NH mental health crisis efforts get back on track, with new urgency
June 1, 2021
Annmarie Timmins, New Hampshire Bulletin
The New Hampshire Legislature’s $20 million plan in 2019 to expand desperately needed mental health services stalled after the pandemic hit. A recent state Supreme Court ruling and stories of kids and adults waiting days in emergency rooms for help has put that effort back on track.
The Senate is poised to reverse two significant cuts to the state Department of Health and Human Services: a $50 million budget reduction and the elimination of $30 million for a new secure psychiatric hospital. And, the state recently announced it will pay community mental health centers more to expand transitional housing and give hospitals and long-term care facilities $200,000 per bed and $45,000 per bed a year, respectively, to add 50 inpatient beds for psychiatric crisis care to the approximate 250 now available to the state. That reimbursement rate is twice what’s been offered in the past, and three to four hospitals have reportedly shown interest.
Adults and children wait hours, sometimes days in hospital emergency rooms for one of the state’s approximately 250 psychiatric crisis beds to become available. The state tracks the daily count on its website. Since mid-May, the number of adults has gone from 44 to 5. The number of children has increased, from 26 to 30, in that time period.
(Source: New Hampshire Department of Health and Human Services)
Meanwhile, a statewide mobile crisis response unit, a key piece of the 2019 plan, is expected to come online this summer and reduce the number of people whose only choice is to go to an emergency room.
The expenditures are in line with recommendations in the state’s 10-year Mental Health Plan. And while there was bipartisan support for the 2019 mental health investments, there is a sense of urgency now to move as quickly as possible, due in part to a May 11 state Supreme Court decision. The court called the state’s process for allowing people to wait in emergency rooms for days without due process hearings unlawful.
Two days after the ruling, Gov. Chris Sununu issued a sweeping executive order that made immediate changes to the state’s mental health policies and called for a review of all mental health services in the state. Sununu also called on hospitals and community mental health centers to do more to solve the mental health crisis and opened the door to bringing in private providers if needed. The centers had been calling for similar collaboration with the state since February.
“I think the Supreme Court’s decision, saying, ‘You must,’ kind of gives us the backing to say, well, we must, so here we go,” Sununu said while announcing the executive order. “Don’t give me 10 reasons why we can’t do something. Let’s impress our citizens with what we can do because they deserve that level of attention to that level of need. This is a crisis.”
That sense of urgency, which Democrats have said was needed more than a year ago, had a near-immediate impact – for adults. The day the Supreme Court issued its opinion in mid-May, there were 41 adults waiting in emergency rooms for a psychiatric bed and two more waiting in a correctional facility. At the end of last week, there were five.
It’s been a different story for kids. The count has gone from 26 to 30 in that time period.
Ken Norton, executive director of NAMI New Hampshire, has been advocating for an increase in all levels of mental health care, from community providers to crisis psychiatric care. He has been encouraged by the progress and hopes to see the same success with kids soon.
“I’m really focusing on looking forward rather than looking back,” he said. “I’m thrilled to see the adult numbers in the single digits. I attribute that to a lot of effort by a lot of people.”
Steve Ahnen, CEO and president of the New Hampshire Hospital Association, shares that optimism.
“Building a system of care for those suffering an acute psychiatric illness is essential to solve the ED boarding crisis,” he said. “As is ensuring that these patients are able to receive the care they need to successfully transition back into the community with outpatient care and other supportive services. The increased funding will help identify solutions and address the challenges facing those patients in acute psychiatric crisis.”