Manhattan Psychiatric Center, Wards Island (photo: @nicknormal via Flickr)

Ten people have died of coronavirus and another 193 have tested positive among the nearly 3,500 residents living in state-run inpatient psychiatric facilities, according to officials, making them one of the hardest hit institutional settings per capita in New York State. Another 283 staff that work at the state's 23 centers have tested positive for COVID-19, which has killed well over 13,000 people across the state.

After inquiries, the information was provided to Gotham Gazette on April 14 by the state Office of Mental Health (OMH), which runs the 23 sites. On April 17, just before publication of this story, OMH said it did not have any new numbers to share.

The centers are home to people with the most severe mental illnesses, who cannot manage their symptoms alone, and are proving to be particularly fertile settings for the virus' spread. They are experiencing exacerbated risks, similar to other congregate settings like jails and nursing homes, which have thus far received virtually all the attention.

Testimony from psychiatric center staff, labor union leaders, and an elected official with oversight of the centers paints a picture of sites where patients continue to gather in groups and staff lack the personal protective supplies needed to limit exposure to the coronavirus, where even basic hygiene and space to quarantine positive cases is lacking. Experts are concerned that the potential for violence among residents, already high, is heightened as they respond to life under the austere conditions of a societal lockdown.

Officials at OMH say the agency has taken precautions to protect residents and staff from the virus, but frontline workers say they have seen few changes on the ground. Union officials representing the workers said they are considering legal action to protect their members.

"There is a degree of fear and uncertainty amongst our workforce as well as, I think, amongst the patients," said Randi DiAntonio, vice president of the Public Employees Federation (PEF), a union representing thousands of healthcare workers in inpatient facilities. "We want to provide the services but we want to be safe and we want the right equipment. We don't want to be going into places when it's not absolutely necessary and critical and we want to be heard."

OMH did not provide information on coronavirus deaths among its staff. In response to an inquiry about a tip that an employee at Manhattan Psychiatric Center had died of COVID-19, spokesperson James Plastiras did not deny the fatality, but wrote: “OMH is prohibited by State and Federal privacy laws from providing protected health information.”

When asked, OMH also did not provide a breakdown of the patient deaths and positive cases by facility or county.

Based on confirmed cases, the psychiatric center coronavirus figures represent an infection rate twice that of nursing homes, and a death rate four times greater than in New York City jails, two settings that have been the focus of significant public attention, as their populations live in crowded spaces, sometimes against their will, and are often more likely to be killed by the virus.

Governor Andrew Cuomo and Mayor Bill de Blasio have each, in the face of public pressure, supported to varying degrees reducing the populations in other congregate living sites and taking stricter precautions to protect the people living in them. Cuomo has faced intense pressure to release more prisoners using his powers of clemency.

But staff and union leaders have reported "business as usual" in psychiatric centers with group therapy sessions of up to 20 people and residents gathering at mealtime in a single large dining room. Health-care workers often see patients with no protective face coverings as they continue to provide support for dozens of residents in shifts of eight to twelve hours.

"In most of the facilities patients were sitting right on top of each other," said Darlene Williams, an occupational therapist at New York State Psychiatric Institute in Washington Heights, of the group sessions that continue to meet during the pandemic. She is a 40-year veteran of the state's inpatient centers and a regional coordinator for PEF members in downstate facilities, including some of the largest in the state, like Manhattan, Bronx, and Kingsboro Psychiatric Centers.

"Somebody is going to have to die and then maybe a change will happen," she said. "I had one co-worker just tell me three days ago, 'Darlene, I don't want to die because I had to come into work.'"

In response to the outbreak, Plastiras said OMH has taken steps to ensure the safety of residents and staff, including restricting visitors except in certain cases for children, and during discharge. The agency is no longer congregating people in groups and that clinicians and staff are providing services via video and phone whenever possible, he wrote in an email to Gotham Gazette.

"OMH is taking every precaution to protect our staff and the people we serve while we continue to provide essential behavioral health services,” he wrote.

But Williams says at the Psychiatric Institute, which is attached to Columbia Presyterian, group sessions have only been reduced to no more than five patients, and that at other larger institutions in the city the sessions continue without distancing of at least six feet between individuals, as recommended by public health officials. OMH may issue directives, she said, "but that information doesn't trickle down all the way into facilities."

Protective Precautions
Workers in OMH facilities are expressing concern that they have not been given the proper protective equipment to keep themselves and the residents safe. In emails among employees at several psychiatric centers reviewed by Gotham Gazette, workers shared with one another heartbreak and extreme duress at having to work with patients who are ill and dying without personal protection.

"We were begging, begging OMH to make sure that we could wear surgical masks because we were still so close working together, employees along with patients," Williams said. She added, if it was not for Wednesday's executive order requiring masks in public at all times, "we still wouldn't be wearing masks."

In an April 7 letter to OMH Commissioner Ann Marie Sullivan, State Senator David Carlucci, a Rockland County Democrat and chair of the Senate’s mental health committee, raised alarms about conditions at an inpatient facility in Sing Sing Prison jointly operated by OMH and the state Department of Corrections and Community Supervision.

"[T]he deteriorated mental health of many of the patients in the program have prevented them from abiding with recommended hygiene practices…,” he wrote. “Despite these concerns, the Sing Sing ICP has not been provided with any hand sanitizers, cleaners, nor protective supplies."

Plastiras said OMH is working to procure and distribute personal protective equipment from available sources in accordance with CDC and state Department of Health guidance.

Staff aren't the only people in need of protective supplies, according to Williams. "The patients are also frightened because a lot of them this is their home and we're coming in and bringing in the virus. A lot of the patients are afraid, 'what will happen to me if I do get the virus?...where am I going, who is going to look after me?'" she said.

The residents of state psychiatric centers have substantial mental health factors that make it difficult for them to live on their own and meet their own daily needs. Many suffer from severe depression, delusions, bipolar disorder, and schizophrenia.

Patients may check into an inpatient facility voluntarily, but often people wind up admitted against their will after being seen in a general population hospital or other clinical setting and deemed by psychiatric doctors to be a danger to themselves or others.

Like other congregate living situations, state psychiatric centers are susceptible to unique consequences of the current coronavirus crisis. In addition to needing round-the-clock staffing, treatment for residents typically requires regular therapy, medication, and evaluation, as well as the structure and routine of life in an institution. Patients frequently have additional medical complexities that may make them more susceptible to the virus and patients may not be inclined to adhere to public safety guidelines.

"Our members, they care about this work and they want to do what's right for the patients,” said DiAntonio, the vice president of PEF. “And we recognize that there is a delicate balance between taking care of people that have high needs and that are going through real disruption, but also keeping people safe."

"One of the biggest issues we had with OMH is they made everybody ‘essential’ and refused to allow any remote working," DiAntonio told Gotham Gazette. "I've worked in facilities, I get that there are things that are hard to do from a distance. But again we are talking about a temporary situation that really may make a difference between life and death."

Plastiras said OMH is no longer holding non-essential trainings, though PEF leaders say they are still taking place. Workers are also afraid of what they have described as substandard quarantining procedures for patients who have tested positive for COVID-19.

Psychiatric wards in the past had isolation rooms for patients with infectious diseases but over the years facility budgets have been reduced and the quarantine rooms have disappeared, according to Williams, the occupational therapist at the Psychiatric Institute in Washington Heights. When a patient -- typically two to a room -- tests positive, their roommate is removed, she said, but the air is still circulated throughout the entire unit.

The union has struggled to get information on positive cases and deaths of patients and its members. "They are not openly sharing that. We finally were able to get them to make sure quarantine notices were being sent to employees if a home or location was under quarantine or there was a suspected case but for the longest time we were not getting that notice. They just started this week," DiAntonio said.

As the Times Union first reported, the New York State Correctional Officers & Police Benevolent Association has filed a complaint with the state and plans to go to court over conditions for its members working in the Central New York Psychiatric Center.

"The health and safety of our members is our number one priority. We are considering any and all actions, including legal action if necessary, to ensure their safety," wrote a PEF spokesperson, in an email to Gotham Gazette.

More Like a Hospital Than a Nursing Home
Reports from several sources indicate public health officials have treated OMH facilities, themselves hotbeds of coronavirus infection, more like overflow for overburdened city hospitals than like the homes of vulnerable populations.

According to DiAntonio, they have become overcrowded in recent weeks as hospital psychiatric units seeking to free up precious bed space for COVID-19 cases transfer to the facilities patients who cannot be discharged on their own or to a caregiver.

The Office of Mental Health did not respond to inquiries about how much the inpatient population has grown since the coronavirus outbreak began, but Plastiras said that 65 new employees had been hired in the last three weeks. The screening process for patient admissions has been "enhanced," according to Plastiras, but he did not elaborate on what the new protocol consists of.

The state Department of Health, which is coordinating the state's hospital system, did not directly respond to questions about patient transfers to OMH facilities, but a spokesperson for New York City Health + Hospitals, the city's public hospital system, confirmed that psychiatric patients that were not ready to be discharged were transferred to state psychiatric centers.

In a March 30 letter, PEF President Wayne Spence wrote to OMH Commissioner Sullivan imploring the agency to adopt a quarantine plan for patients transferred from coronavirus "hotspots" in hospitals to psychiatric centers, including isolation for the 14 days estimated to be the virus' incubation period. PEF representatives say quarantining protocols still do not include a full 14-day isolation.

On April 2, Dr. Brian Belfi, executive director of Kirby Forensic Psychiatric Center on Ward's Island, sent an email to staff saying the center would soon be taking admissions from female units on Rikers Island. "These are inmates that would have historically gone to Elmhurst which is overburdened with COVID," read the email, which was reviewed by Gotham Gazette.

Williams said there was a push by OMH to discharge patients from psychiatric centers but it was largely unsuccessful. "The movement of patients was a lot easier before the pandemic," she added. "Admissions are still happening but patients aren't going anywhere."

Meanwhile, a five-story addition to South Beach Psychiatric Center on Long Island, which was set to open this month to replace an old building damaged by Superstorm Sandy, is now being used to treat coronavirus patients and will no longer house psychiatric residents, according to Plastiras.

Element of Violence
It isn't all business as usual in the pandemic. Major disruptions in residents' routines are taking place as family visitations are cut off, favorite staff members fall ill, and off-campus movement is restricted. "It's sadder on our unit than it used to be. For a person who has been there for so many years and has seen so many things -- I've never seen anything this depressing," Williams said.

The limitations mean some required therapy sessions or family visits cannot take place, which for some is a barrier to being discharged. "We have some places where people are pissed because ‘I'm not getting out as quick’," she said.

OMH has one of the highest rates of workplace violence of any government agency. According to a state Department of Civil Service report, "patient restraint" is a leading cause of workers' compensation incidents, accounting for roughly 9 percent of the total in fiscal year 2019. The report says the job titles with the three highest workplace incident rates were Correction Officer, Direct Support Assistant, and Mental Health Therapy Aide. The two facilities with over 500 employees that had the highest rates were Mid-Hudson Psychiatric Institute and Bedford Hills Correctional Facility.

Williams says physical altercations are not uncommon in inpatient psychiatric settings, but the current strain on daily life may push it to extremes. "It puts staff and our patients at risk because now violent outbursts can happen" more easily, she said.

"I think that's also probably one of the reasons that OMH is so resistant to changing things that might keep employees and patients safer because they do worry that too many changes will create more problems," said DiAntonio, the union vice president. "However...I think there are a lot of things that are in between having no services and having services provided in an alternative way."

"Radio Silence"
Inpatient psychiatric centers have gone entirely unmentioned in the daily briefings held by Governor Cuomo and Mayor de Blasio, where they’ve fielded many questions about other vulnerable populations, including those in nursing homes and correctional facilities.

"In the realm of this specific branch of healthcare delivery it just feels like there's radio silence from providers, from the press, and just I think the general public awareness," said Dr. Julia Eilenberg, a psychiatrist who runs a private practice in Rhinebeck, New York.

"I have a patient who I just spoke to today who is profoundly depressed," she said. "And I'm trying so hard to keep her from needing to be admitted somewhere because I just don't know enough about where it would be safe from an infectious disease standpoint for her to go."