The Need to Save Allen Hospital’s Psychiatric Care for NY’s Vulnerable
In the United States we have come to the point where we jail people as the first line of treatment for mental illness. This means not treating people in a health crisis, but instead putting them somewhere out of the way long enough to CYA then move on.
Yet our politicians, wanting to appear to be solving the complicated and money-soaked problem of gun violence, use people who suffer with mental illness as scapegoats for a problem statistics show they are most likely in danger of being a victim of as opposed to being the ones we need to fear.
What kind of society takes people who are ill and makes them the boogey man when the truth is people who are sick need protecting more than anyone.
I have made a pledge to be transparent in my work, so I will follow through and say I have been inpatient in a hospital psychiatric ward for my diagnosed PTSD which can lead to fun episodes of Major Depressive Disorder which at the start feels like, using a non-scientific term, a nervous breakdown. It has happened twice, and without emergency care I might not be writing today.
Perhaps if more people knew this particular vulnerability of the mind, as a society we would insist on taking care of people who are sick instead of shuffling them around or worse.
Maybe most infuriating, politicians like Governor Cuomo spend their efforts cooking the books to impress the voters upstate by claiming solutions to gun violence so those voters can imagine their children are safer as they put them on the bus in the morning.
The SAFE Act has made our communities more secure, including by banning assault weapons like AR-15s and preventing people who are a risk to themselves or to others from purchasing a gun. As of December 2017, 75,000 people deemed to be dangerously mentally ill by a licensed mental health professional have been added to a database to keep guns out of the wrong hands.
That probably sounds amazing to a mom upstate or New York City for that matter. I mean, that’s a lot of potential school shooters on the governor’s list. Seventy-five thousand. Deemed “dangerously mentally ill” by licensed mental health professionals — and it’s all in a database.
Back in 2014 the New York Times reported, “A newly created database of New Yorkers deemed too mentally unstable to carry firearms has grown to roughly 34,500 names, a previously undisclosed figure that has raised concerns among some mental health advocates that too many people have been categorized as dangerous,” and now that number has more than doubled.
I have a lot of questions about this database, but that’s for another day.
Today there is an urgent and related issue that needs attention. The governor of New York says there are Seventy. Five. Thousand. dangerously mentally ill people out there. If that is the case, shouldn’t the citizens of New York also feel safer knowing those people are getting treatment — especially if they are experiencing a mental health crisis?
Based on statistics the answer appears to be the state of New York touts big numbers in a database while allowing critical treatment to be lost to profit concerns. Right now, New York-Presbyterian is considering closing the Allen Hospital Psychiatric Unit in upper Manhattan.
According to the Treatment Advocacy Center:
This plan continues a worrisome trend across New York, as other hospitals have already eliminated vital psychiatric beds, including Mount Sinai, Staten Island University Hospital, and H+H Woodhull Medical and Mental Health Center.
All of this could be seen to be in direct conflict with the federal parity law, the Affordable Care Act, and New York State’s parity law, known as Timothy’s Law.
These laws, “were designed to improve access to quality mental health treatment when needed,” however, “Despite these two laws, access to quality mental health services remains challenging for several reasons, including inadequate provider networks, and unfair use of managed care mechanisms to control costs, such as prior authorization and utilization review,” according to the NAMI-NYC Metro organization.
From one of the activists fighting to save the beds at Allen Hospital, Miriam Callahan, a 31 first-year medical student at Columbia’s Vagelos College of Physicians and Surgeons:
The Allen Pavilion is the community hospital for Inwood and Washington Heights, and about 50% of the patients in the psychiatric unit come from upper Manhattan. The Allen psych unit specializes in caring for people with dual diagnoses — that is, substance use problems as well as severe mental illness.
These are the details the politicians and the profiteers leave out when they are discussing help for mentally ill people.
Data from the state health department found that the number of monthly adult psychiatric inpatient admissions in New York remained relatively stable at around 6,500 between 2014 and 2016, however the number of state-licensed inpatient beds has steadily dropped by 109 during that time period.
The need is not dropping, but the ability to help seems to be.
In New York, “The great shrinkage started with state-run psychiatric facilities, whose population statewide plummeted more than 90% between 1982 to today, when fewer than 2,400 adults are served, many of them committed after perpetrating crimes,” according to an editorial in the Daily News.
In a letter addressed to politicians, typical of those released to give politicians cover, New York Presbyterian said, “NYP’s commitment to behavioral health is unwavering,” and the hospital also said their goal is to provide better access to appropriate intensive psychiatric care.
But when you look at the actual suggestions— there are no plans for inpatient care. According to the letter the new “comprehensive outpatient program” will include:
Expansion of NYP’s Community Crisis Stabilization program, which provides intensive, individualized, community-based services to patients who often use the emergency department;
Continuation and expansion of mental health services provided at our seven school-based health centers and ten school-based behavioral health sites;
Development of an adult psychiatric intensive outpatient program;
Enhancement of our Pediatric Emergency Department behavioral health programming;
Development of a youth behavioral health crisis hub;
Programming through the NYP Eating Disorders Center; and
Expansion of ambulatory services for children and adolescents.
All of this, is outpatient care.
Predictably, State Senator Marisol Alcantara told Crain’s New York:
The letter showed that New York-Presbyterian got the message that northern Manhattan and the Bronx need more mental health services, not less,” and, “While I still do not agree with the closure of the 30 psychiatric beds at the Allen Hospital due to the significant need of inpatient psychiatric care in Uptown Manhattan, I do believe New York-Presbyterian is taking a step in the right direction by increasing access to mental health services in the area.
That’s an obvious hedge — after Alcantara herself raised concerns about the loss of beds in connection with the high rate of suicide in young Latina girls.
Back in January, at a meeting of the Community Board 12 Health and Environment Committee, which represents the neighborhoods of Washington Heights and Inwood, chair Steve Simon pointed out that when the Allen Hospital, at the time Allen Pavilion, was opened around 30 years ago it provided 300 beds. Simon then asked what happened to the 104 beds no longer available. That question can only be answered in dollars.
Alcantara or Cuomo do not talk about the profit motives of the hospital, but according to Callahan:
NewYork-Presbyterian plans to expand their recently opened — and very lucrative — Spine Center once the psychiatric unit closes,” and the “Spine Center is a specialty surgery and rehab center with a national profile, fully contained within the campus of the Allen — a community hospital meant to serve the surrounding neighborhood. People travel from all over the country, even as far as Kuwait and Saudi Arabia, to get treatment at the Spine Center.
Of course these are likely wealthy patients who are privately insured — unlike many of those who are desperate for inpatient mental health care.
And of course according to the governor, there are seventy-five thousand people out there made so dangerous by their illness they must be kept on a database and not allowed to purchase firearms.
The loss of even one bed means a higher chance of someone who needs help ending up in jail or prison - which is astonishingly the largest provider of inpatient psychiatric service in New York State. In jail or prison the likelihood of someone already dealing with mental health issues being traumatized is increased and when they are released they are given no help to transition.
As with most of our systems and institutions, this is all done with short-term profit and power as priority — for those who already have both. But also as with the other systems and institutions, that formula is not sustainable and as it continues to crumble it will fall on our most vulnerable first — but eventually if nothing changes it will reach everyone’s doorstep.
If you are interested in getting involved, here are the things recommended by the activists working to intervene.
- Attend the rally:
- Through the NYC Socialist Feminist Working Group and Bronx/Upper Manhattan branch of DSA, we are sending postcards to Dr. Ann Marie Sullivan, commissioner for the New York State Office of Mental Health urging her to affirm the need to keep these beds open. Anyone who’d like to sign a postcard should email email@example.com!
- - Sign the change.org petition here: https://www.change.org/p/allen-hospital-administration-protect-the-allen-hospital-s-community-mission