N.H. officials blast mental health critics

Last modified: Wednesday, December 07, 2011
Under the threat of a lawsuit, state officials yesterday slammed a federal critique of the state's mental health system and said they are already working on the shortcomings federal officials want fixed.

"The threatened litigation by the federal government . . . will waste precious state and federal taxpayer dollars that could be better spent on providing services," read a letter signed by New Hampshire Attorney General Michael Delaney and Health and Human Services Commissioner Nick Toumpas.

The letter was addressed to U.S. Assistant Attorney General Thomas Perez, who in April issued a scathing assessment of the state's mental health system, describing it as "broken" and "failing." The 28-page report said the state was violating the Americans with Disabilities Act by unnecessarily institutionalizing mental health patients instead of spending money on less restrictive community care.

Federal law requires that people with mental health disabilities be treated and housed in the least restrictive way possible. The federal investigation was part of a nationwide review of mental health services, according to state officials. Perez threatened legal action if the state failed to make a dozen changes, which included implementing more of its 10-year improvement plan and providing more community supports.

Toumpas and other state officials disagreed with Perez's findings at the time but held off on a formal response until yesterday, after nearly seven months of discussions with federal officials failed to produce an agreement.

Calls to the offices of Delaney and Toumpas were not returned yesterday.

In their letter, Toumpas and Delaney defended New Hampshire, telling Perez the state is three years into its 10-year improvement plan and is shifting state resources to community mental health providers. They complained that federal officials had spent just two days in New Hampshire reviewing the mental health system. They also said the report's investigators had based their critique on deficiencies state officials had disclosed themselves and had used in developing the 10-year improvement plan.

"Contrary to good public policy, you mischaracterized statements in those reports as 'admissions' of noncompliance with federal law," the letter said. "Strategic reports should be used by the state and its citizens as a pathway to improved services - not by the federal government as ammunition for over-reaching . . . litigation."

The letter listed several improvements the state has made to the mental health system in spite of "an extremely challenging fiscal climate." The state has developed community treatment teams in areas that have the highest state hospital admission and readmission, the letter said. It has also tried to expand psychiatric services within the community and has established a program to help homeless people with mental illness afford housing, according to the letter.

In closing, Delaney and Toumpas urged the federal Department of Justice to withdraw its "erroneous findings" and let the state continue its improvements "without the distraction and expense of needless litigation."

A phone call to the U.S. Department of Justice were not returned yesterday.

Roland Lamy is executive director of the New Hampshire Community Behavioral Health Association, which oversees the state's 10 community mental health centers. He issued a statement yesterday saying his organization needed more time to review the state's response before commenting fully.

Lamy did say the state's 10-year improvement plan "rightly deemed" the state's community mental health system as being in crisis.

He wrote: "While some small progress may have been made since then, millions of state and federal dollars have been cut from the system, enrollment has increased, access to community and inpatient beds has decreased and the day-to-day state of the system remains in crisis."

Amy Messer, legal director for the Disabilities Rights Center in Concord, said her office has flagged similar failings for state mental health officials. "I think the federal Department of Justice has it absolutely right," she said yesterday, after reading the state's repose to federal officials.

"The situation has not improved," Messer said. "In fact, I think it has worsened."

She said the state continues to choose costly admissions to the state hospital and the Glencliff home for the elderly over less expensive community solutions, like more housing and additional treatment providers.

New Hampshire's admission and readmission rates to the state hospital, where a day's stay costs $1,300, are higher than the national average, she said. In 2010, nearly 40 percent of state hospital patients returned within 180 days, Messer said. The national average was about half that.

If community services were better, Messer said, people with mental disabilities would not be returning to the state hospital so frequently.

In their letter, Delaney and Toumpas highlighted the creation of eight community mental health teams designed to respond to the most risky patients. What they didn't say was that those teams cover just half the state, Messer said.

She also disputed the state's claims that it has added more community housing as a less restrictive option to the state hospital. "The number of supportive housing units they have created since the start of their 10-year plan (in 2008) has been miniscule," she said. "And it does not come near meeting the needs of people with mental illness."

Asked whether she thought it was likely the state would face a lawsuit from the New Hampshire Disabilities Rights Center, Messer said, "What I will say is that we do believe they are still in violation of the law and we will continue to pursue the avenues available to us."

(Annmarie Timmins can be reached at 369-3323 or at atimmins@cmonitor.com.)