State settles lawsuit alleging it segregated the mentally ill; system fixes to cost millions
The state has settled a lawsuit that alleged it needlessly institutionalized people with mental illnesses instead of providing adequate resources in their home communities. It agreed to expand services for people in crisis as well as to do more to help people with mental illnesses live independently.
The settlement doesn’t prescribe how much the state must spend to accomplish those tasks; that is left to the Legislature to decide.
However, the Department of Health and Human Services estimated the agreement will cost an additional $6 million in the current biennium, and $23.7 million in the 2016-17 budget.
In the settlement, the state agreed to divert more people from hospitals and institutions by:
∎ Expanding community-based crisis teams so they are available 24 hours a day in all areas of the state.
∎ Creating three mobile crisis teams and crisis apartments for people who would otherwise be sent to the emergency room or New Hampshire Hospital.
∎ Expanding supported employment and housing for people with mental illness.
“Addressing our deeply strained mental health system is one of the most pressing challenges facing our state,” Gov. Maggie Hassan said in a statement.
The settlement “ensures that New Hampshire citizens are driving improvements in our mental health system – not federal judges. Continuing the lawsuit would undoubtedly have cost the state millions of dollars in legal fees and untold millions more per year if the state had not prevailed in its case,” she said.
The suit was filed in February 2012 by the Disability Rights Center and the U.S. Department of Justice on behalf of six plaintiffs, three of whom were in the state hospital or Glencliff Home, a state-run nursing facility. The other three have cycled in and out of emergency rooms and the state hospital and are “at serious risk of being institutionalized,” according to the lawsuit.
One of those patients was Mandy Dube, now 24.
Dube first encountered the hospital system when she was 8, when a bipolar disorder began to trigger panic or anxiety attacks and depression, and to cause her to cut herself to ease thoughts of suicide.
She was in and out of the hospital, and lived in an institutional placement from age 11 until she was 17.
Today, she’s living in an apartment of her own in Claremont, and she says she’s very happy with the result of the lawsuit.
“It’s been a hard, long trip with this,” she said. “I still have struggles that I have to get over, but I’ve been doing it.”
She was especially happy to hear that the settlement called for more community care to help people during a mental health crisis.
“Many times when I was having trouble, they had me go into the ER and the ER was just a wasted trip. You didn’t get any help when you were in there,” she said. “A lot of times they would take me into the hospital but I just needed to talk. Those services weren’t available, but now they are, and it’s going to help people.”
Dube is attending classes and hopes to work in a veterinary office some day. She’s engaged and planning to get married in October.
She never thought either marriage or employment was possible for her before, when she was part of the revolving door of the state’s mental health system.
“I figured I’d always be in and out of hospitals every month, because that’s the way it always was,” she said.
Thirty-five percent of patients discharged from New Hampshire Hospital were readmitted within 180 days, according to the lawsuit.
Between 2010 and 2012, 134 people discharged from the state hospital relocated to a homeless shelter, jail or motel, according to records filed in the federal lawsuit.
The lawsuit also cited a 150 percent increase in annual admissions to the state hospital from 1989, when it admitted 900 patients, to 2010, when it admitted 2,300.
By the early 1990s, the state was a national leader in mental health care. Lawmakers had established 10 community mental health centers and put money into local housing and local treatment.
And under the leadership of then-Gov. John H. Sununu, the state opened a modern 316-bed state hospital in place of the 19th-century institution, once called the New Hampshire Asylum for the Insane, that had housed nearly 2,000 people.
At the time, Donald Shumway, then director of the state’s Division of Mental Health, said the national recognition showed “our plan is really heading in the right direction.”
The acclaim would be short-lived as services shrank over the next 20 years.
The 10 community health centers that once brought the state honor have cut services due to ever-decreasing state and federal funding. Less outpatient treatment to manage mental illnesses meant more people experiencing crises who needed inpatient care.
But mental health beds in community hospitals have been cut from 236 to 150, and six hospitals have closed their psychiatric wings altogether. By 2012, the state hospital had only 130 beds.
When the hospital was full, patients in crisis waited, often for days, in local emergency rooms unable to care for them and ill-equipped to house them until a bed somewhere appropriate opened.
The waiting list for a mental health bed peaked in August when 47 people waited in local emergency rooms. The previous record was set in February, when 44 people, 18 of them children, lingered in emergency rooms.
When Hassan announced her budget that month, she implored legislators to find a solution. “That’s not the kind of state we are,” she said.
She proposed, and the Legislature approved, $28 million in the current biennium budget to increase services.
At the time, Amy Messer, the Disabilities Rights Center’s legal director, said the plaintiffs in this case were pleased the governor was addressing the broken system.
But, she said, “We are concerned that much of what has been proposed includes a lot of additional inpatient beds and still not enough of the kinds of evidenced-based community practices that we know can keep people out of the hospitals and promote recovery and meaningful lives for people.”
The settlement addresses those additional concerns.
It calls for the state to meet several deadlines. By June, each mental health region is to have its own crisis team, and by October, they are all supposed to be fully staffed.
By June, the state is supposed to have 240 supported housing units available – increasing to 600 by June 2017. By June, the state is also supposed to open a network of peer support centers and a support system for families of people with mental illness.
State Attorney General Joe Foster said the settlement was only possible because of the funding increase in the current budget.
“That demonstrated commitment brought the parties to the table and made them willing to talk to the state about New Hampshire-based solutions, as opposed to seeking federal court mandates,” he said.
(Staff reporter Annmarie Timmins contributed to this story. Sarah Palermo can be reached at 369-3322 or firstname.lastname@example.org or on Twitter @SPalermoNews.)