Sederer said the theory has some merit, noting that people who experience psychosis are more likely to be violent if they’re using substances, and that particular substances such as K2 and alcohol can make people more prone to aggression.
In recent years, Metropolitan Hospital has closed its detox unit and integrated those services with inpatient care. NYC Health + Hospitals says this is an evidence-based model that has made people more likely to engage in addiction treatment. But some current and former Metropolitan staffers said mixing people who were coming down off substances into the traditional psych units was making the situation more volatile.
“Half the time you’re breaking up fights,” said the nurse who transferred to another public hospital.
That nurse and others who spoke to Gothamist also noted that Metropolitan recently began accepting psych patients directly from the Rikers Island jail complex without having the resources to do so.
“They’re used to that rough and tumble environment,” the nurse said of those coming from the notoriously violent jail.
Buhle of NYC Health + Hospitals said Metropolitan does not admit patients who are under arrest. But she added that “the hospital will provide immediate emergency care to anyone who needs it, and that includes patients in custody in need of emergency psychiatric evaluation.”
dr Katz acknowledged broader staffing issues in behavioral health during a recent panel on health care hosted by WNYC in June.
He said it’s getting harder to recruit psychiatrists and psychologists, in particular, because they can now more easily work in telehealth, which became increasingly popular during the pandemic.
“They’re doing their work by Zoom and suddenly the idea of being on a hospital ward is less appealing to them,” he said, adding that the need for psychiatric care has increased. “You have high demand and decreased ability for people to be able to respond to it.”
In response to questions about understaffing, Buhle said, “There is a nationwide shortage for behavioral health workers, and this affects everyone. However, all NYC Health + Hospitals facilities have the resources they need to deliver high-quality care for our patients and a safe environment for our patients and staff.”
Some current and former staffers also said they wanted hospital police to have a greater presence in the psychiatric units – something they reported seeing at other hospitals.
It’s a stance one former nurse said management had pushed back on, as it could agitate patients who have faced trauma because of their previous interactions with the police.
“While hospital police are onsite for security purposes, use of specially trained staff to both de-escalate and address behavioral health crises has improved therapeutic outcomes for patients and is considered as best practice to ensure safety of both patients and staff,” NYC Health + Hospitals said in a statement.