As House Republicans prepared to vote Thursday on their latest health-care overhaul bill, the first lady of New York City was in Washington stressing the need for more mental-health care.

Chirlane McCray, the wife of New York City Mayor Bill de Blasio (D), has carved herself a powerful role in his administration as a spokeswoman for the 1 in 5 people in the city, and in the country, who have a diagnosable mental-health condition. She’s built a coalition within the city of educators, law enforcement, clergy, housing officials and labor experts to create what she describes as a one-of-a-kind holistic approach to providing much-needed resources for a population that for decades has been dramatically underserved.

Recently, McCray has taken her initiative national by enlisting 153 mayors from all 50 states and Washington, D.C., committed to doing the same in their cities, whether they are rural or urban, big or small, politically red or blue. The group is bipartisan.

“We’re all animated by the same sense of urgency,” she said. “The people we serve need action now, and cities can lead. So we’re sharing best practices regularly. We’re creating a support network of experts they can call on as they build programs in their communities. And we’re combining our voices to demand more help from our leaders here in Washington.”

McCray sat on a small panel with four other mayors Wednesday afternoon on another hectic Capitol Hill day to discuss how their cities were leading where they said Washington had failed to. Later, she met with Health and Human Services Secretary Tom Price’s staff to show how much cities were achieving on their own, and how much more they could do with the federal government fully invested.

But the current iteration of the House GOP health-care bill threatens many of the investments made to create parity between physical and mental-health care. Critics of the bill say the $800 billion Medicaid cuts alone would cripple mental-health programs that many states and localities fund with those federal dollars. It would also leave it up to the states to allow insurance plans to drop coverage of mental health and substance use treatments, and charge higher premiums to people with depression or other diagnosed mental illnesses because they are preexisting conditions, according to the National Alliance on Mental Illness.

In her two years as first lady, McCray developed ThriveNYC, a comprehensive mental-health program that includes, among many other initiatives, putting mental-health resources in every New York City school, screening pregnant women and new mothers for postpartum depression, training 1,000 faith communities in how to administer mental-health aid and launching a massive public awareness campaign called Today I Thrive, with ads in subways and buses featuring people telling their stories of recovery from mental illness.

When McCray, who has spoken openly about both her parents’ and her daughter’s struggles with depression, started talking to people about her desire to change the mental-health-care system in New York City, the first thing almost everyone told her was to change the culture, to change the stigma. Every group she met, whether they were Muslims or African Americans or Orthodox Jews, expressed an uneasiness in their cultures of talking about their mental health, she said. Yet, every time she opened up about her own stories, almost everyone she spoke to had stories of their own.

Mental illness is one of the most pervasive diseases in the world, and yet one of the most under treated. Because it is invisible to most, and because it’s often accompanied by personal shame, it takes a long time for people to admit they need help and even longer to actually seek it. McCray cited a statistic that the average time between the first sign of symptoms and seeking professional treatment is 10 years.

“With any disease if you wait before you get treatment … we’re seeing people who spiraled into a serious mental illness when they shouldn’t have, it was preventable. People don’t have to get that sick, but because we have no infrastructure and people are not treated early, it doesn’t get better,” she said in an interview.

In the late fall, McCray also launched a 24-hour mental-health hotline. It’s more than a crisis hotline, though it can serve as that, but instead it simplifies the often burdensome effort of seeking help. The free service connects New Yorkers with a mental-health professional to not only speak with in the moment, but who can also help them schedule an appointment with a therapist or psychiatrist who is located conveniently to where they live, speaks their language and takes their insurance. They will also offer to follow up with the person to ensure they go to their scheduled appointments and check on them in the interim.

More than 100,000 people have called the hotline, which receives an average of about 500 calls a day and sometimes gets as many as 900, McCray said. She said that when someone is in mental-health distress, they often struggle with how to get help and where to go. “We expect way too much of people who are actually suffering,” she said.

At the panel on Capitol Hill, the mayors in attendance chastised federal lawmakers for forcing them to take this on themselves. Mayor Jacob Day (D), of Salisbury, Md., said the problems are so big, even in his small city, that “we don’t have the luxury of not being solutions oriented.” Mayor Paul Soglin (D), of Madison, Wis., said, “Cities have found that while no one else is stepping up, we’ve had to fill the role and the responsibility of being the adult in the room.” And Mayor John Giles (R), of Mesa, Ariz., said discussion of mental health had been “embarrassingly absent…in the rush to reform” health care.

So many of the nation’s major issues, from criminal justice to homelessness to unemployment, can be traced to the lack of a mental-health structure, McCray said.

“This is a disease like any disease. … For most of these people, it has spiraled out of control, and we’re treating the end result,” she said. “We can’t look at it as a boutique program, we have to look at the whole system from our younger citizens to our seniors, and we need federal government participation. Yes, if they repeal the Affordable Care Act, we will continue on because we have to, but we hope they do not, because we have to do more than we are doing now. This is just the beginning of the needs of the people who are suffering.”

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