Two trade associations representing New York’s community-based mental-health industry—Mental Health America (MHA) and the New York State Association of Psychiatric Rehabilitation Services (NYAPRS)—are eyeing the money Albany spends on inpatient psychiatric care and lobbying the Cuomo administration to close its state-run psychiatric hospitals. In January, New York governor Andrew Cuomo issued a partial reprieve to three of the nine state psychiatric hospitals he previously slated for closure. But the governor is moving ahead with plans to close other state psychiatric hospitals, which will force hundreds of seriously mentally ill patients into jails, shelters, prisons, and morgues. This will come at a high cost to taxpayers and put the public, the police, and the patients themselves at considerable risk. Just as Governor Cuomo would never cede control of tax policy to banking interests, he should not cede control of mental health policy to the mental-health industry. The hospitals should remain open.
Unlike community-based programs, psychiatric hospitals cater to those who need inpatient services, cannot survive safely in the community, or who refuse treatment. New York currently has about 4,000 state psychiatric hospital beds—roughly 27 per 100,000 New Yorkers, down from 600 per 100,000 in 1955. To meet the generally accepted minimum standard of 50 beds for every 100,000 people in a state, New York needs at least 3,000 more psychiatric beds. As a result of the shortage, at least 9,000 mentally ill New Yorkers are currently incarcerated and thousands are homeless. Closing hospitals and losing even more beds will only make the problem worse.
To justify their grab for state funds, the trade associations point out that other large states have even fewer psychiatric hospitals. That’s true. California has only five and Texas eight, compared with New York’s 24. But in California, the mentally ill are almost four times as likely to be incarcerated as hospitalized. In Texas, the imprisoned outnumber the hospitalized by eight to one. This should be a warning to New York’s policymakers, not a model for them to imitate. New York does have one community-based program—Kendra’s Law—that is proven to reduce incarceration, hospitalization, and violence. But the same trade associations arguing for hospital closures are also lobbying against greater use of Kendra’s Law. Why? Kendra’s Law not only allows courts to commit patients to treatment involuntarily; it also lets courts order community programs such as those NYAPRS and MHA represent to provide the treatment. The trade associations want to get their hands on New York’s mental-health funding, but they don’t want responsibility for running programs that would serve those who get kicked out of hospitals.
Cuomo hasn’t said what, if anything, will replace New York State’s psychiatric hospitals once they close, or what will happen to the patients. The New York State Office of Mental Health (OMH) is circulating a Regional Centers of Excellence Plan containing lots of platitudes but few details. What’s clear is that many previously hospitalized patients will be declared “recovered” and left to fend for themselves. Others will be transferred to distant facilities, making it hard for their families to visit them. Anyone who gets sick after the hospitals close will simply be locked out.
The MHA and NYAPRS have never acknowledged the relationship between untreated serious mental illness and violence or incarceration. But the police, the public, and parents of the untreated seriously mentally ill know better. New York State’s law-enforcement community has criticized the OMH plan. In October, Michael Biasotti, past president of the New York State Association of Chiefs of Police, wrote that OMH’s proposed cuts “will further shift care and treatment of the most seriously mentally ill from the mental health system, where it belongs, to the criminal justice system, where it does not. When psychiatric beds go down, incarceration goes up.”
The community-based mental-health industry’s attempt to shutter state-run psychiatric hospitals comes on the heels of its largely successful campaign to empty adult homes in New York State (adult homes are represented by a different trade association). In the past, OMH gave these bad ideas rubber-stamp support, as its former commissioner believed the agency’s purpose was to improve the mental health of all New Yorkers, rather than treat the most seriously ill. Cuomo hired a new commissioner, Ann Sullivan, a medical doctor who has worked with the most seriously mentally ill in inpatient settings. That’s a big improvement. New York State needs its psychiatric hospitals to serve the most seriously ill. Governor Cuomo should not pretend otherwise.