Experts: Community services, hospital beds key for Long Islanders in crisis
Nick Stahlman, left, an outreach and recovery peer specialist with CN Guidance & Counseling Services in Hicksville, and program director Roseann Falcone, in an RV the agency sends into the community to help people who may need mental health services. Credit: Debbie Egan-Chin
When Jeffrey McQueen thinks about how to provide mental health services to those who need it, he latches onto community-based care, as opposed to inpatient psychiatric beds.
McQueen, executive director of the Mental Health Association of Nassau County, said while there has been a push to boost inpatient psychiatric beds at a time of increased need for mental health services, he sees reluctance among some to go to a hospital.
“If you ask someone, 'Would you like to go to the hospital?' Their first answer is no, even if we recognize they need a higher level of care,” McQueen said.
Some people balk because they fear being kept inside for an extended period, he said. Others fear the "stigma" of being hospitalized for mental illness, or their cultural background eschews seeking out such treatment.
As a result, McQueen said, "It’s important we normalize the conversation around mental illness and trauma because it’s important that people know nothing is wrong with them, but that something happened to them."
To that end, he added, "we have a hospital diversion program, where people can go to respite [care] instead of the hospital.”
The “crisis respite care” program provides short-term assistance and intervention when someone's symptoms cannot be managed at home.
But, McQueen noted, sometimes a client's symptoms become too great to be managed in a community program.
“When an individual is supported first in the community-based organization and then guided into the hospital system, or guided to that higher level of care, that individual is more likely to accept it and the end results are better," he said.
Experts have welcomed the state's recent investment in mental health services — a $1 billion, multiyear plan in the 2023-24 fiscal budget, with approximately $118 million in new money included in the recently approved 2024-25 budget, according to the state Office of Mental Health. But the experts also point to a serious need for expanded community-based programs to cover gaps in service across sprawling geographic areas such as Suffolk County, and to help compensate for a shortage of psychiatrists, social workers and other therapists.
Among the groups receiving additional state funding are CN Guidance & Counseling Services in Hicksville and Outreach Development Corp., which has centers from Greenpoint in Brooklyn to Bellport in Suffolk. Both nonprofits are getting startup funds to establish crisis stabilization centers, where clients are assessed in under 24 hours and connected to treatment services.
Jeffrey Friedman, chief executive of CN Guidance, said his agency had received approximately $1.5 million in funds for a crisis stabilization center at its Hicksville facility. Patients can stay there a maximum of 23 hours and 59 minutes since it's not a residential facility.
“Currently, when people are in crisis, often they're brought to the emergency room, and the ER can be full of stigma. It can traumatize an individual and more often than not, it is not an appropriate place for care,” Friedman said. “What we're building here is urgent care for mental health,” which he said they hope to launch in early 2025.
“We're building a center that'll be open 365 days a year, 24 hours a day, seven days a week,” Friedman said. “Open Christmas and New Year's. …When they come here, they can get something to eat. They can take a shower, do their laundry, watch TV. All the time they're in the center, they're being assessed by professionals: a psychiatrist, social worker and a nurse.”
After the assessment, treatment is set in motion.
“We're going to find them a provider who can continue that treatment immediately,” he said.
Krista Whitman, vice president and chief operating officer of Outreach Development Corp. said the organization is in line to receive $1.25 million for its crisis stabilization center, and another $825,000 for suicide prevention and crisis services. Representatives are currently scouting for a building in mid- to eastern Suffolk to lease for the center.
“Our goal is by the end of year we will have a location,” she said.
And like CN Guidance, individuals can only stay 23 hours and 59 minutes.
According to a report last month by state Comptroller Thomas DiNapoli, the mental health needs of New Yorkers have “greatly increased.” The report cited a 23% spike in the number of residents seen by the state's public health system between 2013 and 2022. At the same time, DiNapoli's report said the increase has coincided with a decline of 990 inpatient psychiatric beds in the state — almost 200 on Long Island — between April 2014 and December 2023.
State officials said they are increasing inpatient beds and adding an assortment of community-based care options, ranging from mental health clinics in communities and schools to mobile units and housing programs, in order to meet the surge in demand.
Michael Scarpelli, executive director of The Behavioral Health Service Line at Northwell Health, through its South Oaks Hospital — a 202-bed psychiatric hospital in Amityville — is on target to open an outpatient clinic and a partial hospitalization program in Riverhead, providing mental health services for children from age 5 to young adults by the end of 2024. The partial hospitalization program would operate from 8 a.m. to 4 p.m.
Overall, he said, Northwell has 533 total inpatient psychiatric beds in a health system that includes facilities in Nassau, Suffolk, eastern Queens, Manhattan, Staten Island and northern Westchester County.
“We ended up in Riverhead because there's not a lot resources for children out there,” Scarpelli said.
Asked about gaps in service, Scarpelli said some patients in Suffolk have to travel long distances for mental health care.
“Folks sometimes struggle with transportation. The farther out east you go, there is more mileage to cover,” he said.
To address some of those issues, Stony Brook Medicine is seeking to expand its outpatient substance disorder clinic in Riverhead, via a state license, to improve access to individuals with mental health diagnoses, said Susan Wilner, assistant director of Behavioral Health Services Operations. She added there are 40 inpatient psychiatric beds at Stony Brook University Hospital and 23 at Stony Brook Eastern Long Island Hospital in Greenport. Both hospitals also have outpatient behavioral health services.
Colleen Merlo, chief executive of the Ronkonkoma-based Association for Mental Health and Wellness, said her organization supports proposals to bring back inpatient psychiatric beds that were taken offline during the COVID-19 pandemic. Still, she said her group “believes people can be best served in the community, when those services are adequate.”
Merlo lauded the “huge investment in New York State for mental health services. … But the truth of the matter is the mental health system has been underfunded for decades. So it's going to take multiple years of investments of this level to get us to a place where we're able to meet the demands and needs of our communities.”
Dr. Leslie Marino, a psychiatrist and president of the Suffolk Medical Society, said while inpatient beds are “coming back online, it's been a slow process,” citing as a major reason the difficulty in hiring psychiatrists.
“Long Island has a high cost of living, but psychiatrists in the public sector tend to have lower salaries. From what I've heard from a lot of inpatient facilities, [the holdup] is recruiting doctors,” she said.
McQueen, of the Mental Health Association of Nassau County, agreed “the availability of psychiatric access has decreased. There aren’t enough psychiatrists. There aren’t enough clinics.”
Scarpelli, of Northwell, also noted "individuals have retired, or left the health care field. That’s something that we all need to be working on.”
He said Northwell is developing two new psychiatry residency programs to boost staffing. “One is at Lenox Hill [hospital in Manhattan] and the other is going to be at South Oaks Hospital. We’re hoping to have that starting in July 2025 at Lenox. We hope to start at South Oaks in 2026.”
New York State Office Mental Health Commissioner Dr. Ann Sullivan pointed to the state's $1 billion investment in mental health services as a way to make major inroads toward increasing access, including adding 700 inpatient beds (500 in the community and 200 at state institutions, including 50 at the state's Pilgrim Psychiatric Center in Brentwood), and the “significant expansion of community-based services,” such as certified health centers. She said the health centers will be “tripled” in the next two years, going from 13 to 39.
“There's one on Long Island now,” she said, referring to CN Guidance.
There's also the expansion of ACT teams, which are mobile units that meet people in the community, including on Long Island. ACT stands for Assertive Community Treatment, which the state Office of Mental Health described as "multidisciplinary, evidence-based teams [that] provide comprehensive and flexible treatment, support, and rehabilitation services to individuals in their community."
Friedman said CN Guidance has 56 programs “geared toward supporting people who have mental health and substance use” issues, which he said have reached 30,000 people on Long Island annually.
Programs include a mobile recovery unit — an RV and a smaller van dispatched throughout Long Island. The unit incudes peer counselors, nurses and therapists who meet people in parks, at train stations and elsewhere. They provide information, training on how to recognize an opioid overdose and administer the overdose reversal drug naloxone, and conduct mental health assessments.
“The mission is to connect with people who are suffering from behavioral health issues and to get them into treatment,” Friedman said.
The rooms in the RV are outfitted with computer monitors where the on-site staff can connect someone with a psychiatrist remotely, who can then assess the individual.
Nick Stahlman, an outreach and recovery peer specialist with CN Guidance, explained how a typical encounter with the RV staff might work.
“We park the RV. We set up a table out front. We pull the awning out. We have a nice little area out front that's inviting. We have a sign inviting people to take Narcan training," he said. "But also the 'Hope Rides Here' logo on the side and back of the van, a lot of times it's a conversation starter.”
Staff members explain the services that are available and how people who need them can be connected to treatment “and try to move forward with their lives. Us as recovery peers have been through that. We have real-world, lived experience in both mental health and substance use.”
Stahlman added that often they might hear someone say: “ 'You don't understand. You don't know what it's like.' So us, as recovery peers, we do know what it's like. We have been there. We show them that recovery is not only possible, but it's expected.”
When Jeffrey McQueen thinks about how to provide mental health services to those who need it, he latches onto community-based care, as opposed to inpatient psychiatric beds.
McQueen, executive director of the Mental Health Association of Nassau County, said while there has been a push to boost inpatient psychiatric beds at a time of increased need for mental health services, he sees reluctance among some to go to a hospital.
“If you ask someone, 'Would you like to go to the hospital?' Their first answer is no, even if we recognize they need a higher level of care,” McQueen said.
Some people balk because they fear being kept inside for an extended period, he said. Others fear the "stigma" of being hospitalized for mental illness, or their cultural background eschews seeking out such treatment.
WHAT TO KNOW
- Experts say the need for community mental health services has continued to rise on Long Island.
- New York State's investment in mental health services has also continued to rise.
- More inpatient hospital beds for people in crisis, as well as increased community services, are key for Long Island, experts say.
As a result, McQueen said, "It’s important we normalize the conversation around mental illness and trauma because it’s important that people know nothing is wrong with them, but that something happened to them."
To that end, he added, "we have a hospital diversion program, where people can go to respite [care] instead of the hospital.”
The “crisis respite care” program provides short-term assistance and intervention when someone's symptoms cannot be managed at home.
But, McQueen noted, sometimes a client's symptoms become too great to be managed in a community program.
“When an individual is supported first in the community-based organization and then guided into the hospital system, or guided to that higher level of care, that individual is more likely to accept it and the end results are better," he said.
Mental health investment
Experts have welcomed the state's recent investment in mental health services — a $1 billion, multiyear plan in the 2023-24 fiscal budget, with approximately $118 million in new money included in the recently approved 2024-25 budget, according to the state Office of Mental Health. But the experts also point to a serious need for expanded community-based programs to cover gaps in service across sprawling geographic areas such as Suffolk County, and to help compensate for a shortage of psychiatrists, social workers and other therapists.
Among the groups receiving additional state funding are CN Guidance & Counseling Services in Hicksville and Outreach Development Corp., which has centers from Greenpoint in Brooklyn to Bellport in Suffolk. Both nonprofits are getting startup funds to establish crisis stabilization centers, where clients are assessed in under 24 hours and connected to treatment services.
Jeffrey Friedman, chief executive of CN Guidance, said his agency had received approximately $1.5 million in funds for a crisis stabilization center at its Hicksville facility. Patients can stay there a maximum of 23 hours and 59 minutes since it's not a residential facility.
“Currently, when people are in crisis, often they're brought to the emergency room, and the ER can be full of stigma. It can traumatize an individual and more often than not, it is not an appropriate place for care,” Friedman said. “What we're building here is urgent care for mental health,” which he said they hope to launch in early 2025.
“We're building a center that'll be open 365 days a year, 24 hours a day, seven days a week,” Friedman said. “Open Christmas and New Year's. …When they come here, they can get something to eat. They can take a shower, do their laundry, watch TV. All the time they're in the center, they're being assessed by professionals: a psychiatrist, social worker and a nurse.”
After the assessment, treatment is set in motion.
“What we're building here is urgent care for mental health,” said Jeffrey Friedman, chief executive of CN Guidance & Counseling Services in Hicksville. Credit: Debbie Egan-Chin
“We're going to find them a provider who can continue that treatment immediately,” he said.
Krista Whitman, vice president and chief operating officer of Outreach Development Corp. said the organization is in line to receive $1.25 million for its crisis stabilization center, and another $825,000 for suicide prevention and crisis services. Representatives are currently scouting for a building in mid- to eastern Suffolk to lease for the center.
“Our goal is by the end of year we will have a location,” she said.
And like CN Guidance, individuals can only stay 23 hours and 59 minutes.
More need, fewer beds
According to a report last month by state Comptroller Thomas DiNapoli, the mental health needs of New Yorkers have “greatly increased.” The report cited a 23% spike in the number of residents seen by the state's public health system between 2013 and 2022. At the same time, DiNapoli's report said the increase has coincided with a decline of 990 inpatient psychiatric beds in the state — almost 200 on Long Island — between April 2014 and December 2023.
State officials said they are increasing inpatient beds and adding an assortment of community-based care options, ranging from mental health clinics in communities and schools to mobile units and housing programs, in order to meet the surge in demand.
Michael Scarpelli, executive director of The Behavioral Health Service Line at Northwell Health, through its South Oaks Hospital — a 202-bed psychiatric hospital in Amityville — is on target to open an outpatient clinic and a partial hospitalization program in Riverhead, providing mental health services for children from age 5 to young adults by the end of 2024. The partial hospitalization program would operate from 8 a.m. to 4 p.m.
Overall, he said, Northwell has 533 total inpatient psychiatric beds in a health system that includes facilities in Nassau, Suffolk, eastern Queens, Manhattan, Staten Island and northern Westchester County.
“We ended up in Riverhead because there's not a lot resources for children out there,” Scarpelli said.
Asked about gaps in service, Scarpelli said some patients in Suffolk have to travel long distances for mental health care.
“Folks sometimes struggle with transportation. The farther out east you go, there is more mileage to cover,” he said.
To address some of those issues, Stony Brook Medicine is seeking to expand its outpatient substance disorder clinic in Riverhead, via a state license, to improve access to individuals with mental health diagnoses, said Susan Wilner, assistant director of Behavioral Health Services Operations. She added there are 40 inpatient psychiatric beds at Stony Brook University Hospital and 23 at Stony Brook Eastern Long Island Hospital in Greenport. Both hospitals also have outpatient behavioral health services.
Colleen Merlo, chief executive of the Ronkonkoma-based Association for Mental Health and Wellness, said her organization supports proposals to bring back inpatient psychiatric beds that were taken offline during the COVID-19 pandemic. Still, she said her group “believes people can be best served in the community, when those services are adequate.”
Merlo lauded the “huge investment in New York State for mental health services. … But the truth of the matter is the mental health system has been underfunded for decades. So it's going to take multiple years of investments of this level to get us to a place where we're able to meet the demands and needs of our communities.”
Dr. Leslie Marino, a psychiatrist and president of the Suffolk Medical Society, said while inpatient beds are “coming back online, it's been a slow process,” citing as a major reason the difficulty in hiring psychiatrists.
“Long Island has a high cost of living, but psychiatrists in the public sector tend to have lower salaries. From what I've heard from a lot of inpatient facilities, [the holdup] is recruiting doctors,” she said.
McQueen, of the Mental Health Association of Nassau County, agreed “the availability of psychiatric access has decreased. There aren’t enough psychiatrists. There aren’t enough clinics.”
Scarpelli, of Northwell, also noted "individuals have retired, or left the health care field. That’s something that we all need to be working on.”
He said Northwell is developing two new psychiatry residency programs to boost staffing. “One is at Lenox Hill [hospital in Manhattan] and the other is going to be at South Oaks Hospital. We’re hoping to have that starting in July 2025 at Lenox. We hope to start at South Oaks in 2026.”
Signs of progress
New York State Office Mental Health Commissioner Dr. Ann Sullivan pointed to the state's $1 billion investment in mental health services as a way to make major inroads toward increasing access, including adding 700 inpatient beds (500 in the community and 200 at state institutions, including 50 at the state's Pilgrim Psychiatric Center in Brentwood), and the “significant expansion of community-based services,” such as certified health centers. She said the health centers will be “tripled” in the next two years, going from 13 to 39.
“There's one on Long Island now,” she said, referring to CN Guidance.
There's also the expansion of ACT teams, which are mobile units that meet people in the community, including on Long Island. ACT stands for Assertive Community Treatment, which the state Office of Mental Health described as "multidisciplinary, evidence-based teams [that] provide comprehensive and flexible treatment, support, and rehabilitation services to individuals in their community."
Friedman said CN Guidance has 56 programs “geared toward supporting people who have mental health and substance use” issues, which he said have reached 30,000 people on Long Island annually.
Programs include a mobile recovery unit — an RV and a smaller van dispatched throughout Long Island. The unit incudes peer counselors, nurses and therapists who meet people in parks, at train stations and elsewhere. They provide information, training on how to recognize an opioid overdose and administer the overdose reversal drug naloxone, and conduct mental health assessments.
“The mission is to connect with people who are suffering from behavioral health issues and to get them into treatment,” Friedman said.
The rooms in the RV are outfitted with computer monitors where the on-site staff can connect someone with a psychiatrist remotely, who can then assess the individual.
Nick Stahlman, an outreach and recovery peer specialist with CN Guidance, explained how a typical encounter with the RV staff might work.
“We park the RV. We set up a table out front. We pull the awning out. We have a nice little area out front that's inviting. We have a sign inviting people to take Narcan training," he said. "But also the 'Hope Rides Here' logo on the side and back of the van, a lot of times it's a conversation starter.”
Staff members explain the services that are available and how people who need them can be connected to treatment “and try to move forward with their lives. Us as recovery peers have been through that. We have real-world, lived experience in both mental health and substance use.”
Stahlman added that often they might hear someone say: “ 'You don't understand. You don't know what it's like.' So us, as recovery peers, we do know what it's like. We have been there. We show them that recovery is not only possible, but it's expected.”
