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My Turn: This is beyond a health crisis



For the Monitor
Wednesday, May 31, 2017

This week, the New Hampshire Senate will likely affirm House Bill 400, which is an amended bill meant to address the current mental health crisis.

First of all, I would like to recognize and applaud the attention the Legislature and the governor and his team are giving to this crisis. The bill’s intent is to create a 10-year plan for the mental health system in New Hampshire. And, while there are additional patient beds noted in the bill, they are not the beds that are needed today to respond to the needs of people in acute psychiatric crisis.

People with severe illness must be cared for in a specialized psychiatric facility, like New Hampshire Hospital. New Hampshire has one of the lowest number of inpatient psychiatric beds in the country. Unfortunately, this bill does not create any immediate inpatient beds to address that deficit.

This crisis has placed a dangerous strain on the state’s hospitals, our nursing, physician and provider teams in those hospitals, and most importantly, the patients who are in psychiatric crisis and who are being held, or cared for, in emergency department beds.

This impasse has also affected the medical, surgical and trauma patients who are seeking emergency care.

At the end of February, 22 mental health patients needed 60 percent of our emergency department beds and treatment spaces as they waited for admittance at the proper site of care, New Hampshire Hospital. This is an untenable and dire situation.

As a physician, it is incredibly painful to watch this crisis unfold as patients wait in hallways and rooms with no natural light, in an environment that is not therapeutic and may even be damaging. Beyond the suffering of these mental health patients, our medical, surgical patients, trauma and stroke patients suffer when our emergency department beds, our active treatment spaces, are being used as holding areas for days, weeks and, more recently, up to a month.

As we work to address this crisis, we need to remember that these are our family members and loved ones, our friends and neighbors who are suffering and need intensive inpatient psychiatric care.

They are the young man I saw whose brother died of a heroin overdose and who was struggling to cope and had recently lost his job. They are the teenager who was depressed and now suicidal who had to wait in the hallway for days. And, they are also the patient whose appendix ruptured while she waited for an emergency department bed after a patient care area was closed because a violent psychiatric patient had destroyed it.

When I started practicing emergency medicine at Concord Hospital, New Hampshire had one of the best mental health systems of any state in the country. Our current health care system is suffering from this crisis and the way it constrains our ability to deliver high-quality, safe, humane care. This bill refocuses our attention on a mental health system that is in crisis and provides a foundation for our future.

However, despite some of the longer-term possibilities, this bill does not provide any immediate relief for our crisis, which is beyond a behavioral health crisis and beyond a health crisis, it is a community crisis.

(Michael Lynch is a doctor at Concord Hospital.)