Andrew Cuomo’s record on mental health is a significant point of contention as he seeks the New York mayoral seat, particularly given his previous tenure as governor. Just one month before the Democratic primary, Cuomo maintains a leading position in the polls, yet his past actions regarding mental healthcare have become a central criticism. During his time as governor, Cuomo implemented the ‘Transformation Plan’ aimed at reducing the use of inpatient psychiatric treatment. This involved slashing hundreds of beds from the state psychiatric hospital system, decreasing the supply from approximately 4,000 to around 90,000 since the mid-1950s – a 19% reduction statewide and 17% in New York City. Cuomo justified these cuts by arguing they would lead to more cost-effective, community-based care. However, the reality was far different.
The city Department of Homeless Services saw its mental health shelter budget increase by over 50% in the first four years, alongside a corresponding rise in ‘emotionally disturbed person’ calls for police service and a 16.5% increase in seriously mentally ill inmates within city jails. This occurred partly due to Mayor Bill de Blasio’s ‘Thrive NYC’ plan, which was perceived as having a negative impact on mental health, and because Cuomo’s cuts were spread across the system, making them less immediately apparent. The situation highlighted a critical disconnect between the stated goal of shifting resources to community-based care and the actual outcomes.
As he campaigns for mayor, Cuomo continues to defend his bed cuts, arguing that shifting resources to community-based care is a more efficient approach. This ‘more mental health for all’ strategy, also central to Thrive NYC, is not the optimal solution. New York’s crisis of untreated serious mental illness demands concentrated resources, not diffused ones. The current system struggles to accommodate voluntary hospitalizations, let alone involuntary admissions. Cuomo now recognizes the benefit of inpatient psychiatric care, advocating for adding psych beds in city hospitals, particularly for ‘forensic’ cases involved in the criminal justice system and consistent enforcement of involuntary community law. This shift is partly due to Governor Kathy Hochul, who has restored more than 300 psych beds Cuomo cut, and a supportive political environment. This acknowledgement represents a crucial turning point in Cuomo's stance.
Despite this, Cuomo’s past record remains a major disadvantage. The city relies on the state to address the crisis. The question is whether Cuomo can effectively communicate this need, particularly if he approaches Albany seeking assistance to rectify a mental health crisis worsened by his own policies – a scenario that could be perceived as opportunistic. The Adams administration, despite its flaws, has made promising strides, focusing attention and resources on serious mental illness. Cuomo should pledge continuity with Adams on this issue, recognizing the need to address the crisis effectively. Ultimately, addressing New York’s mental health crisis requires a concerted, state-led effort, and Cuomo’s past actions cast a shadow over his current proposals.
Eide is a senior fellow at the Manhattan Institute and a 2024–25 public scholar at City College’s Moynihan Center. Sandorf is the president of the Charles H. Revson Foundation. The views represented are solely those of the authors.
