David Minot, Executive Director of Mental Health News Education, the non-profit organization that publishes Behavioral Health News, interviewed Mitchell Netburn, President and CEO of Samaritan Daytop Village, a nonprofit organization that has been improving the quality of life for New Yorkers for over 60 years through addiction and mental health treatment and supportive housing.
David Minot: Hi and welcome to the Behavioral Health News Spotlight and Excellence series where we feature exceptional leaders in innovative healthcare solutions that are raising the standards of care in the behavioral health community. My name is David Minot and I am the executive director of Mental Health News Education, a nonprofit organization that publishes Behavioral Health News and Autism Spectrum News. Our mission is devoted to improving the lives and delivery of care for people living with mental illness, substance use disorder, and autism, while also supporting their families and the professional communities that serve them. By providing a trusted source of science-based education, information, advocacy, and quality resources, we aim to improve the delivery of care for those in need. Today, we’re speaking with Mitchell Netburn, the President and CEO of Samaritan Daytop Village, a nonprofit organization that has been improving the quality of life for New Yorkers for over 60 years through addiction and mental health treatment and supportive housing. Mitchell, thanks so much for being here with us today.
Mitchell Netburn: Thank you so much for having me and for focusing on Samaritan Daytop Village.
David: So how about we begin with talking about the mission of Samaritan Daytop Village and sharing an overview of the services provided and the people served.
Mitchell: Sure. Our mission is pretty simple: it’s to help people help themselves. That’s really what we’re about, giving them the tools to overcome whatever challenges they have and doing it in a client-centered way, meaning asking our clients what their goals are and what is the best way for them to reach those goals. We don’t have a cookie-cutter approach; we provide a full range of services. We like to say we’re from “crinkle to wrinkle,” meaning we serve little kids and pregnant moms all the way to seniors. Our main area of focus is certainly substance use disorder, and we have a full range of substance use disorder services: residential treatment, outpatient clinics, recovery centers, and more. We’ve also added mental health services over the years, understanding the link between the two even before it became government policy. We operate a large number of shelters for single men, single women, and families. We have a Senior Center, we run a few proprietary schools for youth with behavioral health issues, and we have employment and education programs. So, we really like to say that we can offer people in need whatever services they need to help them live independent, fully productive lives.
David: You certainly keep busy! I’ve read that Samaritan has opened a few new facilities in the past year. Perhaps you can tell us about the Richard Pruss Wellness Center and why this is a transformative addition to an underserved community.
Mitchell: First of all, I’d like to provide a little bit of history. Richard Pruss was the de facto founder of Samaritan Daytop Village and was our first and very long-term CEO. He was a visionary and understood early on that you couldn’t just treat substance use disorder; it was closely linked with mental health issues in many cases and needed full wrap-around services. He expanded our portfolio to include those other areas. The building is named after him; it’s in honor of his legacy and is a physical embodiment of his philosophy. The building was purpose-built for us, with a very large number of services under one roof, and it’s a beautiful building. It’s a place where clients come in and immediately feel a sense of respect and dignity. It’s very appealing, very client-centered, and friendly.
Regarding the range of programs at the Wellness Center, we have an outpatient mental health clinic, an outpatient substance use disorder clinic, a methadone clinic, and soon we’ll have a licensed Article 28 medical clinic for physical health issues. We have a recovery center for people who have been through treatment where we make sure that we are giving them the tools they need to continue their path to recovery. We also have a central admissions office – the idea is that there is no wrong door; someone comes in, we can find the best place for them and help arrange transportation. We also have a health home case management program there. It’s really one-stop shopping. So, clients can receive all of these services from Samaritan Daytop Village in one building where we can coordinate these services with warm handoffs, resulting in better outcomes and an improved “customer service” experience. It’s been tremendously embraced by clients and staff, and there’s more interaction between staff, so there’s better teamwork.
David: Congratulations on that! Another opportunity where you got to break out the big scissors for a ribbon-cutting was the recently opened Bronx Support and Connection Center. What services are being provided there and what impact will this have on community members with mental health and/or substance use disorders?
Mitchell: There are a tremendous number of services in that facility as well, but it’s a smaller program and it’s one of two pilots funded by the City of New York. The idea is that the people brought to the Support and Connection Center would initially be brought there by New York City police officers if they encounter someone on the street or receive a call and the person is exhibiting some behavioral health issue, whether it’s related to mental health and/or substance use disorder. This wouldn’t include things that would require an arrest or rise to the level of needing to go to the emergency room. Some examples for what would bring a person into the Bronx Support and Connection Center include: public nuisance, urinating on the street, walking in traffic, harassing people, etc. It is a very rich service model so that the issues people who are brought there are exhibiting can be treated.
We can do detox on site, provide mental health services, do a full physical examination – many of the people we see will have chronic health conditions in addition to mental health concerns and/or substance use disorder. They can also stay there for up to five days, with the possibility of an additional five beyond that. It’s not a shelter or a residential program, but rather a short-term solution to address the person exhibiting that behavior, stabilize them, and get them what they need immediately (not making a referral because they may never get to that other place, and if they do make it to an emergency room for example, they may get lost with people who might be exhibiting more severe conditions). A critical component is for us to then link them to whatever services they may need beyond those five or ten days to ensure that they are continuing with whatever program is best suited to them. We also have an open-door policy, so they can always come back, recognizing that issues of mental health and substance use disorder, like any other health issue, can have ups and downs and relapses. We never view those as failures, and the doors are always open for them to come back to that support and connection.
The impact on the community will be positive over time, as we expand our geographic catchment area. The community initially had some concerns, but once they understood the program, they started asking if they could make referrals. The city is not quite there yet, but I think it will have a positive impact on not just the local community but broader as we expand our geographic catchment area.
David: With so many services in one place, for both of these facilities, it must be a bit of a staffing challenge. Are you having issues with the workforce shortages.
Mitchell: Yes, we are facing a problem that not just everyone in our industry is facing, but it’s truly a worldwide phenomenon in all industries. Telephonic and telehealth services have had a big impact on that. Having multiple programs in one facility helps us shift resources more freely and eliminates transportation issues, but it is still a challenge. It’s not the first and only challenge we’ve faced, and we have to deal with it creatively. The burden falls on the staff, who I have to commend. They are true heroes and heroines who have been working through the pandemic and are working in a situation where we are not fully staffed, which adds additional burden. However, they have risen to that challenge.
David: Speaking of the pandemic, how did the most difficult parts of the COVID pandemic shape the way you guys are now operating?
Mitchell: Well, the pivot to telehealth and telephonic services was dramatic overnight, and I have to applaud state government who made quick rule changes that might have taken 10 years happen in just 10 days. This has resulted in a more efficient use of some professionals’ time as they no longer have to spend time traveling. Also, because of the workforce shortage, this makes more efficient use of the staff that we do have. In general, clients have generally responded well. We still offer and have gone back to in-person services, but we can now give people a choice between in-person and remote services.
The pandemic has also led to a shift towards a less paternalistic view of clients. That’s how the system was structured in the past. I’ll use methadone clinics as an example. Many people have to come every day to get their methadone. For certain people, we would always give them a supply for several days – on rare occasions up to 28 days. Well, at the beginning of the pandemic, we didn’t want people coming in every day, so we have to make judgement calls about giving many of our clients longer-term doses for multiple days. We’ve gone back a little to requiring people to come in a bit more, but not all the way. Clients prefer this, and it has also instilled a sense of trust that they can manage their own life and be more independent. We saw that, in our shelters during the height of the pandemic, the city moved many of the clients from congregate shelters with 10-20 people sleeping in one room to hotels with two people sleeping in one room. To be honest, we were concerned about that. Many of our clients have serious mental health issues and/or are active substance users, and now all of a sudden, they are behind a closed door, and you can’t see them. The good news was that we had very few issues – there was a sense from clients that they now had their own room, so they wanted to keep it up to a certain standard and stay in this better situation. Overall, it really empowered our clients more and allowed our staff to be a bit more efficient.
So, we pivoted a bit to remote work but not for all staff, as many of the jobs require you to be there 24-7. In those ways, it has made a profound but positive impact.
David: Switching gears for a moment, we are all well aware of the recent migrant crisis in New York City and I know Samaritan Daytop Village does a lot with supportive housing. What role has the organization played in supporting the asylum seekers who have recently been arriving from Latin America?
Mitchell: Our major response so far to the influx of asylum seekers and migrants has been to open three hotels in Brooklyn, Queens, and Manhattan for asylum-seeking families. In just a few weeks, we opened those programs and are serving 400 families; well over 1,000 people. We have a lot on our plate, but despite staffing shortages, Samaritan Daytop Village has always been there to meet the needs of anyone in New York City and views asylum seekers as New Yorkers. We are a sanctuary city and are responsive to government. We have also converted two single hotels to house approximately 160 men specifically for asylum seekers. We were fortunate to receive funding from a small hedge fund to provide employment skills, job placements, and English as a second language courses for asylum seekers to get better-paying jobs and become productive members of the workforce. We are proud that we have been able to do this and we are currently housing around 1,500 asylum seekers every day.
David: That’s such a huge impact really, and the lasting impact that you are having on these people’s lives in this difficult situation is really wonderful. So, harm reduction is something that is being embraced at the federal level and the New York State level. How is Samaritan embracing this harm reduction approach to substance use disorder treatment to prevent overdose deaths, save lives, and engage clients?
Mitchell: We have fully embraced harm reduction in many different ways. It has been a bit of a culture change for Samaritan Daytop Village, though my predecessor Tino Hernandez really took the agency far in embracing it; I give him a lot of credit for that. However, many of our staff are in recovery, which is something that we are proud of, and did not come through harm reduction programs, so they have their own mindsets. To address this, we are providing agency-wide training on harm reduction and stressing that this is about saving lives. The unprecedented number of overdose deaths is a preventable tragedy that has claimed over 100,000 lives in any 12-month period recently. As we say, “Its lives over philosophy.” You can’t help someone deal with their substance use disorder if they are not alive. It is a matter of life and death. Saving lives is our overriding principle.
In addition to training our staff, we also did some training with our Board. Instead of simply asking our Board if we wanted to run a harm reduction program, we provided educational material and reached out to Joe Turner from Exponents, a leading agency in harm reduction, to present to our Board. We have some staff at Samaritan who are experts that collaborated in the presentation. So, we acknowledged that we are not the experts on this subject and working with Joe was a great experience. From the presentation, we then have to put what we have learned in place.
We are also working on a pilot program at one of our shelters, which was initially designated for people with substance use disorder but has now been expanded to include behavioral health issues. We are partnering with Exponents and Housing Works to provide harm reduction services, including fentanyl testing strips and clean needles, in the parking lot of the shelter. Some of our staff have raised questions and concerns. For example, “I have some clients who don’t want to use but are we condoning this?” You encourage people to express their feelings and then you talk them through it. A lot of it is a change in mindset, education, and just focusing on saving lives. We have also implemented Narcan training and received special funding to address the opioid crisis in three boroughs of New York City. Those people are out on the street doing fentanyl testing and education. It’s about engaging people – there is no caveat that “We are going to do this and you’ve got to go into treatment.” It’s just engaging someone. If you are going to use, be safer and don’t do it alone, regardless of what drug you are using as fentanyl these days is pretty much laced into everything. We have a standing harm reduction committee that meets to discuss ways to integrate harm reduction into our programs. We believe that harm reduction is crucial to saving lives, as the number of overdose deaths is preventable with the right resources and approaches. It is an ongoing process, but we are committed to making a positive impact and saving lives.
David: We’ve touched on a lot of the challenges that come with your work, but what are some of the highlights and positive things that come with your work as President and CEO of Samaritan Daytop Village?
Mitchell: I try to get out of the office and many clients will come up to me and figure out who I am. What I hear a lot is not just that we offer great services, but “You’ve saved my life.” I hear that a lot and it just warms my heart. And that is not a rare thing people say. It’s not just clients, but staff will ask to speak with me, and they will reveal to me that they were a client of Samaritan and they are in recovery. Usually, they will say the same thing: “I probably wouldn’t be alive if it weren’t for Samaritan Daytop Village. The staff are incredibly dedicated. They let me know that they get job offers from other places, but they stay because they want to give back.
The Samaritan buildings that used to run the programs that are now included at the Richard Pruss Wellness Center were all scattered throughout that neighborhood and were below our standards. It makes me feel good to see the new building with client artwork on the walls. Clients come in and don’t expect to be receiving services in such a nice place like that.
The asylum seekers have had traumatic experiences leaving their home countries, getting to the border, and ending up in New York City where they may not have planned on coming. We are able to give them something they haven’t experienced – letting them know they are welcomed and supported. Giving someone permanent housing is certainly rewarding. It is a wonderful thing to be able to provide someone with a key to their own apartment, potentially for the first time in their life and see their joy. The same thing when they get employment.
These are the things that “recharge my battery.” Getting out and about helps me see the fruits of our incredible staff’s labor. Those are the things that really make me feel good.
David: The impact that you and your staff at Samaritan Daytop Village are having on people’s lives is immeasurable.
Mitchell: Yeah, we serve about 33,000 people a year. Every single night, we house about 7,000 people, including 2,200 kids. That’s a lot of people and I know they’re in a safe place. We held a big toy drive for the holidays so that every kid can have a toy. Each one of those 2,200 kids at least will get one toy for sure. Particularly, for people in our shelters of limited means, it just brings joy for the holidays. We try to do that each and every day of the year.
David: Well, I know I speak for many when I say thank you for what you do and to all your staff and I want to also thank you for your time today. It’s been such a pleasure to speak with you!
Mitchell: And thank you! Your publications are great and really help the fields in many different ways. We’re all stronger and better for all the work that you do.
For more information about Samaritan Daytop Village, please visit SamaritanVillage.org and stay tuned for our next installment of the Behavioral Health News Spotlight on Excellence Series.