Closures Are Causing a Full-Blown Mental Health Emergency in New York
NYSNA nurses have sounded the alarm over a new threat: the closure of inpatient psychiatric units in the midst of a historic mental health crisis created by COVID-19 and its related economic fallout.
Please read our white paper, “A Crisis in Inpatient Psychiatric Services in New York State Hospitals.”
Summary
As the COVID-19 pandemic hit New York, Governor Cuomo suspended the Certificate of Need applications which require hospitals to go through a public process before closing or changing services. Consequently, hospital administrations have been emboldened, closing their inpatient psychiatric units, often without clarifying to nurses or the community whether these moves are temporary or permanent.
Private hospital systems like NY Presbyterian and Northwell are taking these services out of the community, despite decades of cuts to mental health care stemming from mergers and hospital closures. The Berger Commission and other efforts to shrink NYS hospital capacity, together with declining Medicaid reimbursements, and the reality that psychiatric patients simply aren’t as lucrative as other patients, have created powerful incentives for hospital systems to shed inpatient psychiatric beds.
Meanwhile, the city’s public hospital system and the correctional system are picking up the burden. This contributes a greater likelihood that individuals with serious mental illness will have a violent encounter with police. The acute underfunding of public hospitals means that the healthcare professionals in our public system are not provided the resources to treat this new influx of psychiatric patients, many of whom have complex diagnoses.
If hospitals continue with their plan to close inpatient psychiatric units, many New Yorkers’ will lose access to mental health care altogether. Many others will be inappropriately shuffled into the correctional system. NYSNA has published the following white paper to document the deep crisis in mental health care in New York State, and to recommend alternative paths to the profit-driven shuttering of vital psychiatric services.
Key Findings on New York State’s Mental Health Emergency
NYC’s Mental Health Crisis is Deepening
- Between 2015 and 2018, NYPD calls reporting emotionally disturbed persons increased about 23%.
- In the same time frame, according to HUD data, the seriously mentally ill homeless population in NYC jumped 23%.
- Since the onset of the COVID crisis, calls to New York City’s Mental Health Hotline and NAMI’s suicide hotline have skyrocketed.
Inpatient Psychiatric Care is Disappearing
- In 2000 New York State had 6,055 certified inpatient psychiatric beds. By 2018 that number had dropped 12% to 5,419.
- In New York City particularly, inpatient psychiatric care has dropped at the same time as the population and the need have mushroomed. NYC accounts for 72% of the decline in inpatient psychiatric beds between 2000 and 2019, a total loss of 459 beds. Another 17% of the total bed decline came from the Long Island Region. NYC gained nearly 400,000 residents in this timeframe; Suffolk and Nassau counties gained 100,000 people.
When Private Hospitals Shed Psych Patients, Public Hospitals and the Corrections System Absorb the Burden
- Between 2009 and 2014, there was a 20% increase in mental health discharges at NYC Health and Hospitals. In the same period, there was a 5% decrease in mental health discharges at NYC’s voluntary non-profit hospitals.
- In a tale of two hospital systems, psychiatric bed closures in the Northwell system, the state’s largest private healthcare system, represent 25% of statewide closures. Meanwhile, H+H hospitals Bellevue, Kings County, and Elmhurst account for roughly 25% of Article 28 inpatient psychiatric beds in NYC.
- The corrections system picks up the remaining burden. Inpatient psychiatric beds in forensic facilities account for nearly one-fifth of the state’s total bed capacity.
- An estimated 12% of the state prison population has a serious mental illness—about five times as many people as there are beds in the correctional hospital system.
Please read our white paper, “A Crisis in Inpatient Psychiatric Services in New York State Hospitals.”