On June 22, 2022, Urban Pathways’ Director of Policy Nicole McVinua testified at an in-person hearing held by Attorney General Letitia James on the inaccessibility of mental health care in New York.

According to a 2021 report from the United States Department of Housing and Urban Development, 25.4% of individuals in New York State emergency and transitional shelters are also living with a serious mental illness. While these numbers don’t specifically reflect the Urban Pathways community, they demonstrate that a significant portion of our clients face additional barriers on their path to independence because of New York’s challenging mental health care system.

In her testimony, Nicole highlighted several difficulties of the system and outlined their detrimental impacts. A summary of her talking points can be found below.

1. Outpatient care for low-income individuals is limited, time-intensive, and often lower quality.

1. The high cost of mental health care makes it impossible for people with low incomes to access a provider who does not accept Medicaid, leaving them with few options.

2. As only a minimal number of psychiatrists accept Medicaid, these individuals face long waitlists and sparse appointment availability.

3. Due to low supply and high demand, individuals are required to complete two to three intake appointments before they are accepted for outpatient treatment. If an appointment is missed, the intake process must start over again.

2. The current responses to mental health crises are inadequate and frequently detrimental.

1. The NYPD responds to the vast majority of mental health crisis calls across the city. A police response often results in the person in need being placed in handcuffs even when transported to the hospital, which can be a traumatic event and criminalizes them for having a mental health emergency.

2. Mobile Crisis Teams are only available between 8am – 8pm and are not always available to respond immediately, sometimes taking up to 24 hours despite the situation being an emergency.

3. When patients are placed in the emergency room due to a crisis, they are often not held for observation and are sent back the same day if they are not actively demonstrating symptoms of psychosis while in the ED.

*Note: This has become worse since the pandemic due to the shortage of psychiatric care beds and prioritization of COVID patients.

3. There is insufficient communication between the healthcare system and human services staff.

1. Patients regularly arrive back at their residence without communication or paperwork from the hospital regarding their discharge plan or result of their visit, leaving staff in the dark as to how best to support the individual.

2. While we recognize HIPAA regulations must be followed, more consistency in asking the person to sign a release form if they are comfortable and improving communication would allow for better continuity of care.

Moving forward, we encourage increased access to high quality psychiatric care for patients using Medicaid, 24/7 non-police responses to mental health crises, and improved communication between temporary shelter and supportive housing staff when clients are discharged from emergency care.

Urban Pathways looks forward to working in continued partnership with the state to ensure New Yorkers have access to the mental health services they need.