In a move to restructure New Hampshire’s mental health system, state officials are making investments aimed at eliminating the longstanding practice of boarding patients with mental illness in hospital emergency departments.

As part of the “Mission Zero” plan, which seeks to eliminate the boarding of psychiatric patients in emergency departments by 2025, the state Department of Health and Human Services, in collaboration with NAMI NH and the NH Hospital Association, publicly unveiled their new strategy on Thursday.

Their approach centers on expanding early intervention resources, increasing the availability of inpatient psychiatric beds, and facilitating smoother transitions for individuals with acute mental health conditions back into the community.

“We are confident and I think what gives me hope is that this is all being led by a multi-stakeholder set of individuals and it’s being centered around people with real experience in a variety of parts of our mental health system,” said Morissa Henn, associate commissioner of DHHS. “This is not something that DHHS or any organization can do alone. What makes this different is that we are harnessing the collective power and strength of so many different individuals.”

A key focus of the plan is to establish community-based crisis stabilization units, designed to serve as access points for those in need of behavioral health care during a crisis.

These units will offer an alternative to hospitals, providing up to 23 hours of care while also assisting individuals to connect with community resources.

The two crisis stabilization units set to open this fall are the Center for Life Management in Derry and the Lakes Region Mental Health Center in Laconia.

This initiative forms an integral part of the state’s crisis intervention model, expanding upon the existing rapid response helpline and mobile crisis units to provide comprehensive support to those in crisis.

“Having a place where people who are experiencing acute psychiatric issues can get an assessment, get care and get stabilization that oftentimes can even prevent the need for a hospital visit altogether,” explained Henn.

Contracts have been authorized for the two centers, each with a budget allocation of $1.47 million for the next two years.

The state is also addressing the need for more designated facility beds by adding 125 more at a total cost of $16 million.

SolutionHealth, the parent organization of Elliot Hospital and Southern New Hampshire Hospital, will open 120 of these beds in early 2025, while Dartmouth Health will provide five beds in the fall of 2024.

The state is not only implementing strategies to ensure individuals with mental health issues receive timely and suitable care but is also developing plans to support individuals who are transitioning from acute care settings back into the community.

The state is currently in the process of identifying rental property owners and is soon set to announce a contract to expand an existing program that has demonstrated success in assisting complex populations, Henn explained.

Apart from providing individuals with mental health conditions access to housing, this initiative frees up acute psychiatric beds for those in need. Patients often don’t get discharged because of a lack of transitional housing or step-down care in the state.

“This model provides having the full support and engagement of landlords who understand that some of these individuals may need extra care, attention patients, physical accommodations, there may even be instances where their mental health issues flare up,” said Henn.

Additional plans in Mission Zero include the expansion of step-down facilities, increased access to integrated substance use disorder treatment, and enhanced collaboration among hospitals, psychiatric facilities, and community providers.

Susan Stearns, executive director at NAMI NH said the collaboration between stakeholders looks promising.

“We have such broad stakeholder representation committing to implementing this plan,” said Stearns. “We will con tinue to advocate for the level of investment that is necessary as well as for continued collaboration between the partners in order to ensure that people who experience psychiatric crisis are able to get the care they need when and where they need it.

These initiatives are part of the state’s 10-year mental health plan, but they require mental health workers, whom the state has struggled to find in recent years.

“We believe that by building a system, that is best in class, we can attract people into these fields and we can keep them engaged and serving patients in need,” Henn said.

The Mission Zero plan aligns with the federal court decision in May, which mandated that the state put an end to the practice of boarding psychiatric patients in hospital emergency rooms within a one-year period. Additionally, as per the judge's directive, the maximum duration for holding individuals in emergency rooms has been restricted to six hours. This represents a substantial decrease compared to the existing norm of patients staying in these facilities for several days and sometimes even weeks.

If you need help

NH Rapid Response Access Point: Call or Text 833-7100-6477  for free and immediate, 24/7 access to mental health and/or substance use crisis support via telephone, text and chat services.

National Suicide Prevention Lifeline: Call 1-800-273-TALK (8255) for free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.

Veterans: Veterans and their loved ones can call 1-800-273-8255 and Press 1, chat online, or send a text message to 838255 to receive confidential support 24 hours a day, 365 days a year. Support for deaf and hard-of-hearing individuals is available.

Crisis Text Line: Free, 24/7 support for those in crisis. Text 741741 from anywhere in the U.S. to text a trained Crisis Counselor.

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