New York City’s first lady explains why she’s so open about mental illness

BETHESDA, Md. — Chirlane McCray has made it her mission to be open about mental illness. That doesn’t mean it’s always easy for her.

As first lady of New York City, McCray is already in the public spotlight. But these days, she finds herself discussing her daughter’s battle with addiction and depression, her parents’ own mental health struggles, and a friend who committed suicide.

The openness serves a purpose. In November, Mayor Bill de Blasio and McCray announced a four-year, $850 million initiative to reform the city’s mental health system. The plan, called ThriveNYC, is designed to be a comprehensive effort to eliminate the stigma of mental illness and better serve New Yorkers who are living with it.

McCray, who gave a keynote speech here Tuesday at a conference for researchers at the National Institute of Mental Health, said she isn’t one to seek attention. “I have most of my life been very happy to be in the background,” she said.

“But what drives me, what motivates me, is knowing that people are suffering unnecessarily,” she told STAT. “Because we have answers, and this is the way I can contribute to making our city and our country a better place.”

There are limits. In the NIMH speech, McCray briefly referenced how her parents’ depression had affected her emotional development. Asked about that after the event, she started to answer before asking a reporter to speak off the record.

“I didn’t understand how depression affects the family and kids growing up, what that means,” she said. She described a video she watched during a city meeting focused on children. In the footage, a baby was trying to interact with a mother with depression.

“The mom was not reacting, and they showed the frustration, how it escalated, the baby actually ending up in tears and crying because the mother was not engaging and not responding,” she said. “That just brought back so many memories for me.”

Those experiences and her willingness to talk about them give McCray an authority on the subject, according to mental health experts in New York City who are supporting the initiative.

McCray said that, as first lady, she didn’t have a very specific job description. But when she thought about her own life and what she could do to help the most New Yorkers, she landed on mental health.

“This really comes out of the first lady’s own life, her own family history, how that galvanized her personally,” said Lisa Furst, vice president of policy and programs at MHA-NYC, which is working on the city’s plan.

Much of ThriveNYC’s agenda, which spans 54 initiatives centered around six different goals, is dedicated to the stigma-breaking and awareness-raising that McCray is advocating.

One plan aims to train 250,000 regular New Yorkers on what the city calls mental health first aid, which helps them recognize the signs of a mental health problem and provide some support before the person suffering is able to get professional attention. Another will introduce social-emotional learning into pre-kindergarten classes by training teachers on how to help their students understand their own feelings and their relationships with others.

Under another initiative being undertaken with cooperation from local hospitals, all pregnant women in the city will be screened for maternal depression, which remains a highly stigmatized disorder. The city is also running a $2 million ad campaign with posters plastered across the subway system.

“It’s not like bleeding or broken bones,” McCray said. “It’s not that something that is visible and tangible to people in the same way as other diseases and we don’t grow up with the kind of understanding that we have with physical diseases.”

She pointed out that the 250,000-person goal for mental health first aid training was based on the number of people who receive CPR training over the same period.

“You learn these basic things to take care of your body. If you have diabetes or asthma, you learn these things as you’re growing,” McCray said. “If someone suffers from anxiety, you don’t learn those basics. You don’t learn what to do if someone is depressed and can’t get out of bed one morning.”

“People so often get into blaming and punishing,” she added, “because they don’t understand there’s a real biological thing happening here.”

Part of McCray’s message to the NIMH researchers was the need for more data. ThriveNYC has been praised for its reliance on evidence — Michael Friedman, a Columbia University professor, described it to STAT as based on a “careful review of available research” — but this field is still relatively new compared with other areas of medical science.

McCray has a ready list of statistics at her disposal (1 in 5 New Yorkers struggle with their mental health; 1 in 10 women suffer from maternal depression; 50 percent of mental health disorders emerge by age 14), but she said mental health professionals still need more research on what problems exist in what communities and what interventions actually work to help solve them.

“We don’t have the kind of data that we need to devote the kind of resources we could have devoted on the scale that we need to,” she said. “That, to me, that’s painful.”