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Editorial: Crisis in state mental health system persists

Much attention has been paid in recent years to the serious toll on the health and well-being of New Hampshire psychiatric patients by the state government’s consistent under-funding of mental health services. This long-running crisis has resulted most dramatically in patients being warehoused in general hospitals for hours or days at a time while waiting for a vacant bed at New Hampshire Hospital, the state-run psychiatric hospital in Concord – a wait that can only make a fragile patient’s mental state worse.

Less discussed has been the effect on hospitals and hospital workers across the state. But two frightening incidents in Manchester have dramatized the issue in a way that government can’t ignore.

In July a psychiatric patient waiting three days to be involuntarily committed to the state hospital was accused of attacking two licensed nursing assistants at Elliot Hospital. Officials say he stole the key card of one of the employees and tried to escape; the worker suffered critical head injuries.

Then in October, a mental health patient brought to Elliot was accused of attacking a security officer. He was subdued by other guards and a city police officer, charged with simple assault and transferred to the local jail. He returned to the hospital the next morning with a broken neck, paralyzed from the neck down. The security guard was treated for significant facial wounds.

To her credit, Gov. Maggie Hassan has created an investigative team to review not only the most recent incidents in Manchester but also the broader trouble of psychiatric patients being held in emergency rooms poorly equipped to handle their needs. She is concerned about how such emergencies are prioritized by general hospitals, how well emergency room workers are trained to deal with psychiatric emergencies and what steps can be taken to reduce the risk of harm to patients and staff.

Hassan and the Legislature made a significant financial down-payment on restoring the state’s mental health system to stability in the most recent budget, but it’s clear the hard work is just beginning. Until there are adequate community-based services to reduce the number of crises that must be treated at the state hospital – thereby bringing down demand for hospital beds – the trouble will likely persist.

Lawmakers will have myriad issues to wrestle with when they return to Concord in January. But they must understand that they have not yet met their responsibility to some of the state’s most vulnerable residents, not to mention those workers charged with caring for them in times of crisis.

Since the "glory days" of Mental Health in NH (1989-2000) the state's system was one of the best in the nation. Consecutive administrations since then have picked HHS clean of pertinent programs. No hospital wants to be a DRF (designated receiving facility) anymore because there is not enough Medicaid payback to make it worth it. There was one in Berlin, Portsmouth, Concord and Manchester. Now there is only one. There as well used to be several private Psychiatric Hospitals in the state, now there are few. The state needs to dedicate "untouchable" funding for the Mental Health System in NH for it to reach even a competent level, never mind a therapeutic one.

This is a problem that has existed forever. It boils down to money, no one wants to spend what is necessary to address the needs of the mentally ill. Most people don't have any concept of the issue they only see dollar signs. I was one of those with little to no sympathy toward this group. That changed when I took an IT position at Tewksbury State Hospital. Though I was an IT/network manager I came into contact with many patients in the course of my support duties. I can attest to some myth busting experiences that changed my indifference to the plight of the patients. It is not a pretty world to be thrust into, but it is a sobering one that at this point only funding can address.

Yes.

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