New York State’s recently passed 2024-2025 budget includes many changes for the disability community. In today’s episode, we share part of a conversation with Western New York Independent Living’s Chief Policy Officer Todd Vaarwerk and Chief Operations Officer Stephanie Orlando about state funding for inpatient psychiatric beds. According to the Budget Office, the budget includes $55 million to add 200 new inpatient psychiatric beds to state psychiatric hospitals.
This week on Disabilities Beat, we feature snippets from our recently aired hour-long special on the New York State Budget. Click here to listen to the full episode.
Plain Language: The New York state budget is focused on increasing psychiatric beds, but as Stephanie explains, many in the disability community would rather see an emphasis on community supports. Stephanie argues that the budget is focused on increasing hospital beds rather than investing in comprehensive mental health programs that help people when they first begin to show symptoms of mental illness, not when they are in crisis.
Stephanie also says there is a lack of transparency about outcomes at psychiatric hospitals.
Todd will discuss New York State’s Safe Discharge Act and the challenges facing disabled people in nursing homes, and how it also applies to mental health care.
Transcript:
Emile Watkins: Hello, I’m Emile Watkins, and this is WBFO Disability.
This month, we bring you highlights from the recently passed New York State Budget for 2024-2025. In today’s episode, we share part of a conversation with Western New York Independent Living’s Chief Policy Officer Todd Vaarwerk and Chief Operations Officer Stephanie Orlando about funding for inpatient psychiatric beds in the state. This interview has been edited for length and clarity, but the entire discussion, including more perspectives and additional aspects of the budget, is available on our website at wbfo dot org.
Emile Watkins: Our state has come a long way in terms of institutionalization and people living in hospitals and institutions. But now the state is adding psychiatric beds again. I think this year’s budget includes funding for 200 psychiatric beds. Stephanie, is this in line with what people with mental illness want in terms of money going to services?
Stephanie Orlando: No. We want the funds to go to community-based services. Now, if you look at where we were 10 years ago, it’s hard to believe 10 years ago, but we were talking about regional centers of excellence. New York had more hospital beds than any other state at one time. If you look at a state with a large population like California, we were way ahead of them in terms of hospital beds. And the culture is really swinging, and I think a lot of it comes from fear and Southern culture. This budget includes 75 home transition units. So when the governor and the mayor of New York announced that they were going to set up these new home transition units, they said this was specifically for patients who are severely mentally ill, poorly communicative, and homeless. And they said it was for “street and subway patients.” So that street and subway patients could get services.
Stephanie Orlando: So you’re talking about a solution that’s going to be to round up homeless people and put them in psychiatric hospitals. This is not a solution to homelessness, this is not a solution to mental health. This is a solution to how do we house people and get them off the streets, and it’s a huge setback. And related to this, 7 million homeless people are going to be put in psychiatric hospitals. [dollars] To advocate for new guidelines on admissions and discharges. The concern from the advocacy world is that we’re going to create more hospital beds and make it harder for us to get out of the hospital. So we’re going to institutionalize people again, instead of investing in comprehensive mental health programs that can address what we really need right now. This is a band-aid approach to a problem that is specifically caused by homelessness. Again, the rising cost of living and the agitated state of people post-COVID, and some of these incidents that are happening on the New York City subway.
Stephanie Orlando: This is reactionary. This is not based on where the problem lies in the system, we need to increase access to services. Right now, when people realize they might need mental health support, they make an appointment and try to get services. [an] It takes a very long time. And our CPEP, our psychiatric emergency room, is really overloaded. People get sent there because there’s nothing else available and they’re not necessarily at the level they need at the time. But it’s the easiest place to get to. That’s where you go. It’s always open and they’re always accepting.
Stephanie Orlando: So this money would have been much better invested in community services, not in the huge number of hospital beds that we already have. And the other thing I want to say about this is the lack of transparency about the performance of these hospitals. In preparation for this interview, I was looking for the Balanced Scorecard on the Department of Mental Health website. I looked for it for a long time, and suddenly it was nowhere to be found. Now, there is no report on the Department of Mental Health website that shows the current state of state psychiatric hospitals. They used to be very transparent. They scored themselves, and I was part of an advocacy group at one point…
Todd Verwerk: And you got a comment on that score, right?
Stephanie Orlando: Yes. And we told the hospitals what they needed to improve and we made that public. Meanwhile, as an advocate, I’m trying to get things like restraints and seclusion to be included in the scorecard. How often were people restrained in the hospital? Was the frequency of restraint too high? From what I’ve found, all of those things are gone. So not only are they investing in something, they don’t even have clear transparency about how effective that service is. Most studies say it’s not as effective as community-based services, it’s not as effective as really helping people at home with a support system.
Emile Watkins: The state seems to be pushing to place people with mental illness, in crisis or committing crimes in long-term care facilities, but advocates want an earlier, more community-based approach.
Todd Vaarwerk: Community support done right the first time is always cheaper and safer than last-minute or just-in-time institutionalized options.
Stephanie Orlando: Yeah. And then there are people who have committed crimes or are in situations where they’re perceived to be potential criminals. We call them quality of life crimes. That sounds awful, and it’s exactly what it is, they’re impacting the quality of life of other people. Like, if they’re yelling on a street corner, that’s a nuisance, and I don’t want to see that. And sometimes the response as a community is, “Well, we need to house them somewhere, they need to go somewhere safe.”
Well, that’s not always true. It’s not always true that a hospital provides a safer, better quality of life, better outcomes. There are other services that can actually do that. And some people who are arrested and put in institutions say, “I’d rather be in jail because I have a sentence. I know when I’m going to get out.” So they end up being admitted, and depending on the new admission and discharge requirements, they’re going to be locked up there indefinitely. That’s what we’ve seen in the past history of New York state.
Todd Verwerk: Remember, New York State has a law called the Safe Discharge Act. No medical facility can discharge you unless they know where you’re going and if they can safely and effectively execute the plan of care that your doctor has prescribed. And we know that when it comes to disabled people going into nursing homes, it’s really hard to define what’s safe. And it seems like untrained social workers think they can block me from leaving a nursing home by saying the only way they’ll agree to discharge you is if you get 24-hour care when you get home and have someone with you at all hours of the day.
Todd Verwerk: Well, the state won’t pay for it unless there’s a medical justification. The facilities don’t care about medical justification. They care about legal liability for what happens to you after you leave. The same thing is happening on the mental health side. So this is one of those cases where we’re reactively building beds to address a temporary problem of people worrying about street corners or the subway, instead of thinking about a long-term solution of where they can go.
Emile Watkins: Disabilities Beat is available to watch on demand, and transcripts and easy-to-follow explanations of each episode are available on the WBFO website at WBFO dot org. I’m Emile Watkins. Thanks for listening.