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State deserves suit over mental health



Last modified: Sunday, January 15, 2012
The state of New Hampshire makes progress lawsuit by lawsuit. One filed in 1975 led to widespread prison reform. Another led to the closing of the state's warehouse for people with developmental disabilities. Serious state funding for public education came about only because of a 1991 lawsuit filed by five property-poor towns.

Yet another lawsuit is almost certain to be filed by the U.S. Department of Justice, a coalition acting on behalf of people with disabilities, or both. The suit will be over the state's unwillingness to provide adequate services and housing for people with mental illness. Since New Hampshire only moves forward at the point of a stick - especially when it might cost money - we urge one or both parties to proceed to court.

Through most of the 1980s and '90s New Hampshire led the nation in its treatment of the mentally ill. It was one of the first states to move patients from a state hospital that once held 3,000 people into the community, where they received care in the least restrictive setting possible, as federal law required. To make that work, the state created a system of community mental health centers, supportive housing and services to help the mentally ill integrate into the community and hold jobs. Over the past decade or so, however, the state so under-funded the mental health system that it deteriorated to the point that the state's own investigation deemed it "broken and in crisis."

Attorney General Michael Delaney and Health and Human Services Commissioner Nick Toumpas say progress is being made as fast as the economy permits, and there have been some improvements. But improvement won't come fast enough to alleviate the cruel conditions created when mental health patients receive inadequate or insufficient treatment unless the state is ordered to pick up the pace.

Largely because adequate care is hard to get, New Hampshire Hospital has an admission rate 40 percent higher than the national average. Its readmission rate is nearly double the national average.

In 2010, more than 15 percent of the patients discharged by the hospital were readmitted within 30 days. Nearly one-third were readmitted within 180 days, and some patients are essentially in and out of the hospital all year. People in the throes of a psychiatric crisis are forced to wait for hours in a hospital emergency room before they receive help. This is both costly and cruel, since delays and inadequate care can make for needless torment.

A stay at Concord Hospital runs $1,800 a day, a cost paid primarily in the form of higher prices for health insurance. The per-day cost of a stay in the state hospital is $1,300, none of which is paid by Medicaid. For what the state is already spending to treat the mentally ill in emergency rooms and the state hospital it could provide them far better care in the community. Not only would that comply with federal law, but care in the community is also reimbursable under Medicaid, which would pick up half the cost.

To keep people out of hospitals, the state needs more teams trained to deal with people in crisis, better funded community mental health centers, and much more supportive housing. There will be an upfront cost, one the state says it can't afford on the schedule the Department of Justice wants, but progress means savings in the long run. The state's position is untenable. If the Department of Justice is correct, and we believe it is, the mentally ill are being denied their rights on the grounds that it can't afford to provide them. That isn't a legitimate excuse, particularly when it's being put forward by one of the richest states in the nation.