State's Efforts to Increase Number of Beds Have Proceeded Slowly
The mental health needs of New Yorkers have greatly increased, with 21.1% of adults struggling with mental Illness and 5.1% with a severe mental illness in 2021-2022, according to federal data. Between 2013 and 2022, there was a 23% increase in the number of individuals served by the state’s public mental health system, with nearly 900,000 residents utilizing the services. According to a report by State Comptroller Thomas P. DiNapoli, the rising need for mental health services coincided with a loss of 990 beds, a 10.5% drop in capacity, in inpatient psychiatric facilities statewide between April 2014 and December 2023.
“Increased mental health services are urgently needed to meet the rising demand for care,” DiNapoli said. “With the COVID pandemic behind us, New York must redouble its efforts to restore inpatient psychiatric bed capacity and preserve and expand telehealth services.”
Increase in Mental Health Needs
The prevalence and number of New Yorkers living with any mental illness (AMI) has increased in recent years, according to the state Office of Mental Health (OMH) and the federal Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH). According to SAMHSA’s data, there were more than 3.2 million adult New Yorkers with AMI in 2021-2022. Incidences of any mental illness were especially high among 18 to 25-year-olds at 30%. According to the National Institute of Mental Health (NIMH), AMI encompasses all recognized mental illnesses and is defined as a mental, behavioral or emotional disorder that can vary in impact, ranging from no impairment to mild, moderate and even severe impairment. The definition does not include developmental and substance use disorders.
The estimated occurrence of serious mental illness (SMI), defined by NIMH as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities, among New York adults aged 18 and older was nearly 5.1% in 2021-2022, or about 783,000 individuals. For those between 18 and 25 years of age the rate was 8.6%. New York’s rates were less than the national average of 23.1% of adults with AMI and 6% with SMI.
The state public health system has mirrored these trends, with significant increases in individuals served since 2013. OMH attributes the growth to expanded eligibility standards, greater efforts to achieve behavioral health parity, higher demand for treatment services, increased awareness of mental health issues, and efforts to reduce stigma.
Declining Inpatient Psychiatric Beds and Long-term Decline of Inpatient Capacity
In Dec. 2023, there were 3,999 inpatient psychiatric beds in New York City and 4,458 in the rest of the state. OMH’s report from that month indicates the counties with the greatest number of psychiatric inpatient beds were largely downstate. The ratio of beds to population was approximately 1 to 2,084 in New York City and 1 in 2,544 in the rest of the state. There were 20 counties, with a total population of 898,895, that had no psychiatric inpatient beds at all.
The last decade reflects a continuation of a long-term decline in the overall number of inpatient psychiatric beds in New York – particularly in state-operated psychiatric centers – due to policy decisions made decades ago. From April 2014 to Dec. 2023, psychiatric inpatient capacity decreased by 506 beds (11.2%) in New York City and by 484 beds (9.8%) outside of the city. Most of the largest bed reductions occurred downstate – in Suffolk and Rockland counties, as well as in the five boroughs of New York City – in that period.
COVID-19 Impact
During the first wave of the COVID-19 pandemic, community hospitals in New York City closed an estimated 20% of their inpatient psychiatric beds to accommodate the need for increased medical capacity, according to OMH. Lockdowns and quarantines, as well as the increasing use of telehealth services, also contributed to decreases in inpatient psychiatric utilization. The expansion of telehealth services in OMH licensed facilities also decreased utilization of hospital psychiatric services during the pandemic, according to OMH officials.
DiNapoli’s report noted the State Fiscal Year 2023-24 Enacted Budget included $1 billion of new funding to support the state's system of mental health care. In January 2023, OMH and the state Department of Health sent a letter to community hospitals directing them to reopen approximately 850 non-operational, licensed inpatient psychiatric beds taken offline during the pandemic. Hospitals were required to reopen the beds by Feb. 10, 2023, or submit a plan to reopen them by April 1, 2023. As of April 17, 2023, only 222 out of 843 off-line beds had returned to operational status. In Dec. 2023, the Executive announced the reopening of a total of nearly 500 psychiatric beds taken offline during the pandemic, but details regarding these beds have not been released publicly. The state also recently increased the Medicaid reimbursement rate – retroactive to April 1, 2022, according to OMH – for inpatient psychiatric beds by 20% to facilitate opening closed acute care community beds.
DiNapoli’s report urged policymakers to continue working with community hospitals to address barriers, commit to expanding the availability, utilization, and effectiveness of telehealth services, and continue efforts to strengthen the overall mental health service structure, including services to youth, stabilizing the mental health workforce and addressing housing insecurity which increases the risk of homelessness and mental health crises.
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