“The issue is not whether these programs work, it is whether we are willing to scale and coordinate them to create an effective continuum of care.”
Outside Lincoln Medical Center, The Bronx. (Adi Talwar/City Limits)
For years, New York City has struggled to meet the needs of people living with the most serious behavioral health challenges. We saw the consequences on our subways and in shelters, emergency rooms, and jails. But in the last few years, the city, state and nonprofit providers developed even more effective programs—including Intensive Mobile Treatment (IMT), Assertive Community Treatment (ACT), medical respite, and Step-down Treatment Ensures Personal Success (STEPS)—and we began to see improvement.
Despite the progress, thousands of people continue to suffer, and New Yorkers see this play out every day on our streets and subways. The issue is not whether these programs work, it is whether we are willing to scale and coordinate them to create an effective continuum of care.
Today, approximately 1,500 New Yorkers are on the waitlist for IMT and ACT, highly intensive and effective intervention designed for the hardest to reach and treat individuals who have often experienced years or decades of homelessness, hospitalization, and incarceration. The challenge had been that once people stabilized, there was no program to step down to that provided the care they needed at a less intensive—and less costly—scale.
STEPS, a program my organization, Institute for Community Living, created with support from The Leona M. and Harry B. Helmsley Charitable Trust, was designed to fill this gap. It provides a crucial step-down service between IMT and existing community services, helping people live independently and reducing the IMT waitlist—a clear win for both individuals and the city budget. Yet STEPS is now running out of money.
In the Fiscal Year 2026 budget, the city allocated $4.5 million to replicate and expand STEPS. As of today, those funds have not yet been released, delaying the program’s ability to help more New Yorkers and relieve pressure on the broader system.
A recent analysis of the STEPS program found it is highly effective and supported people in building stability, with the end goal of moving them to less intense community services. Our analysis of STEPS participants found that:
• 97 percent were housed
• 89 percent avoided hospitalization
• 86 percent avoided emergency room visits
• 100 percent were not arrested or incarcerated during their time in the program.
STEPS also contributed to an estimated 5 percent reduction in waitlists for IMT and ACT, making it possible for other people experiencing crisis to get help.
Brandon is just one example from the nearly 200 people STEPS has supported. Assigned to our IMT program, Brandon—like too many people—spent years moving between shelter, homelessness, jail, and hospitals. It took time to earn his trust, but eventually our team was able to help him stabilize. Once his most acute crisis issues were addressed, he felt comfortable stepping down into STEPS—and we felt confident he would thrive.
Today, he is living in his own apartment, pursuing a GED degree and looking for work. He is living increasingly independently, relying less and less on expensive intervention programs. Brandon’s story is an example of the impact the STEPS program produces and it does so at a bargain price.
Our report shows that STEPS, which costs just $7,497 per person per year, is significantly less expensive than IMT, which costs $42,487, and ACT, which costs $24,391.This makes it a fiscally responsible investment for the city that preserves the gains people make in getting better while expanding capacity to serve more people.
STEPS current funding runs out this summer. If the city releases the $4.5 million committed to STEPS, we can protect the gains New York has made and move closer to a fully functioning continuum of care—one that is humane, effective, and fiscally responsible. I know it’s what all New Yorkers want.
Jody Rudin is the CEO at Institute for Community Living.
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