As Mental Illness Rose, NY Lost Treatment Options: State Comptroller

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

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

"Increased mental health services are urgently needed to meet the rising 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 tele-health services."

The mental health needs of New Yorkers have spiked recently, with 21.1 percent of adults struggling with mental illness and 5.1 percent with a severe 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 state’s public mental health system, with nearly 900,000 residents using the 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 federal Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH).

According to SAMHSA’s data, there were more than 3.2 million adult New Yorkers with mental illness in some form in 2021-2022. Incidences of mental illness were especially 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 being felt in more New Yorkers seeking treatment for mental health disorders, there is also a troubling rise 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 resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities, among New York adults aged 18 and older was nearly 5.1 percent in 2021-2022, or about 783,000 people. For those between 18 and 25 years of age, the rate was 8.6 percent. New York’s rates were less than the national average of 23.1 percent of adults with AMI and 6 percent with SMI.

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

While more New Yorkers feeling comfortable seeking treatment is arguably a good thing, the report finds that the capacity to offer that help has not kept up.

In Dec. 2023, there were 3,999 inpatient psychiatric beds in New York City and 4,458 in the rest of the state. OMH’s report from that month indicates the counties with the greatest number of psychiatric inpatient beds were largely downstate. The ratio of beds to population was approximately 1 to 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 at all.

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

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

The pandemic only served to heighten this divide.

During the first wave of the COVID-19 pandemic, community hospitals in New York City closed an estimated 20 percent of their inpatient psychiatric beds to accommodate the need for increased medical capacity, according to OMH. Lockdowns and quarantines, as well as the increasing use of telehealth services, also contributed to decreases in inpatient psychiatric use. The expansion of telehealth services in OMH licensed facilities also decreased the use of hospital psychiatric services during the pandemic, according to OMH officials.

DiNapoli’s report noted the State Fiscal Year 2023-24 Enacted Budget included $1 billion of new funding to support the state's system of mental health care. In January 2023, OMH and the state Department of Health sent a letter to community hospitals directing them to reopen approximately 850 non-operational, licensed inpatient psychiatric beds taken offline during the pandemic. Hospitals were required to reopen the beds by Feb. 10, 2023, or submit a plan to reopen them by April 1, 2023.

As of April 17, 2023, only 222 out of 843 off-line beds had returned to operational status. In Dec. 2023, a total of nearly 500 psychiatric beds taken offline during the pandemic had been re-opened, but details regarding these beds have not been released publicly. 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 opening closed acute care community beds.

DiNapoli’s report urged lawmakers to continue working with community hospitals to address barriers, commit to expanding the availability, utilization, and effectiveness of tele-health services, and continue efforts to strengthen the overall mental health service structure, including services to youth, stabilizing the mental health workforce and addressing housing insecurity which increases the risk of homelessness and mental health crises.