NYAPRS Note: Several days ago, the state released a plan to spend $10 million to open up units in downstate psychiatric hospitals to provide services and supports to unhoused New Yorkers with major mental health challenges. NYAPRS is opposed to this proposal. Over the past 2 decades, New York has been a national leader in creating a broad array of community-based alternatives to the use of state and local hospitals including
• ‘‘low threshold’ housing that can accept people who experiencing major mental health and addiction related challenges, including Housing First and Safe Haven programs
• new crisis stabilization centers
• peer engagement and crisis support
All of these have received strong support and funding from Governor Hochul and, accordingly, we urge accelerated expansions in the use of all 3 models, using the $10 million proposed for state hospital expansion. We support the use of the $7.5 million for the creation of emergency (not stepdown) short-term residential programs that are followed by the “provision of permanent supportive housing within 120 days or less.”
Far too many New Yorkers in crisis have needlessly cycled through all too frequent stays in local hospitals and CPEPs (see below) only to be discharged to inappropriate settings including homeless shelters. Appropriate discharge plans must include housing as needed and a peer bridger who can support and stay with the individual in the community for as long as is needed.
In summary, the best remedy to homelessness is housing with peer and crisis supports. We must make major investments in these models and the decimated community workforce rather than return to the needless and regressive use of state institutions of the past.
State to Invest $17M in New Programs for Homeless New Yorkers with Severe Mental Illness
By Maya Kaufman Crain’s Health Pulse October 25, 2022
The state will create two dedicated units at psychiatric hospitals for New Yorkers who have a severe mental illness and are living on the city streets or in the subway system, part of a $17.3 million investment that Gov. Kathy Hochul framed as a way to help subway riders feel safe.
The two 25-bed units, which will be called Transitional Housing Units, will serve individuals ages 18 and older who are experiencing homelessness and living with a serious mental illness. The first will open by Nov. 1 at Manhattan Psychiatric Center, and the second will open by early next year at another state-run psychiatric hospital downstate, which has yet to be determined.
The 50 new inpatient beds will cost about $10 million and are being financed using the state’s public emergency fund. They will be staffed by a multidisciplinary team of doctors, nurses, social workers, occupational therapists and other clinical and non-clinical personnel.
The state is also launching a $7.3 million short-term residential program for people who are discharged from the Transitional Housing Units. The program will teach residents skills for independent living, connect them to teams of community-based providers and supply them with permanent supportive housing within 120 days, officials said in a release.
The program will include four, 15-bed units. James Plastiras, a spokesman for the state Office of Mental Health, said the four locations have not been finalized.
The announcement comes one month after a Crain’s investigation found that the mental health care system’s failures to help unhoused New Yorkers led to two deaths and has left countless others struggling to access care, even after they voluntarily sought it out. Hospitals frequently turn away homeless patients who are experiencing a mental health crisis or discharge them before they are stable with little to no care coordination, the investigation found.
“Our expanded subway safety strategy of Cops, Cameras, and Care will crack down on subway crime, help those experiencing homelessness get the support they need to get out of the system, and alleviate concerns of riders to ensure New Yorkers feel safer throughout the subway system,” Hochul said in a statement over the weekend.
Hochul unveiled the mental health care investment as part of a larger subway safety plan announced Saturday with Mayor Eric Adams, which features an increased police presence.
Glenn Liebman, chief executive of the Mental Health Association of New York State, an Albany-based advocacy organization, criticized Hochul for framing the investment as part of a larger subway safety plan unveiled with Mayor Eric Adams, which he said wrongly conflates violent crime with mental illness.
A small fraction of unhoused New Yorkers live with serious mental illness, and research indicates that homeless people are likelier to be the victim of a violent crime than commit one.
Liebman said the success of the new programs may be hindered by the same high staff turnover that has plagued New York’s mental health care system. Human services organizations received a 5.4% cost-of-living adjustment this year, but providers have said salaries are still painfully low and that they struggle to fill vacancies. Hospitals have also struggled to staff their psychiatric units, Crain’s previously reported.
Advocates will host two rallies this week to lobby for an 8.5% cost-of-living adjustment for behavioral health providers in next year’s state budget.
Plastiras, the Office of Mental Health spokesman, said it is using existing staff to open the first Transitional Housing Unit at Manhattan Psychiatric Center.
State officials said the new Transitional Housing Units will at this time only take referrals from hospitals in the city that have comprehensive psychiatric emergency programs, although they did not specify any clinical criteria for referring patients.
There are just 16 of these specialized emergency programs across the five boroughs, according to state data.
Community-based providers and shelter staff who work with unhoused New Yorkers with serious mental illnesses have historically struggled to refer people to a bevy of programs designed to help them, forcing them to rely on hospitals as de facto gatekeepers, the Crain’s investigation found.
Harvey Rosenthal, chief executive of the New York Association of Psychiatric Rehabilitation Services, a nonprofit, said the new inpatient units could set a misguided precedent for repopulating state psychiatric hospitals, which housed tens of thousands of New Yorkers at their peak in the mid-20th century.
Rosenthal said the state should instead increase its reliance on community-based services and peer workers, who have lived through similar experiences as the people they help.
The Office of Mental Health said the staffing plan for the new programs includes two peer positions, but Rosenthal—whose association operates a peer-run program to help patients discharged from hospitals to transition to the community—said peers should not be “attached to a model that’s wrong-headed and will probably be coercive.”
“We’re about engaging people voluntarily,” he said. —Maya Kaufman