The community served by Allen Hospital has held its breath for two years.
In late 2017, NewYork-Presbyterian — which operates the hospital just across the Broadway Bridge from Marble Hill — submitted an application to the state health department requesting the elimination of the 30 beds of Allen’s inpatient psychiatric treatment unit. In its place, the health care system planned a $70 million expansion of its maternity unit and four new operating rooms for its spine center.
NewYork-Presbyterian said it would close the psych unit in June 2018, and started by reassigning doctors and nurses to other posts within its system. Activists held rallies and elected officials wrote letters opposing the closure. The health department application drifted in a yet-to-be-decided limbo.
The deadline for the closure came and went, but nothing happened. Closing was moved to the following summer. The same opposition mounted, the same outcry from the city’s psychiatric community. And again, the unit stayed open.
“We look forward to a continued dialogue with government officials and key community stakeholders in order to achieve the best path forward for patients on these important issues,” the hospital system said in a statement to The Riverdale Press, an identical statement it has sent to other publications in the past.
It leaves many wondering if and when the nearest hospital to the northwest Bronx will lose a vital service. Allen is one of the few hospitals in the city that treats patients suffering from both severe mental illnesses and substance abuse. It serves the largely low-income, majority immigrant populations of Washington Heights, Inwood and Marble Hill.
Allen also is one of the few hospitals that accepts Medicaid and treats those without insurance.
The shortage of inpatient psychiatric care in the city became apparent to Miriam Callahan, a third-year medical student at Columbia University. She and other med students spent time at Allen Hospital’s psych unit, observing psychiatric treatment. She learned enough about health care policy and how treatment gets reimbursed to know inpatient psychiatric care wasn’t a moneymaker, and that’s what’s driven a shortage of inpatient care citywide.
A few weeks after visiting, she heard about NewYork-Presbyterian’s plans.
“I was bothered by the implication that that kind of profit motive might be related to the way that they were deciding what kind of care to provide at the hospital,” Callahan said.
Although outpatient care that doesn’t interfere with a patient’s daily life is ideal, she said, not every psychiatrist takes insurance, there’s an availability shortage and care quality varies. NewYork-Presbyterian said it would boost outpatient psych treatment elsewhere in the system and send severe cases to its Westchester inpatient facility, but it can be days or weeks before someone going through a mental health crisis can be seen.
They can spend six or seven days in the emergency room just waiting for an inpatient bed to open up before they receive care.
“The truth is that these beds are always full,” Callahan said. “We are already stretched to capacity within the city. They’re not planning to open more beds in Westchester. They’re just trying to do more with less, but the truth is that less is already not enough.”
For those in danger of hurting themselves, the consequences of delayed treatment could mean death. When Assemblywoman Carmen De La Rosa took office in 2016, she advocated for providing help to the disturbingly large number of children of color who attempt or die by suicide.
“Around that time, I read a New York Times article about the number of people who have jumped off the George Washington Bridge, which is just on the edge of my district,” De La Rosa said. “I grew up in Inwood and Washington Heights, and when I saw that bridge, I knew I was home.”
But she realized the bridge’s silhouette accentuated despair and hopelessness to others.
She began pushing for more mental health care for the immigrant communities in her district. Mental illness isn’t just stigmatized in the United States — other cultures avoid the topic even more. And for all the talk in Albany about opioid addiction, substance abuse and mental illness, “there’s never a focus on communities of color,” De La Rosa said.
After a few months of talking to doctors and social workers about outreach, she got the call that unraveled her plan.
“For me, that was a devastating call because here I was, knee-deep in research in how to prevent suicide, how to break the stigma, how to get more access to mental health resources for our community,” De La Rosa said. “And here we have one of the biggest, most recognized health care providers in the country — and the largest employer in our area — and for them to be closing a unit, I feel that it would be a disservice to our community.”
NewYork-Presbyterian officials told her patients the Westchester facility could handle demands for treatment, she said. But that plan leaves out the patient’s support — their families, friends, spiritual leaders and a hospital staff that understands their background.
Many working-class people in her district don’t have personal vehicles to trek an hour to visit every day, she said. Staff in a predominantly white, higher-income area won’t have the cultural knowledge to identify with immigrants.
De La Rosa wrote letters to the state health commissioner, imploring them not to approve NewYork-Presbyterian’s application. And when she approached hospital system officials directly, they took her on a tour of the hospital, explaining their plans to provide her district a state-of-the-art maternity department, which is especially important because women of color are far more likely to die in childbirth than white women.
“But our community should not have to choose between having state-of-the-art maternal care and having state-of-the-art mental health care,” De La Rosa said. “NewYork-Presbyterian has the resources and the real estate to provide both services.
“What are we saying to our communities when we tell them they can do without a psych unit, when we know the crisis that’s going on about mental health and illness in our community?”