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New York City Council Hearing: Coordination of the State and City in the Provision of Mental Health Services

Charles Barron, MD, Deputy Chief Medical Officer, Office of Behavioral Health / Medical and Professional Affairs
Thursday, April 21, 2022

Good afternoon Chairperson Lee, Chairperson Abreu and members of the Committee on Mental Health, Disabilities and Addiction and the Committee on State and Federal Legislation. I am Dr. Charles Barron, Deputy Chief Medical Officer of the Office of Behavioral Health, and Medical and Professional Affairs at NYC Health + Hospitals (Health + Hospitals). I am joined this morning Dr. Rebecca Linn-Walton, Senior Assistant Vice President in the Office of Behavioral Health at Health + Hospitals. I am happy to testify before you today to discuss the coordination of the State and City in the provision of mental health services at Health + Hospitals.

Health + Hospitals is the main provider of behavioral health and inpatient psychiatric care services in New York City, currently operating one of the largest and most robust continuums of mental health and substance use services in the country. All of our mental health services are licensed and regulated by New York State. Our mental health programs, which includes psychiatric emergency, inpatient, and outpatient clinics are licensed and regulated by New York State Office of Mental Health (OMH). Our substance use in medical settings which includes the emergency department, inpatient medicine, outpatient substance use, and methadone programs are all licensed and regulated by New York State Office of Addiction Services and Supports (OASAS). As hospitals, we are also licensed and regulated by New York State Department of Health (DOH) and are subject to joint commission review. As such, we work with the State closely in the provision of all of our behavioral health services.

Health + Hospitals is in regular communication and coordination with OMH, as well as City agency partners like the Department of Health and Mental Hygiene (DOHMH), Department of Homeless Services (DHS), New York Police Department (NYPD), and the Mayor’s Office of Community Mental Health (OMH), and others, to support homeless patients with behavioral needs. This includes the most recent Subway Safety Plan and the B-HEARD program.

When COVID-19 saw its first case in New York City in March 2020, Health + Hospitals was at the forefront responding to the needs of its patients and the City overall. Amidst unprecedented circumstances, Health + Hospitals kept its doors open so that New Yorkers could safely access care. We utilized all modalities, including in-person, telephonic, video calls, home visits, and mobile crisis outreach, to provide care. Working hand-in-hand with DOHMH, OCMH, OMH, and OASAS, Health + Hospitals ensured coordination of all available behavioral health beds across all hospitals. To accommodate the surge in critical COVID-19 patients, Health + Hospitals worked as one system to safely transfer behavioral health patients to other facilities that had capacity, even standing up COVID+ psychiatric units in several hospitals.

COVID led to a necessary relaxing of certain regulatory barriers to care that have greatly improved our ability to receive and retain patients in our care. When the pandemic began, telemental sessions rolled out in psychiatry, substance use services, the Family Justice Centers for domestic violence victims and families, Addiction Consult teams for both Med ED and Inpatient Medicine, and mobile treatment (both mobile crisis and assertive community treatment teams). To help make this possible, Health + Hospitals distributed iPads to inpatient/ED behavioral health consult services. To date, Health + Hospitals has completed 520,000 behavioral health sessions telephonically and virtually.

Other initiatives launched during the pandemic included the Virtual Bupe Clinic created to provide same-day buprenorphine access to existing and new patients. We also partnered with the State DOHMH and OASAS to provide methadone delivery to patients on quarantine at hotels and in their homes, or to stable patients who were at high risk of complications from COVID for whom it was not safe to attend in-person sessions. For New Yorkers who required quarantine at a Test & Trace hotel, we provided access to behavioral health services. Once COVID-19 vaccination outreach began, and Test & Trace launched the Street Health Outreach & Wellness (SHOW) mobile units, we also began providing free mental health and substance use screenings on the units, as well as linkage to ongoing care.

With the introduction of behavioral telehealth services Health + Hospitals has seen significant positive effects. Virtual access to mental health and substance use, especially being able to initiate Bupe via virtual care has meant patients have access to care including detox support right in the safety of their homes. Virtual Express Care helps us assess urgent cases and reduce unnecessary ED visits. Tele and video therapy have enabled patients to see clinicians safely and more frequently, when needed, and helped us retain patients in treatment through lockdown and beyond. Methadone delivery to patients isolating due to COVID has greatly supported patients. We look forward to building on the successes of these evolved services to continue to meet New Yorkers where they are and provide the care they need.

In October 2021, Health + Hospitals received a $1.8 million award from OASAS to expand services to opioid and stimulant use in underserved communities of the Bronx, Manhattan, and Queens. The funding helps coordinate emergency department substance use access, Consult for Addiction Treatment and Care in Hospitals (CATCH) programs, outpatient services, and virtual access to substance use care, and bridge between SUD and psychiatry for patients with co-occurring mental health and SUD diagnoses.

However, there are a lot of areas within the behavioral health system nationwide that need improvement. The federal government continues to regulate methadone in a manner that is overly restrictive for patients. Patients must receive medication in heavily regulated specialized clinics. The state is currently rightly advocating to allow methadone to be dispensed at traditional outpatient substance use clinics, which exist in greater numbers, and to make this life-saving medication available in pharmacies. This change will allow patients to receive their medication when and how it is convenient, and to receive treatment as a support, rather than a condition tied to receiving lifesaving medication. We support this effort to remove barriers to easily accessing medication and treatment.

Another of the better-known issues is the parity for behavioral health care billing, and the inability to bill for social work in primary care settings. As Health + Hospitals moves to implement behavioral health support throughout the system, including right there in primary care settings, having these licensed clinicians able to bill for services is key to patient care and financial sustainability. In order to overcome these barriers, health care providers need increased funding for new models of care and care provision for uninsured, advocacy from stakeholders, including elected officials, to reduce regulations that increase barriers to care; and expansion of key existing safety net services, especially for special populations.

Health + Hospitals has a long history of taking care of the most vulnerable New Yorkers, and will continue to do so, come what may. We look forward to continuing to partner with government and key stakeholders to forge solutions. I thank your committees for your attention to this important topic; we are happy to answer any questions you may have.