On June 22, NYSNA nurses submitted testimony for New York State Attorney General Letitia James’ hearing on the mental health crisis. The testimony came amid Black Indigenous People of Color Mental Health month. Irving Campbell, RN, PMHNP-BC, and Ezra Maurer, RN, testified before the committee. They highlighted how the loss of inpatient psychiatric beds has negatively impacted communities, and how that mental health void has taken a great toll on communities of color and low-income communities. Their testimony is outlined here:
My name is Ezra Maurer, and I am testifying today on behalf of the New York State Nurses Association (NYSNA). NYSNA represents more than 40,000 nurses for collective bargaining and is a leading advocate for universal health care coverage for all New Yorkers. I am a registered nurse with over six years of experience working in in-patient, acute care psychiatric care units. I began working at the Health Alliance Hospital Mary’s Avenue Campus in-patient psych unit in Kingston six years ago, but for the last two years I have been reassigned to the psychiatric inpatient unit at the Mid-Hudson Valley Division of Westchester Medical Center in Poughkeepsie due to the closure of the psych units at Health Alliance.
I have a personaL commitment to working in the mental health field and to providing vital mental health services to the people in my local community. New York is currently experiencing a serious mental health crisis that has been worsened by the stress of the COVID pandemic. In addition, because of a state policy priority to reduce expenditures on acute care beds for the treatment of psychiatric patients, we find ourselves without enough resources and beds to provide the care that our patients need. Since 2000, the state of New York has reduced state psychiatric hospital in-patient capacity by more than 20%. At the same time, public and private hospital psych beds were cut from 6,055 in 2000 to 5,419 in 2018 (12%). The reasons for the bed reductions include:
- State budget cutting efforts and downsizing of hospital system bed capacity;
- Poor reimbursement rates by public and private payers for psychiatric services;
- The drive by private hospital systems to increase revenues by converting psych beds to provide more expensive services such as surgical, cardiac, cancer and other specialty care.
The COVID crisis has made the situation worse. The pressures of the crisis have caused an explosion in people needing psychiatric care, including in-patient care, but the State has directed or encouraged hospitals to convert non-critical inpatient beds to ICU and acute care beds to treat COVID patients. This situation gave many hospitals the opportunity or excuse to temporarily or permanently close their psych units and reduce beds. Hundreds of those psych beds remain closed and have not been restored, even though the need for COVID treatment beds is now greatly reduced. In my facility in Kingston, I have personally experienced the impact of the COVID crisis and the ongoing closure of our 40-bed in-patient psych unit and the 20-bed detox unit. On April 2, 2020, we received notice that our psych and detox units would be temporarily closed to serve as emergency COVID overflow units. I and the other staff were then transferred to work at the psych unit of the Mid-Hudson Valley Division of Westchester Medical Center in Poughkeepsie. To my knowledge, our unit was never actually used for COVID overflow patients. Instead, it appears that the building was closed and our transfer to Poughkeepsie allowed the hospital to begin its planned construction of new hospital facilities that are to replace our existing campuses in Kingston. The closure of our 40-bed psych unit eliminated all in-patient psych beds in Ulster County, forcing the 200,000 residents to seek in-patient care at other locations much further away — we are the only hospital in Ulster County with certified psych beds and our census was consistently at 35 or more beds (or at about 80% of capacity). With the closure of our unit, local patients who needed in-patient psych treatment were instead referred or transferred to the Poughkeepsie site (about 40 minutes by car). Others were being referred to the Westchester Medical Center psychiatric units in Valhalla (about 1 ½ hours by car) or to Bon Secours in Port Jervis (about 1 1/3 hours by car).
The closure of the psych units in Kingston was a big problem for our patients and their families. The other facilities with psych beds were much further away, required a lot more travel time, and required them to have access to a car to make the trip to visit their loved ones. Many of our patients would travel to the Poughkeepsie site, which was closer to Kingston, to avoid the chance that if they came in through the Emergency Room that they might be admitted and transferred to the units in Valhalla or Port Jervis. They preferred the relatively closer site in Poughkeepsie. The long distances to the alternate sites also lead to a waste of ambulance and transport resources. When a patient is evaluated in Kingston and deemed needing of in-patient service, that patient is then transported via ambulance to Poughkeepsie, Valhalla or Port Jervis accordingly. I have had conversations with the ambulance staff, and they say that when they have to transport to these facilities from their local service area that they are effectively taken out of service for an hour and a half to 2-1/2 hours for the round-trip transport. This takes away from anyone else in the local area who might have to rely on an ambulance for an emergency transport to the hospital for any reason.
As I noted earlier, the now closed mental health units in Kingston included a 40-bed acute care psych unit and a 20-bed detoxification unit. The Poughkeepsie site to which we were transferred also operated a 40-bed psych unit and shortly after we were transferred they added 15 psych beds, bringing the total to 55 beds. That means that until our unit is reopened, there are 25 fewer psych beds in the Hudson River region and 20 fewer detox beds. There are currently no in-patient psych beds available for our patients in Ulster County. In addition, it is our understanding that the newly constructed hospital in Kingston will be reducing the current in-patient psych unit capacity from 40 beds to 20 beds — we will have a permanent loss of 20 psych beds in Ulster County when the new hospital building is opened. The state must take immediate action to address the ongoing mental health crisis and to restore psychiatric in-patient capacity to meet the needs of New Yorkers, including the following steps:
- Significantly increase the Medicaid reimbursement rates for in-patient psychiatric care to make them competitive with other procedures;
- Require all hospitals to re-open all psychiatric beds that were “temporarily” closed during the height of the pandemic, with strict timelines and oversight;
- More tightly control the approval process for permanently closing psych units or beds and implement a moratorium on closure applications;
- Seek federal approval to allow Medicaid to reimburse providers of long-term psychiatric care patients;
- Increase the total numbers of psychiatric in-patient treatment beds to comply with generally accepted standards for available beds on a per capita basis.
I look forward to working with you to increase psychiatric bed capacity in Ulster County and statewide to meet the mental health needs of our people and to improve the care of patients suffering from acute mental illness in my community. Thank you for providing me with the opportunity to share my concerns and testify today.
Dear: Attorney General James
I have been a registered nurse for over 20 years and recently fulfilled my dream of becoming a Psychiatric Mental Health Nurse Practitioner. I have been practicing in the community, serving those diagnosed with Serious Mental Illness (SMI). I am also a proud New York State Nurses Association (NYSNA) member and a mental health advocate. I would like to thank you and your office for this opportunity and forum to speak on such an important topic. I am unfortunately too well aware of the dangers that come when our communities do not have adequate access to mental health care, namely inpatient psychiatric beds. Before the pandemic, I worked for eight years in the inpatient psychiatric unit at New York-Presbyterian Brooklyn Methodist Hospital (NYPBMH)—before seeing many institutions, including NYPBMH, repurpose their psychiatric units to take in COVID-19 patients. I understood the need at the time, but years later, many of these beds have not been reinstated despite vaccines, other medical advancements, and decreased COVID-19 hospitalization rates. Most clearly, these beds remain inaccessible because they are primarily used by those whom Medicaid insures, and the reimbursement rates for these individuals are extremely low. The loss of inpatient beds includes the 52 beds at New York-Presbyterian Brooklyn Methodist Hospital, which were accessible to the people of Brooklyn, NYP Allen, and Northwell Syosset, to name a few. Unfortunately, this created a mental health void for the community and surrounding communities, including many communities of color and those with lower socioeconomic status.
The pandemic helped expose the need for these inpatient beds. The National Institute of Mental Health states that 18.5% of adults experience mental illness annually, 1 in 5 youth aged 13–18 (21.4%) experiences a severe mental health condition at some point during their life; for children aged 8–15, that estimate is 13%, 20% of state prisoners and 21% of local jail prisoners have a recent history of a mental health condition, 70% of youth in the juvenile justice systems have at least one mental health condition. A staggering 60% of adults and almost 50% of youth ages 8-15 with a mental illness received no mental health services in the previous year. At the same time, African-Americans and Hispanic-Americans used mental health services at about half the rate of Caucasian-Americans in the past year. You may wonder how this equates to real dollars; well, mental illness costs America $193.2 billion in lost earnings per year. Mood disorders, including major depression, and bipolar disorder, are the third most common cause of hospitalization in the U.S. for youth and adults aged 18–44. Suicide is the 10th leading cause of death in the U.S., the third leading cause of death for people aged 10–24, and the second leading cause of death for people aged 15–24. More than 90% of children who die by suicide have a mental health condition. Two million people with mental illness are booked into jails each year. While incarcerated, at least 83% of jail inmates with a mental illness do not have access to needed treatment, and as a result, their conditions worsen. Many are released with no continued access to mental health care.
All statistics show the need for inpatient psychiatric beds as we have seen an increase in anxiety and depressive disorders, substance use disorders, and suicidality. In addition, children are affected where the suicide rates for those under 18 increased tremendously during the pandemic. Children not only experienced grief and loss, but isolation due to our city being on lockdown and not having enough psychiatric beds. As a medical professional, I witnessed the direct need at my facility, patients with active suicidality waiting for 96 hours in an overcrowded emergency room for an inpatient psychiatric bed only to be transferred to as far away as Westchester Medical Center away from their community and support systems. Unfortunately, this was not a select few but rather the norm. Throughout my institution, we cared for and are still caring for patients who would generally be on the inpatient psychiatric unit, now on medical-surgical units while not receiving care from trained psychiatric mental health nurses.
The need is glaring; we continue to see New Yorkers experience mental health symptoms daily with very few places to go. The city has promoted NYC WELL and Governor Hochul spoke of millions of dollars going directly towards psychiatric beds; however, this has yet to be seen. New York-Presbyterian Brooklyn Methodist states that they will resume inpatient psychiatric services potentially in September of this year. They have invested millions of dollars into remodeling a unit only to bypass the certificate of need process. They intend to cut two beds on one unit while remaining non-committal when or even if the other unit will reopen. The institution has however remained committed to using that unit as an ICU unit for COVID-19 patients. One would think that we have learned our lesson after witnessing the increase in violence, suicide rates among children, and an indisputable need for inpatient psychiatric beds. Yet, we continue to penalize those with mental illness and lack of resources. Unfortunately, this often leads to incarceration and not receiving the necessary care. Worse, we have innocent victims such as Michelle Go, who was pushed in front of a train by a man who is believed to have a psychiatric history.
You may ask what can be done. My simple answer is to immediately reopen all inpatient psychiatric units that were closed in relation to the pandemic. We can also push to enact bills that will hold institutions such as NYP accountable for purposely keeping these beds away from those who need them the most. It is the least we can do for those members of our community who require access to mental health beds. History has shown that we lose countless beds every year, never to come back, but now is the time we must respond to the mental health crisis and put an end to the loss of beds, for if we fail to do this, the future of our children and those we love will be at risk. Thank you once again for this opportunity to contribute to this discussion. I look forward to other forums such as this in the future.
Irving Campbell R.N., PMHNP-BC
A staggering 60% of adults and almost 50% of youth ages 8-15 with a mental illness received no mental health services in the previous year.”