Mental health care system in NY struggles to meet demand

An important preface: The vast majority of those struggling with mental illness are not violent and for most, it is unlikely you would even know they are struggling with their mental health behind the scenes. But what this piece focuses on is: What is the City and State doing to help the small percentage of people struggling with severe mental illness and are not getting the help they need?

In the 1950s, public mental health care systems in New York and across the United States started to shift away from state-run mental institutions to community-based treatment.

Instead of institutionalization, more money was poured into community mental health centers, supportive housing, and outpatient treatment.

But as psychiatric centers started to close, some of those unable to seek help on their own ended up on the streets or in prisons. According to the Vera Institute of Justice, nearly 1 in 5 women and 1 in 10 men entering New York jails have a serious mental illness.

"The public library systems, the transit systems, all kinds of systems find out that they’re in the mental health care business as a result of the fact that the public mental health care system is just not doing the job that we need it to," Stephen Eide, a senior fellow at the Manhattan Institute said.

More than 90% of those with severe mental illness can be stabilized and discharged within a few days or weeks.

"They’re going to go to the medical doctor, get in line to see a psychiatrist or therapist to figure out what’s going on, and get a diagnosis," Lisa Dailey, the Executive Director of the Treatment Advocacy Center explained.  

But the number of hospital beds the state has for this group of people is rapidly shrinking since psychiatric beds are reimbursed at a lower rate.

According to the Treatment Advocacy Center, the state has only about half the number of beds needed to treat mental illness.

On top of that, 600 psychiatric beds went offline during the pandemic to increase capacity at hospitals for COVID patients and have yet to reopen.

These beds can help those stabilize in immediate need so they can later transition to community care.

"I think the notion is that most people, if they have access to the acute care beds in these public hospitals, they will get better and move on to the community," Glenn Liebman, CEO of Mental Health Association in New York State said.

There is also a very small percentage of people with severe mental illness who do not realize that they need treatment. It is estimated that 50% of those living with schizophrenia and 40% of those with bipolar disorder do not recognize they have an illness.

The approach to how this group receives treatment is where researchers and advocates are split.

"Any mental health care system that aspires to be functional, that aspires to connect people to the treatment that they need is going to have to provide involuntary treatment," Eide said.

Harvey Rosenthal, with the New York Association of Psychiatric Rehabilitation Services, however, disagreed saying, "We created a program right up in Westchester and they engaged 80% of a group of people that otherwise might have gotten a court order. We know how to engage people."

Recent violent incidents in the city, whether linked to mental illness or not, have some calling for more institutionalization. Something advocates say they have heard before.

"What goes through my head is, we’re going to get back into let’s sweep them up, let’s sweep away they rights, let’s go back to the past, let’s put them all in hospitals, as if this whole community is dangerous and violent," Rosenthal explained.

But all agree, that more can be done to help those falling through the cracks of the mental health care system.

"What we have created is a system that doesn’t have near enough for people just to be inpatient long enough to actually stabilize," Dailey said.

New York still has 24 state-operated psychiatric facilities to help treat those struggling with mental illness for a longer period of time.

But when it comes to acute care beds at public hospitals, the New York State Nurse’s Union is also raising alarm at the rapidly shrinking number of beds.

Governor Kathy Hochul is proposing to increase the Medicaid rate for these beds in order to make it more profitable for hospitals to keep these psychiatric beds open, but it will take time before the effects of this would be seen.