Criminal Justice Residential Initiative

The New York State Office of Mental Health (OMH) has selected The Bridge as one of five agencies for a new initiative to provide housing and services to men and women released from State Correctional Facilities. Through this initiative The Bridge will dedicate 14 residential beds to this special population. In addition to providing housing, The Bridge will offer mental health and substance abuse treatment, vocational and related rehabilitation services, and primary health care. The new initiative is the latest Bridge response to meet the needs of seriously mentally ill men and women in the criminal justice system. While the census in New York’s State psychiatric facilities is now less than 4,000, there are many more thousands with serious mental illness in the correctional system.



Seven years ago, The Bridge pioneered the Iyana Project with Bedford Hills State Correctional Facility in which a Bridge in-reach team works with inmates nearing release and provides post-release permanent housing and services. The agency also participated in the Frequent User Service Enhancement (FUSE) Program, a New York City initiative to provide housing to criminal justice clients. FUSE targets individuals through data matching that identifies people with multiple stays in both the jail and shelter systems, and places them in supportive housing. 

We are pleased to participate in this new initiative designed to meet the critical needs of an especially vulnerable population.

HIV/AIDS Housing at The Bridge

HIV/AIDS housing at The Bridge is a 20-bed facility on Amsterdam Avenue in Manhattan. This residence is an important part of our mission to help special needs populations. Residents in this housing must be diagnosed with HIV/AIDS, have been or are currently homeless and have co-occurring mental illness. Most residents also have drug/alcohol addiction issues.

The program opened 10 years ago with funding from the Federal Ryan White program, which is contracted through New York City’s Public Health Solutions, a not-for-profit conduit for Federal Health money. The building is a five-story walk-up with 2 studios and 9 two-bedroom apartments. Each resident has his/her own private bedroom and bathroom, and share a kitchen and living/dining space. The Bridge provides furniture and equipment.

This is an emergency/transitional program where residents stay for approximately 9 to 12 months while they stabilize medically and psychologically and financially. After being homeless, it is imperative that these individuals have this opportunity to stabilize. The goal of this program is to help residents acquire the skills and strength to move to permanent housing where they can live more independently.

The Bridge works with each incoming resident to get the medicine and health care they need, connect them to financial programs (such as social security, food stamps, Medicaid, etc), and teach them skills needed for living independently. Residents are required to keep their apartments clean and have food in their kitchen. 

A continental breakfast is served each morning in the common kitchen area, and each evening, residents work to prepare and eat dinner together. Many of the residents do not have cooking skills or nutritional knowledge when they enter the program and staff works with them and teaches them how to cook healthy meals for themselves and/or the group.

There are also group meetings/classes run in the residence two evenings per week. One class discusses medical issues, housing, and substance abuse. The second class focuses on LGBTQ relationship issues, medical and medication issues. 

Residents go on group trips to help them integrate back into society, and they visit museums, go to the movies, attend free concerts and other activities that are of interest to the residents. During the day, residents can also attend the drug/alcohol program at The Bridge headquarters, which is licensed and funded by New York State’s OASAS (Office of Alcoholism and Substance Abuse Services), as well as other Bridge programs. The Bridge strives to bring integrated care to each client.

Veterans Poetry

The Bridge is proud to announce that its long-established Poetry Program has been the seed for a similar venture. When Patricia Thackray, Director of the Bridge Poetry Workshops lectured at the International Society For The Psychological Treatments of The Schizophrenias And Other Psychoses (ISPS), she inspired one member of the audience, Barbara J. Davidson, to found and run a similar program at James J. Peter's Department of Veteran Affairs Medical Center in The Bronx.

Barbara J. Davidson, LCSW, Clinician in Schizophrenic Treatment and Research (STAR) said, "Patricia Thackray's work and that of her clients influenced us to explore poetry in our own VA writing group. Our veterans enjoy reading published poems as well as writing their own." We at the Bridge are happy to play this role in enriching veterans' lives.

Ms. Davidson anticipates that her clients' work will appear in the quarterly national publication Veterans' Voices, the only publication dedicated solely to veterans' writings. This magazine was created by the Hospitalized Veterans Writing Project (HVWP) to further veterans' art and writing. Similar to the focus of our Bridge Poetry Workshop, HVWP's therapeutic writing program acknowledges veterans' experiences and helps to build self-esteem through creative expression.

The Bridge Poetry Program provides clients with the ability to express themselves through an art medium that they are unable to express in any other way. The clients learn about themselves through their poetry, and their self-confidence and feelings of well-being are increased through their creative experiences. The Bridge Poetry Workshop meets twice a week and has been headed by Patricia Thackray for the past 25 years.

The Bridge has long supported veterans. In an innovative partnership, The Bridge, Community Preservation Corporation Resources (CPC-R) and The Briarwood Organization, successfully came together to develop a large parcel of City-owned land in the Melrose section of The Bronx for the Melrose Commons veterans' residence project. This ambitious project will include the development of affordable family housing for the community, senior housing and Bridge housing for 60 homeless veterans who have experienced significant challenges in returning from service.

AIDS Walk 2011

The Bridge team will be participating in the AIDS Walk 2011 on May 15th. Our team will be meeting at 9am on 72nd street and Central Park West to start the walk. Please join us in walking or sponsor our team by contacting Katherine Canto at t:212-663-3000 ext. 424 e: kcanto@thebridgeny.org, or Patricia Edwards at t:212-234-9746.

The Bridge offers Emergency and Transitional Housing for People with AIDS. Our 20-bed emergency/transitional residence for people with AIDS is funded through a contract with Public Health Solutions, the NYC conduit for Federal Ryan White AIDS funding. The program features an easy-access admissions process and provides 24-hour staffing, including case managers and a housing specialist to assist residents in obtaining permanent housing. Linkages to the full range of services at The Bridge are available to the residents. Referrals are made to other service providers as well, with the program’s case managers helping to coordinate services.

Although the housing is transitional, with a length of stay not exceeding 6 months, the period of stable housing offered by the program is crucial to link residents to the medical and other services they need. The trusting resident-staff relationships formed in the program create an important foundation for residents to move forward in their lives with hope about the future. 

Elderly Mental Health Housing

Little attention has been focused on elderly mental health housing. Older persons who have serious mental illness with co-occurring serious medical conditions require integrated mental health and health care that comprehensively addresses their complex needs for an improved life. In the Spring 2011 edition of Mental Health News, Peter Beitchman, Executive Director of The Bridge, writes about the achievements of our Sheridan Hill House for elderly and the psychiatrically and medically frail as a model for success.


As opposed to a typical nursing home, the elderly mental health housing model of the Sheridan Hill House costs only $23,000 per resident annually, which is a small fraction of the $130,000 average annual cost of a nursing home in New York City. As a cost-containment model, the program has documented a sharp decrease in the number of emergency room visits and inpatient hospitalizations by residents. The rate of missed medical appointments is currently close to zero and there is a very high rate of medication and treatment compliance. Many residents whose health was previously highly unstable have been maintained in the residence without significant medical emergencies.

Housing For Homeless

The Herkimer Street building in Brooklyn is one of 4 projects in The Bridge pipeline that will provide housing for homeless adults with serious mental illness, and for the first time, in an integrated building with low-income families. The Herkimer Street building in Brooklyn will be our first mixed use or integrated building which will offer housing and support services for 20 young adults aging out of foster care and/or the children's mental health system, 20 adults recovering from serious mental illness, and 20 low-income families from the community. 

Mixed-use housing for homeless is a model supported by the New York State Office of Mental Health that integrates people with mental illness into a building with families and other individuals. As outlined in the "Guiding Principles for the Redesign of OMH Housing and Community Support Policies, May 2007," this model helps to reduce stigma associated with mental illness, is more accepted by communities because it provides much needed housing for community residents, and it provides opportunities for recovery and rehabilitation.

The Bridge has now signed a contract of sale for the vacant piece of land for development and DeLaCour & Ferrara Architects have completed a feasibility study that determines the size of the building, number of units it can accommodate based on the zoning, a schematic design and layout as well as the costs to build. The next step in the process will be environmental reviews and approvals and a financing plan with support from OMH and low-income housing tax credits.

As with our other new developments, we are very excited about exploring green building elements such as solar energy and materials that will help to save energy costs as well as being good for the environment.

Sheridan Hill House for the Psychiatrically and Medically Frail

Sheridan Hill House (SHH) for the psychiatrically and medically frail is another unique asset of The Bridge. We know of no other housing like it in the city or state. It is a specialized residence offering permanent housing for adults with both serious mental illness and serious physical conditions due to aging or health issues. This residence officially opened its doors on March 6, 2007 and offers a community care environment, staffed 24 hours per day.

The staff provides case management services, medication monitoring, referrals to community resources, nurse assistance and one nutritional meal a day. A Care Manager is responsible for the coordination of medical and psychiatric services for all of the residents. The Care Manager also serves as liaison between healthcare providers, evaluates residents, and provides referrals for needed services and specialists. Nutritional meals are coordinated with the chef based on residents’ dietary needs. Through medication monitoring and management, training for staff, groups for residents and benefit assistance, the treatment tenants receive is extremely comprehensive.

Sheridan Hill House is a HUD 811/Section 8 development. There are 24 residents living in studio apartments. There are 16 NY/NY (homeless) designated beds, 8 of which are for long-term shelter-stayers (LTSS), and 8 community beds for those coming from Bridge transitional housing programs. The facility costs only $27,800 per bed annually to run versus a typical Medicaid nursing home, which costs $123,400 per year according to the NY State Partnership for Long-Term Care. Tenants are required to pay 30% of their income towards rent. This type of cost-effective housing saves on emergency care costs for residents who otherwise would not receive similar round-the-clock care nor would they be able to remain in the community.

Services for Special Populations

The Bridge offers many innovative services for special populations. Special populations are made up of people with specific needs for treatment. They are the most vulnerable in the community and have physical or mental impairments that interfere with performing everyday activities.

The services for special populations The Bridge offers are the following:

• The homeless - We offer outreach, support services and housing. 
• Those with psychiatric and substance abuse disorders - We offer a licensed medically supervised integrated mental health and substance abuse treatment problem, support groups with intensive relapse prevention, and housing. 
• Persons with mental health diagnoses and HIV/AIDS - We offer intensive case management, treatment services and housing. 
• People who have been in the criminal justice system - We offer specialized treatment and housing.  

It is our whole approach to treatment that enables clients to get the support they need, where many can lead more independent lives.

Cost of Supported Housing

The real cost of supported housing for the mentally ill and homeless has been a hotly debated topic for some time. At the University of Pennsylvania, Dr. Dennis P. Culhane studies homelessness and assisted housing policy. His research has contributed to a shift in public policies to address homelessness, including expansions of supported housing for people who are chronically homeless and housing stabilization programs.

Formerly, the goal of homeless programs was to treat people for issues like substance abuse and metal illness, with the goal that this would lead them out of homelessness. Presently the attention has shifted to getting people back into housing quickly with the treatment and support they need to start living independently for the long term.

Dr. Culhane’s study “Service Use and Costs for Persons Experiencing Chronic Homelessness in Philadelphia” examines the service utilization and costs within the chronically homelessness populations in sheltered and unsheltered locations. Using shelter and street outreach records over a 3 year period, the study found that 20% percent of the persons who incurred the highest costs for services accounted for 60% of the total service costs of approximately $20 million a year. Most of the costs were for psychiatric care and jail stays. A small population was incurring the most cost because they were using expensive services like hospital emergency room instead of regular doctor visits.

Supportive housing programs for people with serious mental illness who experience chronic homelessness were found to substantially offset their cost because the use of acute care services diminishes in that environment of housing stability and access to ongoing support services. 

Mental Health Supportive Housing

Mental health supportive housing is critical for the treatment of, and recovery from serious mental illness. Supportive housing is a type of affordable housing that provides on-site services to people who need professional assistance to live more independently, including the former homeless, those with HIV/AIDS and people with mental illness or individuals with a history of substance abuse.

In some New York City neighborhoods however, support for building these residences has been scarce. There is, in some cases, a prevalent misconception that the mental health supportive housing developments would decrease property value. Recently NYU’s Furman Center for Real Estate and Urban Policy released a large-scale study disproving this misconception by evaluating the impact of supportive housing on property value based around home sale prices. The study confirmed that well run supportive housing can help both formerly homeless citizens and the neighborhoods in which they are built.

The Furman study evaluated the impact of 123 mental health supportive housing developments, opened between 1985 and 2003, across the city's five boroughs. The finding showed that in the 5 years after the residences were opened, prices of buildings nearest to the supportive housing development experienced steady growth, appreciating more than comparable properties that were slightly farther away. Mental health supportive housing apartment buildings cost substantially less than shelters, jails or beds in psychiatric hospitals. They are also often visually handsome and replace neighborhood eyesores or empty lots.

Our experience at The Bridge is consistent with the Furman study. In the past 25 years, we have developed 12 buildings in neighborhoods throughout Manhattan and the Bronx. In every instance, property values have risen dramatically on the blocks in which we have developed. An example is our building on 105th Street between Central Park West and Manhattan Avenue. When we took over the abandoned building, it was a drug den and source of criminal activity. There were a number of other buildings on the block that were either abandoned or in very poor condition. Our construction became the anchor for development on the block. Within 10 years, there were no longer any abandoned buildings and the quality of life on the block improved dramatically. This experience has been repeated in virtually all of our other projects.

This study is significant because it proves beyond a doubt that people who were once homeless can be good neighbors and citizens. The findings refute fears that supportive housing developments will depress the value of neighboring properties over time.

Green Mental Health Housing

The Bridge is moving on up with green mental health housing upgrades to be completed by December 31st of 2010. Through innovative re-financing secured through Low Income Housing Tax Credits (LIHTC), New York City Housing Development Corporation (HDC), and NYC Department of Housing Preservation and Development (HPD), Bridge was able to secure $5 million of capital necessary to upgrade residence buildings that were opened between 1983 and 1992. This undertaking is called the 202 Revitalization Project and involves the renovations, upgrades and energy-efficient/green additions to 5 Housing and Urban Development (HUD 202) mortgaged properties that Bridge bundled together under this one project. 

The project has immeasurably enhanced the quality of life for the 76 tenants who are mentally ill, formerly homeless and aging. The green housing upgrades include new energy star windows, elevator and fire alarm upgrades, new kitchens and some bathrooms, new low flow toilets and shower heads, mailboxes, energy star appliances, new energy efficient lighting in the apartments, stairwells and all common areas, weatherproofing and some re-pointing as needed, insulation and white roofs, painting (using low VOC paint and adhesives), and handicap accessible hardware for all entry doors.  

Energy audits were conducted by EME Group and each green mental health housing building qualifies for NYSERDA incentives by reaching 20% reduction in energy costs. This was a difficult project in that the tenants remained in place. Every level of the agency staff including administrators, finance, housing directors, area directors, managers and line staff as well as facilities and maintenance staff worked together to accomplish the project which will be completed by December 31, 2010 in order to meet the LIHTC requirements and secure the tax credits. 

Richman Housing Resources is the syndicator; Nixon Peabody LLP is the counsel; DeLaCour & Ferrara Architects P.C. is the architectural design firm; P&P Contracting Corporation is the general contractor; and Aaron Lewit is the owner's representative.

June Housing Highlights

20 new scatter-site beds to be located in the Bronx

These beds were awarded by NYS Office of Mental Health for chronically homeless adults who have a serious mental illness or who are diagnosed as mentally ill and chemically addicted. The program will provide quality housing and support services to ten chronically homeless men and women referred from city shelters and ten persons referred from Manhattan Psychiatric Center and Rockland Psychiatric Center. These will be scatter-site apartments in the Bronx, either studios or shared two bedrooms. We will begin leasing units this fall and anticipate 100% occupancy by the end of 2010. With these 20 beds, The Bridge will have 744 beds in operation in Manhattan, the Bronx and Queens.

Deutsche Bank to fund housing development activities

The Bridge was recently selected as a recipient of Deutsche Bank’s SHARE (Supportive Housing Acquisition and Rehabilitation Effort) Round V awards with $150,000 in grant funds and $75,000 in loan money over three years. These funds will be used to support upcoming housing development projects including our 60-bed homeless veterans project in the Bronx and our 60-bed Brooklyn program for young adults and adults with serious mental illness.

Special Note: During this past year (July 2009- June 2010) our agency opened 167 new beds.

A New Place to Call Home: East River House

As of December 30th, 2009 we have opened our largest residence to date – our 41-bed East River House located in East Harlem. We have been planning this project for several years and with the support of New York State Office of Mental Health (OMH), we purchased the property in March of 2006 and began construction in January 2008. The design is by DeLaCour and Ferrara Architects, and the general contractor is Rende Contracting Corporation. We would also like to thank the Corporation for Supportive Housing (CSH) for providing a small loan toward the acquisition.

East River House will be home to 41 adult men and women with serious mental illness who are referred from Bellevue Hospital’s inpatient psychiatric unit, Kings County Hospital inpatient psychiatric unit, Manhattan Psychiatric and Rockland Psychiatric Centers, and the Brooklyn Mental Health Court. Like our other residences and scatter-site apartments, East River House can help halt the cycle between hospital, shelter and jail for these individuals and provide them with shelter and comprehensive services that will help them move on to more independent housing and lead more productive lives.

These on-site services include:

• Peer counselor assistance
• Case management
• Entitlements counseling
• Psychiatric rehabilitation including (symptom management, socialization, community integration, discharge planning from day one)
• Substance abuse treatment
• 24/7 front desk coverage
• Computer training
• Benefits assistance
• An evening meal prepared by a cook
  

Residents will have access to building amenities such as a laundry room, computers, a community room with a kitchen and a large backyard for outdoor activities. In addition to fulfilling the needs of our consumers, our housing program has made an initiative to meet the needs of our environment by becoming more eco-friendly. East River House includes green elements such as ENERGY STAR windows and appliances, central a/c and heating.

Besides being our largest residence to date, East River House is also noted for being one of the first Bridge residences to use low-income housing tax credits (the other housing project is The Bridge Revitalization [HUD 202]). Other sources of financing are from Dormitory Authority of the State of NY (DASNY) bonds, and OMH rent subsidies and service dollars. Tenants also contribute 30% of their annual income as rent.

Take a look inside East River House:

Program Profile: SHACT

As of January 1, 2010, The Bridge has implemented a first-of-its-kind program, SHACT – Supportive Housing and Assertive Community Treatment, but before you can understand SHACT, let’s discuss ACT, Assertive Community Treatment Program.

ACT
This program was created to respond to the needs of people with serious mental illness who do not do well in conventional programs. The ACT program responds to these circumstances by providing highly individualized treatment, support and rehabilitation services to people in their natural living settings, usually where they live. ACT brings the services to the consumer instead of the consumer attending programs at the agency site. The program uses a multi-disciplinary team approach made up of psychiatrists, psychiatric nurses, social workers, occupational therapists, substance abuse specialists, vocational counselors, and a peer support workers. Each day teams visit consumers in the community and work with them to meet recovery goals set in their service plans (i.e. educational goals, employment skills and opportunities, improving family relationships); at least one team member is on call for emergencies. Services are not time-limited; clients may utilize the services of ACT for as long as they need them. The Bridge Act team is one of 43 teams in the New York City region and 78 across the state of New York.

SHACT
SHACT will be implemented by The Bridge in the Bronx. 68 clients will be enrolled in ACT and will be able to live in 68 supportive housing beds being created for the project. SHACT will offer an essential housing resource to ACT participants many of whom are in shelters, newly discharged from hospitals without housing or are living in substandard environments. ACT agencies across the New York City region will be able to refer ACT clients to The Bridge SHACT program in the Bronx to receive housing in addition to ACT treatment, support and rehabilitative services.

Not only do ACT and SHACT offer a solution to reduce psychiatric hospitalizations and visits to the emergency rooms, but they offer individuals an opportunity to live more independent and productive lives within our community.

Read More About ACT
For more information check out:
National Alliance on Mental Illness (NAMI)
New York State Office Mental Health

Thank You to Our 2009 Supporters!

We are grateful to the following funders for their contributions to The Bridge's $25 million annual budget that gives 1,800 men and women the opportunity to lead more independent lives.

Public:

• NYC Council
• NYC Department of Health and Mental Hygiene
• NYC Department of Homeless Services
• NYC Human Resources Administration (HASA)
  
• NYS Office of Alcohol and Substance Abuse Services
• NYS Office of Mental Health
  
• NYS Office of Temporary and Disability Assistance
• NYS Office of Vocational and Educational Services to Individuals with Disabilities
• Public Health Solutions
  
• US Department of HUD

Private:

• AstraZeneca
• Burpee Foundation
• DeLaCour Family Foundation
• DSJJ Fund of Tides Foundation
• Educational Foundation of America
• Fay J. Lindner Foundation
• Glickenhaus Foundation
• Helen M. DeMario Foundation
  
• Herman Goldman Foundation
• Irma L. & Abram S. Croll Charitable Trust
• J.P. Morgan Chase Foundation
• Taproot Foundation
• United Way of NYC Emergency Food Shelter Program (HPNAP)
• van Ameringen Foundation
• And many business and individual donors!!!
  

Community Partners:

• CHEM Rx Pharmacy
• Exclusive Ambulette Service Inc.
• Harlem United Community AIDS Center
  
• Helene Fuld College of Nursing
• Jewish Home and Hospital Lifecare System
• Museum of Modern Art
• The Horticultural Society of New York
• William F. Ryan Community Health Network
  

Extra! Extra! Read all about it!

If you haven't already, be sure to read the 2009 Winter Edition of The Bridge News posted on our website. If you would like to receive updates about The Bridge events, programs and services sign up for our e-newsletter here.

If you're on Facebook - vote in our poll about which program/service you would like to get to know more about....housing, urban farms, treatment, creative arts therapy - we want to hear from you!

One Agency’s (and the System’s) Pathway to Recovery

Executive Director, Dr. Peter Beitchman discusses The Bridge's Pathway to Recovery in the Winter 2010 Edition of Mental Health News. Below is the featured article.

Here’s a prescription for how to approach treatment of people with schizophrenia: “mental illness can be alleviated if the person is treated in a considerate manner, if he has the opportunity to talk about his trouble, if his interest is stimulated and if he is kept actively involved in life.” What may surprise you is that this prescription was written in 1806 by Phillipe Pinel, the founder of the moral treatment movement in France. What Pinel prescribed, before the advent of Freudian psychology, our modern understanding of the biological underpinnings of serious mental illness, and today’s focus on active recovery, was revolutionary at a time when mental illness was thought to be a matter of religious possession. In defining mental illness as a medical condition and prescribing consideration, supportive verbal therapy, and active engagement in life, Pinel, and his followers laid the foundation for the evolution of mental health policy in America.

Pinel conceptualized the asylum as the place where his moral treatment would be carried out, where “patients” (a revolutionary concept in contrast to the “possessed”) would live and work in a therapeutic environment. In the 1840s and 50s, the crusaders in the United States (notably Dorothea Dix) successfully advocated state-by-state for the establishment of asylums that evolved into the State hospitals that dominated the system for 100 years. Sadly, the vision of moral treatment was short-lived in the United States where the state hospitals evolved into the custodial, largely non-therapeutic institutions of the 20th century.

By the 1950s, the New York State psychiatric hospital system had an astonishing 93,000 patients. The cost of the system and the patient-care scandals that regularly rocked and embarrassed professionals and legislators alike, combined with the nascent community mental health movement that envisioned ending the institutional isolation of the mentally ill in favor of community-based care, set the stage for reforms to come. 1954 was the year that New York enacted historic community mental health legislation and Thorazine was introduced as the first effective anti-psychotic medication. It was also the year that The Bridge, the community-based mental health agency in New York City that provides services to more than 1,800 men and women with serious mental health conditions, was founded. The history of The Bridge reflects the evolution and revolutions that have occurred in the mental health system over the past 55 years. It’s an instructive history, charting the system’s path to recovery.

Given the undeveloped state of community mental health in 1954 it is not surprising that it was a group of patients who had been together in a psychiatric hospital and who were discharged with medication prescriptions in-hand and appointment slips for follow-up clinic visits, who joined together to form their own support program, giving birth to The Bridge. For the next 15 years The Bridge was a kind off self-help psychosocial club. The “members” (a term still used by many today), supported by a group of volunteers who raised money to lease space and provide other necessities, participated together in social and mutual-aid activities. The primary value of the group was non-institutionalism, staying out of the hospital. The agency served as a place of friendship, there was no professional staff and the role of the members was to socialize and provide mutual support.

By 1969 the policy of deinstitutionalization was in full swing. Thousands of patients were discharged from the five State psychiatric hospitals that served New York City. The Upper West Side of Manhattan, with its abundance of inexpensive single-room occupancy hotels, was a magnet for those discharged and, with few program options, both the quality of life of those discharged and the neighborhood were seriously impacted. It was then that The Bridge, located on the Upper West Side, was sought out by the State Office of Mental Health and offered its first government contract that combined State, City and agency matching funds.

The first order of business was to hire the agency’s first professional Executive Director who was a social worker, psychoanalyst and group psychotherapist. The first thing he brought to the task was the theory of the origin of schizophrenia that was widely accepted at the time: the schizophrenegenic family. According to this theory, the cause of schizophrenia could be traced directly to deviant and harmful family interactions. His response to this theoretical proposition was to create in The Bridge “a second chance family” in which the new family, comprised of staff, would offer a corrective family relationship based on caring and nurturing. When combined with the second major idea he brought from social work, the importance of addressing basic living needs such as food, clothing, safety, income and medical benefits, decent housing, and daily structure, the agency quickly became focused around a paternalistic paradigm in which the staff assumed the role of parents with the clients viewed as children to be taken care of indefinitely.

This paradigm flowered in the 1970s and well into the 80s, as the agency added a number of programs, at the heart of which was a 12-hour-a-day Continuing Day Treatment Program that operated 365 day-a-year. In 1979, in response to the poor living conditions that many clients endured, the agency offered its first housing programs.

In the late 1980s a crucial change process began, and significantly it was initiated by the agency’s clients. In a confirmation of Abraham Maslow’s concept of the hierarchy of human needs, the clients acknowledged that they were indeed being well cared for – with 365 days of program, quality housing, their entitlements in place and medication therapy all under one roof. But they asked what else did the agency have to address their growing desire to do more? When asked what they wanted, their response was: work. Following the clients’ lead, in the late 80s The Bridge started offering vocational services (job training and experience, placement in competitive employment) funded by both the State Office of Mental Health and, later, by what is today’s City Department of Health and Mental Hygiene.

It was the advent of vocational services and the goal directed clients who eagerly participated in them that began the agency shift to rehabilitation. In addition, advances in the science of understanding schizophrenia had a major impact on the agency. With the schizophrenogenic family theory repudiated and discarded and with new understanding of the biological underpinnings of the disorder, “the second chance family” paradigm was challenged. The client role was shifting from passive recipient of services to active pursuer of individual life goals; the agency function was shifting from nurturing to rehabilitation.

The new paradigm certainly challenged staff whose role was being redefined from parent to facilitator/teacher. This shift not only required acquiring the new technologies of rehabilitation, but also entailed embracing a new set of values, which agency leadership promoted but which were met with understandable resistance. In this new paradigm, which required individualized services, staff’s role was to encourage clients to define their own goals, a revolutionary idea.

In 1998 the seminal PORT Study (Schizophrenia Bulletin 24(1):1-10, 1998 NIMH) was published with its 30 consensus recommendations of practices that improve outcome for persons with schizophrenia. Twenty-one of the thirty recommendations related to medication practices; seven to other psychosocial rehabilitation services, including the provision of skills training to address the deficits in persons with schizophrenia, creating opportunities for positive family involvement in treatment and support, providing vocational services including supported employment programs for those who express interest and the appropriate use of intensive case management and ACT Programs. These recommended practices and other evidence-based practices that have emerged over the last decade now form the core of services at The Bridge.

Borrowing from the world of substance abuse, recovery has also emerged as a core concept in the last decade. The articulate and inspiring Patricia Deegan defines recovery, not as a cure, but as “try[ing] to stay in the driver’s seat of my life. I don’t let my illness run me.” (Social Work in Mental Health: Trends and Issues ed. Uri Aviram. Vol. 25, No. 3, 1997, pp. 11-24). This vision, combined with a new emphasis on peer empowerment and responsibility have had a major impact on reshaping services. Today at The Bridge many programs include peer workers on the staff and the Peer-to-Peer Program offers clients the opportunity to learn and practice the skills of effective advocacy both inside and outside the agency.

In some senses the evolution of the mental health system over the past 55 years has brought The Bridge full circle. Today’s clients provide mutual aid and support and, along with staff, they share the knowledge and skills they have developed to empower others. It is an exhilarating experience to witness the fruition of Phillipe Pinel’s prescription more than 200 years ago: persons with mental illness claiming the consideration that is their right and being actively engaged in life.

To see Dr. Peter Beitchman's article and to read the Mental Health News in it's entirety, visit this link.

Remembering Curtis J. Berger

On Friday, November 20 we will be hosting The Second Curtis J. Berger Symposium on Mental Health and the Law in partnership with Columbia Law School and the New York City Bar Committee on Mental Health Law.

Many of those attending the symposium however are unfamiliar with the story behind Curtis Berger's commitment to help The Bridge house New York's most vulnerable men and women. Curtis Berger was a teacher, scholar, lawyer, humanitarian, "birder" and volunteer who approached everything he did with tremendous gusto and dedication. He served The Bridge as a board member for close to twenty years and as president for six years. He joined the Columbia Law School faculty in 1962 and was named Lawrence A. Wien Professor of Real Estate, a position he held until his death in 1998.

With humor, intellect and integrity, he paved the way for our success. Under his presidency, The Bridge created new housing for 100 clients and added programs for the homeless. Under his leadership in two capital campaigns, the agency raised over $4 million to relocate The Bridge to a larger building which is still our current headquarters on Manhattan's Upper West Side (pictured left). He also went on to acquire, renovate and furnish the adjacent building, which was joined to the headquarters.

In September 1999, The Board of Directors named our headquarters "The Curtis J. Berger Building" in his memory - a fitting and lasting tribute to a truly dedicated public servant and outstanding human being.

The symposium on Friday, November 20 is only one of the many ways The Bridge is paying tribute to Curtis Berger and his family especially Vivian O. Berger (current board member of The Bridge) for their many years of service towards The Bridge.

Blog Action Day: What are We doing about Climate Change?

As a human service and housing provider, we are concerned, not only with the cost of providing housing, treatment and vocational services, but also with the quality of life of our clients – and climate change affects all of the above.

The Coalition for the Homeless reports this week that there are more than 39,000 homeless people and 10,000 homeless families in New York City shelters each night. New construction programs are well underway to meet this high demand, and we have taken an extra initiative with the help of Community Environmental Center (CEC) to make these new buildings, green buildings. We are working with CEC to install green elements from the initial design including energy efficient elevators, Energy Star equipment and windows, energy efficient lighting, irrigation and rain water collection, native plants, use of green building materials for floors, cabinets, low or zero VOC paints and adhesives. In addition to their help, Enterprise Green Communities program has granted The Bridge $21,000 to help in the green design of a new residence, Bridge Gardens.

Our efforts don’t stop at new construction; we are also retrofitting 5 existing buildings that house clients and serve as program sites. Since 2008, The EME Group, an environmental engineering firm, has been working with us to transform our outdated buildings into energy efficient structures.

During this process it has been encouraging to receive funds from both federal and state governments that have supported the high up-front costs to make these changes. The federal government through its stimulus funding is offering tax credits and putting more money into retrofitting certain types of low income housing. The New York State Energy Research and Development Authority (NYSERDA) through its Multifamily Performance Program, is providing incentive funding based on saving 20% in energy costs to put in new windows, provide energy efficient lighting, purchase Energy Star refrigerators and other equipment, etc. We are currently working with CEC to apply NYSERDA. Another funding source is the Weatherization Program for low-income tenants which provides financial assistance for new windows, insulation, etc. These funds are made available through the NYS Division of Housing and Community Renewal (DHCR) on a matching basis, and the good news is that the federal stimulus bill has increased the amount of money being made available for this program.

As we continue to combat climate change with retrofitting and creating new housing, the higher up-front costs still remain a concern. Even though there are substantial future savings with green designing through decreasing operating costs for fuel and water, government agencies that provide capital funding for special needs housing have not yet routinely supported the expensive costs of these green projects. This issue needs to be addressed at all levels of government.

Nonetheless, The Bridge acknowledges the dangerous consequences associated with climate change and we will continue to implement our green housing initiatives to make the world a safer place for future generations. Cartoon Source: Unknown Source

Dr. Peter Beitchman

Executive Director

Carole Gordon
Director of Housing Development

Blog Action Day 2009 | Climate Change
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