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Natasha Appleweis leaves her Flatbush, Brooklyn, apartment weekly to meet her intimate team of colleagues in an unmarked Brownsville office. Appleweis is a behavioral health specialist on one of New York City’s mobile treatment teams.
Inside the renovated loft, the meeting space is filled with bottled water, feminine hygiene products, and other supplies. At the center, a whiteboard lists the team’s 27 clients.
The seriousness of her job aside, Appleweis, 31, is quick to make a room laugh and rarely in a rush to get anywhere. Her nine-person crew, the Prospect team, serves some of the most vulnerable New Yorkers who are often experiencing the most severe cases of mental illness — schizophrenia, bipolar disorder, schizoaffective disorder, borderline personality disorder. The small and personal wins on the front lines keep her going.
New York City funds five nonprofit agencies to run these intensive mobile treatment teams as an alternative to inaccessible social services and law-enforcement interventions. Thirty-one teams serve 972 clients, most of whom have a diagnosed psychiatric disorder.
The city’s Department of Health and Mental Hygiene must approve clients to determine whether IMT is an appropriate level of care. Each team provides a range of services to their clients spread across the city’s five boroughs.
With nearly half of uninsured adults unable to receive the mental health services they need, this type of intervention, addressing underlying causes of mental illnesses where people are, is what the Centers for Disease Control and Prevention says can help achieve larger and more equal public health goals.
IMT clients receive services beyond medication, like career and housing guidance because, as the CDC says, socioeconomic status and education can affect physical and psychological health, making mental well-being a public health imperative.
An assortment of three- and four-letter acronyms representing mobile behavioral health teams hoping to support severe cases of mental illness have surfaced across U.S. cities. The spread of these teams has been amplified by fatal interactions between law enforcement and people in need of mental health care, such as Win Rozario, the Queens teenager fatally shot by the New York Police Department in March after calling for help.
“This type of care model is one of the only sensible psych care models for people with severe mental illness,” Appleweis said, referring to the intimacy of her team.
Team personality is part of the model for care
Bridgette Callaghan has overseen six IMT teams since the Institute for Community Living was brought into the city-funded program in 2018 as one of the five nonprofits. Without a lot of red tape, Callaghan said, the IMT model welcomes trial and error and is based on team personality and how people engage with services.
Within the national growth of mobile mental health care, models vary, but most center around meeting clients where they are. With labeled vans and matching uniforms, some teams operate as a 24/7 call center serving a continuously changing list of clients. The Prospect team follows a model focused on treating mental illnesses individually for sustained periods. Clients are referred to the Prospect team after unsuccessful experiences with traditional New York institutions.
Once on the Prospect team, clients can access services from substance weaning and antipsychotic medication to the occasional résumé assistance. Or they can be referred to nearly any outside service they need: clinics, care coordination, housing, and education. For day-to-day needs of clients — sending them through school to become security guards or buying a computer for job applications — Callaghan doesn’t have to ask for approval. She simply pulls from funds — nearly $1.2 million in 2023 for each team — allotted by DOHMH.
When working in the field Appleweis sports a rugged multicolored backpack. Absent uniforms or a company car, it isn’t obvious if she’s on or off the clock. The subway-dependent Prospect team is nearly unidentifiable at work.
With no stigmatizing “social services” labels across their bags or nametags, she could — to the lay commuter — be heading to the park, school, or any job. When a single off-putting interaction with a behavioral health professional can lead someone to have a distaste for the services they need, appearance matters. Callaghan tells the Prospect team to leave the collared shirts and bright vests at home.
Prospect team members say their approach is a refreshing and non-exploitive model for a workforce often defined by their wages, the hours they work, and the trauma they inherit.
A New York City Comptroller’s audit this year measured the success of IMT as a whole by using data points such as the number of calls answered, prescriptions followed, and referrals made — not qualitative accounts of the client’s progress.
One of the audit’s findings said, “merely remaining in the program sets a very low bar.” However, disengagement from mental health services comes with devastating consequences for individuals with schizophrenia, according to research published in the National Library of Medicine.
“The audit found that DOHMH does not track individual progress of clients or report outcomes in the aggregate,” Comptroller Brad Lander, who is running for mayor, said in his written announcement. “Consequently, there is no effective measurement of the overall treatment rate of IMT clients and associated outcomes.”
Callaghan said IMT is reaching people previously unserved – a metric not properly quantified into the comptroller’s checkboxes. The audit calls out IMT staffing shortages, an issue not unique to the model. New York would need an additional 411 mental health care professionals to enter the workforce to meet the full demand as defined by KFF’s tracking of mental health care professional shortages.
For social workers, appreciation inhibits burnout
Appleweis’ early 20s brought an experience that propelled her trajectory. During a Rosh Hashanah gathering in 2014, her cousin told her, “I’ll see you at Yom Kippur.” By the time the High Holy Day came, he had died by suicide.
“He knew damn well he wouldn’t see me at Yom Kippur,” Appleweis said. The grief and anger that ensued propelled her interest in mental illness and led her to briefly work at Friends Hospital, the first private psychiatric hospital in the United States. Founded in 1813, the institution that was formerly known as the Friends Asylum for the Relief of Persons Deprived of the Use of Their Reason, still operates on a sprawling property north of Philadelphia.
Working with clients experiencing suicidal ideation is a frequent presence in Appleweis’ work. She credits her ability to continue onward to the intimacy of her team.
Social workers who feel their employer and team appreciate their work tend to inherit less trauma and burnout, said Carol Tosone, an expert in collective trauma and co-director of New York University’s trauma-informed clinical practice. “Even though [social workers] are in difficult circumstances, if you feel that what you do is valued and appreciated, and you also get a degree of satisfaction and gratification from your work, you’re going to fare better.”
Earlier this year during a weekly meeting, one of the Prospect team’s clients stopped by. A collectively excited “Brandon!” rang throughout the small loft as he entered, smiling and dropping his coat over a chair. The team’s registered nurse, Tatiana Baker, a Harlem-raised mother of three, stepped away to give Brandon his monthly antipsychotic injection. Rolling up the sleeve on his left arm, Brandon said he likes the independence he feels with the Prospect team, which has treated him for almost a year.
‘Work can be like a mini vacation for a few hours’
The intentional duty sharing among the Prospect team is a key reason they’re having success. But much of the clinical treatments can only be administered by Baker, the 33-year-old R.N.
After getting her 9-, 7-, and 2-year-olds off to school and daycare, Baker commutes into Manhattan from Palisades Park, New Jersey. On a recent rainy Thursday in the Upper West Side, she visited a few clients.
Riding the elevator up one of 16 apartment buildings in the city owned by the Postgraduate Center for Mental Health, Baker explained that she was there to chat with a 31-year-old client and to administer an antipsychotic medication.
The medication is one of the most intense antipsychotics, so her client is at a heightened risk of side effects like paranoia and suicidal thoughts. However, once injected, the medication quickly became an afterthought as her client carried on in conversation. She asked about new bras and budgeting for groceries.
“You have to show up as yourself in these spaces, and then use the thing that you went to school for to help them in treatment,” Baker said later.
Inside a Midtown women’s shelter, Cindy, another client, sat with Baker, sinking into casual conversation and digging between vials and sanitizing wipes. Baker’s long braided hair nearly touched the continually ringing iPhones tucked in each back pocket of her jeans.
Unfazed and patiently waiting, Cindy, knowing how busy Baker was, joked about whether she needed to get to her next client. While understanding the question likely comes from past experiences with more traditional social workers, Baker reminded her there’s no time limit.
Cindy wasn’t interested in the injection that day, combatively disputing the dosage. Not a stranger to this conversation — and using skills learned as a teen in customer service at Home Depot — Baker struck a balance of an empowering communicator and a confident educator. Cindy welcomed the shot, and they carried on in conversation.
Like Appleweis and other IMT staff who spoke with Healthbeat, Baker experienced a dominant “white coat” sense of authoritative treatment in hospital settings that is absent in the mobile model.
“I get to be honest about myself, and my failures,” Baker said. “It totally humanizes the job. I don’t think a lot of nurses can say that they’re allowed to be human at work. We’re robots in certain settings.”
Her role on the Prospect team is unique, not because she is the only parent but because she technically isn’t a social worker. She enters spaces as a nurse. The rest is “Tatiana the mom and Tatiana the human being,” she said.
Outside the Prospect team, raising three kids, cooking family-style beef stew, and running between football and swimming practice, 95% of the day is dedicated to a mother mentality. “Work,” Baker said, “can be like a mini vacation for a few hours.”
If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”
Owen Racer is a freelance writer for Healthbeat, based in New York.
