus allowing other people in crisis to receive assistance.

Brandon is just one example of nearly 200 people STEPS has supported. Assigned to our IMT program, Brandon—like too many people—spent years moving between shelters, homelessness, prisons, and hospitals. It took time to gain trust, but eventually our team was able to help him stabilize. Once his most acute crisis issues are addressed, he feels comfortable descending into STEPS—and we’re confident he’ll thrive.

Now, he’s living in his own apartment, pursuing his GED and looking for a job. He lives more and more independently, relying less and less on expensive intervention programs. Brandon’s story is an example of the impact the STEPS program has had and done so at a low cost.

Our report shows that STEPS, which costs only $7,497 per person per year, is cheaper than IMT, which costs $42,487, and ACT, which costs $24,391.

STEPS funding is now running out this summer. If the city releases the $4.5 million commitment to STEPS, we can maintain the gains New York has made and move closer to the full continuum of care functions—one that is humane, effective, and fiscally responsible. I know that’s what all New Yorkers want.

Jody Rudin is CEO at the Institute for Community Living.