Mental health cuts compromise safety

Last modified: 8/11/2011 12:00:00 AM
When New Hampshire lawmakers cut funding to treat people with mental illness, they knew there would be consequences. Last week, in a conversation with Monitor reporter Annmarie Timmins, Louis Josephson, the president and CEO of Riverbend Community Mental Health, said those consequences include an increased threat to the mentally ill and the public. His assessment is disturbing.

Because it is home to the state psychiatric hospital and prison, Concord has a higher than average percentage of residents with mental illness. If, as Josephson fears, the hospital is discharging patients early for financial reasons or to make room for more critically ill people, the public needs to know and lawmakers need to respond.

In the most serious incident to date, a suicidal man shot himself in the chest, was treated for the wound at Concord Hospital and transferred to New Hampshire Hospital. Six hours later, after deciding the man was no longer a threat to himself or others, the state hospital released him without notifying Riverbend.

Dr. Robert MacLeod, the state hospital CEO, admits there was a lapse in communication, but he is emphatic in stating that discharges are made only when medically appropriate and never for financial reasons. Before budget cuts the hospital had 210 beds to serve the whole state. It now has 157, but it is not always full. On the day that the gunshot victim was released, it's unclear what the hospital census was.

New Hampshire, which once led the nation in its treatment of the mentally ill, is now in triage mode. Last spring, the federal Department of Justice said the state was violating the Americans with Disabilities Act because it wasn't providing adequate mental health care in community settings. Local hospitals like Androscoggin Valley in Berlin that once operated units for psychiatric patients closed them because low Medicaid reimbursements made operating them became unaffordable. That put more pressure on institutions like Concord Hospital, where people in the throes of mental illness sometimes have to wait for several days before space becomes available at the state hospital.

Mental patients can't be safely be housed on wards with other patients. On troubled patiently recently injured four members of Concord Hospital's security staff before they managed to restrain him, so Concord Hospital has established a separate space in the emergency room to serve them. It's also hiring psychiatric nurses to help doctors stabilize mental patients until they can be transferred to the state hospital.

Housing a patient at the state hospital costs about $900 per day - at the emergency room, roughly twice that. If a mentally ill patient stays at Concord Hospital, the cost to the state is nothing. The cost to Concord Hospital is $1,800 minus the few hundred dollars that Medicaid will pay. Those costs are shifted from the state to employers and the insured.

The state's community mental health centers are in line for yet another budget cut next year. We don't expect that lawmakers will rescind that cut because they're downshifting costs to hospitals and the insured. They knew that's what they were doing. They also knew that the mentally ill would get less care. What they can't know is what else will happen. Will adequate funding for treating the mentally ill have to wait until someone who was released too soon - or not monitored to make sure he was taking his medications - harms not himself but someone waiting for a bus?

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