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Alliance Note: Much of ����������’s plan to address the current mental health crisis has centered around increasing inpatient hospital capacity. While hospital beds are a necessary aspect of the overall continuum of services, they do very little to support people maintaining their recovery in the community. As our colleague Doug Cooper mentioned in the article below, the money the state is spending to increase the number of state hospital beds would be much more effective if it was used to support the community-based services which prevent people from needing hospitals in the first place.

Our problem is not a lack of beds, but rather our ineffective use of the beds we currently have. The state must focus on improving discharge plans so people are not cycling in and out of hospitals. Those leaving the hospital must have: a person to walk with, such as offered through Peer Bridger programs; a place to go, like the low barrier housing with supports offered through Housing First programs; and a place to go to like a Clubhouse, recovery center, or stable job.

The state cannot expect people to maintain their recovery outside of the hospital without these and other services from community-based organizations. We are heartened by Governor Hochul’s investments in the community behavioral health services over the last two years, but we know much more must be done to reverse the effects from decades of disinvestment. The state must provide more investments in this crucial workforce, starting with a 3.2% Cost of Living Adjustment in this year’s budget. We then need to expand many of these effective programs, such as supportive housing, so more people have access to needed services.

The Alliance will continue to fight for workforce investments and alternatives to hospitalization as the Governor and Legislature negotiate the budget. You can join our efforts by attending one of our upcoming regional forums and our Annual Legislative Day in Albany on March 5th!

���������� ramps up capacity, but available psych beds still lacking, report finds
By Amanda D’Ambrosio | Crain’s Health Pulse | January 29, 2024

����������’s efforts to expand the number of available beds at state-run psychiatric facilities have made it more prepared than most other states to address the mental health crisis, according to a report released last week. But some groups say that the state’s inpatient psychiatric capacity is still inadequate.

����������’s state-operated psychiatric hospitals have 3,491 beds for adults with severe mental illness, equating to roughly 18 available beds for every 100,000 residents, according to data from the Office of Mental Health.

���������� ranks fifth in the country for its available state-operated inpatient psychiatric bed space, based on data from the first half of 2023, according to a report released by the Arlington, Virginia-based nonprofit Treatment Advocacy Center last Wednesday.

But the report noted that the rankings are relative, citing a historic decline in inpatient psych beds across the country. Lisa Dailey, executive director of the Treatment Advocacy Center, said that research shows state-run inpatient capacity should total 50 open beds per 100,000 people, far more than ����������’s current capacity.

“There is no state that is actually anywhere close to being adequate,” Dailey said.

The Treatment Advocacy Center, founded in 1998, has pushed to reform state civil commitment laws in an attempt to ensure that people with severe mental illness can be admitted before harming themselves or others. But not all behavioral health advocates agree that boosting inpatient capacity is the solution to the mental health crisis, with some arguing that the state’s deinstitutionalization effort has placed a greater emphasis on community-based care.

“I don’t think there’s necessarily a shortage of state hospital beds,” said Doug Cooper, associate executive director of the Association for Community Living. “Is it a good use of resources? Not necessarily.”

Cooper said that ���������� state pays anywhere between $300,000 and $400,000 per year for each inpatient psychiatric bed, a figure he said is “substantially more than what it would cost to treat someone in the community.” Although inpatient psychiatric beds are a necessary facet of the mental health care system, most people don’t need that type of care, and would be better off recovering in community-based settings, he said.

“That’s really what I think is the most humane and appropriate way to get services to people with mental health conditions,” Cooper said. He added that estimates totaling 50 available beds per 100,000 residents would triple ����������’s inpatient capacity — a volume he deemed unnecessary.

Gov. Kathy Hochul has cited a historic lack of funding as the reason for her , which she unveiled last year. Inpatient psychiatric capacity has become a cornerstone of that plan, and the state touted the  in 2023. This year the governor plans to expand inpatient capacity even further by opening 100 more beds in state hospitals, she said during her State of the State address in early January.

The governor’s plan also attempts to address the shortage of beds for patients in the criminal-legal system. Approximately 25 of the new state psych beds will be slated for forensic patients, and 50 will be repurposed for patients with severe mental illnesses who are awaiting a trial.

Justin Mason, a spokesman for the Office of Mental Health, said that the agency “is fully committed” to boosting mental health care in the state, including by increasing civil and forensic capacity at state psychiatric centers.

Although ���������� has more open inpatient psych beds than most other states, forensic beds — which are slated for patients admitted through the criminal-legal system — account for a small portion. During the first half of 2023, ���������� had 757 forensic beds, less than a quarter of its total inpatient capacity at its 24 state-run facilities, according to the Treatment Advocacy Center.

“Basically, we are choosing to invest in a system that withholds care until people have entered the criminal-legal system,” Dailey said. “There has to be a victim, there has to be some sort of negative impact on the public … before we will even look at getting somebody into longer-term care.”

Dailey said that although inpatient beds are lacking across the board, ���������� should be commended for its efforts to restore inpatient psych beds at private hospitals that were converted to medical beds during the Covid-19 pandemic. Last year Hochul threatened to fine hospitals up to $2,000 a day for refusing to comply with orders to bring psych beds back online.

But the workforce to staff those beds is what’s lacking, Dailey said. Although there might be physical bed space, hospitals are struggling to obtain the workforce to staff them safely, she added. Dailey said that staffing solutions are the first step to addressing inpatient bed shortages, encouraging states to fund training programs and address pay disparities that affect the behavioral health workforce.

As ���������� state moves to boost inpatient psychiatric capacity, Cooper said, there has been increased attention from the governor on community programs too. The state has built up 42,000 units of mental health housing — yet there’s a need for further investment to adequately staff and resource those programs, he said. Mason, from OMH, said that Hochul’s mental health plan includes the development of early intervention and youth programs, expanding community-based services and strengthening the workforce “to ensure that all ����������ers have access to care when, and where, they need it.”