Kingsboro Psychiatric Center (photo: New York State Office of Mental Health)
One-fifth of patients in state-run inpatient psychiatric centers have contracted COVID-19 since the outbreak began last March, and 58 out of a total 8,200 individuals admitted to those institutions have died, according to new data provided by the New York State Office of Mental Health (OMH) after a Gotham Gazette inquiry. The facilities embody one of several types of congregate living settings where residents are more vulnerable to the virus, and while they have smaller populations and receive less attention than other congregate settings, the latest data shows the state’s psychiatric facilities have also been home to dire outcomes.
Like much the rest of the state, psychiatric centers were caught off-guard at the outset of the pandemic last spring. Infection was rampant and the death toll rose quickly, with more than a third taking place over the course of a week in April. Reports from people living and working in the facilities painted a picture of chaos and grief as facilities struggled to contain the virus.
While the number of deaths per capita in psychiatric hospitals is dwarfed by nursing home resident deaths, which account for close to a third of the 46,600 statewide fatalities thus far, it far exceeds the rate in state prisons, where advocates have raised alarms about covid-related conditions. Little public and government attention has been paid to how covid is impacting residents and staff of state psychiatric facilities. The latest data raises new questions about the vulnerability of New Yorkers with the most severe mental illnesses and the care the state is providing them in its 23 psychiatric centers.
Between March 2020 and February 10 this year, 58 patients died of COVID-19 either in psychiatric centers operated by OMH or in medical hospitals after being transferred, according to OMH. That amounts to .7 percent of the 8,172 total individuals admitted to inpatient psychiatric facilities or on-campus supportive residences at some point in the previous 11 months. The OMH census on February 10 was 4,455.
The fatality rate, although less than 1%, is at least a factor of ten greater than the per capita death rate among people incarcerated in state prisons. That is based on the prison census, which varied between 44,200 in January 2020 and 32,600 in February 2021, out of which 32 incarcerated people have been killed by the virus, according to the Department of Correction and Community Supervision (DOCCS).
Nearly 1,700 psychiatric patients and residents have contracted the virus -- 846 presumed and 838 confirmed through testing -- since March, a full one-fifth (21%) of the total patient population. With roughly 5,800 recorded positive cases among DOCCS inmates as of late February, the per capita inmate infection rate is somewhere between 13 and 18%. (OMH began a broad-scale testing regime in inpatient facilities last summer, which means more asymptomatic cases were likely discovered.)
OMH would not provide information on which facilities the deaths of psychiatric patients occurred in and when they took place, limiting the assessment that can be done of both the vulnerability of long-term psychiatric patients and the performance of OMH in protecting them.
Both prisons and psychiatric facilities are state-run congregate living settings where residency is largely involuntary -- formally so in prisons and functionally so, at least in an immediate sense, in psychiatric facilities. Both contain diverse populations in terms of age, race, and geography, and both are part of a larger system of individual state trusteeship. A year into the pandemic, a lack of public data about total infections among nursing homes residents, the total number of incarcerated individuals who passed through state prisons since March 2020, per capita covid rates in homeless shelters, and a more granular breakdown of death and infection rates in psychiatric facilities makes further comparisons difficult.
A number of factors could influence the larger death and infection rates in psychiatric facilities, but it largely comes down to two: demographic differences between inpatient and incarcerated populations, and differences in the OMH and DOCCS settings that could impact a person's risk of contracting or dying from the disease: social distancing practices, sanitation, and the quality of health care provided.
"You are comparing a prison setting, where movement is restricted, to hospital and residential settings which do not have the same restrictions," wrote OMH Director of Public Information James Plastiras in an email to Gotham Gazette, when asked about the higher per capita rates in state psychiatric facilities.
"Additionally, our patients are more likely to be medically compromised with underlying conditions. They are also on average much older," Plastiras said, calling the comparison to prisons "misleading."
Age has been one of the most salient factors contributing to COVID-19 deaths, and death rates in both OMH and DOCCS facilities pale in comparison to the number of nursing home residents who have died.
The average age of psychiatric "inpatient adult clients" is 51 years old, according to Plastiras, and 41 of the 58 deaths were of patients over 65. According to a spokesperson for DOCCS the average age of state prison inmates in December was 40.5 years old.
Psychiatric patients, who are admitted for severe mental health issues from depression to schizophrenia, tend to have more co-occurring health conditions than the general population and for that reason may be more susceptible to the coronavirus.
"If you are living with schizophrenia and you're going to the doctor and you're not as able to explain exactly what's going on with you physically, it's probably very difficult for that practitioner to treat you," said Wendy Burch, executive director of the the state chapter of the National Alliance on Mental Illness, in a phone interview. "And as we know, when it comes to covid, anyone with these underlying conditions are more susceptible to having a more severe case."
"Mental health patients may not always be able to wear a mask or follow other COVID safety protocols," wrote Rob Merrill, a spokesperson for the Public Employees Federation, which represents psychiatric staff, in an email to Gotham Gazette. "OMH has stated that they cannot force patients to wear a mask, whereas DOCCS has more control over rule enforcement in a facility."
Studies have found adults with mental health disorders are at higher risk for COVID-19 infection and are more likely to have worse outcomes as a result. One recent study from NIH’s National Institute on Drug Abuse found adults with recent diagnoses of depression are at greatest risk of infection among the populations surveyed, followed by schizophrenia. Within those groups the outcomes tend to be more severe for African-Americans and women. According to the CDC, smoking, another risk factor for poor COVID-19 outcomes, is more common among people with mental illness.
But it is unclear the extent to which disparate infection and death rates from prisons are the result of comorbidities and age and to what extent they are influenced by the operations in OMH psychiatric centers. In terms of infections, specifically, the disparity may also be a reflection of the widespread testing that OMH undertook in its facilities last year.
OMH's Covid Response
As Gotham Gazette first reported last spring, the state's 23 psychiatric centers were ravaged by the virus at the peak of the outbreak last March and April, with 10 confirmed deaths in mid-April rising to 30, with another 7 suspected deaths, a week later. Doctors, nurses, patients, and the lawyers assigned to represent them described harrowing conditions in facilities, with close-quarter living, communal dining, limited personal protective equipment, and staff and residents struggling to maintain basic levels of disinfection.
Psychiatric centers across the state, but particularly in upstate facilities, experienced an uptick in covid cases at the end of the year, which have since fallen, according to multiple sources with knowledge of facilities. Without information on where and when the deaths occurred, which OMH would not provide, it is difficult to tell how the agency has fared in controlling the spread of the virus and whether it faced a second outbreak crisis this fall and winter or if cases were more spread out.
Union officials have criticized the agency for a lack of transparency around psychiatric hospitals. "From the start of the COVID-19 pandemic, New York State has been largely uncooperative about providing PEF with infection rates among patient and staff populations at in-patient facilities," Merrill wrote. "We have repeatedly asked for data to track trends and make recommendations about control measures, but we have not received it."
Psychiatric hospital residents and staff became eligible for vaccination early on, unlike the majority of prison and jail populations, which are still ineligible.
In December, the state began opening vaccines to psychiatric center patients and staff, which may account for a recent dip in positive cases. By February 23, roughly 3,140 patients had received a first dose of the vaccine, with 2,650 having received both doses, according to OMH. "As of February 20, we are now down to 13 active cases among our current census of 4462," Plastiras wrote to Gotham Gazette, down from 22 cases on February 10. "These numbers highlight the excellent job our facilities have done managing COVID cases and reducing the risk of exposure to the virus."
Roughly 7,000 of the 12,7000 employees at inpatient and residential psychiatric facilities had received their first shot by February 10, of which about 5,700 had received both shots, according to OMH.
"On a positive note, OMH ramped up a broad-based testing program fairly quickly and has administered the vaccine to staff," Merrill of PEF wrote. "They now have ample PPE and a reserve stockpile."
Most people in prison are still ineligible to receive vaccines. On February 5, the state opened eligibility to inmates over 65 and as of February 24 "more than 6,750 vaccinations have been administered," wrote Thomas Mailey, a DOCCS spokesperson, in an email. "We expect to complete the first vaccines for all interested staff and incarcerated individuals 65+ by the end of the week."
OMH would not say directly what metrics or tools the agency uses to evaluate outbreaks in its inpatient and residential facilities, which would provide insight into how officials view the problem and whether deaths could have been avoided.
Based on accounts from multiple sources, there appears to be wide variability in covid response among the psychiatric centers around the state. Lawyers and staff who work with patients expressed a feeling that the approach of staff on the ground, rather than a centralized methodology from OMH, made the difference in the severity of outbreaks in individual facilities.
"Even though its required to mask in a hospital," in some facilities, particularly upstate and in OMH's corrections-based operations, "they take minimal to no precautions," said Darlene Williams, an occupational therapist at New York State Psychiatric Institute in Washington Heights and a regional PEF coordinator, in a recent interview.
Unlike state prisons and nursing homes, there have been no oversight hearings around state psychiatric facilities in either of the State Legislature's mental health committees, and little attention anywhere else.
"I haven't been in any of the psychiatric facilities but...I'm sure they have utilized infection control practices in those places because we would have heard it on the news about transmissions within a facility and I have yet to hear it," said Assembly Member Aileen Gunther, who chairs the chamber's mental health committee, in an interview with Gotham Gazette. "I've heard some in some of the prisons but I really haven't heard anything and no one has contacted me about increased transmission of covid from the outside-in."
"There is always oversight. They have reporting mechanisms but I have not heard of anything about an increased rate of covid," Gunther added.
When presented with the latest figures on death and infection rates, Gunther said: "Not good. Not good. I haven't received that report myself."
"I don't know about the infection control practices in there but overall any death is tragic," she added.