12/28/12

Did Sandy Break City's Psychiatric Emergency Response System?

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The New York Times reports that Hurricane Sandy has crippled the city's ability to respond to mental health crises by knocking out some of the city's biggest psychiatric hospitals, disrupting outpatient services, and flooding out scores of coastal nursing homes and adult facilities that housed the mentally ill.

When Bellevue Hospital Center, the city's flagship public hospital, NYU Langone Medical Center, and the Veteran's Affairs Hospital were all evacuated due to storm-related damage, Manhattan's Beth Israel saw a nearly 70% spike in psychiatric admissions, and was so overtaxed it had to turn ambulances away.

When backup power failed at Coney Island Hospital, one of the city's biggest acute care psychiatric hospitals, psychiatric emergencies were diverted to Brooklyn's Maimonides Medical Center, where psychiatric emergency room visits rose by 56% and admissions by 24%.

At Staten Island's Richmond University Medical Center, psychiatric resources are at the limit.

Missionaries at the Church of Assumption-St. Paul in New Brighton reported that disoriented mentally ill people, evacuated from Far Rockaway to a facility in New Brighton, have been coming to the church rectory to beg for socks and underwear.

Bellevue and Coney Island Hospital are not expected to re-open until February.

Inmates from the forensic unit at Bellevue were transported to Kirby Forensic Psychiatric Center on Ward's Island, with more than 300 patients from Staten Island's South Beach state mental hospital being moved to Creedmoor in Queens and the Bronx Psychiatric Hospital.

Bellevue psychiatric patients went to private or city hospitals, including Metropolitan in East Harlem and Kings County in Brooklyn, where federal court monitors are in place.

Many of the city's most vulnerable mentally ill residents have been disconnected from shelter and services. Evacuees were sent first to storm shelters, where many lost access to their medications and their medical records.

Advocates are working to reconnect patients who lost contact with their families and caseworkers. One elderly woman, arrested for public urination, was found by her caseworker locked down at Gracie Square Hospital on Manhattan's Upper East Side with a broken leg, lying in her own feces.

Psychiatric hospitalization is a revolving door, with involuntarily committed patients being moved out every 30 days to make room for the next emergency.  The storm has shrunk the already short supply of discharge options.

The state's mental health system still relies too much on private nursing homes and substandard adult homes -- historically neglect and exploitation hotspots -- to house the mentally ill.   It has been censured by judges again and again for overusing this type of facility.

Although the state has plans to build more supportive housing for mentally ill people, they will address only a fraction of the need. 

The article from the New York Times.

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