With annual increases of $27.5 million for inpatient psychiatric beds, $9 million to recruit psychiatrists and psychiatric nurse practitioners, and $12.5 million for 500 additional supportive housing beds for people experiencing homelessness, it should benefit many New York residents. At the city level, the Subway Safety Plan is expected to address public safety concerns and support people experiencing homelessness and serious mental illness on the subways, with comprehensive investments. These data points underscore the need for increased funding to support the mental health of New Yorkers.
Among those living in NY state who used to be in therapy 22% said they stopped going because it was too expensive. The same amount (22%) said they stopped mental health therapy because their insurance coverage changed, and an additional 15% said it was because Employee Assistance Program (EAP) benefits ran out.
The Public Health Ramifications of This Funding
Neuroscientist and clinical social worker Renetta Weaver, LCSW-C, says, “The former leaders Andrew Cuomo and Bill de Blasio did not view mental health care as a priority and took measures to erase traditional methods of mental health care by reducing funding for hospital beds and closing mental health facilities in the name of deinstitutionalizing people." Unfortunately, Cuomo’s policies around deinstitutionalization contributed to homelessness, criminal activity, and untreated mental illness, according to Weaver. “The goal of this bill is to restore mental healthcare to the residents of New York, and reduce the inmate population,” she says. Weaver explains, “In this way, Governor Hochul and Mayor Adams, are taking efforts to restore the provision of intentional and comprehensive mental health care that existed prior to the last administration.” When hospitalized mental health services initially changed and mental health facilities began to close, Weaver notes that the residents were mostly elderly people with dementia, but the residents eventually became younger with more severe mental health treatment needs. Weaver highlights, “While the plan was for outpatient mental health care, there were no true methods for compliance so mental health challenges went unaddressed, and the activation of criminal behaviors increased.” The prison system is filled with individuals with untreated mental health conditions, as Weaver notes that the goal of creating more access to mental health care should be to reduce the inmate population by getting to the root of the mental health condition, rather than criminalizing mental illness. Weaver explains, “Similar to the spike in prisons, homeless people aren’t receiving appropriate treatment and engaging in symptomatology related to their mental health conditions. This includes documented cases of the homeless engaging in killing others and/or themselves.” The goal of this psychiatric bill is to increase the stability and safety of the homeless population and the community at large in New York. Weaver notes that the role of public health should be to make a positive difference in protecting the health, safety, and wellbeing of the population. Weaver highlights, “Kendra’s Law monitors outpatient and community programs that were designed to bridge the gap between the residents of NY and needed mental health support services, while simultaneously reducing homelessness and incarceration.” The Subway Safety Plan includes programs to increase safety and stability for paying train passengers and homeless individuals occupying seats, as Weaver notes that programs include trained clinical care and response teams throughout the city, long and short-term housing, etc. Weaver explains, “Overall this plan offers community mental health services, hope, validation, empowerment, safety, and stability. Public health efforts have to be championed to shift from an idea to an action.” Such funding at the state and city levels are necessary public health efforts, according to Weaver. “They are funding programs that will allow for appropriate mental health programs to be developed and care to be delivered to the critically mentally ill populations,” she says. Weaver highlights that New York City has historically been a leader in many areas, including the provision of mental health care, so, it goes without saying that the world takes cues on how it treats its residents. Despite some of the cultural differences between the East and West coasts, Weaver notes that one commonality that NYC and LA share is the need for mental health services for its homeless and at-risk populations. The new policies in NY could have a positive influence on LA’s policy around reducing homelessness and providing mental health care. Weaver explains, “When we properly treat the mental health of others, we all reap the benefits. Being proactive ensures that appropriate programs are being created and appropriate care is being provided. Being reactive results in other social problems such as homelessness and incarceration.”
A Multifaceted Approach to Mental Health Treatment
Psychologist Shamin Ladhani, PsyD, says, “The NYC psychiatric bill is funding 600 beds and staff to support it for inpatient psychiatric care. These beds will be allocated to existing hospitals to address the growing mental health crisis that has only been made worse by the COVID-19 pandemic and past leadership errors in defunding mental health care." Ladhani explains, “The decrease in funding and under prioritization of mental health care is directly related to the spike of mental illness in prisons as the mentally ill are unable to access care. Since this legislation will increase that access, it may lead to a reduction in crime and incarceration, according to Ladhani. “The shutting down of mental health institutions and repurposing of beds has created an increase in the homeless population that grew under de Blasio’s term,” she says. The Subway Safety Plan takes a multifaceted approach, according to Ladhani. “It’s an approach that looks to address the mental health needs of homeless populations that often occupy the subway,” she says. Ladhani highlights, “It hopes to increase behavioral response teams, work to find housing for those that need it, connect them to services in the community, and train officers to enforce transit rules in a fair way.” By expanding medical services to offer behavioral health support to this population, Ladhani notes that New Yorkers may live healthier lives. “This approach builds on the New York psychiatric bill and supports the expansion of inpatient beds by providing the important infrastructure to support an individual once they come out of the hospital,” she says. Ladhani explains, “Improving mental health cannot be addressed by adding 600 beds alone; there needs to be a warm handoff to collaborative treatment and support in housing. This plan helps to support that.” Mental health services are often the first to go, as Ladhani notes that cities are seeing the carnage of those decisions. “These plans together offer a multifaceted approach to address mental health needs,” she says. While the addition of 600 beds is important, Ladhani explains how the additional aspects of the Subway Safety Plan takes it several steps further to address these issues at the community level by investing in services that work to connect those people with much-needed treatment. Ladhani highlights, “Mental health is best addressed by building an infrastructure that supports its mentally ill by helping it to heal in body and in mind and to provide the support to maintain those gains.” By understanding that crime is not remotely solved by incarceration, Ladhani notes mounting evidence supports community-based approaches and not only leaving treatment to the clinician alone. Ladhani explains, “Approaches that build on peer support and individuals that have experienced mental health themselves can help with recovery and relapse prevention - developing these types of communities that can be relied on for support and connection rather than just relying on a clinician’s interventions to create a cohesive approach.” With holistic approaches that understand that an individual is a product of how they interact with their environment, Ladhani says, “It would have us not only thinking about mental health but about civil rights, vocational training, building resources and connection in those communities and involving those individuals in the process.”
