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Editorial: Slowly improving the mental health system

In recent days we have seen, again, the cruel reality of New Hampshire’s crippled mental health care system and a small, new glimmer of hope.

As Monitor reporter Sarah Palermo described, New Hampshire recently set yet another grim record: the highest number yet of psychiatric patients warehoused in emergency rooms across the state, waiting for a bed at the state hospital in Concord. The previous record, set back in February was 44. But on a recent Monday in August, the number hit 47. That’s 47 people too ill, too suicidal, too dangerous to be let go but getting little if any of the help they so desperately needed – which, no doubt, made their crises even worse. Such emergencies are hard on hospitals too: Their emergency rooms are crowded with patients they’re not equipped to care for, making their regular work that much more challenging.

More troubling still: Local experts worry that the demand for psychiatric care will likely spike in the coming weeks as children with mental health trouble react to the start of the school year. In other words, last month’s record might ultimately be eclipsed, and soon.

To their substantial credit, Gov. Maggie Hassan and the Legislature went a long ways toward improving this dysfunctional situation this year. New Hampshire Hospital recently expanded its beds by 12, increasing its capacity to 142 (still down from 250 beds available just three years ago). And the new state budget increased support for mental health services by $28 million over the next two years. Some of that money is being used to create a new 10-bed mental health unit in Franklin, expected to open next month; it will provide an alternative to the state hospital for patients in the throes of a crisis. The money will also increase the availability of special treatment teams that can respond to crises and, with luck, prevent hospitalizations. Trouble is, much of the money won’t become available until the second year of the budget, which starts next July.

What the terrible new ER record makes clear is that fixing the system will take time. That’s why we were encouraged to hear about a promising new program under way in Keene.

As part of a $4 million federal grant, a group from Antioch University New England’s Center for Research on Psychological Practice will test the effectiveness of new mental health care models in reducing the number of children with severe emotional disturbances who are placed in hospitals or residential programs. In other words, are there betters ways of preventing some of the crises now clogging the state’s hospitals from occurring in first place? Among the project’s goals: better coordination among the myriad services often at play for mentally ill kids and their families: school counseling, mental health therapist, peer-support services.

As part of the study, up to 160 New Hampshire children and teens will be served over the next four years.

Back in 2008, advocates for the state’s mentally ill residents drew up a 10-year plan for restoring what was once a nationally recognized high-quality system of care for New Hampshire’s most vulnerable patients. It recognized that the disintegration of care had happened over time, so improvement would take time too.

The governor and lawmakers must not take their eye off the ball at this point. Their initial investment of much-needed cash into the system was a critical first step. Now they must carefully monitor the effectiveness of that investment. One simple goal: No more records like the ones being set and then broken at hospitals across the state.

Here's an idea? Force mental health agencies to cooperate with law enforcement regarding background checks for weapons. Then everyone would understand that guns aren't the problem - our mental health care system is.

Well, I have to say that what goes around comes around. When the ACLU and patients rights advocates turned tens of thousands of patients out into the streets in the mid-70's we then created the homeless problem, helpless people self medicating and a fractured mental health system. We had a hospital, although not ideal and we had people being medicated regularly and being treated. Now we have clinics and homelessness and people not staying on their medication. Liberals wanted "justice" for patients and this is the end result. You can place today's problems at the feet of the APA and advocacy movement. At least in 1985 Reagan signed legislation to encourage and fund the Community Support Program within the NIMH but the advocacy movement with people chaining themselves to the gates of state hospitals really brought this problem on and today, 35 year later we are paying the price.

I seem to recall that last year this hypocritical RAG pushing for more local solutions and yet they now want to double the # of beds in the one size fits all BIG govt central Hospital....liberals ....sheeesh

I'm curious. In Laconia, you have a multimillion dollar addition, beautiful outside architecture, and a huge lobby. And that helps exactly no person experiencing a mental health crisis. Zero. The people that brought that addition to reality also make large sums of money every year. Where is the "Needs" commission or CON Board on this? The CON board seems to be against anything that competes with LRGH, yet LRGH can build multimillion dollar additions that for the most part serve no one.

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