At START Treatment and Recovery Services (START) — a nonprofit providing behavioral health care services to overwhelmingly Black and Brown communities and people across New York City — we’ve seen the life-saving impacts of our essential team every day for almost 55 years. We also know these hardworking New Yorkers are living with record-high inflation — making a meaningful cost-of-living adjustment imperative for staff well-being and retention. It is no secret that all over the State, behavioral healthcare organizations are struggling to recruit and retain staff.

New York needs a strong, sustainable workforce to meet the current moment and prevent future crises. As part of its effort to address the opioid epidemic, New York must address historic underfunding for the human services workforce and support community-based behavioral health providers by increasing the cost-of-living adjustments (COLA) to 3.5% at a minimum.

For almost two decades, New York has put a COLA statute on the books for the human service workforce. Yet, for the vast majority of that time, the COLA was not included in the State budget, resulting in the sector losing 30% of funding during the last 20 years. We are thankful Governor Hochul implemented a 2.5% Human Services COLA in FY24 but significantly more is needed to help mitigate the economic impact of the pandemic and years of underfunding.

Countless lives are on the line. In 2022 alone, someone died of a drug overdose every three hours in New York City. The crisis continues to disproportionately affect Black and Brown communities. As of last year, the drug overdose mortality rate remained highest in the city’s Black (53.5 per 100,000) and Latinx (49.2 per 100,000) residents compared to the white (36.2 per 100,000) residents. These racial disparities are not new, and the gap has only increased over time.

These disparities are unacceptable but could be attenuated with significantly more investment in the behavioral healthcare workforce. At START, our integrated approach to physical health, mental health and substance use services is proven to create healthier communities broadly. The staff managing these services provide critical on-the-ground support for individuals and communities struggling with addiction and mental health challenges — ensuring people have ready access to life-saving medications for substance use and mental health disorders, delivered with compassionate, culturally responsive care.

In many cases, our staff come from the same communities most impacted by the current overdose and mental health crises and often face similar barriers in meeting their social and healthcare needs. Of START’s current workforce of 180 staff members, almost 70% identify as Black or Latinx. Underfunding in the behavioral health workforce compounds longstanding underinvestment in Black and Brown people, exacerbating longstanding health and socioeconomic disparities.

With industry-wide challenges sourcing and retaining quality people to serve New Yorkers with mental health and addiction needs, community-based providers are struggling to offer competitive compensation to behavioral health workers as these organizations lack the broader financial structures that extensive hospital networks have. This poses a significant challenge for organizations caring for communities most in need, as those who face the most barriers to services are often more comfortable in less institutional healthcare settings, engaging in programs with longstanding relationships in the community. 

Black and Brown New Yorkers are dying at a disproportionate rate due to the severe mental health crisis. Families are suffering. We can not allow structural challenges to perpetuate race-based disparities in behavioral health outcomes.

Meaningfully increasing COLA would be pivotal in supporting community-based behavioral health providers to build up their workforces, ultimately allowing these organizations to better serve their participants, help mitigate the crisis upon us and ultimately prevent premature mortality. 

New York’s overdose crisis has reached a tipping point. Increasing the Human Services COLA to 3.5% would be a significant step forward in building a robust, sustainable and diverse behavioral health workforce. This is a matter of life and death for countless Black and Brown New Yorkers. By investing in the people, communities and providers most affected by this issue, New York State can take significant strides toward equitable health outcomes and genuine progress in curbing the overdose epidemic.

Michael T. McRae, PhD. is the Chief Program and Strategy Officer at START Treatment & Recovery Centers.