The majority of the public mental health system is in voluntaryoutpatient programs, the largest and most used being clinic treatment services.[2]Inpatient care is provided mainly by homeless shelters, supplemented by the general hospital network, jails, and state psychiatric centers.[3] 45–57% of New York mental health consumers useMedicaid, which is the largest single source of funding.[4]
Morepsychiatric emergencies are being pushed intoemergency departments where many patients are "boarded" (held after a decision to admit/transfer) for hours to days.[5] Comprehensive psychiatric emergency programs (CPEPs) are meant to provide a single entry point for psychiatric emergencies, including crisis intervention in an emergency room setting, mobile crisis outreach, crisis residence beds, extended observation beds (up to 72 hours), and triage/referral.[6][7]
As of February 2025[update], OMH reported 9,251 inpatient psychiatric beds statewide—including 4,902 beds in general hospitals—amid a ~10.5% decline in total capacity since 2014.[8]
OMH regulates and licenses private mental health services, such private psychiatric centers, clinics, and treatment facilities, including those in hospitals and schools.[citation needed] OMH also regulatesresidential treatment facilities for children and youth operated by nonprofit corporations.[9][10] Programs include inpatient, outpatient, partial hospitalization, day care, emergency, and rehabilitative treatments and services.[11]
All mental healthclinics must obtain an operating certificate from OMH to legally operate.[12][13] OMH uses acertificate of need (CON) process for prior review of proposed programs, and inspects and certifies existing programs on a regular basis.[14]
The agency employs security officers to maintain order and protect patients, grounds, and buildings.[15] These officers have limited peace officer authority while on duty. OMH Special Officers are prohibited by state law from carrying firearms. All applicants must attend a training program within five weeks of hire covering fire prevention, basic criminal law, first aid and CPR, investigations, proper use of restraints, and other required training.
The New York State Incident Management and Reporting System (NIMRS) is used by providers for reportable incidents, and the Justice Center for the Protection of People with Special Needs has the responsibility to track, prevent, investigate, and prosecute reports of abuse and neglect of vulnerable persons.[16]
New York excludes most inpatient psychiatric hospital services fromMedicaid managed care plan coverage, with coverage instead directed to community and ambulatory programs such as ACT, MHOTRS, CPEP (with limited observation beds), CDT, Partial Hospitalization, PROS, and crisis services.[17] New York could, but does not, because the United States will not pay for it.[18] Care coverage extends only to token short-term substitutes like CPEP extended observation beds, capped at 72 hours, and to outpatient or partial services.
The Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) is aHIPAA-compliantweb application for using Medicaidclaims and health data to support clinical decision making, care coordination, and quality improvement.[22]
In theState Legislature, the SenateMental Health and AssemblyMental Health standing committees conductlegislative oversight, budget advocacy, and otherwise reportbills on the services, care, treatment, and advocacy for individuals with various disabilities,[26][27] while the SenateHealth and AssemblyHealth standing committees focus on healthcare facilities operations and services delivery more generally.[28][29]
In theState Judiciary, theMental Hygiene Legal Service (MHLS) provides legal representation, advice, and assistance to mentally disabled persons under the care or jurisdiction of state-operated or licensed facilities concerning their admission, retention, care, or treatment.[30][31][32]
In 1836–1843 theUtica State Hospital was established, and in 1865–1869 theWillard State Hospital was established to relieve Utica of the incurably insane and relieve thealmshouses of mentally illpaupers.[33][34][35][36] Throughout the late 18th and most of the 19th centuries, families and county almshouses provided care to the mentally disabled, but in 1890 the State Care Act made the state responsible for the pauper insane.[37][36] In 1909 the Insanity Law was consolidated in chapter 27 of theConsolidated Laws of New York.[38]
The Department of Mental Hygiene was established in 1926–1927 as part of a restructuring of the New York state government, and was given responsibility for people diagnosed withmental retardation,mental illness orepilepsy.[39][40][41] Dr. Frederick W. Parsons was appointed the first department commissioner in January, 1927.[42] He was replaced by Dr. William J. Tiffany in 1937, who then resigned in 1943 over an investigation into handling of an outbreak ofamoebic dysentery atCreedmoor State Hospital.[43] By 1950, the department had grown into the largest agency of the New York state government, with more than 24,000 employees and an operating cost exceeding a third of the state budget.[44] The state acceded to the Interstate Compact on Mental Health in 1956.[45] In 1964 the law oninvoluntary commitment was amended with the express purpose of increasing patients' rights.[46][47][48] In 1972 the Mental Hygiene Law was revised and reenacted.[49]
In 1977–1978, the Department of Mental Hygiene was reorganized into the autonomous Office of Mental Health (OMH),Office of Alcoholism and Substance Abuse, and theOffice of Mental Retardation and Developmental Disabilities.[50][41] The three commissioners serve on a council that performs inter-office coordination.[41][50] In 1989, comprehensive psychiatric emergency programs (CPEPs), hospital-based crisis centers with observation beds, outreach, and referral services, were authorized to relieve overcrowdedemergency departments.[51][6] In 2012, the Protection of People with Special Needs Act (PPSNA) established the Justice Center for the Protection of People with Special Needs to create uniform safeguards for people with special needs served in residential facilities and day programs by provider agencies that are operated, licensed, or certified by a multitude of state agencies, including the OMH, OASAS, and OPWDD.[52][53]
^Gorman, Carolyn D. (14 August 2025)."U.S. Psychiatric Hospitals Under Medicaid's Institutions for Mental Diseases (IMD) Exclusion".Manhattan Institute for Policy Research. Retrieved11 September 2025.Residential treatment facilities that treat both mental-health and substance-abuse disorders—often a step down from more intensive hospital care—are also typically considered IMDs. … States can elect to cover IMD services under Medicaid, but the state is responsible for the full cost of that care—unlike in virtually all other settings, in which the federal government covers at least half (and as much as 83%[13]) of the cost.
"The Policy Revolution, 1945–1965".Mental Health in New York State, 1945–1998. New York State Archives, New York State Education Department. Archived fromthe original on 2011-05-25. Retrieved2011-05-19.
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