Experts: Patients could have avoided state hospital

Last modified: Monday, February 04, 2013
Of 25 state hospital patients recently studied by mental health experts, all but one or two could have avoided 30-day hospital stays if there had been adequate crisis counseling and housing in their communities, according to new filings in a federal lawsuit against the state.

The experts drew a similar conclusion about 20 patients they studied at the state’s Glencliff Home for the elderly with mental illness and developmental disabilities.

“Rather than the modern system . . . I saw a mental health system that was consistently broken, failing (patients) in a similar way regardless of their individual needs or conditions,” wrote Susan Curran, a Virginia-based expert in community mental heath care. “I saw a system reliant on institutionalization, utilizing treatment models and approaches I hadn’t encountered in 20 years.”

The lawsuit, filed a year ago by the Disabilities Rights Center in Concord and joined by the U.S. Justice Department, alleges the state is violating the Americans with Disabilities Act by failing to provide less restrictive, community-based treatment for people with mental illness.

It’s the same argument local mental health providers are making now to Gov. Maggie Hassan and the Legislature as they request more state money for community care.

Nearly all the community-level treatments called for by that group and the lawsuit – more crisis response teams around the state and more community group homes or apartments with supervision or counseling attached – are laid out in a 10-year-plan the state adopted in 2008 to improve mental health care.

But almost none of the plan has been pursued because the state has been in a budget crisis since the plan was adopted. That inaction, in large part, led to the federal lawsuit.

In an effort to get the case certified as a class-action lawsuit, the plaintiffs hired five mental health experts from across the country to review the hospitalization records of about four dozen patients selected by state officials. The experts’ conclusions were filed with the court last week.

Amy Messer, legal director for the Disabilities Rights Center, is the lead attorney on the case.

These findings “just confirmed and highlighted everything we’ve been seeing and hearing regarding the lack of community mental health services and the unnecessary institutionalization of people with serious mental illness.”

Curran reviewed two years of hospitalization and community treatment records for 25 people who had spent 30 days at the state hospital between July 2011 and June 2012.

She determined 24 of the 25 of the patients could have “very likely” avoided hospitalization had they had adequate community mental health treatment.

If hospitalization was still required, 24 of the 25 could have spent fewer days at the hospital, where a bed costs about $1,000 a day, Curran said. And when asked, 23 of the 25 said they’d rather live in the community, with help, than be committed to the state hospital when they suffered a crisis.

Dr. Thomas Simpatico, a Vermont-based psychiatrist and former medical director of the Vermont State Hospital, reported similar findings. The difference was that Simpatico thought 23 of the 25 could have avoided hospitalization with adequate community-based treatment.

Judith Boardman, a psychiatric mental health nurse in Massachusetts whose work now focuses on treating veterans in their own homes, studied two years of records for 22 patients at the Glencliff Home.

Boardman found that all 22 patients could have “very likely” avoided admission to Glencliff, located in the remote town of Benton, if they had had services in their own communities. Of the 22, 17 said they would choose to live in their own communities instead of Glencliff if services existed.

“The strong pattern of unnecessary institutionalization across the review, allows me to confidently conclude that there are systemic deficiencies in the New Hampshire mental health system, including an over-reliance on institutional care,” Boardman wrote.

MaryLou Sudders, the former acting director of New Hampshire’s mental health division, was hired to assess the status of the state’s community-based mental health services. She’s done similar reviews for other states.

While the 10-year-plan called for an increase in community residential services, including housing, the number of those units across the state has decreased, Sudders found. There are too few “Assertive Community Treatment” teams around the state, she said. Those teams, which usually include a psychiatrist, mental health nurse and case manager, respond quickly and as a group when a client has a mental health crisis.

Sudders concluded that if the state shifted its resources from expensive hospitalizations to cheaper and more effective community treatment services, patients would need hospitalization far less often.

“The current lack of community-based mental health services in New Hampshire is the result of the actions and inactions of state officials,” she wrote. “It is their responsibility to establish services priorities and to direct and redirect funding to address the well-known and well-documented lack of community-based mental health services.”

The state has not yet filed a response to the experts’ reports. Anne Edwards of the state attorney general’s office, which is defending the state, did not return a call seeking comment.

The case is scheduled to go to trial in the summer of 2014. Messer said she would welcome a chance to settle the case if the state is willing to increase community services. She said she’d also welcome the chance to work with lawmakers to resolve the dispute.

“We hope to have discussions with the governor and the Legislature because we have a lot of expertise and experts working on this case who are best equipped to help us resolve some of these issues,” she said.

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