Our Turn: A misguided decision on forensic hospital

Published: 4/3/2019 12:15:06 AM

We at Advocates for Ethical Mental Health Treatment are deeply disappointed at the recent decision by the House Finance Committee (Monitor front page, April 2). The failure to provide the fiscal resources needed to construct a new forensic facility has now left this situation in a precarious state.

We strongly disagree with the plan to place civilly committed forensic patients in New Hampshire Hospital for the long term. We see this as only an interim solution until such time a new facility is constructed.

The Disability Rights Center released a statement voicing their opposition to a new facility. They wish to see resources invested in community-based care. We respectfully disagree with their position regarding the construction of a new facility. We fundamentally agree with DRC about community-based care; that is where individuals with serious mental illness enjoy the best quality of life. It is the message of almost all the nation’s protection and advocacy organizations. Institutions are costly. Historically, they have been epicenters of abuse and neglect that most protection and advocacy organizations have litigated zealously to end.

We in New Hampshire are still evolving. It is only recently that any concrete actions have commenced to stop the incarceration of civilly committed individuals in the state prison. The fact this practice has existed for decades shows how much work is left to be done. It is now less important as to how we reached this point than it is to identify the best plan moving forward.

Given the dramatic increase in both utilization and acuity of those seeking mental health services, a new facility is indicated. There are numerous algorithms used to determine the number of beds needed to accommodate a state’s population. We do not have enough inpatient bed capacity.

While a community-based system is ideal, we have individuals waiting weeks in emergency rooms across the state. Many of the civilly committed individuals in the prison have languished there for years. Until there is adequate treatment at the acute level, individuals are not able to fully participate and reap the benefits of community-based care. A cycle of repeated, costly and traumatic hospitalizations occurs. The construction of a new facility would hopefully provide the secondary gains of providing relief to our emergency rooms dealing with this ongoing issue, while improving the overall standards of care.

We are concerned that the addition of this population to New Hampshire Hospital as a permanent solution is misguided. The impact on NHH’s operations, we believe, would be potentially adverse long term. The needs of the forensic population are specific and demanding. The time has come to develop this aspect of behavioral health care in New Hampshire.

It is most likely this population will continue to grow and will no longer be able to be safely housed in NHH in the future. It is time for vision and critical thinking. A fiscal decision based on an ideal rather than the current reality facing the state lacks any well-reasoned examination of the facts.

The state is currently being sued in federal court over both the emergency department boarding and the civil rights violations associated with SPU. Now is not the time for a quick fix.

Two legislative study committees in recent years both concluded a new facility was indicated. Both studies also recognized the legal jeopardy for the state over current practices. The most recent study was done in 2010. There has been bipartisan support for the construction of a new facility. We have a governor who has put the weight of his office behind the construction of a new facility. Most importantly, the people of New Hampshire have spoken. They have testified. They have demonstrated. Those whose lives have been touched by SPU have both endured and suffered. This plan does not reflect the will of the people. Dignity is not a partisan issue. This issue at its core is a humanitarian one, not a political one.

A forensic facility is not some new, novel idea. They exist in 49 other states in various models. It is time for a true understanding of why this facility is needed. Its construction would demonstrate a commitment to providing safe, evidence-based care to a vulnerable population that essentially was discarded by the state for decades. Such a facility may now provide this population with the indicated treatment that will allow them to be integrated into community-based care. It would signal a new era in behavioral health standards in New Hampshire.

We vow to continue to be the voice for this population.

(Beatrice Coulter and Wanda Duryea are the co-founders of Advocates for Ethical Mental Health Treatment.)

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