Plan to Close NYC Neighborhood Psych Beds Raises Controversy: Our View

NYAPRS News: A NYC hospital system’s proposal to eliminate 30 inpatient psychiatric beds in upper Manhattan has created considerable controversy among hospital officials, local politicians and service providers and community members.

NYAPRS’ view is that the analysis should start from the ground and that community needs must be the dominant factor. But in the absence of informed decisions, choices narrow and hospitals are too easily are viewed as the default service to address mental health needs. 

Are all stakeholders in this primarily Dominican community sufficiently aware of the array of prevention, crisis and hospital diversion services that can be deployed in their communities? One only has to look at the range of innovative services that were put in place after inpatient psych beds were closed in 3 New York City neighborhoods (see https://www.omh.ny.gov/omhweb/transformation/nyc.html) or the abbreviated list below).

But where does the funding for these exciting community alternatives come from?  Does the NY Presbyterian Hospital system have some responsibility to reinvest healthcare dollars here? Do the NYS and NYC health and mental health agencies? NYAPRS believes all three do.  See comments below from community politicians, service providers and NYAPRS executive director Harvey Rosenthal.

Politicians Oppose Plan to Close Allen Hospital Psychiatric Unit

Crain’s Health Pulse  April 5, 2018

Presbyterian/Allen Hospital's plan to decertify 30 psychiatric beds has drawn political and community opposition, threatening the health system's $70 million plan to use the freed-up space to upgrade its maternity services and expand a surgical suite at the Inwood campus.

But ensuring appropriate care for people with serious mental illnesses is more complex than merely keeping hospital beds open, mental health experts said.

Given the statewide strategy of reducing unnecessary hospitalizations, community providers need funding to be able to care for more people in outpatient settings, said Jason Lippman, executive vice president of the Coalition for Behavioral Health.

"This speaks to the macro issues occurring, where hospitals make economic decisions to close inpatient psychiatric beds and community-based mental health and substance use providers are called upon to fill gaps," he said.

Rep. Adriano Espaillat cast doubt on whether community services in Inwood are adequate. Over the weekend he wrote to Dr. Steven Corwin, New York-Presbyterian's CEO, urging him to reconsider the health system's plan to reduce inpatient psychiatric care at Allen. Community Board 12 in Manhattan previously voted 34-0 in opposition to the plan.

New York-Presbyterian's certificate-of-need application is under review by the state Department of Health.

"Quality psychiatric care is important for any community hospital, but psychiatric care offered at Allen is of importance to the Inwood community, given the lack of other treatment options in the neighborhood," Espaillat wrote.

Espaillat said that 78% of New York-Presbyterian's psychiatric beds are at the health system's psychiatric hospital in White Plains.

The system does have 25 psychiatric beds at NYP/Columbia, which is three miles away in Washington Heights.

New York-Presbyterian did not respond to a request for comment in time for publication.

Other politicians, including state Sen. Marisol Alcantara, Assemblywoman Carmen De La Rosa, Manhattan Borough President Gale Brewer, Bronx Borough President Ruben Diaz Jr. and City Council members Mark Levine, Carlina Rivera and Diana Ayala, sent a letter to the state Office of Mental Health that criticized the proposal.

Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, said the state has invested in new outpatient initiatives, such as mobile crisis teams and Assertive Community Treatment (ACT) teams, which provide mental health services in people's homes or in the community. Access to those types of programs could make a difference if less inpatient care is available.

"Hospitals by no means are the answer to every issue," Rosenthal said. "We've come a long way from making the hospital the first line of defense."

Susan Wiviott, CEO of the Bridge, which offers mental health services in Upper Manhattan and the Bronx, said it is worthwhile to look citywide at the availability of psychiatric beds because people often travel to receive inpatient care. But within individual communities, she said, there needs to be access to outpatient services.

Her organization operates seven ACT teams, including three that work with people in shelters. Adding capacity to offer more mental health services is difficult, she said, because of the low reimbursement rates for such care.

"If you want to have a lot of outpatient services, you have to support them with rates that make sense," she said.

This below example and others can be found at https://omh.ny.gov/omhweb/transformation/nyc.html

Holliswood Hospital:

  • 15 Home and Community Based Services (HCBS) Waiver Slots for intensive home based services targeted at children who would otherwise require hospitalization or residential treatment.
  • Children’s Crisis Respite Beds to offer short-term overnight respite of up to 21 days for relief from a current stressful living situation children aged 4-18. This funding increases bed capacity in Queens and Bronx Counties from 16 beds to 21 beds.
  • Rapid Access Mobile Crisis Teams provide short-term crisis response and management for children and adolescents aged 0-17 in Brooklyn, Queens, Staten Island, and Manhattan. This funding adds a total of 6.5 new teams.
  • Family Advocates to work with children and families accessing community hospital emergency departments and inpatient and outpatient units by advocating for their needs and assisting them in accessing and navigating services and supports in the community. Family advocates are family members with a child with emotional challenges who have experienced firsthand the services offered through the community mental health system.
  • Three Family Resource Centers to strengthen secure attachment between parent and child relationships, and to promote healthy social-emotional development in children ages five and under from high risk families residing in the Bronx and Harlem.
  • High Fidelity Wraparound (HFW), a youth-guided, family-driven planning process that allows youth and their family achieve treatment goals that they have identified and prioritized, with assistance from their natural supports and system providers, while the youth remains in his or her home and community setting.
  • Child Specialist Staff to assess and divert children from inpatient admissions and develop linkages to Home Based Crisis Intervention and other intensive services.

https://www.omh.ny.gov/omhweb/transformation/nyc.html