In just four years, New York City will have more residents over 60 years old than under 18. This demographic shift is not a future problem — it is unfolding before our eyes, reshaping neighborhoods, hospitals, and public spaces. Yet one group of New Yorkers still remains largely overlooked: older adults living with serious mental illness.
Nearly one in four older adults in New York experiences a mental health challenge, and about 6% live with a serious mental illness which affects their ability to function independently. It is a gross understatement to say that daily life is challenging for this population. Our mental health system is not designed for them, which leaves many hiding in plain sight with few options for treatment and support.
The lack of coordinated support has led to a costly and cruel mismatch. Programming for people with serious mental illness is typically designed around younger adults, rarely factoring in aging bodies and the medical or practical realities of later life.
Exacerbating the issue, aging services often are not equipped to provide robust psychiatric care. This leaves older adults at risk of falling through the cracks until they surface in the most visible and expensive systems we have; emergency rooms, hospitals, shelters, and, too often, the justice system.
But New York does not lack services; it lacks the right model. What’s missing is a full-day, clinically robust, age-affirming program for older adults with mental health conditions, embedded within a continuum of care.
This challenge underscores the need for the city to support development and evaluation of a specialized, age-appropriate behavioral health pilot for older adults, potentially delivered through qualified community-based providers with relevant clinical and aging-services experience. Such a model could blend the strongest elements of existing systems under one roof while remaining tailored to older adults.
The timing could not be more urgent.
Mayor Mamdani has made clear that addressing serious mental illness — particularly among those living in public spaces — is a top priority within a broader community safety strategy. Simultaneously there is growing recognition that behavioral health care is as essential as medical care itself.
Investing in specialized, age-appropriate behavioral health programming is both compassionate and practical. It reduces pressure on hospitals, shelters, and corrections. It improves quality of life. And over time, it saves public dollars by preventing crises rather than reacting to them.
This is not a theoretical need. Much of the service infrastructure already exists, and a pilot could be structured through a blended funding approach: billable clinical services — psychiatry, medication management, individual and group therapy — supported through Medicare, Medicaid, and commercial insurance, alongside city support for core Older Adult Center costs such as meals, transportation, and other non-billable services. What is needed now is city leadership to evaluate and pilot the right model.
New York has an opportunity to better align aging and behavioral health policy with the realities older adults face every day. The city should examine and consider piloting an integrated mental health model for older adults, while also strengthening staff training and coordination across aging and behavioral health services.
Leadership means designing systems that reflect who we are now, not who we were decades ago. Older adults with serious mental illness deserve more than crisis care and invisibility. They deserve a place in our communities — and in our policy priorities.
Hudson represents parts of Brooklyn in the City Council. Thurston, a licensed clinical social worker, is CEO of Service Program for Older People (SPOP).