Good afternoon Chairperson Rivera, Chairperson Ayala, and members of the Committee on Hospital Systems, and the Committee on Mental Health, Disabilities, and Addiction. I am Dr. Charles Barron, Deputy Chief Medical Officer for NYC Health + Hospitals (“Health + Hospitals”). Thank you for the opportunity to testify before you on the future of psychiatric care in New York City’s hospital infrastructure.
Health + Hospitals is the main provider of behavioral health and inpatient psychiatric care services in New York City, with nearly 1,500 licensed psychiatric beds – representing 48% of all psychiatric inpatient beds in the metropolitan area. As such, we provide a significant portion of behavioral health inpatient services in New York City, which underscores the need for continued stability in the public hospital system. Over the last several years, health care delivery in New York State has been undergoing a transformation – a shift from providing care in the inpatient setting to community-based care. In April 2014, the federal Centers for Medicare and Medicaid Services (CMS) approved New York State’s Medicaid waiver request in the amount of $8 billion over five years. The goal of the Delivery System Reform Incentive Payment (DSRIP) program was to achieve a 25% reduction in avoidable hospitalizations for Medicaid patients, including psychiatric hospitalizations, and restructure the health care delivery system. To that end, from 2014 – 2017 Health + Hospitals has seen a decrease in our “all-cause,” and psychiatric readmission rates by 24% and 27%, respectively.
In keeping with the hospital industry’s shift from inpatient to ambulatory care, at Health + Hospitals we are in the process of deploying a system-wide, and multi-phase expansion of integrated ambulatory behavioral health care, which we expect to complete by the end of 2020. NYC Health + Hospitals/Metropolitan will serve as a demonstration site and center of innovation, bringing together the most innovative care models and community driven strategies. Additional, and complementary initiatives will also include: 1) collaboration with community based providers focusing on depression, substance misuse, and unstable psychosis in neighborhoods especially impacted by behavioral health issues; 2) strategies to improve safety for our patients; 3) intensive outpatient programs, which allow increased frequency and customized treatment to meet each patient’s needs; and 4) use of tele-psychiatry to assist with workforce shortages, and provide increased access for patients.
Our acute care behavioral health services include seven adult, and one child & adolescent comprehensive psychiatric emergency programs (CPEPs), which include psychiatric emergency rooms, extended observation beds, mobile crisis intervention services, and access to crisis beds. Last year, there were more than 63,000 adult and 8,000 child/adolescent visits to Health + Hospitals psychiatric emergency rooms.
Our inpatient services provide individualized, therapeutic care to stabilize mental illness episodes and promote rehabilitation, recovery, a return to the community, and less restrictive modalities of care. As previously acknowledged, while inpatient care will always be needed, especially for those with serious and persistent mental illness, acute psychosis, or risk for suicide, we agree with the imperative to keep patients out of the hospital if they don’t need to be there.
Health + Hospitals provides a comprehensive array of ambulatory behavioral health care programs, including mobile crisis teams, outpatient clinics, day treatment, partial hospitalization programs, and case management mental health programs. For those patients who require significant levels of support, our facilities operate Assertive Community Treatment (ACT) Teams. The ACT Team program functions as a “clinic without walls” treating individuals in their homes and community. Of the 38 ACT Teams in New York City, Health + Hospitals operates 12 teams. Children and adolescents receive services through developmental evaluation clinics, family support programs, adolescent treatment programs, school-based programs, and outpatient clinics.
Harmful substance use is a significant population health problem in NYC, and among Health + Hospitals’ patients. There are approximately 90,000 unique patients with substance use disorder (SUD) at Health + Hospital every year. Approximately 20% of primary care patients are at moderate risk of harmful substance use or SUD. Of the patients with SUD, close to 15% have a primary diagnosis of opioid use disorder; and 45% have a primary diagnosis of alcohol use disorder.
Health + Hospitals facilities provide an extensive array of SUD services. Inpatient detoxification is provided in seven facilities, and we have 13 outpatient counseling programs, four methadone treatment programs, two halfway houses, and a number of specialized services for families, adolescents, and women.
In 2017, the Mayor and First Lady announced Healing NYC, a comprehensive effort to reduce opioid overdose deaths by 35% over the next five years. Health + Hospitals is a key partner in this initiative, reinforcing our commitment to transform into a system of excellence for opioid services. We are grateful to the City for providing nearly $5 million in funding to date, which has allowed us to implement several initiatives, including:
In 2015, the Mayor and the First Lady announced Thrive NYC – a plan of action to guide New York City to effectively and holistically support the mental health of its residents. With over $3 million in funding to date, Health + Hospitals has implemented a number of programs.
Health + Hospitals as the main provider of care to individuals with mental illness and substance use disorder in New York City, faces many challenges in providing high quality, patient-centered care. These challenges, which are not unique to us, include:
Health + Hospitals cannot resolve these challenges alone and will continue partnering with government and key stakeholders to forge solutions. I would be happy to answer any questions that you may have.