Building mental health capacity at NYC Health + Hospitals

NYC Health + Hospitals is the city’s largest provider of behavioral health services, accounting for nearly 60% of that care. In 2023, 76,000 patients relied on its emergency, inpatient and outpatient care. Omar Fattal started in his current role in early 2023, when mental health needs and challenges were on the rise across the five boroughs. He played a pivotal role in shaping a three-year plan announced in June that aims to strengthen and improve NYC Health + Hospitals’ mental health care. City & State spoke with Fattal about the plan and how it aligns with other local and state efforts. This interview was edited for length and clarity.

NYC Health + Hospitals recently released a plan to build inpatient capacity and strengthen the behavioral health workforce. What led to the creation of this three-year plan?

It coincided with me starting my new role for behavioral health at H+H, but also at the time we had noticed the surge in demand for services. There are multiple crises that hit at the same time. We have the loneliness epidemic, we have the opioid crisis, we have the surge in suicide in youth, and we have the mental health crisis post-COVID we all experienced. We, as the largest provider of behavioral health services and also serving the majority of people with complex needs, felt that we needed a plan to be able to meet that need.

The process that we followed was a multipronged approach, where we talked to the executives at the acute care facilities to listen to them. We also talked to our chiefs of psychiatry, and we also took into account the policies and priorities at the city and the state level. And most importantly is our patients, listening to our patients and understanding what they need. Some of the things that we understand for our patients is that they want access. They want to be able to be met where they are and they want flexibility. Those are the different factors that went into putting this plan together.

In what ways does this plan align with the state’s mental health investments, and also the city’s plan and priorities?

We’re very aligned. We have six priorities that are outlined in this blueprint, and the first one, is increasing inpatient capacity and restoring inpatient beds, which is something that we were successful in doing. As of January 2024, we were able to restore all the inpatient beds that were closed during COVID. That was a huge priority for the governor and for the state.

There are other priorities, including improving care management and wraparound services to make sure that patients not only have a plan for their care, but that they’re able to stick to that plan that we have made. We are going to be making a lot of investment in care management, in our care management workforce and care management workflows. As far as the city and the response to the crisis in (serious mental illness) and homelessness, we already have two extended care units that we run. These are inpatient units, but people can stay for up to 120 days. One of the things that we do is connect those patients to housing upon discharge. That has been a hugely helpful program for certain patients who need it. And we have plans to open a third extended care unit in the fall in Queens.

Obviously this is still in the early stages, but what are some of the priority areas for the upcoming year in terms of rolling out some of these proposals?

One approach that we’re having and are prioritizing is to go to people and meet them where they are in the community and we’re doing this in different ways. This includes opening up to 16 school-based mental health clinics. Out of those, we’ve opened seven so far. A big priority for us is to continue to roll those out, because we believe that that not only helps the kids who are in the school, but it helps the whole school community and it helps the families of these kids. We are also going to 55 domestic violence shelters across the city. Out of those, we are at 28 right now, so we’re making good progress. These are survivors of domestic violence who are in these shelters, and they might need mental health services, and there are so many barriers for them to come to us, so we are going to them.

There has been a workforce shortage nationwide, and we’ve been affected by this as well. And without workforce, we cannot really do anything. We’ve been very focused on our workforce in three ways. One is recruitment, two is training and professional development, and three is retention. We have the loan repayment program that has been very successful. We recently announced a $5 million gift that we’re very lucky to receive that will extend this program for two more years. This is a program that has two buckets. One is loan repayment grants that we give up to $75,000 to our staff toward the debt. But also there’s $1 million that’s focused on capacity-building and retention activities.