New York City Community Mental Health Indices 

Investigators: Carole Siegel, Ph.D., David O'Neill, Ph.D., Kristine Jones, Ph.D., Eugene Laska, Ph.D., Morris Meisner, Ph.D., Judith Samuels, Ph.D., and Gary Haugland, M.A.

An indicator provides information on the state of a particular condition. An index relates indicators into a number characterizing global conditions. Two interrelated indices were designed for New York City: A Mental Health Index to measure the status of persons with mental illness; a Social and Mental Well Being Index to measure the status of residents of the community at large.  Indices are of value in the allocation of funding for programs and  their subsequent monitoring, and in other decision making processes. 

PROJECT GOALS

While there are many indicators of social, health and mental health status that are used to monitor, analyze and plan for public health services, only one index to date, a social health index, amalgamates such indicators into a single number. In this project, two inter-related indices were developed to monitor:

• (1) the status of persons with mental illness – the Mental Health Index, and 
• (2) the social and mental well being of residents in the community at large – The Social and Mental Well Being Index. 

While the project was conducted for NYC, the methodology can be adapted for other communities. The project was funded through the New York City Department of Mental Health, Mental Retardation and Alcoholism Services (DMHMRAS).

RESEARCH ACTIVITIES AND RESULTS 

A conceptual model was developed to describe the relationship between community outcomes and the domains of influence on these outcomes. The model is based on two premises: (i) the socio-economic environment of a community impacts the social and mental well being of its constituents and their risk for mental illness; and (ii) the provision of social and economic support systems and behavioral services improves a community's well being and the outcomes of mental illness. For each index, a set of factors was selected to characterize the domains and indicators to characterize each factor. The domains are

E: socio-economic: represented by factors for poverty and employment;

N: needs: represented by the prevalence of mental illness, and by the size of the community population;

S: supports: represented by the availability of mental health and residential services for persons with mental illness; and the availability of a broad range of public services for the community at large;

O: outcomes: represented by negative outcomes of persons with mental illness of inappropriate service use, substance abuse, criminal justice system involvement, homelessness; factors related to the community’s quality of life for the community at large.

Indicators are weighted averaged up to the domain levels E, N, S, and O. A community panel chooses the weights to reflect the importance of each indicator to the domain as a whole. A formula for combining the domain indices was developed based on a set of necessary properties of the Indices as well as on the input-output aspects of the conceptual model. The formula for both Indices, denoted by P is: P = [O^a S^bE^c]/N, a, b, c>o; a + b + c = 1.

While the numerical values do not have intrinsic meaning by themselves, positive changes registered do reflect an improvement in overall conditions for both persons with mental illness and the community at large. The Indices serve to quantify essentially qualitative constructs, and provide an ability to examine the extent to which change in an input domain is related to change in an output domain.

The findings reflect the historical record for New York City for the years studied: reduced crime, improved housing and employment conditions despite downturns in the economy. At the same time, there was an increase in support services for persons with mental illness and a modest increase in favorable outcomes for this group.

The practical use of these kinds of indices is dependent upon the availability and timeliness of needed data.

A report containing the report card of indicators, domain indices and indices evaluated for 1991–1995 was submitted in September, 1996 to the NYC DMHMRAS. It was revised with the receipt of new data in January and again in June of 1997. An article on the indices appeared in the New York Times on June 10, 1997. During 1998, the 1996 update was developed and a report written describing the changes.

The indices are intended broadly to monitor:

1. social and economic factors relating to community mental well-being and mental illness;
2. need as measured by the magnitude of vulnerable/problem populations and the size of the population of those with mental illness;
3. availability and utilization of support systems;
4. social and mental well-being of the community; and
5. outcomes of those with mental illness.

Siegel, C., et al. (1998), The Development and Construction of Two Community Indices of Mental Health and Social and Mental Well Being. Final Contract Report to the New York City Department of Mental Health, Mental Retardation and Alcoholism Services.  

Siegel, C., Laska, E., Haugland, G., O’Neill, D., Cohen, N., Lesser, M. The construction of community indexes of mental health and social and mental well being and their application to New York City, Evaluation and Program Planning 23:315-327, 2000.

Siegel, C., Community level outcome measures: New York City mental health indices. Talks presented at:

i) The New School for Social Research and the New York City Department of Mental Health, Mental Retardation and Alcoholism Services. New York, NY, October 1996.

ii) New York State Office of Mental Health, 9th Annual Research Conference, Albany, NY, December, 1996.

iii) National Association of State Mental Health Program Directors Annual Meeting, Crystal City, VA, February, 1997.

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