Hochul’s mental-illness plan, though not gutsy, marks real progress

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Gov. Kathy Hochul announced a $1 billion “Comprehensive Plan to Fix New York State’s Continuum of Mental Health Care” in her State of the State address Tuesday. She pitched this initiative as part of an ongoing partnership with Mayor Eric Adams on serious mental illness.

The Hochul plan is less gutsy than Adams’ involuntary-treatment push, rolled out in late November. But her mental-health policies do complement Adams’, and, assuming the Legislature enacts them, they will benefit New Yorkers.

The Adams plan issued a directive, effective immediately, for city workers to be more proactive in identifying candidates for psychiatric hospitalization. It also included several requests for state-government action to improve the hospitalization process.

One of Adams’ more promising asks was for the state to require hospitals to evaluate everyone they discharge for Kendra’s Law, New York’s assisted outpatient treatment program. Expanding Kendra’s Law has long been debated due to its success in stabilizing seriously mentally ill people via community-based court-ordered treatment programs. The only realistic road to expansion goes through psychiatric hospitals because that’s where the vast majority of court-order recipients get put in Kendra’s Law.

Hochul took a pass on mandating evaluation for Kendra’s Law upon discharge, which won her the praise of progressive civil-liberties groups. It likely put Kendra’s Law expansion on hold, for now.

Mayor Eric Adams
Mayor Eric Adams’ plan declared that effective immediately, city workers be more proactive in identifying candidates for psychiatric hospitalization.
AFP via Getty Images/ Kena Betancur
protest mentally-ill homeless
There are also requests to improve the hospitalization process.
Getty Images/Spencer Platt

The most constructive criticisms of Adams’ plan focused on bed capacity. Any push on involuntary treatment won’t get very far if hospitals have nowhere to put people. Last year, articles in The CityCrain’s and Gothamist documented instances of hospital systems at capacity and people in need of inpatient treatment having to wait days, weeks even, for a bed.

Hochul proposes adding 150 beds at state-run psychiatric facilities, which would come on top of 50 more such beds announced in October. Hochul touts this as “the largest expansion of State inpatient capacity in decades.” Back in the 1950s, state psychiatric hospitals were host to more than 90,000 beds, but that number has since dwindled to around 3,000. Expanding capacity will make the state system better positioned to serve people who need long-term care and are too troubled for private general hospitals to handle.

Thanks to past administrations’ reckless bed-cutting efforts, New York faced a bed shortage before the pandemic that was exacerbated by the repurposing of psychiatric hospital beds for COVID overflow. Around this time last year, Hochul tried to bring those beds into service by boosting the Medicaid rate at which hospitals are paid for psychiatric care.

KATHY HOCHUL
Hochul pitched the initiative as part of an ongoing partnership with Mayor Eric Adams on mental illness.
AP/Hans Pennink

That carrot-style approach proved less effective than hoped. About 850 psychiatric beds remain offline, an extraordinary 15% of the state’s total stock. Hochul has therefore decided to try sticks. She wants hospitals to face fines of $2,000 per day for every bed they don’t restore.

Hospitals, for their part, insist that reimbursement is still inadequate for the care of the seriously mentally ill. No one informed about the ins and outs of hospital financing would say that claim is wholly bogus. Whether New York will be able to fine and regulate its way to more psychiatric beds very much remains to be seen.

If all the city gets from Albany on mental health this year is the Hochul plan, that’s still progress. New York has come a long way since Chirlane (“change the mindset around the mind”) McCray was seen as one of the city’s top mental-health experts. Her husband, Mayor Bill de Blasio, ever sensitive to “stigma,” resisted framing mental illness as a public-safety question. Adams and Hochul are more comfortable with that idea.

Columnist Harry Siegel noted last month that the Adams plan could be described as “literally the most popular policy in New York City,” given that a recent poll shows New Yorkers support “Making it easier to admit those who are dangerous to the public, or themselves, to mental health facilities” by an 11 to 1 margin. Future progress on mental health in New York will be marked by how much policy is brought in line with public opinion.

Stephen Eide is a senior fellow at the Manhattan Institute and contributor to “The Next New York: Renewing and Reforming the Empire State,” a project of the Empire Center at NextNewYork.net. 

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