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Shortchanging the mentally ill costs New Yorkers


While scientific data shows COVID-19 risks waning in New York, another very serious medical issue is becoming more intense, disruptive and tragically fatal.  We know how to treat it, but state leaders refuse to address it head-on.

Consider this reporting on May 15 in The New York Daily News:

“Nearly one in every 25 New Yorkers live with a serious mental illness, with around 280,000 adults dealing with diagnoses like major depressive disorder or schizophrenia, city health officials reported last month.

Thirty hospitals statewide have repurposed about 600 psychiatric beds for COVID-19 patients, according to the state Office of Mental Health (OMH). All told, the state has 5,815 licensed psychiatric beds, including the 600 not currently being used for psych patients — a decrease of about 30 beds statewide since 2019.

“We’re seeing a New York City where everybody who’s vaccinated can take the mask off … And still, we have a lot of mentally ill people in the streets, we have them in the subways, we have them surrounding hospitals, and they’re begging for the help that is not there.”

Virginia Davey, PEF’s Labor-Management committee chair at OMH, said the agency has been shifting mental health resources from inpatient mental health care to the less expensive community-based services for several years.

PEF leaders say the state’s most vulnerable patients cannot always be cared for as outpatients.

“They are sick and need higher levels of care, not to be moved into lower levels of care prematurely,” said PEF Vice President Randi DiAntonio.

“This strategy has created an internal race for resources, often leaving the sickest patients to fend for themselves while providers battle for dwindling financial resources to help those ‘qualifying’ for services,” Davey said. “Every new tragedy should serve as a reminder of how crucial it is that we firm up our commitment to both inpatient and outpatient services, given that they are equally essential for the survival of those managing their mental health needs.

“We really need to budget our resources in two separate funding streams: one for inpatient care, and one for out-patient care,” Davey said. “The diminishment of one system of care to bolster another weakens both systems.  OMH requires greater funding across the board, and one that does not improve one level of care while undermining the success of the other.”

While state legislators listened to PEF and derailed a state budget proposal to close Rockland Children’s Psychiatric Center, they also authorized the closure of an additional 200 OMH beds across the state. Now OMH is snipping away at in-patient beds a few at a time at the remaining psychiatric treatment centers statewide.

The New York Daily News quotes a nurse at a city hospital struggling to meet patients’ needs as saying: “Telehealth and tele-psychiatry are not a replacement for inpatient hospitalization. Those who are suicidal, homicidal, extremely psychotic, they come through the emergency room, they come through NYPD custody, they come to us in their worst state,” he added, noting that he has seen his former patients wandering the streets.

What people too often see as criminal justice issues are actually the result of inadequate mental-health services.

PEF President Wayne Spence said he believes the focus on parole reform should, instead, be to fund better mental health and drug-treatment options, services that directly help parolees and could help reduce the violent attacks taking place in New York City.

Darlene Williams, PEF’s Health & Safety chair at OMH, said she’s spoken with a fellow PEF member at the state Psychiatric Institute’s Washington Heights Unit in Manhattan, who said he takes the bus for his daily commutes.

“He’s a pretty big guy, but when I asked him if he feels safe on the bus, he said, ‘No,’” Williams said.  “He said he is seeing a lot more people with mental illness on the bus and he thinks they are ‘hiding out’ there to avoid the rising violence at the shelters and on the subways.  They ride the bus all day and all night, to try to be safe.  It might be safer than the subway or the streets, but violent incidents do happen sometimes on the buses, too.  The driver won’t try to intervene unless a situation really escalates or becomes violent.”

On May 5, the subway system experienced serious delays and other disruptions when riders experiencing mental health crises on three different lines forced a 90-minute service shutdown to downtown Manhattan and other problems.  Such incidents are traumatic for the person who is in crisis, and they can also be traumatic for other passengers and MTA employees and police who respond.

The incident led to this statement from Metropolitan Transportation Authority spokeswoman Meredith Daniels: “Three incidents in less than four hours involving people threatening harm to NYCT employees is a stark reminder of why the city needs to surge essential mental health services and police officers ASAP.”

The city assigned 250 more police to cover subway stations and trains.  Policing of mass transit is now at its highest level in 25 years.

The disruption to timely train service, and frequent reports of mental-illness-related violence, creates anger, frustration, distrust and resentment among the affected public, businesses, and other organizations.  Such incidents breed ill will toward people with mental illness and increase the stigma that makes it easier to dismiss their needs, assume all mentally ill people are dangerous, and treat them disrespectfully.

Williams said PEF members at OMH are seeing more young patients admitted to inpatient care, but too often they aren’t allowed to remain long enough to become fully stabilized before they are discharged.  The result, she said, is a revolving door.  “We are hoping we will never see them again, but they are back in three weeks, and they are here briefly, discharged and return again and again.”

That’s because it takes time to figure out which medications work best for a specific patient at a specific time, and the medications need to be gradually adjusted, Davey said.  Once you have the medications right, then the patient may do well in the community if they receive the level of outpatient care they need.

“We used to have a number of very valuable programs, such as Family Care, mental health intervention teams, and intensive case manager teams to support people in the community, but those teams and programs are mostly gone.  When patients were discharged from in-patient services, we sent them home with resources.  Now, if they are lucky enough to get any resources, they don’t last long enough.”

“We’re just running on a shoestring budget.  It’s the sickest, neediest people who are losing services.  The money being taken from in-patient services, is supposed to be building the community services, but the need is increasing too fast,” Davey said.

PEF is forming a coalition called NYS Fund Our Future with a mission to make that exact case. Decades of service cuts and privatization have caused the crisis the state now finds itself in, and only a committed legislative, advocacy and public relations effort by unions and the communities they serve will help turn things around. PEF will share more information as the campaign develops, but for now interested members can sign up to be involved – and submit a video telling us about the vital work you perform for New Yorkers — here.

In one very recent horrifying case in New York City, a man walked into a police station near his home and told the officers that he had awakened with an overwhelming need “to hurt someone.”  He then walked down to the basement where he raped and killed his own mother.

This isn’t just an urban issue, Davey said.  Rural communities, such as those in St. Lawrence County where she works, experience their own tragedies.

“We’ve had two high school students commit suicide after they were bullied on social media, and there was a shooting in an area real estate office,” she said.

“People who are mentally ill and become violent are often victims, too,” Davey continued.  “They are stigmatized, but we are failing them first when treatment resources are limited.  Those who become that sick often failed to receive the treatment and care they needed.”

It doesn’t have to be that way, she said.  New York should attack lagging mental health services with the same zeal and commitment that it attacked COVID-19.

“We need to name it.  Claim it.  And then fix it!”