Report Says N.H. Lags, But Gaining Ground, On Mental Health Services

Jul 9, 2015

High readmission rates to N.H. Hospital is one piece of evidence community services are lacking across the state.
Credit Thomas Fearon / NHPR

Last year, New Hampshire settled a class action lawsuit that alleged the state was violating the civil rights of people with mental illness. In the settlement, the state agreed to spend $30 million over four years to beef up services for those individuals.

Now, one year into the deal, a report from a court-appointed monitor says the state hasn’t yet hit the benchmarks it agreed to.

Bad news first

The state is behind schedule in developing nearly every type of service it has promised people with mental illness: job and housing support, mobile crisis teams, and round the clock access to clinicians.

That means on the ground this year, virtually nothing has changed for people in crisis.

"I’m not seeing any incremental improvements," says Jonathan Vacik, an emergency room doctor at Catholic Medical Center in Manchester. "But I’m also not seeing anything worse happening. But then again it’s pretty hard to go down from here."

I am not seeing any incremental improvements. But I am also not seeing anything worse happening. Then again it is pretty hard to go down from here. - Jonathan Vacik, emergency room doctor at Catholic Medical Center, Manchester

The essential problem is the state lacks basic services for people with mental illness, and so when those people have a crisis, they often get stuck in emergency rooms – sometimes for hours, sometimes weeks. That’s why the Disability Rights Center and the federal Department of Justice sued New Hampshire.

"These are civil rights for people with disabilities," says Amy Messer, the DRC’s lawyer on this case. "So really at its base what this means is that individuals have a right not to be unnecessarily institutionalized. So people have a right to receive those services in the community, and they’re both better for people and really a much better fiscal policy for the state."

Here’s one of the ways taxpayers could save money. The state runs a psychiatric hospital in Concord. And in the first ten months of Fiscal Year 2015, about one out of six patients admitted to that hospital had already been admitted once before in the previous three months.

Many of those patients are in and out of the hospital because they don’t have enough help at home. Meanwhile, taxpayers help pay for those repeat hospitalizations.

The silver lining

The report did say – and here comes a bit of the silver lining – state officials are committed to faithfully implementing the mental health settlement. And it identified one of the biggest challenges to turning those good intentions into change: organizing the data needed to measure progress. In other words, how many people is the system serving, are those numbers increasing, and do those numbers indicate New Hampshire is making progress?

Nick Toumpas, the Commissioner of the Department of Health and Human Services, says organizing this data is among his department's top priorities.

"For one thing you get data that’s coming in from multiple sources, multiple different data types, some of it manual, some of it automated," says Toumpas. "And there’s a concerted effort that needs to be done in order to pull that together. So when I look at the report it really provides us with a road map."

And that road map is detailed. New Hampshire not only has to help people in crisis, but that help has to be consistent across the state and up to the best practice standards. And until that happens, Dr. Vacik at Catholic Medical Center says people with mental illness will only suffer more.

"When people can’t receive services that are appropriate for them, they self-medicate and there’s a huge increase in drug use," says Vacik. "So I mean you’re seeing sort of ripple effects from this problem."

Despite all of this, Amy Messer, the lawyer who helped sue the state, is optimistic. She says this is a gargantuan task, and the state is on the right track for the first time in years.

These services take time. It is a significant change to our mental health system. - Amy Messer, Disability Rights Center

In response to the mental health settlement, both Democrats and Republicans proposed increasing funding for mental health services over the next two years. But right now funding is stuck at last year’s levels while the Legislature and Governor Hassan are stalled over that budget.

Meanwhile, Commissioner Toumpas is considering shuffling funding within his department to make sure mental health funding stays on track to hit the settlement’s benchmarks.