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Impact of Hospital and Nursing Home Closures on Psychiatric Services

This testimony was given by Michael B. Friedman, Chairman of the, Center for Policy and Advocacy, a joint project of The Mental Health Association of New York City and The Mental Health Association of Westchester County, at a hearing held by the New York State’s Regional Advisory Committee on March 30, 2006.

Good Afternoon Chairman Webb and members of the Regional Advisory Committee. Thank you for the opportunity to testify before you today.

My name is Michael Friedman. I am the Director of the Center for Policy and Advocacy, which is a joint project of The Mental Health Association of New York City and The Mental Health Association of Westchester County.

Hospitals Throughout NY State Provide Important Psychiatric Services

I am here today to speak to you about the importance of the psychiatric services provided by hospitals throughout New York State and to encourage you to pay careful attention to the impact of your decisions on the people with mental illness who depend on these services.

New York’s general and private hospitals provide 65% of all inpatient psychiatric care in the state. In 2004, these hospitals had capacity for more than 7,800 inpatient psychiatric beds and an occupancy rate of 87.3%. In New York City, the psychiatric inpatient occupancy rate was 91%. This is significantly higher than the 65.3% statewide average occupancy rate for all hospital services, and it is essentially full capacity.

Many individuals rely on access to inpatient psychiatric services in local hospitals to help them recover and allow them to remain close to family and friends. But hospitals provide many other mental health services as well, including emergency services, outpatient clinics, continuing day treatment, case management, crisis intervention services, family support services and peer advocacy. In several communities, hospitals are the largest provider of such community-based mental health services.

Services Could Be Lost in Effort to Reduce Size of State’s Hospital System

The Center for Policy and Advocacy is very concerned that these services could be lost in the Commission’s effort to “rightsize” the state’s hospital system.

We are pleased that the Commission’s criteria for rightsizing include such factors as services to vulnerable populations, availability of services, quality of care, and utilization. However, there is very little data on the Commission’s website to assist in the application of these criteria as they relate to mental health services.

Commissioner of Mental Health Should be Involved in Plan Development

We believe it is critical that the Commission get detailed information from the Commissioner of Mental Health about psychiatric services provided by hospitals and that the Commissioner be involved in the development of plans to develop replacement services when hospitals close.

I want to be clear that we are not categorically opposed to the closure of hospitals or nursing homes. We are concerned about the preservation of the capacity to deliver inpatient and outpatient psychiatric services in local communities.

Need Plan for How to Reallocate Resources After Closures

When decisions are made to close hospitals or nursing homes, there should be a plan for how resources will be reallocated to provide continued access to the needed range of psychiatric services in affected communities. And there should be a plan for how psychiatric and housing needs will be met for people discharged from hospitals and nursing homes affected by closures and consolidations.

I have personally been involved with New York State’s mental health system since 1968. I was on the ground, as it were, in one of the few community-based psychiatric rehabilitation programs at the height of deinstitutionalization in the early 1970s. I have devoted much of my career to helping to build a system of community care that has compensated for the reckless deinstitutionalization process that abandoned ten’s of thousands of people with serious mental illness in squalid, dangerous housing and in homelessness. Hospitals have been an essential element of constructing a decent system of community care in New York State. It is horrifying to think that so much of our work over the past quarter century could be undone by this commission if it does not devote appropriate attention to psychiatric service needs.

Thank you.

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