The Impact of COVID-19 on Psychiatric Services and Individuals with Serious Mental Illness in New York State during 2020

ABSTRACT

Background: New York State was the epicenter of the COVID-19 pandemic's initial US surge in March 2020. The pandemic precipitated dramatic and immediate changes throughout the State's psychiatric treatment system and presented serious threats to the wellbeing of individuals with serious mental illness in 23 State-operated psychiatric hospitals. Methods: We describe how the State mental health authority rapidly restructured the public mental health system and implemented infection control and vaccination programs targeting individuals with serious mental illness. Results: Changes in the supply of and demand for psychiatric services When the pandemic struck, general hospitals in the NYC and its suburban region immediately closed about 20% of their inpatient psychiatric beds. The NYC public hospital system, which accounts for ∼40% of the city's inpatient psychiatric beds, converted ∼30% of its adult inpatient capacity and 40% of its child/adolescent capacity to COVID-19 medical services. State-operated psychiatric hospitals responded by significantly increasing admissions. These shifts were coordinated to create a single psychiatric inpatient system of care during the height of the pandemic. We will present data showing a dramatic shift to telehealth platforms for outpatient psychiatric outpatient services in the early stages of the pandemic. Risk of infection and mortality among individuals with serious mental illness Within 3 months of the onset of the pandemic in NYS, five of the 23 State-operated psychiatric hospitals reported 50% or more of their residential/inpatient census exposed to COVID-19. Over an 18-month period from 2020-2021 spanning 3 distinct COVID-19 surges, ∼12% of the almost 11,000 patients treated in these programs were diagnosed with COVID-19 illness and 53 died from the virus. We will review infection control practices implemented in these State-operated psychiatric hospitals to mitigate the impact of the virus. Implementing a COVID-19 vaccination program Within 8 months of onset of the pandemic, surveillance testing and vaccination programs were implemented in all 23 State-operated psychiatric hospitals. We will present data showing marked reductions in COVID- 19 transmission in this population following this implementation, which occurred while COVID-19 cases were peaking in NYS during the 2nd surge in January-February 2021. Population level management of the economic fallout related trauma, stress, anxiety, and depression Finally, we will review results from 2 surveys of New Yorkers who used psychiatric services during the pandemic. We will report on their experiences with access to care, telehealth, and the impact of COVDI-19 on their health and wellbeing. Discussion and Implications Mental health authorities can rapidly implement new policy and protocols to protect the health of individuals served in psychiatric hospital systems during urgent public health crises. Assertive cross-agency coordination is necessary to ensure the safety and wellbeing of these individuals.