Montefiore children’s hospital seeks to open new psychiatry unit

Montefiore Medical Center is seeking approval from the New York State Department of Health to create an $8.9 million mental health center at its children’s hospital, according to plans filed with the state.

The project, which requires full review from the state health department, would establish a 21-bed child and adolescent psychiatry unit at an 18,300-square-foot space leased at the New York City Children’s Center (NYCCC)–Bronx Campus. Hospital officials and elected leaders touted the project as a necessity in an already underserved area.

“Mental and behavioral health needs are at an all-time high among our Bronx children, and we have a moral obligation to do everything in our power to create conditions in which they can thrive and live healthy lives,” New York State Assembly Speaker Carl Heastie, who has helped allocate about $5.7 million in state funding for the project, said in a statement.

The proposed facility would serve kids ages five to 17 who are deemed a danger to themselves or others and are not functioning well in the community, according to the application’s health equity impact assessment. The projected average length of stay is 18 days. The plans also include therapeutic and social spaces, classrooms, art therapy studios, and other areas to aid treatment, per the assessment.

Of the approximately 300,000 children in the same age range who live in the Bronx, Montefiore officials said 20% have a mental health disorder and 10% are considered to have “serious emotional disturbances.” Often, these children exhibit “serious behavioral conditions, including severe depression, anxiety, trauma, suicidal thoughts, psychosis, and other acute psychiatric conditions.”

Yet when these kids seek inpatient acute psychiatric care through Montefiore’s emergency department, they’re often required to wait for an available bed, which can be far from their community and requires travel, per Montefiore. In 2023, the average wait time for inpatient psychiatric services was 48.2 hours, with 16 children a month seeking a bed, according to the application’s health equity impact assessment.

The children are often directed to Four Winds and St. Vincent’s hospitals in Westchester, New York, according to the application. Though it takes under an hour to drive to those hospitals from Montefiore, transportation access can be a burden, especially for those who don’t own a car in the city.

The lack of psychiatric beds isn’t just an issue in the Bronx. A recent JAMA study found that pediatric emergency room visits for mental health crises increased by 43% between 2015 and 2020, rising 8% per year on average.

Still, the borough is a designated mental health care professional shortage area, per Montefiore, meaning the population-to-provider ratio is at least 30,000 residents to one mental health worker, according to KFF.

The lack of mental health professionals is also a health equity issue in the Bronx, which is largely populated by Black (44.3%) and Latino (56.6%) residents, per Census data from July 2023. Both populations experience worse health outcomes compared to their white counterparts nationally, including non-white children, who are more likely to receive lower-quality healthcare, according to a recent study.

Pediatric patients in the Bronx are also often eligible for or receive public health benefits, lack third-party health coverage, or identify as queer or victims of trafficking and/or domestic violence. Many are also experiencing homelessness or have had contact with the juvenile justice system, according to the health equity impact assessment.

Montefiore officials anticipate that the psychiatric unit will provide care for nearly 350 discharges in its first year and reach 364 discharges by its third year of operations.

The state health department confirmed it has received the application, though spokesperson Danielle De Souza said the agency can't comment on applications under review.