NYC Health + Hospitals this week launched new post-discharge Critical Time Intervention (CTI) teams to support New Yorkers managing ongoing mental health challenges. Aimed at adults with multiple psychiatric hospitalizations or emergency visits over the past year, the CTI program provides up to nine months of structured follow-up care after discharge.
Funded by a five-year, $32.2 million grant from the New York State Office of Mental Health, each team brings together nurses, social workers, mental health clinicians, care managers, and peer specialists. The program will operate at Bellevue, Jacobi, Kings County, Metropolitan, and Queens hospitals and is expected to serve up to 650 people annually.
What the teams do
- Day-of-discharge transition: Ensure a safe return home and immediate linkage to care.
- Continuity in the community: Connect patients to outpatient treatment, recovery supports, and neighborhood resources.
- Stability supports: Assist with benefits that promote housing security, food access, transportation, and other basic needs.
- Personal recovery goals: Help patients set and pursue individualized goals that reduce relapse and rehospitalization.
The CTI initiative builds on NYC Health + Hospitals’ established Peer Bridger program, which pairs individuals leaving Comprehensive Psychiatric Emergency Programs with certified peer counselors for several months of follow-up. Peer Bridgers—many of whom draw on their own lived experience with mental health or substance-use challenges—help patients navigate outpatient clinics, clubhouses, crisis respite services, and community resources such as libraries and food pantries. Peer Bridgers are stationed at Bellevue, Elmhurst, Harlem, Jacobi, Kings County, North Central Bronx, Queens, and Woodhull.
“NYC Health + Hospitals serves more patients with behavioral health needs than any other organization in New York City, and these two programs will help our patients establish care in the community after they leave the hospital,” said Mitchell Katz, MD, President and CEO of NYC Health + Hospitals.
At NYC Health + Hospitals/Harlem, team members such as Samantha Wiggan and William Trice work directly with patients returning to their communities. “We are proud to announce new initiatives that provide intensive support for patients with complex behavioral health needs to help them reach their personal recovery goals,” said Omar Fattal, MD, MPH, Chief of Behavioral Health Services at NYC Health + Hospitals.
System leaders emphasized that expanding both CTI teams and Peer Bridgers strengthens the continuum of care during the critical post-discharge period, reduces repeat hospital visits, and builds durable connections to community services. State officials noted that linking people leaving inpatient psychiatric care to intensive wraparound support can significantly improve recovery outcomes.
NYC Health + Hospitals employs more than 100 peer specialists across its network—nearly half trained through the system’s Peer Academy—making it one of the largest peer employers in the city. The public health system remains New York City’s largest behavioral health provider, delivering over 60% of all behavioral health services and caring for nearly 80,000 patients annually across emergency, inpatient, and outpatient settings.
