New York Spends Millions on Mental Health Street Teams. Do They Work?

New York City has poured tens of millions of dollars into a program to treat severely mentally ill people on the streets and in the subways for nearly a decade without ensuring that it was operating effectively, according to an audit made public on Wednesday by the city comptroller.

The program, known as intensive mobile treatment or I.M.T., was meant to help hundreds of the city’s most vulnerable residents by providing them with medication, psychiatric treatment and connections to housing and other services.

But fewer than a third of the people whose cases were reviewed by auditors regularly took their prescribed medications. The audit found that one in four people never met with a psychiatrist or nurse from a treatment team. And it showed that the city agency overseeing the program, the Department of Health and Mental Hygiene, had not set clear standards to measure its effectiveness despite spending more than $37 million on the initiative last year alone.

“We need the I.M.T. program to work — to help mentally ill and homeless New Yorkers get the treatment they urgently need,” the comptroller, Brad Lander, said. “Unfortunately, poor management and coordination mean the program is increasingly failing to help participants get off the street into stable housing — and we don’t know whether or not it’s working to keep I.M.T. clients and other New Yorkers safe.”

The audit also documented a failure by the city to properly monitor the nonprofit organizations it contracts with to run the treatment teams and showed that officials had done little to hold the teams accountable for serious lapses. City officials became aware of more than 130 such issues in recent years, ranging from inadequate staffing to a failure to complete client assessments. But the officials waited months to follow up, the audit found, and when they did, they did not always ensure that the problems were fixed.

One team was allowed to continue operating and even expand its business with the city despite its failure to fill a key behavioral health specialist position for more than three years.