New Yorkers are fed up with erratic, sometimes violent behavior from the growing ranks of homeless mentally ill on the streets and subways. That frustration has led to increased scrutiny of Mayor Bill de Blasio’s Thrive NYC initiative in recent days, with reporters, city comptroller Scott Stringer and some City Council members asking probing questions about the Big Apple’s mental health status quo.
They would be remiss, though, if they didn’t also direct their attention to state government. In New York, most of the important mental health decisions are made by the state, not City Hall — and some of those decisions are terrible ones.
In his latest budget proposal, Gov. Andrew Cuomo called for closing “unnecessary” beds in psychiatric centers, a ka mental institutions run by state government, and reinvesting those funds in community services.
The official name for the state’s strategy is the Transformation Plan, but in truth, the state has been on the same path on mental health policy for decades. In the 1950s, when mental health care in New York was almost exclusively an inpatient matter, patients in state facilities numbered 93,000. The census is now down to below 3,000, but the Cuomo administration thinks that it could stand to drop still lower.
Back in the 1980s, Mayor Ed Koch argued that “deinstitutionalization” had gone too far, and criticized state government for betraying the promise of better care in community settings.
But de Blasio and other city officials have largely given the Cuomo administration a pass on mental health, even while adult beds in state-run psychiatric centers in the city have declined by around 180, or 15 percent, during the recent Transformation Plan era. Those are cuts to a system that was already inadequate for addressing the challenge of untreated serious mental illness.
That challenge must be one of the most obvious public policy failures to the average New Yorker. If you use the subway, you can’t avoid at least an occasional encounter with a dazed and disheveled individual who’s obviously not receiving the treatment he needs. The city has estimated that 40 percent of unsheltered homeless are “severely mentally ill.”
At the city level, “community services,” for thousands of mentally ill homeless people, amount to shelter. Beds in mental health shelters now number more than 4,000, up from around 2,800 in 2015. It costs the city’s Department of Homeless Services more than $150 million annually to run its network of mental health shelters.
Rikers Island’s status as one of the largest mental health care facilities in the nation is both a civic disgrace and a costly burden on city government. With an average daily census of around 350 patients, Creedmoor is the largest actual state-run psychiatric center in the city, whereas more than 1,000 inmates in city jails have a serious mental illness.
It is extremely doubtful that the city’s challenges at Rikers would be as pronounced as they are had state government not dismantled its inpatient system of mental health care.
Hizzoner’s failure to speak out about reductions in state bed capacity, which have placed a great burden on a number of city agencies and taxpayers, has been a glaring oversight. If de Blasio, perhaps because he shares the state’s doctrinaire commitment to deinstitutionalization, is unwilling to speak up, then other city officials should pick up the slack.
Mental health care prior to deinstitutionalization wasn’t an across-the-board hellscape of abuse and deprivation. Anyone who thinks it was should read “Mental Hospital,” a 1962 book about conditions at Pilgrim State Hospital on Long Island close to when it and New York’s institutionalized population as a whole were at their peaks.
“Mental Hospital” portrays Pilgrim State as an up-to-date facility run by dedicated professionals that provided patients with an array of services and daytime programming. Such accounts attest that governments can be trusted to run systems of inpatient care that are both large in scale and also humane and high quality.
Not that anyone is seriously contemplating a return to 1960s. Advocates are right that running mental institutions is an onerous and expensive task and that strong community services can relieve state government of that burden.
Indeed, community mental health is one area in which New York is well-served by its commitment to big government: Our Kendra’s Law program is by far the most successful assisted outpatient treatment program in the nation, and we have many valuable providers of supportive housing, such as Community Access and Project Renewal.
The policy quandary comes down to this: Should inpatient care and community services be a question of “both/and” or “either/or”? Officially, the state says that it is a both/and. The only beds Albany is closing are ones that are unnecessary, because they are “vacant.” But could it be that the reason why we have so many “vacant” beds is that we aren’t making enough use of the system?
This piece originally appeared at New York Post
Stephen Eide is a senior fellow at the Manhattan Institute and author of the report, Systems Under Strain: Deinstitutionalization in New York State and City.
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