Good afternoon, Chair Narcisse and thank you for holding this hearing today. I am here to say that we must invest in our public hospitals in order to maintain appropriate staffing levels, robust programs addressing maternal health and mental health, and high-quality care. Health equity in our hospitals is ensuring that patients receive the quality care and attention that they deserve. We applaud this administration for listening to our calls last fiscal year to successfully give our public sector nurses a contract that includes pay parity and safe staffing for critical care patients. This is only the first step in ensuring that our most vulnerable New Yorkers get the care they need.
The Preliminary Budget includes $3.06 billion funding for H+H in Fiscal 2025, of which $2.97 billion is City funds. Although this investment is 68% greater than the FY24 adopted budget, it still puts H+H at an operating deficit of $51 million for FY25, which will progressively decrease between FY26 and FY28 should funding levels remain the same. (Of this investment, however, it must be noted that 59% is dedicated to asylum-seeker related services.) The most concerning cuts are those that impact the mental health of some of our most vulnerable New Yorkers. Compared to the FY24 budget at adoption, this includes:
- A decrease of $5.7 million, or 31.3%, in the B-HEARD program
- A decrease of $1.3 million, or 11% in the Mental Health Service Corps
B-HEARD has shown progressive improvements in staffing and responsiveness, at 25% during Q3 & Q4 of 2023 compared to 15% of total 911 call responses during the first two quarters of FY23. It has also increased the number of calls eligible for B-HEARD response, with 42% being connected to community-based behavioral health services.1 Up to half of people who become victims of police violence have a mental health disability,2 but 911 has become one of the main options for helping people in mental health crisis. Police officers are not trained social workers or counselors and lack comprehensive training to address situations of mental health crisis, often leading to tragic bodily harm and death. Individuals with untreated mental health illness are 16 times more likely to be killed during a police encounter compared to others who encounter police for other issues.3 Unfortunately, individuals who are Black and Latinx make up a disproportionate percentage of those who are unjustly killed.4 Programs like B-HEARD help triage care to mental health professionals as first responders to ensure that New Yorkers suffering from mental health crisis are treated with a trauma-informed and cultural-competent approach, preventing avoidable deaths. A divestment in this program could impact continued program expansion.
Of similar concern is the divestment in the Mental Health Service Corps, a workforce development program that integrates behavioral health into a variety of settings including primary care, women’s health, pediatrics, and other non-behavioral health care settings, which may impact the number of providers in the program. Since its launch in 2020, the program has provided over 2,700 New Yorkers with mental health services at 48 clinical sites in the Health + Hospitals system, including 76% located within areas with federally-designated mental health professional shortages.5 My office’s Brooklyn Comprehensive Plan shows the high rates poor mental health among communities of color, with a focus in South Williamsburg, Brownsville, East New York, Sunset Park, Borough Park and Coney Island. Those who need these services are vulnerable and underserved populations, including those identifying as LGTQIA+, domestic violence survivors, hate crime survivors, asylum seekers and recent immigrants, veterans, and people with disabilities, among others. In communities with the lowest connection to mental health care, only 20% of those with mental health needs receive treatment.6 Mental Health Corps services become critical lifelines for residents who cannot afford mental health care.
Cuts to these two programs will only contribute to the cycle of incarceration because of mental illness, increasing correctional health care costs. The National Alliance on Mental Illness estimates that between 25% and 40% of all mentally-ill Americans will be jailed or incarcerated at some point in their lives, compared to 6.6% of the general population.7
The anticipated operating losses will also result in lost opportunities for investments that are critical to improving maternal health care.
Currently, New York City faces one of the most severe maternal mortality crises, with Brooklyn having the highest rates. According to DOHMH’s 2011-2015 Maternal Mortality Report, Black and Brown birthing people are dying at eight times the rate of their White counterparts. When I was elected, I promised that I would make Brooklyn the safest place to give birth. During my first year, I invested my entire capital budget of $45 million to three Brooklyn H+H hospitals – Woodhull, South Brooklyn, and Kings County – so that they could improve their NICU and Mother-Baby Units and build state-of-the-art birthing centers. I hope that these capital investments will allow our hospitals to in turn, invest in its personnel.
Of these personnel improvements, I want to call attention to our midwifery workforce. Midwives are critical to reducing maternal death rates. Midwives work with patients throughout their prenatal and postpartum experience to offer clinical assessments, guidance, and emotional support. However, perhaps most important, they center a philosophy of care built on a trusting partnership between midwife and the childbearing person, prioritizing their autonomy, self-determination, and satisfaction, and ensuring informed decision-making in a safe and trusting environment. In fact, my wife had two successful births at Woodhull Hospital in large part due to the care of midwives. According to a NIH 2023 study, the inclusion of midwives as part of the birthing team is associated with “fewer emergency Caesarean sections, higher rates of vaginal births, lower rates of episiotomies, and shorter neonatal stays in intensive care units.” If appropriately integrated into the healthcare delivery system, midwives could help avert 41% of maternal deaths, 39% of neonatal deaths and 26% of stillbirths; even a moderate increase in staffing can avert deaths by 22%.8
When I started my fatherhood journey, I was disappointed to learn that of our three Brooklyn H+H hospitals, Woodhull is the only Brooklyn H+H hospital that has centered midwives in obstetric care for our birthing people. In 2021, 72.4% of its births were attended to by a licensed midwife, while this number was disproportionately lower at Kings County Hospital and South Brooklyn Health Hospital at 7.5% and 12.2%, respectively.2 In the same year, the cesarean birth rate in Woodhull was 23.3%, while it was 34.3% in Kings County and 34% in South Brooklyn Health.9 I was further surprised to learn that at Kings and South Brooklyn Health hospitals, midwives were not always playing a leadership role, and some Birthing Suites housed only one midwife.
Midwives need to be a part of a patient’s care journey from Day One. We need a collaborative model where midwifery care is strong, autonomous and integrated part of perinatal care and hold leadership roles. This requires a significant investment to ensure that we pay obstetricians and midwives appropriately, so we are adequately staffed to allow for a partnership model to thrive.
I am deeply concerned about the implications of this budget on state of care among our public hospitals. New York State Department of Health’s January 2024 Study on the Healthcare System of Inequities and Perinatal Access demonstrates that a significant proportion of Brooklyn residents, especially those with commercial insurance are electing to access care outside of Brooklyn. Those who do elect to stay in Brooklyn for perinatal care are not going to our public hospitals. The majority of births in Brooklyn are happening at private institutions – 29% in Maimonides, 19% in NYU Langone BK, and 17% at NewYork-Presbyterian/Methodist. There is no reason Brooklyn’s public hospitals should fall behind and it must start from proper investments in fair wages and adequate staffing for maternal and mental health.
Thank you again for the opportunity to testify today. I look forward to working with the Council throughout the budget process to ensure that our public hospitals have the support they need to provide equitable and quality care.
