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Disabilities Beat: NYS funding 200 new inpatient psychiatric beds concerns advocates

A generic iimage of two people holding hands in a hospital. One person has monitors hooked up to them.
A stock photo of two people in a hospital holding hands. One person appears to be connected to monitors.

New York State’s recently-passed 2024-2025 budget included a lot of changes for the disability community. On today’s episode, we share part of a conversation with Western New York Independent Living’s Chief Policy Officer Todd Vaarwerk and Chief Operations Officer Stephanie Orlando about the state’s funding of inpatient psychiatric beds. The budget includes $55 million so 200 new inpatient psychiatric beds can be added to state-run psychiatric hospitals, according to the Division of the Budget.

This week’s Disabilities Beat features part of a recently aired one hour special on the New York State Budget, which you can hear the entirety of by clicking here.

PLAIN LANGUAGE DESCRIPTION: The New York State budget focuses on increasing psychiatric beds, but as Stephanie explains, many people in the disability community would rather see a focus on support in the community. Stephanie argues that the budget focuses on adding hospital beds instead of investing in comprehensive mental health programs that help people when they first start to show symptoms of a mental health condition, rather than when they are in crisis.

Stephanie also says there is a lack of transparency in mental health hospital outcomes.

Todd explains New York State's "safe discharge law" and challenges faced by people with physical disabilities in nursing homes and how that might apply to mental healthcare as well. 


Emyle Watkins: Hi, I’m Emyle Watkins, and this is the WBFO Disabilities Beat.

This month we’re sharing highlights from the recently-passed New York State budget for 2024 to 2025. On today’s episode, we share part of a conversation with Western New York Independent Living’s Chief Policy Officer Todd Vaarwerk and Chief Operations Officer Stephanie Orlando about the state’s funding of inpatient psychiatric beds. This interview has been edited for length and clarity, but we have the entire discussion, including more perspectives and additional aspects of the budget on our website at wbfo dot org.

Emyle Watkins: Our state has moved a far distance away from where we were in terms of institutionalization and having people live in hospitals and live in institutions. But now we see the state adding back psychiatric beds. I believe this year in the budget they've included funding for 200 psychiatric beds. Stephanie, is this in line with what people with mental health conditions want to see as far as where money is going towards services?

Stephanie Orlando: No. We want to see funds going towards community-based services. Right now, if you look where we were 10 years ago, it's hard to believe it was 10 years ago, but we were talking about Regional Centers of Excellence and how New York had more hospital beds than any other state sometimes. You look at a state like California that has a high population and we were just way far above where they were in terms of hospital beds. And the culture has really swung, and I think a lot of that comes from fear and downstate culture. With this budget comes 75 transition to home units. So when the governor and the mayor of New York City announced that this new transition to home units was going to exist, they said that it was specifically for patients experiencing homelessness with severe mental illness or poor communication. And they said for “street and subway patients.” Street and subway patients to get services.

Stephanie Orlando: So you're talking about really trying to scoop up people who are homeless and put them into mental institutions as a solution. So it's not a solution to homelessness, it's not a solution to mental health issues. It's really about how do we warehouse people and get them off the streets, and it really takes us a huge step backward. Really what also goes along with this is that they're going to add in seven million [dollars] to support new guidance on admission and discharge. So the concern from the advocate world is: so you're going to add hospital beds and then make it harder for us to get out of the hospital. So you're going to, again, warehouse people in institutions instead of investing in a comprehensive mental health program that can really serve needs now. It's a band-aid approach to a problem that particularly stems from homelessness. Again, the rising costs of living and the agitated state that people have been in post-COVID, and some of these incidents that have been happening in the New York City subways.

Stephanie Orlando: So this is a reactionary thing. It really isn't based on where the pain points are right now in the system, and we need to have more access to services. Right now, when people, when they identify that they might need some mental support, trying to get an appointment and get into services takes [an] excruciatingly long time. Then we have our CPEP, our psychiatric emergency room that's really overwhelmed. People just get sent there because there's nothing else available and it's not necessarily the right level that they need at the time either, but they're the most readily accessible. That's where you go. That's always open and will always take.

Stephanie Orlando: So this money could have been well better invested into community services rather than the exorbitant amount of hospital beds that we already have. And the other piece that I want to say about this is the lack of transparency around the outcomes of those hospitals. So in preparing for this interview, I was doing research on the Office of Mental Health website trying to find their Balance Scorecard. I had looked at it for a very long time and suddenly I can't find it anywhere. There's no report, currently, on the Office of Mental Health website that will tell you how they're doing in their state-operated psychiatric hospitals, whereas before it was very transparent. They scored themselves, they even at one point I was a part of an advocacy group…

Todd Vaarwerk: And took comment on those scores, didn't they?

Stephanie Orlando: Yes. And told their hospitals where they needed to do better and published it. Whereas as an advocate, I work to include in that scorecard things like restraint and seclusion. How often were people being restrained in hospitals? Was it a high amount, too much? All of those things are gone, that I can find anyway. So not only are they investing in something, but there's not even a clear transparency around how effective that service is. Most of the research says that that isn't as effective as community-based services and really helping people in their homes with their support systems.

Emyle Watkins: It sounds like, the state has been pushing towards having people who have mental health conditions and maybe they're experiencing a crisis, maybe they commit a crime, they're put into these long-term care facilities versus, it sounds like, advocates who would like to see an earlier community-based approach.

Todd Vaarwerk: Community supports done first and done well will always be less expensive and safer than last-minute or just-in-time institutionalization options.

Stephanie Orlando: Yeah. And you have people that have been in this situation where maybe they have committed a crime or are viewed as potentially, we call them “quality of life crimes.” It sounds horrible and that's what it is, where you're affecting someone else's quality of life. Like, you're being loud on the corner of the street and that's disruptive and I don't like seeing that kind of thing. As a community that response is, okay, well, sometimes, “well we need to put them somewhere, they need to go somewhere where they're safe.”

Well, that's not always true. It's not always true that they're safer and have a quality of life and outcomes that that hospital is providing. There are other services that can really do that. And you have people who have been picked up and maybe put in an institution that say, “I would've rather gone to jail because I have a sentence time. I know when I'm going to get out.” With this you could get hospitalized and depending on what these new admission requirements and discharge requirements are, get stuck there for an indefinite amount of time. And we have seen that in our past, in our history in New York State.

Todd Vaarwerk: Remember that New York State has what's called a safe discharge law. No health facility can discharge you unless they know the place that you're going to and your ability to follow the plan of care prescribed by your doctors is going to be safe and effective. And we know for people with physical disabilities who end up in nursing homes, that that becomes a real challenge in terms of to define what's safe. And we've discovered that untrained social workers seem to get the idea that they can prevent me from getting out of a nursing home by saying, the only way we'll agree to let you leave is 24-hour care when you get home, somebody there to be with you every minute of the day.

Todd Vaarwerk: Well, the state's not going to pay for that unless there's a medical justification for that. The facility doesn't care about the medical justification. The facility cares about the legal responsibility of what happens to you after you leave. And the same thing happens on the mental health side of the aisle. So this is another one of those examples where they're reacting and they're creating these beds in order to deal with the temporary problem of people being concerned about street corners and subways. Instead of looking at the long-term solution of where they could go.

Emyle Watkins: You can listen to the Disabilities Beat segment on demand, view a transcript and plain language description for every episode on our website at WBFO dot org. I'm Emyle Watkins. Thanks for listening.

Emyle Watkins is an investigative journalist covering disability for WBFO.