In Reply: We appreciate Dr. Sederer's recognition of the long-standing lack of appropriate and adequate housing and clinically and developmentally specific services for young adults with mental illness and co-occurring substance use disorders.
In describing the approach taken by the New York Department of Mental Health and Hygiene (DMHH), Dr. Sederer said, "we identify need, engage in effective planning, and support advocacy for needed services, and on the basis of these efforts we direct funding for populations in need." Who are the "we" in DMHH who are engaged in this approach for young adults? Unless and until there is a "we" for young adults in both DMHH and the New York State Office of Mental Health, this population will continue to be neglected.
The absence of a "we" has resulted in young adults' being worse off now than they were a few years ago when an agency decided to respond to a request for proposals for supportive housing for mentally ill young adults aging out of foster care. The program was poorly designed and underfunded. Not able to manage the young adults and not able to obtain any additional support from DMHH, the agency closed the program and returned the grant to the city. Young adults have less housing and services now than they've ever had.
There are necessary risks involved in change, and the problems of compartmentalization and splintering are certainly preferable to the complete absence of appropriate and adequate housing and services. The absence of an organized and ongoing approach to dealing with young adults has contributed to the major clinical problems this population presents and the fragmentation of the system. The current adult mental health system does not offer appropriate and adequate housing or services for adolescents when they reach age 18.
At Covenant House about 1,000 homeless mentally ill young adults have participated in our mental health day program since 1996, and we have nowhere to send them. These systemic problems are long-standing, but the time has come to actually do something about them. We look forward to working with Dr. Sederer and with the New York State Office of Mental Health to develop strategies for the solution of these problems.
Mr. Henry is executive director of Covenant House in New York City, where Dr. Giugliano is director of mental health.