Mental health patients left without beds

New York feels side effect of tailoring hospital space to handle coronavirus

Hundreds of beds for psychiatric, detoxification and drug patients have been closed in New York over the past six months for use instead by coronavirus patients.

The closures have prompted healthcare advocates to warn that they could spark a mental health crisis as those affected struggle to find immediate care.

"People don't stop getting sick just because there's nowhere to treat them," said John Snook, executive director of the Treatment Advocacy Center in Arlington, Virginia.

At least one in five US citizens (46.6 million in 2017) has mental health issues. Yet, 542 beds in 27 New York hospitals were closed or redesigned for COVID-19 patients, The Wall Street Journal said.

A further 403 rehabilitation and detoxification beds are no longer available to those in need, the New York Office of Addiction Services and Supports said.

The New York State Nurses Association warned: "Psychiatric and behavioral health services have been relegated to an afterthought, and New York state has been left with a fragmented care system that fails many of its citizens."

Dealing with COVID-19 has forced widespread change in the healthcare system this year. In March, Governor Andrew Cuomo ordered that all hospitals in the state must have a 30 percent surge capacity to cope with a potential jump in coronavirus cases.

The closed psychiatric units include Allen Hospital in Inwood, part of the New York-Presbyterian system and a Brooklyn methadone clinic in the Northwell Health system. Also closed are psychiatric and detoxification inpatient beds in the HealthAlliance hospital in Kingston, New York.

But the state's health authorities said that despite the temporary loss of these beds, there are still sufficient facilities to treat those in need.

However, the nurses association said the pandemic could be used as a pretext to close even more psychiatry units because they are not profitable. It found that the average net patient revenue per psychiatric bed fell from $99,000 in 2000 to $88,000 in 2018. But each bed would generate more money if converted for general patient use.

One of the psychiatry units that was repurposed during the pandemic was the 30-bed psychiatric wing of Allen Hospital. It had been due to close in 2018 but was kept open after a backlash by healthcare workers because it serves low-income communities in northern Manhattan and the Bronx.

"Our acute care providers have begun to make changes to their services that we believe are preludes to permanent closures of inpatient psychiatric beds," the nurses association said in a report titled "A Crisis in Inpatient Psychiatric Services in New York State Hospitals".

Pre-COVID goals

"Many of these changes are changes that align with providers' pre-COVID goals of reducing inpatient psychiatric capacity, and also track with general industry trends."

The Treatment Advocacy Center said it was "very concerned about psychiatric bed shortages in New York and around the United States".

"Without access to hospital care, acutely ill individuals deteriorate, families and caregivers buckle under stress, emergency rooms fill with acutely ill patients waiting for a bed to open and police and fire responders find themselves increasingly diverted to mental health calls."

It said that a minimum of 50 beds per 100,000 people is necessary to provide minimally adequate treatment for individuals with severe mental illness.

In New York state, the number of beds in psychiatric units fell from 6,055 in 2000 to 5,419 in 2018. The beds were lost mainly in New York City and Long Island.

These changes in care caused visits to mental health emergency departments to fall at the height of the pandemic in March, a report by the New York City Department of Health and Mental Hygiene found.

They fell from nearly 5,000 visits a week in 2019 to fewer than 3,000 in March and April and did not return to normal by June.

Coping with the stress of the pandemic has proved difficult for many. Calls to the Disaster Distress Helpline at the Substance Abuse and Mental Health Services Administration rose 891 percent in March compared with March last year.