As Mental Illness Rose, NY Missed Treatment Options: State Intervention

NEW YORK New York State Comptroller Thomas P. DiNapoli is sounding the alarm as the percentage of New Yorkers with mental illness is rising, even as the overall availability of psychiatric beds has declined.

A new report from DiNapoli’s office finds that the state’s efforts to increase the number of beds have gone too slowly.

“Increased mental health services are urgently needed to meet the growing 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.”

New Yorkers’ mental health needs have increased recently, with 21.1 percent of adults struggling with a mental illness and 5.1 percent with a serious mental illness in 2021-2022, according to the most recent federal data available . Between 2013 and 2022, there was a 23 percent increase in the number of New Yorkers served by the states public mental health system, with nearly 900,000 residents using services.

The prevalence and number of New Yorkers living with mental illness has increased in recent years, according to the state Office of Mental Health (OMH) and the National Survey on Drug Use and Health (NSDUH). of the Substance Abuse and Mental Health Services Administration (SAMHSA). ).

According to SAMHSA data, there were more than 3.2 million New York adults with some form of mental illness in 2021-2022. The incidence of mental illness was particularly high among 18- to 25-year-olds at 30 percent. According to the National Institute of Mental Health (NIMH), any mental illness 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.

While the growing mental health crisis is felt in more New Yorkers seeking treatment for mental health disorders, there is also a troubling increase in acute cases, according to DiNapoli’s report.

The estimated occurrence of serious mental illness (SMI), defined by NIMH as a mental, behavioral, or emotional disorder that results in severe functional impairment, substantially interferes with or limits one or more major life activities, among New York adults 18 and older. it was almost 5.1 percent in 2021-2022, or about 783,000 people. For those aged 18 to 25, the rate was 8.6 percent. New York’s rates were lower than the national average of 23.1% of adults with AMI and 6% with SMI.

The state public health system has reflected these trends, according to the comptroller’s findings, with significant increases in patients seen since 2013. The Office of Mental Health (OMH) attributes the growth to expanded eligibility standards, to more efforts to achieve behavioral health parity, to greater demand for treatment services, greater awareness of mental health issues, and efforts to reduce stigma.

While more New Yorkers feel comfortable seeking treatment is certainly a good thing, the report finds that the ability to provide that help has not kept up.

As of December 2023, there were 3,999 inpatient psychiatric beds in New York City and 4,458 in the rest of the state. The OMH report that month indicates that the counties with the highest number of psychiatric inpatient beds were largely in the lower part of the state. The ratio of beds to population was approximately 1 in 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.

The comptroller found that the past decade reflects a continuation of a long-term decline in the total number of inpatient psychiatric beds in New York, particularly in state-operated psychiatric facilities, due to policy decisions made long ago decades

From April 2014 to December 2023, psychiatric inpatient capacity decreased by 506 beds (11.2 percent) in New York City and by 484 beds (9.8 percent) outside of New York City. city Most of the largest bed reductions occurred in Suffolk and Rockland counties, as well as the five boroughs of New York City in this period.

The pandemic only served to widen that gap.

During the first wave of the COVID-19 pandemic, community hospitals in New York City closed approximately 20 percent of their inpatient psychiatric beds to meet the need to increase medical capacity, according to OMH. Lockdowns and quarantines, as well as the increasing use of telehealth services, also contributed to the decline in inpatient psychiatric use. The expansion of telehealth services at OMH-licensed facilities also reduced the use of hospital psychiatric services during the pandemic, according to OMH officials.

DiNapolis’ report noted that the state fiscal year 2023-24 budget included $1 billion in new funding to support the state’s mental health care system. In January 2023, OMH and the state Department of Health sent a letter to community hospitals directing them to reopen approximately 850 licensed psychiatric beds for inpatients who were not connected during the pandemic. Hospitals had to reopen beds by February 10, 2023 or submit a plan to reopen by April 1, 2023.

As of April 17, 2023, only 222 of the 843 offline beds had returned to operational status. As of December 2023, a total of nearly 500 offline psychiatric beds had been reopened during the pandemic, but details about these beds have not been made public. The state also recently increased the Medicaid reimbursement rate, retroactive to April 1, 2022, according to OMH, for inpatient psychiatric beds by 20 percent to facilitate the opening of closed community beds. acute care

DiNapolis’ report urged lawmakers 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 structure of mental health services, including services to young people, stabilizing mental health. healthcare staff and address housing insecurity that increases the risk of homelessness and mental health crises.

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