Many psychiatric patients in New York City’s public hospitals are locked up during their stays with no chance to leave, sometimes for weeks or months at a time, according to a new report by a state watchdog agency that oversees the treatment of psychiatric patients and a non-profit organization. legal group
No law or policy in New York explicitly requires time in the outdoors for psychiatric patients, but the authors of the reports note that state law has such a requirement for inmates. They also argue that, even without an explicit policy or law to that effect, patients have a legal right to be out.
Advocates are calling on the city to adopt a policy that regularly provides psychiatric patients with access to fresh air whenever their doctors deem it clinically appropriate.
But there are significant challenges to providing patients with regular access to the outdoors, including staffing and safety concerns, NYC Health + Hospitals said in a statement included in the report, a sentiment echoed by a former city official who told Gothamist that giving patients access to the outdoors introduces liability. questions
Even if they’re stable, you don’t want them out because if something bad happens, it’s on you, said Dr. Lloyd Sederer, an assistant professor at Columbia’s Mailman School of Public Health who served as the think tank for the city health commissioner under the Bloomberg administration and served on the board of NYC Health + Hospitals during that time. If someone goes out and hits someone, or someone goes out and throws themselves in front of a car, it’s you.
Lawyers from the state watchdog agency Mental Hygiene Legal Services and the nonprofit legal group Disability Rights Advocates investigated the policies and practices regarding outdoor recreation at each psychiatric unit at a NYC-run hospital Health + Hospitals between May and December last year. They found that seven of the 11 hospital systems deprive patients of all access to fresh air, regardless of their medical conditions or length of hospital stay.
Only four hospitals in the system offer some level of regular outdoor access, according to the report: Jacobi Hospital in the Bronx and Kings County, South Brooklyn Hospital and Woodhull Hospital in Brooklyn.
The average length of a psychiatric hospitalization at a city hospital is two weeks, according to NYC Health + Hospitals. But lawyers spoke to some patients in the course of their investigation who had been hospitalized and locked up for months, or in rare cases, more than a year.
Some city hospitals deny patients access to the outdoors despite having written policies recognizing the benefits of fresh air, the findings found.
NYC Health + Hospitals said in its response to the investigation that the health system does not agree with the proposed law filing in the report, but is nevertheless strongly committed to caring for its patients in appropriate settings and therapeutic support. The health system did not respond to an additional request for comment Monday.
Lawyers found that children and teenagers, including those in Bellevue’s pediatric psychiatric units, were among those denied time out.
Leonard Simmons, senior attorney for the Mental Health Legal Service, said some of the kids interviewed by the nonprofit didn’t understand at first why they were being asked about going out.
Whenever we talked to the kids about their experiences, the first thing they said was, Wait, does that mean I have to go out? can i go outside he said We should explain why we were telling them about this. That was heartbreaking.
According to the report, some adult patients who were interviewed in hospital psychiatric units said they preferred to be in jail or prison because they had more time outside.
The authors identified many states that have laws that address the issue. New Jersey, for example, gives patients in psychiatric units the right to be outdoors at regular and frequent intervals, absent medical considerations, while in Massachusetts, patients in facilities operated by the Department of State Mental Health are entitled to reasonable daily access. outside
However, the report’s authors argue that existing laws are sufficient to make the practice of denying patients outdoor time illegal in New York. They argue in the report that the current denial of fresh air constitutes discrimination against people with disabilities under the federal Americans with Disabilities Act. They also argue that it specifically violates patients’ constitutional rights, denial of liberty without due process and the city’s Human Rights Act.
Simmons said his company has been able to reach agreements on fresh air policies with hospitals in the past when it raised this issue, including with Bellevue in the early 2000s. The report cites an agreement between the Service Mental Health and Bellevue Legal that resulted in the hospital providing a patient access log to its closed rooftop. The report says the roof was available to psychiatric patients for about 20 years, but cites no reason why it is not now.
Simmons said he wasn’t sure whether access was cut off because of the pandemic or other concerns, such as staffing, and it wasn’t addressed in NYC Health + Hospitals’ response to the report.
If a new agreement cannot be reached with NYC Health + Hospitals, litigation is not off the table, the nonprofits said.
We are prepared to use whatever avenues we have to use to resolve this, said Erin Gallagher, an attorney for disability rights advocates.
The NYC Health + Hospitals statement included in the report says it does not address the many challenges to ensuring access to fresh air for acute psychiatric inpatients.
Providing outdoor access to facilities that do not have secure outdoor space poses particular safety concerns, including the potential for patient escape, and requires extensive staffing to ensure patient and staff safety, he said. say NYC Health + Hospitals.
Sederer, the former mental health commissioner, said that even if patients are being transported to a safe outdoor space, they may have to go through other hospital units, which could present additional safety and staffing issues, Sederer said.
Last year, the International Journal of Environmental Research and Public Health published a review of studies from the US and other countries on the effects of outdoor access on psychiatric patients. She found that being in nature helped make patients happier and more relaxed, but that it was important to have a safe and supportive environment.
Sederer argued that the benefits are not as great in an urban environment and are not worth the risk. Nature has been shown to be good for a variety of our hormones and neurotransmitters, he said. But this is like a walk in the woods. This is no stroll down First Avenue.
Still, the report’s authors noted that there are some facilities, such as NYC Health + Hospitals, that offer regular access to the outdoors, which shows it can be done.
This story has been updated to correctly describe Mental Health Legal Services as the state oversight agency that oversees the treatment of psychiatric patients.
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Image Source : gothamist.com