In preparation for a surge of coronavirus patients in late March and early April, many New York hospitals repurposed their beds, reassigned personnel from different units, and put most of their other medical services on pause.
Meeting the demands of the pandemic was an all-hands-on-deck effort, so Irving Campbell, a nurse who usually treats psychiatric patients at Brooklyn Methodist Hospital in Park Slope, said he understood when the hospital opted to temporarily convert its two 25-bed psychiatric units into intensive care units.
But with coronavirus cases down this summer and hospitals starting to reactivate other services, Campbell and his colleagues are still helping out on other units, rather than treating their usual patients. Brooklyn Methodist, part of the NewYork-Presbyterian hospital system, is currently sending patients in need of inpatient psychiatric care to other facilities in the network--either Gracie Square Hospital on the Upper East Side or Westchester Behavioral Health Center in White Plains, Campbell said. This makes it harder for family members to visit, he said, and the transfer isn’t necessarily speedy.
“We have had patients in our emergency rooms who have come in with intentional overdoses stay 40 hours before being transferred,” Campbell said. “We’ve had patients who have suicidal ideations [stay] for over 30 hours.”
Several New York hospitals that repurposed their psychiatric units in the spring are keeping them closed to accommodate Governor Andrew Cuomo’s mandate that hospitals maintain 30% surge capacity in case of another uptick in coronavirus cases. These include the psychiatric units at Brooklyn Methodist and Allen Hospital in Inwood that's also part of the NewYork-Presbyterian system, as well as Northwell Health’s Syosset Hospital on Long Island.
While the state Office of Mental Health told Gothamist/WNYC there’s still sufficient capacity to treat psychiatric patients who need to be hospitalized, mental health advocates and psychiatric nurses are ringing alarm bells, in part, because there is no set timeline for bringing the units back. Although OMH and hospitals insist the closures are temporary, critics are worried hospitals will take advantage of the pandemic to permanently eliminate psychiatric units, which have already been on the chopping block in recent years.
“Accessing psychiatric beds was already a challenge for so many people before COVID,” said Matthew Shapiro, associate director of public affairs at the New York State chapter of the National Alliance on Mental Illness. “Part of the reason is that these beds have always been targeted by private hospitals for elimination because they’re the least profitable types of beds.”
As private hospitals in New York have shed psychiatric beds, health care leaders have often said they are strategically investing in outpatient behavioral health care instead. But even if someone is able to get effective care in the community, it’s crucial to have hospital beds available when people need them, Shapiro said.
“There are certain people who need more all-encompassing services, especially during times of crisis when someone might be having a psychotic break or be suicidal,” said Shapiro. “These are really life-or-death issues where you need that intensive care you can only really get from a hospital.”
One of the units that was repurposed during the pandemic is the psychiatric wing of Allen Hospital. The health system submitted a proposal to the state in late 2017 to close the 30-bed unit permanently and replace it with an expansion of its maternity ward and additional operating rooms for its shiny, new spine center--a project that would cost $70 million. But the closure was postponed amid strong opposition from advocates, health care workers, and members of the largely low-income communities the psychiatric unit served in northern Manhattan and the Bronx.
Now, Shapiro and others suspect that the hospital might use the pandemic as cover to move forward with its plan.
To allow hospitals to rapidly adapt to the demands of the pandemic, Cuomo issued an executive order in mid-March temporarily suspending the prior-approval process hospitals typically undergo to make changes to inpatient capacity, repurpose hospital beds, or move forward with construction projects.
But hospitals will still have to get state approval to make any changes permanent. NewYork-Presbyterian has an application pending with the state Department of Health to close Allen Hospital’s psych unit. For NYP to move forward, it would also have to submit a request for prior approval to the state Office of Mental Health, which a spokesperson for the agency said it has not done. “We expect that the beds will eventually be reconverted to psychiatric beds,” the OMH spokesman added.
In late June, Campbell said hospital delegates from his union, the New York State Nurses Association, told him one of the psychiatric units at Brooklyn Methodist would remain closed for up to a year-and-a-half to undergo renovations. He said no timeline was provided for the other unit to reopen and he and other staff have been told to start thinking about what other units in the hospital they want to work in.
NewYork-Presbyterian declined to provide a timeline for when inpatient psychiatric services would return to Brooklyn Methodist and Allen Hospital.
“Over the last few months, the COVID-19 pandemic has shown we must continuously evaluate our services and how best to meet our patients’ and communities’ needs, including preparing for the possibility of a second surge of COVID-19,” NewYork-Presbyterian said in a statement. NYP added that it has more than 500 psychiatric beds systemwide and “extensive outpatient and tele-psych services.”
At Northwell Health’s Syosset Hospital, psychiatric nurse Larry Wills said he and his colleagues face similar uncertainty. At the start of New York’s coronavirus outbreak, the hospital’s 20-bed psychiatric unit was equipped with oxygen lines and reconfigured to serve coronavirus patients. Now, he said, the unit sits dormant while he and other psychiatric staff screen patients coming in for surgeries for coronavirus in tents set up outside the hospital.
“You’re bringing all these patients in and we’re testing them before they come in,” said Wills. “Why can’t we test psychiatric patients and have them come in, too?”
Northwell said in a statement that the psychiatric unit at Syosset is only closed temporarily “so these additional medical/surgical beds remain available to be placed into service in the event of a second spike in COVID activity.” Patients who would have been seen at Syosset are being redirected to other hospitals in the network, Northwell said.
But even a temporary closure can deter patients from getting care, especially if they have been going to the same facility for years, according to Wills and Campbell, who both say they’re worried about their regular patients during the pandemic.
“If they have a crisis, they don’t want to go somewhere where the treatment team has to completely relearn all their issues and their life story and how things got that way,” Wills said.
Wills said he’s also concerned a temporary closure will turn into a permanent one at Syosset Hospital because of Northwell’s track record. The health system has closed multiple psychiactric units in its hospitals on Long Island in recent years, saying it aims to centralize behavioral health care in two “centers of excellence” at South Oaks Hospital in Amityville and Zucker Hillside Hospital in Glen Oaks.
A couple of years ago, Wills said there was also a push to close the psychiatric unit at Syosset. “Every month or so, the chief nursing officer...would meet with us and ask how we’re doing and have we found other jobs and encourage us to go find other jobs,” he said.
Ultimately, the unit remained open, but Wills said he has always been made aware by higher-ups at the hospital that the unit is not a priority because “the money is in surgery.”
This story is part of PriceCheckNYC, a collaborative project from Gothamist, WNYC and ClearHealthCosts promoting transparency in health care. Have you or a family member struggled to access behavioral health care during the pandemic? Let us know! You can email us at healthcosts@gothamist.com. You can also submit recent medical bills to our searchable health cost database below.
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