Hospitals blame psych bed reopening delay on suicide precautions, staff shortages

NEW YORK — Hundreds of hospital beds for psychiatric patients will remain offline past Gov. Kathy Hochul’s April 1 deadline due to staffing shortages, inadequate funding and even suicide risks, according to records obtained by POLITICO.

Details of hospitals’ reopening plans, obtained through a public records request, have not been previously reported.

In several cases, hospitals told the state they need more time to reconfigure areas that were converted into medical and surgical units during the pandemic and would therefore present a “ligature risk” to psychiatric patients — meaning there are portions of the facility that a patient could use to hang or strangle themselves.

That was one reason cited by Northwell Health for the continuing closure of Syosset Hospital’s 20-bed inpatient psych unit, according to a reopening plan submitted in February. The unit was repurposed for Covid patients in 2020, which required the rapid installation of electrical and gas lines that remain exposed in the rooms.

“We cannot simply re-open the unit as a psychiatry unit as reconfiguring the rooms requires very significant time and expense,” Manish Sapra, executive director of Northwell’s behavioral health service line, wrote in the plan.

Sapra said the hospital permanently reassigned the psych unit’s staff at that time and would need about nine months to a year to hire at least 60 people to staff it. The rest of Northwell’s 533 licensed psychiatric beds are online, according to the plan.

NYC Health + Hospitals described a similar issue with a 24-bed unit at Elmhurst Hospital in Queens, which is being used as a medical unit and needs to be reconfigured before it can house psychiatric patients again.

The system’s plan, which is dated Jan. 18, says it expects to restore 179 of its 253 offline beds by the end of the year. The rest will not be back online until December 2024.

Health + Hospitals spokesperson Chris Miller said the April 1 deadline does not apply to health systems like the city's that were already working with the state on a reopening plan.

“NYC Health + Hospitals is working closely with the state’s Office of Mental Health to reopen 200 psychiatric beds by this December, and we are on track to meet that goal,” Miller said in a statement. “Similar to other health systems, staffing remains the biggest challenge, and we have taken a number of steps to address this -- from recruitment campaigns to school loan repayment for staff to new professional development programs.”

Other hospitals blamed staffing shortages for remaining offline beds. New York-Presbyterian reported in its January reopening plan that Weill Cornell Medical Center’s 32-bed unit could only “safely staff and accommodate” 20 patients, and another 33 beds were offline at its 233-bed Westchester Behavioral Health Center due to “provider and staff coverage constraints.”

Catholic Health’s Mercy Hospital, which is in Nassau County, said in its plan that it can only operate 29 of its 39 licensed beds due to size constraints and staffing levels and “does not have the ability to open these beds by the April 1st deadline.”

Key context: As part of her $1 billion mental health plan unveiled in January, Hochul directed hospitals across the state to restore 850 inpatient psychiatric beds that they repurposed or closed during the Covid-19 pandemic.

Hochul released her plan as Democratic lawmakers across the country face increasing pressure to address escalating and often intersecting crises of homelessness and serious mental health concerns in their states and cities.

Of the 850 beds Hochul told hospitals to reopen, approximately 200 have already been brought back online. Another 300 will become operational by the end of this year, according to the governor’s office.

“Since Governor Hochul took action to restore psychiatric hospital beds taken offline during COVID, hospitals have developed plans to bring nearly 60% of the missing psychiatric beds online,” Avi Small, a spokesperson for Hochul, said in a statement.

Small said the state Office of Mental Health is in active conversations with hospitals about how best to achieve compliance.

State officials have also called on hospitals to restore beds they took offline prior to the pandemic, citing a “need for acute psychiatric inpatient capacity across the State,” according to a January memo first reported by POLITICO.

“Restoring these beds to active status is a crucial component of the State’s plan to increase the availability of acute inpatient mental health services,” the memo said.

Under Hochul’s budget proposal, hospitals may be fined up to $2,000 per day for each psychiatric bed that remains offline after April 1, but it is unclear whether the policy will make it into the final budget. The Assembly has proposed eliminating it, and the Senate wants to require the state to first consider mitigating factors.

More constraints: Long wait times for a spot in other facilities or programs have also squeezed psychiatric capacity at hospitals.

According to New York-Presbyterian’s reopening plan, its Westchester Behavioral Health Center has an average of 22 patients per day awaiting beds in state-run psychiatric institutions, which are intended for longer stays and typically take referrals from hospital psychiatric units.

The Westchester facility also reported an average of eight patients per day awaiting placement in a residential treatment center and “routine delays” finding supportive housing units for patients who had arrived unhoused.

Hochul has pledged to add 150 new beds to state facilities and create 3,500 new units of housing for New Yorkers with mental illnesses in the upcoming state budget. And Mayor Eric Adams has said he would build 8,000 supportive housing units.

What’s next: Despite Hochul’s directive, some health systems are forging ahead with plans to decrease their numbers of psychiatric beds.

Mount Sinai Beth Israel has a state license for 92 psychiatric beds but was only operating 64 of those before the pandemic. The hospital is relocating those 64 beds to the bygone nursing home Rivington House, which it is converting into a behavioral health center.

The system will also decertify 21 psychiatric beds at the Mount Sinai Hospital on the Upper East Side, citing space needs for an expanded cancer hospital and “significant congestion” in the emergency room, according to its reopening plan submitted in January.

But because Mount Sinai Morningside is reopening a 29-bed psychiatric unit, which had been offline for over a year before the pandemic due to planned renovations, the system claimed a net increase of eight operational psych beds — despite the decrease in licensed beds.

The system claimed in its reopening plan that it has seen a “decline in the need for inpatient psychiatric hospitalizations for our patients” and would work to expand its psychiatric emergency departments and outpatient programs.

A Mount Sinai spokesperson declined to comment.

New York-Presbyterian Brooklyn Methodist Hospital has 49 psych beds across two units that were used for critical care during the pandemic. The hospital restored 24 of those last summer, but the remaining 25 beds “require further assessment and planning,” the system said in its reopening plan, noting its intent to open a behavioral health and primary care center nearby.

“It is anticipated that this new facility will address the behavioral health needs of the service area,” system executives wrote. “The establishment of this new outpatient program will shape future considerations for inpatient psychiatric care.”

Angela Smith Karafazli, a New York-Presbyterian spokesperson, said in a statement that the system “remains in active discussions with regulatory agencies about our proposed plan.”

“At this point we don't have additional info to share,” she added.