Report: 'Time For Patience is Over' With N.H.'s Lagging Mental Health System

Jul 6, 2016

Here is the scathing conclusion from a report about New Hampshire’s struggling mental health system: “The time for patience…is over.”

The state is behind schedule in expanding the types of community-based mental health services that keep people out of hospitals and other institutions. The timeline for developing those services was laid out in a $30 million class action lawsuit settlement that alleged New Hampshire was violating the civil rights of people with mental illness. The state settled that suit in 2014, but is struggling to implement the plan it promised at that time.

NHPR’s Health and Science Reporter Jack Rodolico has been following this story; he joined All Things Considered host Peter Biello to explain.

So this report was expected this week.

Yes, it’s required every six months or so. It’s done by a court-appointed expert reviewer.

Let’s backtrack a little. This report came about because the state got sued, right?

Yes, the state got sued in a pretty big way. So if you backtrack even further, you go back to the 90’s, when New Hampshire used to be a national model for shutting down institutions and making sure people with mental illness could live in communities. But over the course of a few decades we cut funding, and increasingly people were forced back into institutions. We re-institutionalized hospitals, prisons, and nursing homes until we got sued by the federal government and the Disability Rights Center of New Hampshire.

The settlement that the state came to—a $30 million dollar settlement— issued the state a bunch of marching orders. It basically said, “You need to get on track with a range of different types of services, such as support of housing and employment for people with mental illness. You need mobile crisis units, and teams of mental health professionals that meet people in the community.” The goal, over time, was to beef up these services and to have fewer people getting stuck in hospitals, nursing homes, and prisons.

So that was the goal; are we hitting that goal?

It’s not clear yet. The data is wishy-washy. But here are a couple of findings:

New Hampshire's state psychiatric hospital is one of the places we hope to see fewer people getting stuck trying to get in or trying to get out. As of right now, the waiting list to get into New Hampshire Hospital has increased over the last couple of years. At the same time, though, more people who are being discharged from New Hampshire Hospital are going home, as opposed to places like nursing homes or prisons. So the data is really muddled.

A concrete example of where we’re behind is in the case of the mobile crisis units that I mentioned earlier. They function like ambulances that respond to crises within the community. We are supposed to have four of these units around the state. We only have one. In many instances, they are treating people by phone. They are supposed to be going out into the community to meet people, but they are actually just talking to them on the phone.

There’s a whole range of ways that the state is just behind schedule. This is the fourth report, and each one is getting more and more urgent in tone, ending with the conclusion that you started off with, that “time for patience is over.” That’s a quote from the expert reviewer.

In the last couple of weeks we’ve been hearing about controversies at the state hospital—staff quitting amid a contract dispute with Dartmouth-Hitchcock—how does that impact the findings of this report?

The backdrop here is that the mental health system is a mess right now. We are losing psychiatric beds across the state. Cheshire Medical Center closed its inpatient psychiatric unit; there were 18 beds there, and even though they only filled about 10 at a time, that’s still a lot of beds. New Hampshire Hospital was in the news this week because they finally opened a crisis unit with 10 beds, but that comes a week after Dartmouth-Hitchcock in Lebanon temporarily shut down nine beds. So we are basically at a net loss of half a dozen beds in the state over the last couple months. It’s not good.

What does the report say about what‘s next?

Basically this expert reviewer gives the state some hard goals they have to hit as early as August first. We’ll see if they are able to do that. It also gives a little backhanded compliment by saying that there’s new leadership at the health department, and that’s a good thing. It says the new leadership is doing a better job than the previous leadership, but it still says that the state’s leadership has to be more aggressive and assertive in building this plan. If they don’t, more people will get stuck in emergency rooms, waiting to get mental health care.