The need for psychiatric and behavioral health services throughout New York is not disappearing, but inpatient Psych services are. Download and share the informational Flier.
Need for Psychiatric Services
A study conducted by the Schaffer Center at USC in 2017 estimated that more than 1.6 million New Yorkers are living with serious psychological/mental distress. When investigating Medicaid expansion data from 2014, these researchers found 1 in 5 new Medicaid enrollees used mental or behavioral health services after enrollment. 1 Despite attempts to increase access and availability of outpatient services, there are still few alternatives to the emergency department / inpatient hospital stay for patients in severe mental health crisis that need immediate access to care and medications. Our mental health system increasingly relies on nursing homes and sparsely regulated adult homes for the care of most mentally ill patients.
Hospitalization rates for New Yorkers with serious mental illness are higher than the national average. Overall, 4% of all NYS hospitalizations were for serious mental illness. Length of stay for serious mental illness is much longer on average than other hospital stays, around 20 days for the most serious diagnosis of schizophrenia.2 Yet the Treatment Advocacy Center’s research found that NYS only has 52% of the inpatient beds needed to treat severe mental illness in all populations (including prisoners) in the state.3
Need for Inpatient Detox and Rehab Services
According to NYS Dept of Health (authors of the state Prevention Agenda) approximately 12% of people in New York have experienced a substance abuse disorder.4 Unlike with severe mental health crises, there are more alternatives to inpatient stays for substance abuse disorders. Residential rehabilitation is a popular alternative, but most of these facilities are not subject to reporting requirements that an article 28, hospital-based detox or rehab unit is subject to. Therefore, much less is known about rehab and detox need and capacity. Last year, all of NYC’s public hospitals closed their inpatient detox centers, claiming that treatment was better provided in the community.5
Inpatient Psych Capacity and Usage
In the Post Berger era of hospital consolidation, there has been a decrease of more than 40,000 inpatient psychiatric bed days available at NYS Article 28 hospitals since 2013. That is a decrease of 4% in just 5 years. Similarly, the number of beds that have been decertified between 2013 and 2018 stands at -390, a decrease of 12%. At the same time, total discharges are almost flat with a less than 1% decrease.6 These numbers do not include the NYS Inpatient Psych hospitals which were not regulated as Article 28 facilities and therefore did not submit institutional cost reports. These hospitals represent about 32% of the state’s inpatient psych capacity. These facilities have seen a 19% decrease in staffed beds per the Office of Mental Health’s “Transition Plan” – a plan to reduce inpatient psych capacity.7
As private non-profit hospitals shed psych patients, the burden is being picked up by public hospitals. The NYC independent budget office showing a 20% increase in mental health discharges at NYC Health and Hospitals during the 5-year period of 2009 to 2014, while NYC’s voluntary non-profit’s show a 5% decrease in discharges.8 In New York City, net patient service revenue per psych discharge actually decreased in nominal dollars between 2013 and 2018 (whereas overall statewide, NPSR from psych discharges did increase slightly but not nearly the rate of medical inflation.9
Inpatient Detox and Rehab Capacity and Usage
While detox bed days have declined nearly 3% between 2013 and 2018, staffed rehab beds have increased almost 33%, likely a result of the opioid epidemic. Still detox discharges increased nearly 1% and rehab discharges increased 25%.
COVID-19’s Effect on Need for Psych and Behavioral Health Services
In the immediate aftermath of Hurricane Sandy, as many inpatient psych centers (Bellevue and Coney Island Hospitals) were off offline, the fall out for other hospitals with inpatient psych beds was immediate and dramatic. Then Beth Israel hospital reported a nearly 70% increase in inpatient psych patients in the month immediately following the storm. Caseworkers lost track of patients, only to find them days later in unfamiliar hospitals being cared for by overwhelmed staff.10 During the COVID-19 crisis, there were no inpatient psych departments open to pick up the need as every hospital scrambled to be able to accommodate the dead and dying of the epidemic. As of yet, we have no sense what happened to the more than 2000 inpatient psych beds in NYC and their patients. We have no idea what outcomes were for patients in state regions with no psych beds at all.
We are also just beginning to understand how COVID-199 and the related economic fallout will increase the need for inpatient psych services. Nearly half of Americans reported mental health strain to the Kaiser Family Foundation.11 What we don’t know is the number of people who will present with severe mental health issues requiring hospitalization – either as a new manifestation or as a chronic condition, stable with outpatient care, but that has been exacerbated by an inability to access outpatient care during the pandemic.
1 See NYS Chartbook, Behavioral Health and Economics Network: https://www.bhecon.org/portfolio/state-chartbooks/
2 See NYS Chartbook, Behavioral Health and Economics Network: https://www.bhecon.org/portfolio/state-chartbooks/
6 NYS Institutional Cost Reports
7 See: https://www.omh.ny.gov/omhweb/planning/docs/507-plan.pdf note that some of these facilities are run in conjunction with Dept of Corrections for the NYS prison population
9 NYS Institutional Cost Reports