Hochul expands inpatient psychiatric capacity as New York reconsiders decades of deinstitutionalization

New York Gov. Kathy Hochul is moving to reverse a decades long policy trend by expanding inpatient psychiatric capacity, a push officials say will reduce crisis situations in streets, shelters and jails.

A Manhattan Institute report traces the shift to the mid 20th century, noting that closing large state psychiatric hospitals in the 1950s and 60s and the steady reduction of inpatient beds pushed many seriously ill people into other settings. The report uses the term transinstitutionalization to describe how individuals with serious mental illness moved from hospitals to prisons and jails, as well as public spaces and shelters. The analysis argues that community based treatment and supportive housing have had many years to prove their value, but they have not by themselves solved the problem in New York.

Hochul's plan to add hundreds of hospital beds is described by her office as a key part of reversing the slide. State capacity for mental health inpatient care remains below the level it had in 2014, when bed reductions accelerated under the previous administration. The administration emphasizes that the expansion is part of a broader effort that includes stabilization services and stronger coordination with providers to speed admissions and planned discharges.

Advocates say inpatient care remains the most effective option for the seriously mentally ill and can prevent crises that lead to homelessness or cycles of incarceration. But experts caution that simply increasing beds will not fix the problem without sustained investment in ongoing treatment, housing options, and follow up after hospital care. The policy debate in New York has long intertwined health and public safety concerns, with supporters calling the shift a humane response to a stubborn crisis.

Roughly 20 percent of detainees at Rikers Island are seriously mentally ill, a statistic cited to illustrate how gaps in treatment can translate into public safety challenges. Critics warn that without adequate community based services and housing, a bed expansion on its own risks producing short term relief rather than lasting change.

As capacity shifts, officials emphasize a combination approach that emphasizes beds while bolstering community based services and housing, arguing that no single element will solve the crisis. The development signals a potential shift in New York policy toward treating mental illness as a public health issue rather than a solely criminal justice matter, even as the health and housing systems work to keep pace with demand.