Lucille Cook's son, James, was born with brain damage and cerebral palsy. He couldn't speak. He couldn't feed himself. He needed diapers throughout his life. When something was wrong, he would start hitting himself on the head, Lucille Cook said.

The emergency room of the hospital near his hometown of Unity couldn't deal with him. The group home where he lived in Charlestown couldn't deal with him. Only the neuropsychiatry unit at New Hampshire Hospital could properly diagnose his physical problems and figure out how to treat them, his mother said.

James Cook died in August at age 44. He had stayed at the hospital three times, most recently for the year and a half before he died.

"I felt more comfortable with him there than I had for a long time," Cook said. "There was no other place that could deal with that in the state."

The hospital's neuropsychiatry unit closed last week, a move projected to save the state $2.5 million. The closure was one of the biggest effects of a $25 million personnel cut that Gov. John Lynch made to fulfill a legislative mandate. After state employees rejected a contract that would have included unpaid furloughs, Lynch laid off or demoted about 300 workers, the bulk from the Department of Health and Human Services, which oversees the hospital.

Paula Mattis, the hospital's acting chief executive officer, said the neuropsychiatry unit was chosen because it was the smallest. On a typical day, the 12-bed unit had an average of eight patients, Mattis said. Last year, only 22 people were admitted. By comparison, the entire hospital had almost 2,400 admissions last year, with 183 patients on an average day.

"This looks like the smallest number of people would be affected. That doesn't mean the impact isn't going to be huge (for those patients)," Mattis said. "It just became an exercise in evaluating numbers, both financial and the parameters of the population served at the hospital."

The closure now leaves organizations that deal with brain injury struggling to figure out what's next for their sickest patients.

"We have no resources at this point," said Bud Elkind, president of the Brain Injury Association of New Hampshire and clinical director at Robin Hill Farm, a brain injury rehabilitation facility in Deering.

The unit at New Hampshire Hospital had served those with acquired brain disorders related to trauma and other neurological impairments. What made it unique was its ability to handle people with multiple illnesses. A brain disorder often leads to psychiatric illness, so a person with brain damage from a motorcycle accident might also develop depression or schizophrenia.

Dr. Tom McAllister, director of the hospital's neuropsychiatry program and a faculty member at Dartmouth Medical School, said psychiatric illness looks different after a person has already suffered from brain disease or brain injury, and few facilities know how to handle that. For instance, he said, it is harder to diagnose depression in a person who had a stroke and is unable to speak.

The unit had a team of professionals working together to evaluate each patient. The team included a neuropsychiatrist, a neuropsychologist, a behavioral psychologist, an occupational therapist, a recreational therapist and nursing staff, among others. The group could assess patients' problem-solving skills, examine their physical symptoms, even determine how safe they would be cooking in a kitchen.

A patient might need full-time care, or he might just need a visiting nurse or a regular medication regimen.

"In a lot of cases the mission the unit served was to determine what is the best setup for someone with these kinds of challenges," McAllister said. "Do they need to be in an institution, or can we put in a different array of supports so they might be able to live in a less restrictive setting?"

Some patients stayed for weeks; others for months.

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