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HHS Commissioner Toumpas calls for $10 million investment in mental health care

The commissioner of Health and Human Services announced yesterday that he will ask lawmakers for about $10 million to improve mental health care, mostly at the community level so patients can remain close to home and in settings less expensive than the state hospital.

Commissioner Nick Toumpas said he’s also temporarily adding 12 beds to the hospital’s existing 130 beds to shorten the increasingly long wait to get into the hospital until he has the money to expand community services.

On weekends especially, it’s not uncommon for 20 people to be waiting in local emergency rooms across the state, all in a mental health crisis, for a state hospital bed, according to mental health providers. In rare cases, patients have waited two weeks at an emergency room for a state hospital bed.

“This is of critical concern to me personally, and DHHS as an organization,” Toumpas said in a statement. “It is unacceptable for someone experiencing a psychiatric crisis to have to wait this long for critical inpatient care – for both the individual as well as their concerned family members.”

Gov.-elect Maggie Hassan is open to Toumpas’s request, according to her spokesman.

“Hassan believes we must take steps to improve New Hampshire’s mental health system and address the waiting list for mental health services, which has put an enormous strain on families throughout the state,” Marc Goldberg said in an email. “The governor-elect is currently in the process of bringing people together to make the difficult, fiscally responsible decisions needed to balance our budget while protecting New Hampshire’s priorities, including providing high quality health services. She looks forward to working with Commissioner Toumpas.”

Community mental health providers have been raising concerns about long waits and diminishing mental health care for nearly a year and were planning a Jan. 7 press conference to sound that alarm again. After learning of Toumpas’s plan yesterday, which they didn’t know was coming, they expressed cautious optimism.

“We really welcome this by the department,” said Ken Norton, executive director of the state chapter of the National Alliance on Mental Illness. “I think there may have been hope (by state officials) that what was happening was a temporary situation, and I think people are now seeing that it is not.”

A $10 million investment in mental health care would be a real change, they said, in a state that has cut services for the last several years to balance the state budget.

Louis Josephson, president of Riverbend Community Mental Health in Concord, said Toumpas’s plan will improve mental health care only if it truly increases the treatment at the community level. That means increasing the number of people providing care as well as residential housing in local communities

Of the additional 12 beds at the state hospital, Josephson said, “I’ll take it, but it’s a short-term Band-Aid.”

Erik Riera, administrator of the state Bureau of Mental Health, said yesterday’s announcement was not a direct response to the federal lawsuit pending against the state over its mental health care system. That lawsuit, which names Toumpas, Gov. John Lynch and other state officials, alleges the state discriminates against people with mental illness by keeping them in state hospitals instead of investing in community treatment that would be better and less restrictive.

Riera said he and others in his agency have been working on a plan to improve mental health care at Toumpas’s request since the spring when there became a waiting list to get into the hospital.

“We are very much trying to be proactive,” Riera said. “When we identified the issues out in the community hospitals, the commissioner asked that we develop a plan. He wanted to release that plan as we were going into the (state) budget sessions. We want to get this out for public discussion and hopefully garner significant public support.”

Amy Messer, the legal director for the state Disabilities Rights Center, which is involved in the federal lawsuit against the state, said she too was glad to see the state “beginning” to address its mental health system.

She said Toumpas’s ideas come from the state’s 10-year-plan to improve mental health care, which was written in 2008 but has largely languished because of budget cuts. “Whether the proposal here is a sufficient array of services and of sufficient capacity, we’ll have to look more closely at that,” Messer said. “The plaintiffs (in the federal lawsuit) continue to be open to discussions with the state regarding the resolution of the case. Those discussions are not happening at this juncture.”

Toumpas divided his plan into two parts: immediate action and improvements he’ll seek through budget requests.

Immediate action

Starting now, Toumpas’s office will do the following:

∎ Track all people waiting for a bed at the state hospital on a daily basis and admit those in the greatest need first, ahead of others on the list in less of a crisis.

∎ Finalize a plan to use state hospital psychiatry staff to provide additional counseling at local emergency rooms. Concord Hospital, for example, spends $1 million a year just caring for the people awaiting mental health care, Josephson said.

∎ Reopen the 12 beds at the state hospital. Three years ago, the hospital had 202 psychiatric beds, but that number has dropped, largely because of budget cuts. Mental health providers, though, said the state could reduce the number further if it increased the amount of care at the community level.

Doing so would not only be better for the patient, they said, but also cheaper. It costs the state $1,000 a day to care for a patient at the state hospital. It costs $200 a day to care for someone in a community residential setting.

∎ Within 10 days, finish introducing a new discharge process that requires the hospital to more closely follow up with patients after discharge to reduce re-admissions.

∎ Expand the number of “peer-run” crisis beds, which are beds in local community settings staffed by volunteers who have expertise with mental health crisis. The state currently has just two of these, said Riera.

Long-term plan

The longer-term plan will depend on what Toumpas does with the following budget requests:

∎ Increase the number of residential, inpatient beds at the community level.

∎ Expand other peer-run services to serve an additional 400 adults with severe mental illness annually, at the local level.

∎ Continue expanding the local “Assertive Community Treatment Teams,” which have proven effective in responding quickly to people in crisis so they don’t have to be hospitalized. There are seven teams in the state now. Toumpas wants 17.

∎ Expand residential options for people with mental illness, including day programs. This includes doubling the size of a housing subsidy plan by the end of the 2015 fiscal year.

Roland Lamy Jr., the executive director of the New Hampshire Community Behavioral Health Association, learned of Toumpas’s plan late yesterday, although it called for the support and collaboration of community mental health centers.

Lamy said it’s a good start because it acknowledges the problem.

“The press release was a surprise to us,” he said. “We are happy that we are listed as part of the solution. We do want the opportunity to talk to the governor-elect and some of the Legislature as well to give them facts and details about what we believe is a crisis.”

(Annmarie Timmins can be reached at 369-3323, atimmins@cmonitor.com or on Twitter @annmarietimmins.)

Legacy Comments1

The State Hospital needs to open again, full scale. There are too many people walking around that need to be re-built.

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