My Turn: The trouble with New Hampshire’s Secure Psychiatric Unit

For the Monitor
Last modified: 2/28/2016 1:05:23 AM
Earlier this month, a hearing was held debating HB 1541 before the House Committee on Health, Human Services and Elderly Affairs.

The bill, introduced by Rep. Renny Cushing, would prohibit the placement of non-adjudicated civilly committed individuals in the Secure Psychiatric Unit (or SPU) at the New Hampshire Prison for Men. I attended the hearing. I also testified. I am a registered nurse with extensive experience working with acute psychiatric populations.

Last year, I accepted a nursing position on SPU. I resigned fours days into my employment. By my clinical and ethical standards, I found it unacceptable.

For a number of years I coordinated involuntary hospitalizations in an urban hospital crisis unit. No one was ever civilly committed to a prison in the absence of having been adjudicated. The legal firewalls to prevent unlawful incarceration versus an involuntary hospitalization were understood by all responsible for the process.

Striking the balance between public safety and treatment in the least restrictive environment can be a challenge. However, it is not a license to abandon civil liberties and quality treatment.

Detention in a prison is not treatment. It is custodial management. It also is inconsistent with the concept of “milieu” referring to a therapeutic environment. Department of Corrections leaders are not subject matter experts on the treatment of the mentally ill. We must be vigilant to protect vulnerable individuals from a corrections paradigm being substituted for a behavioral health treatment one.

At the hearing, SPU was characterized by a DOC official as a “hospital.” My experience with forensic hospitals is that they are licensed by the state to operate as a hospital, are accredited, usually by the joint commission, and are under the umbrella of the Department of Health and Human Services. It is usually the combination these factors that make a facility eligible for reimbursement.

I am not aware that SPU possesses any of these characteristics. Once a facility is eligible for reimbursement, it is subject to quality assurance reviews by outside entities. Utilization of SPU for non-adjudicated individuals is a creation of crisis, failed policy and fiscal starvation.

There are currently individuals who have languished in SPU for years in the absence of criminal charges or adjudication. The lack of a forensic treatment facility does not give this practice legitimacy.

In the current health care climate, it is stunning to hear of hospitalizations of such duration. An independent review of treatment plans and objectives should commence to examine the need for such prolonged hospitalizations. If no clinical progress is being made, then transfer to a licensed, accredited forensic hospital should be discussed by the treatment team with the family or guardian.

If SPU were receiving reimbursement, I suspect many questions would be asked about such remarkable lengths of stays. Psychiatry practiced in state institutions across the country has a long, dark history of practices that have violated human and civil rights. At those times in history, these practices were vigorously defended by state officials as needed tools to manage violence and promote public safety.

History also shows us that grassroots activism and litigation were the only remedies to end such treatment.

It appears that litigation will probably be the only remedy to promote the needed policy change in respect to SPU. We need to be addressing options rather than wasting time defending this failed practice.

It is time to confront the growing utilization and acuity of those needing psychiatric care and fund it responsibly. It is also time to begin demonstrating compassion. We do not have a forensic hospital in New Hampshire. Let us begin the conversation and plan for the future.

For history has already demonstrated to us where we need to be on this issue.



(Beatrice Coulter, a registered nurse, lives in Concord.)


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