Hochul's $1B mental health plan aims to reverse longtime trend of declining psychiatric beds

Jan. 18—Inpatient psychiatric beds have been declining

Since 2014, the number of inpatient psychiatric beds across New York has declined by 20%.

That, coupled with a lack of services to which patients can be safely discharged, has resulted in high occupancy rates at inpatient facilities as well as some people falling through the cracks of a broken system, according to Gov. Kathy Hochul's office.

"Right now, nearly 3,200 New Yorkers struggling with severe mental illness or addiction are living on the street and subways," Hochul said during her State of the State address earlier this month. "At the same time, we have insufficient levels of inpatient psychiatric beds and outpatient services."

It's why Hochul announced plans for the state to spend more than $1 billion to try to fix the state's continuum of mental health care.

A major part of that plan: adding 1,000 inpatient psychiatric beds across the state, which will involve bringing 850 psychiatric beds in hospitals back online as well as funding 150 new beds in state facilities.

"This is more than half of the beds we have lost since 2014, and they will serve more than 10,000 New Yorkers each year," Hochul said. "These actions are overdue."

But how did we get to this point?

The decline in beds

Hearing Hochul's plan took me back to mid-2013, to my first big story as a business reporter at the Press & Sun-Bulletin, the newspaper in Binghamton.

The state had a different idea back then: It was implementing a new Regional Centers of Excellence Plan that would consolidate New York's 24 state psychiatric hospitals into 15 regional centers over three years, expand outpatient services and save about $20 million statewide in the first year.

As originally concocted, the plan would have ended inpatient services at the Greater Binghamton Health Center as early as July 2014.

The human cost of that: Binghamton-area children needing hospitalization would receive treatment in Utica, while adults would have to go to Syracuse. Both trips are an hour-plus from Binghamton.

Mental health experts at the time were concerned about the rapid change, noting that unless all the cost savings were reinvested in outpatient care, there would be collateral damage.

This was all about 20 years after another state plan: The New York State Community Mental Health Reinvestment Act, which was signed into law in December 1993.

The principle behind that 1993 legislation was that the funds saved from the planned downsizing of the state hospital system through closures and patient census reductions would then be reinvested to create more community-based services.

As experts back in 2013 and now told me, that's where the problem lies: The state has always seemed better at getting people out of institutions than building up programs in the community to provide care and support.

Through the efforts of many, including local politicians, the Greater Binghamton Health Center stayed open.

But the decline in inpatient psychiatric beds across the state continued.

In 2014, according to figures from Hochul's office, there were 9,320 inpatient psychiatric beds across New York, which included 6,228 beds in community hospitals and 3,092 in state facilities.

By 2022, the overall inpatient psychiatric bed count had fallen 20% to 7,471, including 4,954 in community hospitals and 2,517 in state facilities.

Hochul's plan

As Hochul's office notes in her plan, the inpatient psychiatric beds are needed to provide immediate treatment for the most acute cases of serious mental illness.

To encourage community hospitals to bring beds back online, Hochul last February announced spending of $27.5 million to support higher reimbursement rates for inpatient psychiatric beds.

But 850 beds remain offline.

A major reason why, Hochul said, is because the Office of Mental Health doesn't have the teeth to compel hospitals to bring those beds back.

So as part of her plan, Hochul plans to propose legislation to allow the Office of Mental Health to fine hospitals — up to $2,000 per violation, per day — for not complying with the terms of their operating certificates.

"This is the level of authority necessary to ensure that 850 inpatient psychiatric beds are brought online at long last," reads the 2023 State of the State Book.

The governor's plan also calls for opening 150 new adult beds in state-run psychiatric hospitals, with 100 of those beds planned in New York City and 50 of them outside of the city.

"This will build on the 50 new beds that the governor announced in November and constitutes the largest expansion of state inpatient capacity in decades," according to the State of the State book.

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