Since Hurricane Sandy, only one psychiatric center in lower Manhattan with a comprehensive emergency room remains open: Beth Israel Medical Center. The storm battered Bellevue Hospital Center, the city's largest psychiatric facility, NYU Langone Medical Center and the Veteran Affairs Hospital. Many adult homes, used as a last resort for mentally ill individuals, were flooded. At the same time, the hurricane caused many mentally ill people to lose their housing or their outpatient facilities to close, losing them to follow-up. As a result, in an already strained mental health care system, many people are falling through the cracks.

The New York Times reports how the strained Beth Israel Medical Center has reported a 69 percent spike in psychiatric cases last month compared to November 2011. The hospital could only admit 1 in 4 cases, down from 1 in 3, and diverted ambulances 15 times to other hospitals. In one case, a woman who suffered from paranoid delusions and who attacked her neighbor with a meat cleaver was sent to the facility. She was released four hours later. It took four more days for her to be admitted into an inpatient facility for two weeks, at the behest of her psychiatrist and caseworker.

Though most of the physical damage from the storm has already been assessed and, in all but the worst cases, repaired, the psychiatric toll that the storm has taken will likely remain for months, if not years, to come. In the confusion while being sent to other hospitals, some patients at in-patient facilities lost contact with their caseworkers and families. Many disabled people lost access to psychiatric medications that kept their symptoms at bay. Those lucky enough to still have access to their medications are often in danger of relapsing. Dr. Andrew Kolodny, the psychiatry chairman at Maimonides Medical Center in Brooklyn, said that sleeping in a gym with 100 other people can cause individuals to become paranoid.

"The dominoes start falling backwards," Yves Ades, a psychologist and the chief operating officer of Services for the Underserved, which runs 36 supportive housing developments for people suffering from mental illness and which lost 71 units from the storm, said to the paper. "It was always a strained system, but it was functioning. Now, it's breaking."

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