As admissions rise for mentally ill patients in New York City, officials wonder if hospitals have become the default provider of mental health services.
The metropolitan area’s overall number of hospitalizations have declined in line with broader national trends toward increased access to outpatient care, according to the Independent Budget Office of New York City (IBO). Mental health hospitalizations have been a notable exception, however, with admissions up markedly in the period between 2009 and 2014.
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Public hospitals in the city have seen their number of mental health hospitalizations rise 20% in the six-year period. They currently reserve nearly 30% of their roughly 4,730 overall beds for psychiatric patients. But voluntary hospitals saw a 5% decrease in admissions in the same period, and while they devote roughly the same number of beds to psychiatric patients as public hospitals, that number represents a much smaller 8% of their approximately 19,090 total beds.
Fully a quarter of the city’s mentally ill patients occupy beds in three public hospitals: Bellevue, Kings County and Elmhurst, according to the IBO.
IBO spokesman Doug Turetsky told the New York Post the enactment of the Affordable Care Act likely accounted for at least some portion of the rise in mental health admissions.
“Until ACA, a lot of health plans balked at providing coverage and with the expansion of Medicaid more people became eligible for coverage that included behavioral health,” he said. The IBO report suggests that the combination of increased coverage and the historical provision of mental health services at public hospitals have made them essentially default providers for the population.
In order to cope with the influx, NYC Health + Hospitals, the city’s public health system, is working on a plan to serve mental health patients on an outpatient basis, integrating behavioral health services with their primary care, pediatrics and maternal health practices, according to the IBO report.