All posts by Alexander Robateau

Communities and Social Justice [Future of Mental Health]

Clarifying Key Concepts

Social justice has, in recent years, been disparaged and demonized. However, social justice is what allows big cities like New York to evolve and meet the needs of its residents. As Squires and Kuprin point out, big cities are characterized by uneven growth, which is concurrent with spatial inequality. Often, cities develop along patterns of segregation, where minority-majority communities often have less access to services, employment, and education.

For the purpose of our group, it’s important to consider these limitations to accessible mental healthcare. In low-income, often minority-majority communities, access to mental health services often means leaving the community and utilizing many forms of public transportation to attend weekly therapy sessions. The recurring cost of transportation adds up to make attending therapy a financial burden for clients. This makes it exceedingly difficult to reach low-income clients when existing symptoms and possible side effects from medication may make it difficult for the clients to leave their homes. It’s no secret that mental healthcare is a profession that is disproportionately white and middle class. In order to change this trend, social justice tactics to destigmatize mental health and create comprehensive pathways to care must, as Squires and Kuprin point out, be class-based and race-based.

Thrive NYC is, in concept, a good way to reach out to New Yorkers in need of mental health services. Its ideal of inclusion and simplification of pathways to care sound like noble causes. Our issue is that we still haven’t seen these changes. What we’ve discovered through reaching out to our many community contacts is that even among professionals, there is a lack of awareness that the government is even trying to change the mental health system or—more realistically—build one in the first place.

Discussion question: How is place privilege eliminated? How do we expand services to low-income, predominantly minority communities and ensure that these services are of equal or comparable quality to services in middle and upper-class communities?

4/6 Project Update

Updates - Mental Health

Key project activities: Our group has still been in the phase of contacting potential community members for more information about their impressions of Thrive NYC. So far, all of our community contacts have been unavailable to speak with us. Since dropping contact with our initial community representatives (Families Together, Fountain House, Urban Justice Center’s Mental Health Project), we’ve attempted to reach out to Dr. Alexander William Fietzer, a clinician at Mount Sinai Hospital and a professor at Hunter College. As of today, we still haven’t heard back from him. We’ve contacted the counseling center at CCNY asking for a comment about Thrive NYC and requesting a meeting to become our community contact. Unfortunately, they admitted that they had never heard of Thrive NYC and declined to be our community contact. Kashaf’s community contact was also unaware of Thrive NYC and declined to be our contact. Because so many of our potential contacts have no strong opinions about Thrive NYC, we have met to discuss changing our tactic. Without clinicians’ input regarding the current government initiative to address mental health issues, it’s impossible to speak to the criticisms professionals have for Thrive NYC or even the awareness of noticeable changes in treatment adherence, accessibility, pathways to care, etc. We have agreed to incorporate more of a focus on the lack of advertisement and press coverage surrounding Thrive NYC into our project. In regards to our particular interests in mental healthcare, our focus has remained the same: we are still interested in comprehensive care and access to mental health services. However, we want to incorporate a discussion of how government programs attempt to transform the mental health system in New York.  In regards to our research, we’ve met to develop a comprehensive timeline of mental health initiatives in the United States, dating back to the early 19th century. We’ve found gaps in mental healthcare innovation and policy which we might incorporate into our white paper and use to illustrate the trajectory in mental health services.

Activities in progress: Instead of asking potential contacts to guide us as we continue our research, we have proposed interviewing clinicians at the Mount Sinai outpatient clinic where I work and using their input to inform our development of the white paper our final popular education product. On Thursday, April 7th, Sam is interviewing Dr. Mike Lamb, the director of the Macaulay Wellness Program, an honors college-specific initiative designed to support Macaulay students through “direct, professional mental health counseling, services, and guidance”. In such a small community, the effects of the Macaulay Wellness Program could be very positive, but the funding could also be used ineffectively. Regardless, it could represent a role model in accessible mental healthcare, which could in turn influence our popular education product. In addition to meeting with Dr. Lamb, we’ve discussed interviewing contacts within the CCNY community. Libby will be meeting with Aashna, a contact from the Gleam project, which aims to increase accessibility to mental health services for people of low socioeconomic status. Finally, I will be reaching out to Dr. Robert Melara, the chair of the psychology department at CCNY, for a brief interview about Thrive NYC and how (or if) government initiatives inform treatment. In preparation for potential contacts, our group has met to develop pertinent questions that would help us interview community contacts and guide research in the right direction, such as:

  • What resources do you offer to people with social, behavioral, and emotional challenges?
  • What mental illnesses do you typically treat? Are there any good examples of such cases?
  • What community-based practices are you aware of (e.g., other organizations that provide mental health services, government policies, and initiatives)?
  • Do you feel that clients are getting the services and resources they need to overcome their mental health challenges? What additional services would they benefit from?
  • What are your opinions about government programs like Thrive NYC and Parachute NYC? Do you think their aims are achievable, adequate, or likely to be effective?
  • Are the clients you work with aware of or benefiting from these programs?
  • What are these programs lacking in how they serve people with mental health challenges?
  • What kinds of barriers do patients usually encounter in receiving treatment?

Challenges: We have come to the conclusion that being a community contact for the purposes of this class is a significant undertaking and requires a time commitment on behalf of our potential contacts, many of whom are clinicians or specialists in their field. The lack of contact with representatives from our organizations is understandable; mental health professions are prohibitively time-consuming, and (we hope that) our potential contacts go above and beyond to make treatment accessible for their clients. With little other to work with than a timeline of mental health and the Thrive NYC white paper, securing a contact is our main priority at the present time.

Team dynamics: Our group has met on several occasions to clarify any uncertain objectives, deliver report-backs about community contacts (or lack thereof), and discuss alternative methods of informing research. There is a clear and consistent breakdown of work and, for the most part, we are accommodating with each other’s busy schedules and willing to make up for any missed work. Each team member contributes what they are realistically capable of undertaking and is eager to contribute any experiential knowledge or prior community contacts. In order to document our discussions and ensure that there is no miscommunication, many of the important points are written in Google Docs accessible to all team members, and coordination is conducted through Facebook Messenger. These tactics have been relatively efficient in setting up meetings and assigning tasks.

Bottom line: Without a community contact, we’ve done a significant amount of research on our own. We’re quite frustrated with the lack of press coverage on Thrive NYC and we’d like to investigate why such a groundbreaking and significant initiative has almost zero visibility among mental health professionals. We’d like to incorporate that into the development of our popular education product and use Thrive NYC as an example of poor advertising.

Intersections of Community and Psychology

Clarifying Key Concepts

To a Robert Moses fan, the difference between “community” and “neighborhood” has very real implications politically, economically, socially, and so on.

However, an important characteristic of urban planning that is often overlooked is psychology. Thus, community organizers have sought to remedy the problem using psychology, whether consciously or not. According to DeFilippis, community “fulfills a range of human desires from shelter and nurturance, through safety at home and in one’s daily rounds, to historically rooted, politically, and ecologically defined space in which individuals, households, and groups contest and cooperate with each other to make life possible.” This conception of the ideal community evokes images of Maslow’s hierarchy of needs, which is an iconic symbol of human development theory. Respect of others cannot be achieved until a sense of safety (of property and of resources) is achieved. If people feel that their living situations are prone to being uprooted by city planners at any given moment, community cannot exist. Change cannot take place in communities unless special attention is paid to the needs of individuals.

Dr. Mindy Fullilove’s book Root Shock provides important insight on community-building. Coming from the field of clinical psychiatry, a field which focuses on individuals, Fullilove’s insights paint a micro view of community. More than just a conglomeration of consumer units in close proximity to one another, as DeRienzo’s definition of ‘neighborhood’ holds, communities are built out of the interaction of similar and different experiences, and the co-creation of an “emotional ecosystem”.  Community development is aided when a collective memory, through social and economic exchanges, create a sense of belonging in a neighborhood. This is often compromised by rezoning and urban development initiatives.

The RPA and the Growth Machine

Contemporary Planning in NYC

In previous classes, we’ve discussed how the growth machine is responsible for much of the city’s urban planning. Scott Larson describes the mechanisms responsible for this in chapters 5 and 6 of Building Like Moses with Jacobs in Mind. We’ve already discussed the dangers of the interactions and intersections of business, politics, and development, which seem quite obvious. The communities aren’t anywhere in the equation, which can be problematic.

Larson’s discussion of the Regional Plan Association’s “Third Regional Plan” highlights the fact that despite their best attempts, bridging the “nuanced” Jacobs school of urban planning with the “bold strokes” of Moses school had some positive benefits to communities, but many of these benefits were unintended consequences of a larger plan that ultimately benefited industries.

The RPA, a conglomerate of pharmaceutical companies, real estate interests, banks, media outlets, and other large organizations, sought to “improve the quality of life” and “economic competitiveness” of New York City and the surrounding region, which appears to be a noble goal on the surface level. Regional preserves, urban parks, greenways, and new harborfront parks were planned and “inward growth” was supported to give existing employment and residential centers a boost. These improvements in turn increased property values and rents, which would allow these new improvements to pay for themselves. However, this is the essence of gentrification. Scott Larson points out a fatal flaw in the image of pioneering gentrifiers seeking to “turn around” low-income neighborhoods—the first new tenants of gentrified neighborhoods are real estate companies.

Larson points out that from the 1990s forward, gentrification was no longer the “block-by-block form of neighborhood rehabilitation that Jacobs celebrated”. Gentrification had been methodical and capitalized, with real estate interests and planning associations coordinating it. This phenomenon was precisely what the Regional Plan Association advocated: inward growth to improve economic competitiveness, raise property values, and rents.

Discussion question: According to Larson, the public was irrelevant to Robert Moses. He hired experts and specialists who shared his modernist ideals and only attempted to convince business leaders and politicians of the efficacy of his planning. Because the RPA was a conglomerate of corporations and powerful interests, is it simply a perpetuation of the Moses school?

Benign Neglect as a Social Strategy

Uncategorized

“So that breakthrough that we thought was going to happen in ‘88 or ‘89 if we just worked fast enough—it did happen, but not until ’96. And so a lot of people died. Maybe if Reagan had started putting money into AIDS earlier, they wouldn’t all be dead.”                                            — Mark Harrington

In an earlier class, we discussed how New York City urban planners used the policy of ‘benign neglect’ and ‘planned shrinkage’ to target specific populations (mostly low-income people of color) to decimate entire populations for urban renewal. These programs were ultimately ineffective due to the resilience of the inhabitants of these areas. Even today, these areas are in the process of regrowth and revitalization.

In a similar fashion, David France’s How to Survive a Plague highlights the way conservative leadership in the United States failed HIV/AIDS victims from the 1980s onward. Conservative figures such as Ed Koch, Ronald Reagan, George Bush Sr., Jesse Helms, and Archbishop Joseph O’Connor used their political powers to downplay the severity of the AIDS epidemic in New York and associate the spread of AIDS with immorality. This served as the prevailing justification for the inadequate funding and foot-dragging in AIDS research. This in turn influenced the policy in some New York City hospitals of turning away or refusing to treat patients with HIV due to a lack of education or concern about the prognosis of the illness.

The parallels between the neglect of HIV/AIDS victims and neglect of ailing communities are striking. When AZT first emerged on the market after FDA approval, the initial costs were prohibitively expensive: at $10,000 per patient per year (around $21,000 today, adjusted for inflation) for a drug that was minimally effective, class distinctions in the gay community of Greenwich Village became a matter of life or death. Similar to how the Rand Institute botched the statistics regarding fires in the Bronx, the early refusal of hospitals to treat HIV/AIDS victims influenced the statistics regarding the prevalence of HIV in the early 80s. Clearly, the process of decimating communities by denying them essential services was not a tactic used only to build highways.

The quote from Mark Harrington above points out some pressing questions regarding this grim era in New York’s history: if ACT UP did not exist, at what point would AIDS have been considered a public health crisis? Did the NIH willfully neglect the gay population of New York City to thin out a “problem population”?

The Community As A Body

A Plague on Houses

It’s interesting to think of a community as a body. Similar to a body, communities have their own stages of development, growth, period of sickness, period of prosperity, and ultimately—if the state allows it—death. In this metaphor, Wallace emphasizes the fact that the government of the City of New York failed to revitalize its ailing neighborhoods. In the medical profession, doctors are bound by the Hippocratic Oath to ensure that their patients “suffer no hurt or damage”. Clearly, these rules don’t apply to legislators. Through racist and classist notions of the ideal community, neighborhoods in Brooklyn and the Bronx were systematically destroyed.

“Benign neglect” and “planned shrinkage” were essentially as harmful and blatant as Robert Moses’ physical destruction of communities of color. As the large-scale residential clearance for highways and bridges became controversial and fell out of favor, subtler forms of racism ensued. The “top-down” model of urban planning struck again as ignorance influenced the destruction of low-income communities of color. By using meaningless, pseudo intellectual mathematical models and botched fire report data, Rand was able to bring about the rapid decline in population in these areas. Specifically, Wallace points out that the Resource-Allocation Model didn’t take into account the fact that fires fluctuate depending on the time of day and the season. Just speaking to a community member or a nurse at a local hospital would emphasize this important variable. The disregard for public safety in these areas on behalf of Rand, Daniel Moynihan, and Roger Starr was far more antisocial than the community members themselves.

One issue mentioned early in the reading was the lack of industry in the South Bronx, which was cited as one of the reasons for its slow rate of development and the social climate of the area. Following Robert Moses’ urban planning model, it would follow that revitalizing the area would mean emptying out entire pockets of residential areas to create industry sectors. The city wasn’t interested in orchestrated attempts to revitalize the neighborhood. The “slash-and-burn” approach to urban planning is random, as city planners can’t choose where fires will happen—for obvious reasons. If we’re following the trajectory for the Robert Moses school of urban planning, we can refer to one of his more unabashedly racist quotes from 1977: “Now I ask you, what was that neighborhood? It was a Puerto Rican slum. Do you remember it? Yeah, well I lived there for many years and it was the worst slum in New York. And you want to leave it there?” This ideology of urban planning is based on a standard of achievement with middle class whites as the norm. Under this standard, it’s easy to assume why the South Bronx, East Harlem, Brownsville, and East New York were targeted for “planned shrinkage”.

It is the City’s responsibility to create sustainable communities for all residents. No city should allow communities to fail because of their demographies. One might argue that one of the reasons for the turmoil and social climate of the South Bronx was the earlier “renewal” caused by the displacement of hundreds of residents for Robert Moses’ Cross Bronx and his stance on public transportation (he hated public transportation, which many South Bronx residents were dependent on, as they couldn’t afford to purchase cars). As Wallace points out, communities are like bodies, and proper scales, measures, batteries, surveys, analyses, and examinations need to be performed before legislation is passed.

Discussion: Should urban planning be subject to greater scrutiny and regulations?