Latest Plan to Bolster N.H.'s Mental Health System Missing Key Fix

May 8, 2017

New Hampshire Hospital, a state-run psychiatric facility in Concord, maintains long wait lists for accepting new patients.
Credit Thomas Fearon

Every day, an email goes out to leaders in New Hampshire’s mental health system. It gives an updated count on the number of people in immediate need of inpatient psychiatric care, but are being denied that care because of a shortage of beds in New Hampshire hospitals.

On February 20th of this year, that email contained a staggering number: 68 adults and children were being housed in hospital emergency rooms and hallways because of a lack of available beds. It was a new high.

Three years ago, a major lawsuit against the state and resulting settlement was supposed to fix this problem, but people with mental illness continue to lack support. Now, New Hampshire lawmakers are again proposing a plan to increase services. But despite some high-profile support, including from Gov. Chris Sununu, it may not be enough. 

“It’s absolutely unacceptable, and it is unconscionable that we have let it go on this long,” Sununu told members of the Senate Health and Human Services Committee in support of an amendment to House Bill 400. “To be blunt about it, these problems could have and should have been addressed long ago. And I can’t speak for previous administrations, but I can tell you in my first 100 days here, it has come to stark new light, to me, just how problematic, how much in disarray, our mental health system truly is.”

Disarray wasn’t always the norm. In the 1980s and 90s, New Hampshire had one of the top-rated systems in the country. But underfunding, chronic staffing shortages and growing need have stretched resources thin.

The number of inpatient psychiatric beds across the state has fallen, including at state-run New Hampshire Hospital, forcing patients--adults and children--to be held in emergency rooms and hospital hallways for days until space becomes available. The wait-list for low income residents to see an outpatient counselor runs hundreds of people deep in some areas of the state.

Justin Looser works in the behavioral health unit at Portsmouth Regional Hospital, where despite a recent decision to add more psychiatric beds, patients in need of care often languish in the emergency room due to high demand

“It is the hardest thing--I think any of our clinicians will say this--to meet a patient, assess a patient and then tell their family, and the patient, that they have to sit and wait, there are no beds available to them,” he says. “It is a problem that is unique to any other medical diagnosis. We would never withhold that for anything else.”

That disparity in care led to a major lawsuit against the state filed on behalf of patients. In 2014, the suit was settled, with New Hampshire pledging to invest more in community-level treatment.

While that money continues to flow, it still isn’t meeting the demand.

This new plan, backed by Gov. Sununu and top Republicans in the GOP-majority Senate, would spend an estimated $10 million more in state money. It funds 20 additional hospital beds aimed at treating the sickest of the sick. There’s also money for 40 community beds, such as apartments or group homes for people who don’t need hospital-level care, but aren’t ready to be on their own.

And third, it provides money for more mobile crisis units.

“In clinical terms, we do what’s called a lethality assessment. In normal layman's terms, it’s, we’re asking questions about safety,” explains Megan Parnell, who helps manage the mobile crisis unit for Riverbend Community Mental Health Clinic in Concord, the first such unit to launch in the state.

Riverbend’s 24-psychiatric crisis line takes in calls from people in distress or their loved ones.

The phones never stop ringing.

“So in February of 2017, we got 317.”

After completing each of those 317 assessments, the team determines if someone needs emergency room care, or, if the mobile crisis unit is able to successfully divert--keep a patient in psychiatric distress safe outside of a hospital setting, saving the system money and being more humane in the process.

The legislation would fund up to two more mobile crisis units in the state, and along with the new inpatient and community beds, may seem like a large investment.

But advocates caution it’s not enough.

“There’s no magic bullet. It’s all just part of a bigger puzzle,” says Jay Couture, CEO of Seacoast Mental Health.

She praises the bill, but says the state isn’t addressing one of the biggest issues plaguing the system: an outdated Medicaid reimbursement rate. That’s the money the state pays mental health providers for routine counseling and case management work for certain low-income patients. The reimbursement rate hasn’t been increased since 2006.

Without adequate funding for this basic care, counseling wait lists will continue to grow, and patients who could have been treated with less intensive therapies are put at risk of spiraling.

Couture says there’s still hope lawmakers will address that issue in the next budget. But until then, this legislation, for mental health advocates, is seen as a good start.