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Story of the Year No. 3: N.H.’s struggle to improve mental health care

  • LNA Karen Johnson works with mental health patients in a makeshift care area in a Concord Hospital Emergency Room hallway. In recent months and especially for the last two weeks, the hospital has experienced a backlog of patients waiting to be admitted to New Hampshire State Hospital. In the meantime, other, medical patients are experiencing longer wait times. Monitor file

  • LNA Karen Johnson takes a phone call in-between assisting mental health patients in the Concord Hospital Emergency Department Thursday. Elodie Reed

  • A bedroom inside New Hampshire Hospital’s mental health crisis unit is seen in Concord in 2016. Elizabeth Frantz / Monitor file

  • Monique Miller speaks during an interview Thursday about navigating New Hampshire's mental health system for her son, Tyler, who has schizophrenia. Elodie Reed

  • The nursing station at New Hampshire Hospital’s new ten-bed mental health crisis unit gives staff a clear view of patient bedrooms and a community area as seen on Tuesday, July 5, 2016. (ELIZABETH FRANTZ / Monitor staff) Elizabeth Frantz



Monitor staff
Friday, December 29, 2017

The problem with New Hampshire’s psychiatric facilities wasn’t new.

For years, complaints rolled in about patients who were suicidal or in psychiatric crisis languishing for days in the hallways and holding rooms of emergency rooms before receiving treatment.

“What other illness would we allow people to suffer like this without treating them?” Ken Norton, executive director of NAMI New Hampshire, told the Monitor in February. “It’s absolutely inhumane.”

But the conversation intensified this summer and into the fall, when a record high of more than 70 people were waiting at one time for a bed at the state’s psychiatric hospital. If the problem was obscured, it struck an alarm when three local teenagers took their lives in a two-month period this fall.

Health professionals suggest states should have at least 40 to 50 psychiatric beds per 100,000 people. New Hampshire has just 11.9 per 100,000, according to the Treatment Advocacy Center.

Between 2005 and 2013, the state’s total psychiatric bed count fell from a total of 526 to 384, according to the Foundation for Healthy Communities. New Hampshire Hospital’s bed count has gone from more than 200 to roughly 160 over the last decade, state officials say.

The waitlist at the New Hampshire Hospital started about five years ago, when it lost beds to budget cuts and private hospitals began shutting down their psychiatric units due to workforce shortages. Wait times for the remaining beds have been steadily creeping up in the years since.

But while the mental health community is in agreement over the problem, some are divided over the fix. Should the state spend to build more beds, or fund only community-based care meant to keep patients out of the hospital?

Republican Gov. Chris Sununu signed legislation in June allowing the state to contract with private hospitals and nonprofit facilities to set up 20 beds at designated receiving facilities for patients subject to involuntary admission, and 40 community-based beds to help people transition out of New Hampshire Hospital.

But some advocates say the bed increase, while an improvement, is far from enough.

“We really don’t think the answer to the psych boarding problem is to increase the bed capacity,” staff attorney for the Disability Rights Center of New Hampshire Aaron Ginsberg said.

A state Department of Health and Human Services report released last week looking at New Hampshire’s health system recommended increasing patients’ access to community-based services, such as peer support, crisis units and urgent care, to help alleviate the burden on hospital emergency rooms.

DHHS Commissioner Jeffrey Meyers said the evaluation confirms what the department had suspected – that the lack of services is prohibiting the timely discharge of patients from New Hampshire Hospital. Meyers said the report will serve as a foundation for the development of its 10-year health plan to address the mental health crisis.

Meanwhile, organizations like NAMI New Hampshire have been offering training to health facilities, law enforcement officers and schools on how to address and work with someone who may be suffering or in crisis.

The Change Direction campaign, spearheaded by John Broderick, the former New Hampshire Supreme Court chief justice who is now senior director of Public Affairs at Dartmouth-Hitchcock, has encouraged people to recognize the five signs that someone may be suffering from a mental illness – personality changes, irritability, withdrawal, lack of self care or risk-taking behavior or feelings of hopelessness.

For Paul and Martha Dickey, the loss of their 19-year-old son Jason to suicide inspired them to join an ongoing conversation surrounding the stigma and lack of resources for those struggling with mental illness.

“That’s all I can do – fight for awareness. It’s not going to bring Jay back, but I can spread awareness for Alec’s family, for Triston’s family and for all the other future suffering families out there,” Martha Dickey said, referring to two local teens who had also died by suicide this year.

Paul Dickey will be joining the board of New Hampshire’s chapter of the American Federation for Suicide Prevention. Both he and Martha said they hope to work with the Federation to grow Concord’s suicide awareness walk in September.

“The banner you see on Main Street for the Breast Cancer walk, we want one up for the suicide walk – in a place everyone can see it,” Martha said. “That’s our goal for next year.”