Most NYC public hospitals deny psych patients time outside, lawyers say

Published May 6, 2024 at 3:57 p.m. ET

Modified May 6, 2024 at 4:40 p.m. ET

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Published May 6, 2024 at 3:57 p.m. ET

Modified May 6, 2024 at 4:40 p.m. ET

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Many psychiatric patients at New York City’s public hospitals are cooped up during their stays with no opportunity to go outside, sometimes for weeks or months at a time, according to a new report by a state watchdog agency that monitors treatment of psychiatric patients and a nonprofit legal group.

No New York law or policy explicitly requires time outdoors for psychiatric patients — but the report’s authors’ note state law does have such a requirement for prisoners. They also maintain that even without an explicit policy or law to that effect, patients have a legal right to time outside.

The advocates are urging the city to adopt a policy that regularly provides psych patients access to fresh air — as long as it’s deemed clinically appropriate by their doctors.

But there are significant challenges to providing patients with regular outdoor access, including staffing and safety concerns, NYC Health + Hospitals said in a statement included in the report — a sentiment echoed by a former city official who told Gothamist giving patients access to the outdoors introduces liability issues.

“Even if they're kind of stable, you don't want them to go outside because if something bad happens, it's on you,” said Dr. Lloyd Sederer, an adjunct professor at Columbia’s Mailman School of Public Health who served as the city’s mental health commissioner under the Bloomberg administration and sat on the board of NYC Health + Hospitals during that time. “If somebody goes out and they hit somebody, or somebody goes out and they throw themselves in front of a car, it's on you.”

Lawyers from state watchdog agency Mental Hygiene Legal Services and nonprofit legal group Disability Rights Advocates investigated the policies and practices around outdoor recreation at every psychiatric unit at a hospital operated by NYC Health + Hospitals between May and December of last year. They found that seven of the system’s 11 hospitals deprive patients of all access to fresh air, regardless of their medical conditions or how long they’re being kept in the hospitals.

Only four hospitals in the system offer some level of regular access to the outdoors, according to the report: Jacobi hospital in the Bronx and Kings County, South Brooklyn and Woodhull hospitals in Brooklyn.

The median length of a psychiatric hospitalization in a city hospital is two weeks, according to NYC Health + Hospitals. But the lawyers spoke to some patients in the course of their investigation who had been hospitalized — and confined indoors — for months, or in rare cases, more than a year.

Some city hospitals deny patients outdoor access despite having written policies that recognize the benefits of fresh air, according to the findings.

NYC Health + Hospitals said in its response to the investigation that the health system “does not agree with the presentation of the law provided in the report,” but “is nonetheless strongly committed to caring for its patients in appropriate, therapeutically-supportive environments.” The health system did not respond to an additional request for comment Monday.

The lawyers found that children and adolescents, including those in Bellevue’s pediatric psych units, were among those being denied time outside.

Leonard Simmons, principal attorney at Mental Hygiene Legal Service, said some of the children interviewed by the nonprofits didn’t understand at first why they were being asked about going outside.

“Whenever we spoke to the children there about their experiences, the first thing they would say is, ‘Wait, does this mean I get to go out? Do I get to go outside?’” he said. “We would have to explain why we were talking to them about this. That was heartbreaking.”

According to the report, some adult patients who were interviewed at hospital psych units said they preferred being in prison or jail because they got more time outside.

The authors identified many states that have laws that address the issue. New Jersey, for instance, gives patients on psychiatric units the right to “be outdoors at regular and frequent intervals, in the absence of medical considerations,” while in Massachusetts, patients at facilities run by the state Department of Mental Health are entitled to “reasonable daily access” to the outdoors.

However, the authors of the report argue that existing laws are sufficient to make the practice of denying New York patients outdoor time illegal. They argue in the report that the current denial of fresh air constitutes discrimination against people with disabilities under the federal Americans with Disabilities Act. They also argue that it violates patients’ constitutional rights — specifically, the denial of liberty without due process — and the city’s Human Rights Law.

Simmons said his firm has been able to reach agreements on fresh air policies with hospitals in the past when raising this issue — including with Bellevue in the early 2000s. The report cites an agreement between Mental Health Legal Service and Bellevue that resulted in the hospital providing a log of patient access to its enclosed rooftop. The report says the rooftop was available to psychiatric patients for about 20 years, but does not cite a reason why it isn’t now.

Simmons said he wasn’t sure if access was cut off because of the pandemic or other concerns such as staffing, and it isn’t addressed in NYC Health + Hospitals’ response to the report.

If a new agreement with NYC Health + Hospitals can’t be reached, litigation is not off the table, the nonprofits said.

“We're prepared to use whatever avenues we need to use to get this resolved,” said Erin Gallagher, an attorney with Disability Rights Advocates.

The statement from NYC Health + Hospitals included in the report says it does not address the “many challenges to guaranteeing fresh air access to acute psychiatric inpatients.”

Providing outdoor access in facilities that don’t have secure outdoor space raises particular security concerns — including the possibility of a patient running away — and requires extensive staffing to ensure patient and staff safety, NYC Health + Hospitals said.

Sederer, the former mental health commissioner, said even if patients are being transported to a secure outdoor space, they may have to go through other hospital units, which could present additional safety and staffing challenges, Sederer said.

Last year, the International Journal of Environmental Research and Public Health published a review of studies from the U.S. and other countries on the effects of outdoor access on psychiatric patients. It found that being in nature helped make patients happier and more relaxed, but that it was important to have a “safe and supportive environment.”

Sederer argued that the benefits are not as great in an urban setting and are not worth the risk. “Nature has been proven to be good for a variety of our hormones and neurotransmitters,” he said. “But that's like a walk in the woods. That's not a walk up First Avenue.”

Still, the authors of the report emphasized there are some facilities, including at NYC Health + Hospitals, that provide regular outdoor access, proving that it can be done.

This story has been updated to correctly describe Mental Hygiene Legal Services as a state watchdog agency that monitors treatment of psychiatric patients.

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Caroline Lewis is on the health care beat for WNYC and Gothamist — and also covers cannabis, both with an eye towards equity and accountability. She was previously a health care reporter for Crain’s New York Business. Lewis has a degree from the CUNY Graduate School of Journalism and is a native New Yorker, although she has left occasionally. She did a Fulbright in Chile in 2011 and is fluent in Spanish. She now resides in Brooklyn.

Gothamist is funded by sponsors and member donations

Gothamist is funded by sponsors and member donations

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