People with Mental Illnesses Often Rely on Emergency Care

Researchers at UNH’s Disability Institute analyzed hospital data over 10 years to look at state-wide trends in demand for mental health and substance abuse services.

Peter Antal is a UNH professor and lead author of the report.

He said that emergency room visits to hospitals for mental health and substance abuse rose by nearly 40% over a decade.

“What we found is that there are certain consistent clusters around the state where residents of certain towns and groups of towns are far more likely than others to seek hospital level care.”

Those clusters include several towns in the North Country, Keene, Rochester, and towns in the Lakes Region.

And the data also revealed a common pattern of treatment.
Many patients with mental illnesses came back to the ER again and again.

Mike Cohen, the executive director at National Alliance on Mental Illness in New Hampshire, says that he often hears about that revolving door from people seeking treatment.

“The number of times I have heard someone call me and said to me my adult son has just gotten out of hospital this is the second time and they can’t get the treatment they need in the community. And I’m afraid they’re going to end up in the hospital again.”

Those episodic treatments are expensive.

Hospital charges added up to $320 million just for the small percentage of patients who used the ER frequently.

Kim Meuser is a psychiatrist at the Dartmouth Psychiatric Research Center.

He says that it makes sense that care costs go up for such patients.

Many of them also have substance abuse issues – but even for those that don’t – without steady healthcare their physical health deteriorates.

“One of the things we know for example is that people with severe mental illnesses die on average 25 years earlier than people who don’t have severe mental illness. That increased rate of morbidity is not explained by suicide – suicide only explains a very small percentage of that.”

And Meuser says that even when services are available, patients don’t always know about them.

So he believes the state should develop a system with tighter networks among all types of caregivers.

Medical doctors would work more closely with psychiatrists and substance abuse clinicians.

Evidence shows,he says, that treating patients simultaneously for mental disorders and substance abuse is more effective and less costly.

And he says that the tight network allows patients to walk through any door to get access.

“The concept of a No Wrong Door is that when a person walks into a treatment system … and there are many portals into the treatment system - it could be through primary care, an addiction agency, a mental health agency, it could be indirectly through the courts or an arrest. Whatever door a person walks through what you want them to be able to do is access the full treatment they need for all or both of their disorders”.

Such an approach might make sense - but no one argues that it solves the underlying and well-documented problem – a shortage of beds and treatment slots.

Nancy Rollins, Associate Commissioner at the Department of Health and Human Services, says that the state is aware of these issues and developing a plan to overhaul the system.

The plan includes everything from training clinicians to boosting reimbursement rates to community mental health centers.

“There are specific requests and dollar proposals and of course it’s a sizable amount but again we’re looking to phase it in over 10 years trying to put it into our request every biennium to keep the forward movement.”

She says that a full report on the plan will be released within a month – with a price tag.

For NHPR News, I’m Dianne Finch