Walk down the streets of Manhattan or ride the subway late at night, and you see a painful truth: New Yorkers, many of whom are struggling with serious mental illness, caught in a cycle of neglect. Right now, our system fails them. It fails their families. And it fails our city.
The heartbreaking reality is that for too many New Yorkers, the cycle looks like this: the street, the subway, the emergency room—and then back to the street. Too often, we are relying on emergency rooms and city jails to serve as our mental health system. We see the same individuals enter crisis again and again because we do not have the inpatient care capacity or enough beds to break this cycle.
This revolving door of neglect is not only a public health failure, but a profound moral one. We are leaving our most vulnerable New Yorkers to languish, rather than provide them with dignity and care.
Let’s talk numbers. Over the last few decades, we lost over 400 inpatient psychiatric care beds. While some have reopened, most were lost in private hospitals, meaning the public hospital system is covering most psychiatric care needed today. But even our public hospitals have a severe shortage of beds.
The Manhattan Psychiatric Center on Randalls Island is Manhattan’s only state psychiatric care facility. And while there used to be 4,000 beds at the facility, today there are only 450. At Bellevue, if you need extended inpatient psychiatric care, you’d be lucky to get one of just 19 beds available. Yes, just 19 beds.
And when an inpatient bed isn’t available, healthcare providers too often have no choice but to stabilize patients enough for release, oftentimes back to the street, without a plan for ongoing care.
The cycle continues.
Inpatient hospital beds matter. Rather than risking patients in crisis being discharged back into the streets, inpatient care offers space for patients with sudden or severe symptoms to receive structured care tailored to their needs through medication adjustments, therapy and close monitoring by experienced professionals.
As outlined in my policy plan “Breaking the Cycle,” a solution is hiding in plain sight. Randall’s Island is home to one of our city’s most critical mental health programs—a revolutionary program called Transition to Home.
Transition to Home (“THU”) helps New Yorkers living with serious mental illness receive voluntary and involuntary recovery-focused wraparound services that help them get ready for independent living and care at home in their communities. And we need to expand it. Our proposal would dramatically increase the number of inpatient THU beds on Randall’s Island, and we could use buildings on the campus that already exist and sit vacant.
This would be one step toward building a system that works—one that prioritizes treatment over triage. One that stops relying on emergency rooms as the only response to serious mental illness. One that gives people the long-term care they deserve.
We know what needs to be done. Now we need to act before the cycle repeats again.
