NYC START Connects Patients With First-Episode Psychosis to Mental Health Services

Official patch of the NYC Department of Health and Mental Hygiene
Official patch of the NYC Department of Health and Mental Hygiene
The relative success of NYC START might lead other local governments to fund similar programs to connect individuals with first-episode psychosis to available community supports.

High enrollment rates demonstrated that the NYC START initiative, a program for individuals hospitalized for first-episode psychosis, achieved its goal of connecting patients to community mental health treatment and resources, according to study results published in Psychiatric Services in Advance.

In 2014, the New York City Board of Health began requiring that hospitals report to the Department of Health and Mental Hygiene all individuals between the ages of 18 and 30 hospitalized for first-episode psychosis. Patients were then offered a voluntary, 3-month critical time intervention program provided by social workers and peer specialists to connect them to community mental health services after discharge.

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Daniel Anderson, MSW, Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York, and colleagues examined the implementation of NYC START.  Data were retrieved from service logs completed by program staff and summarized to determine mean number of contacts per client per week, types of services provided, and connection rates with community mental health services.

Of 404 individuals offered admission to the NYC START program, 285 consented to receive services, and 78% of these received services for at least 3 months. Of enrollees, 67% were male, 48% were black, and 60% had Medicaid. Involvement on the part of clients was most intense at the beginning of the program, with a mean of 2.5 contacts in the first week per client, and 79% attended an outpatient mental health appointment within 30 days of hospital discharge. The caseload per social worker was 11.7 clients and per peer specialist 22.3 clients. Social workers provided a mean of 17.3 client activities per week and peer specialists provided a mean of 8.5.

The study was limited by the small number of staff assigned to clients and the possible failure of staff to complete some service logs, which may have caused an underestimation of use of services.

“[The] NYC START 30-day connection rate of 79% is promising in that it is higher than the rate observed in the [Department of Health and Mental Hygiene] Medicaid analysis, which showed that only 59% of NYC young adults had attended a mental health appointment within 30 days after discharge from a psychiatric hospitalization,” the investigators wrote.


Anderson D, Choden T, Sandseth T, Teoh T, Essock SM, Harrison ME. NYC START: A model for securing community services for individuals hospitalized for first-episode psychosis [published online May 14, 2019]. Psychiatr Serv. doi:10.1176/