Report highlights lack of resources for mental health services in N.H.
A report released by Gov. Maggie Hassan yesterday highlights the lack of resources to appropriately deal with mental health patients and suggests reforms in line with recommendations in the state’s recent settlement of a lawsuit over inadequate services.
In November, Hassan commissioned a review of “sentinel events,” a term for serious mental health crises leading to such outcomes as homicide or suicide, sexual assault, physical or mental abuse or a high-profile police intervention. She requested the report in response to two incidents at Elliot Hospital in Manchester last year in which patients had violent outbursts while awaiting involuntary admission to New Hampshire Hospital – in one case for several days.
“The representatives of nearly every hospital with whom we met described similar events or close calls,” the report said.
In 2012, there were 196 sentinel events in New Hampshire’s acute care facilities, and in 2013 there were 228, according to the report.
The report points to reductions in state hospital and psychiatric beds, a decrease in community-based services and increased substance abuse, along with the recession, as factors contributing to the strain in the mental health system.
Former state Supreme Court justice Joseph Nadeau led the review.
“This report underscores the significant challenges faced by those with mental illness in New Hampshire as well as health care providers, and we must continue working together to strengthen community-based mental health services that will help prevent individuals from reaching the point of crisis,” Hassan said in a statement.
The report recommends a greater focus on housing for the mentally ill, better training and uniform standards for dealing with mental health crises, expanded access to health insurance and better treatment for cases of mental illness alongside substance abuse. It suggests asking hospitals to develop plans to expand beds and to create a cooperative call center that can help find open beds for patients when none is available at New Hampshire Hospital or other appropriate facilities. It suggests asking for waivers of Medicaid provisions that restrict reimbursement for psychiatric care.
The report also acknowledges that it’s much easier to determine what the problems are than it is to put systems in place to address them.
“It is clear that the mental health problems our state faces cannot be ignored or minimized without grave consequences. They must be confronted and changes made. Continuing to pursue policies of the past will not accomplish the task,” the report concluded.
While acknowledging not much is new in the report, Health and Human Services Commissioner Nick Toumpas said the fact that the review team came up with these recommendations independent of the lawsuit settlement affirms the need for the state to commit to improving mental health services. The report also shows that improving services will be a collaborative effort, he said.
“It really underscores the fact that this is not a state issue, it is not a community issue – it is a state and community issue,” Toumpas said.
The settlement involved a lawsuit filed in February 2012 by the Disabilities Rights Center and the U.S. Department of Justice on behalf of six plaintiffs, alleging the state needlessly institutionalized people with mental illness instead of providing treatment in their communities. In the settlement, the state agreed to specific changes that would divert more people from institutions, but left it to the Legislature to find the money.
The Department of Health and Human Services estimated that would cost an additional $6 million in the current biennium, and $23.7 million in the 2016-17 budget.
Some of the suggestions in yesterday’s report, such as creating a system where hospitals can collaborate on finding beds for patients, will require the state, communities and outside groups to work together on finding money. The report, for example, suggests the creation of a tax-exempt mental health trust fund supported by private and public funding.
New Hampshire’s mental health services are far from adequate, and it will take time to find the money and implement programs to correct the problem, Toumpas said.
“It wasn’t overnight that we got into this situation, and it’s not overnight that we will get out of this situation,” he said.
(Kathleen Ronayne can be reached at 369-3390 or firstname.lastname@example.org or on Twitter @kronayne.)