Psychiatric emergency boarding to be phased out in NH hospitals


Monitor staff

Published: 05-20-2023 3:19 PM

A decade of overwhelming challenges in New Hampshire’s mental health sector has reached a milestone after a federal judge ruled that the state must cease the practice of prolonged confinement for psychiatric patients in hospital emergency rooms.

“I am heartened that this seems to clearly put an end to the inhumane practice,” said Susan Stearns, executive director of National Alliance for Mental Illness for New Hampshire. “This is an opportunity for all stakeholders to work together to ensure people who are experiencing one of the most challenging times in their lives get the very best care as quickly as possible.”

Last week, a U.S. District Court judge issued a permanent injunction directing the state’s Department of Health and Human Services to put an end to the practice of holding psychiatric patients in hospital emergency rooms within a one-year period.

In addition, per the judge’s order, the duration for which individuals can be detained in emergency rooms has been limited to a maximum of 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.

The court’s ruling will protect the constitutional rights of individuals experiencing mental health crises in hospital emergency departments, according to Gilles Bissonnette, the legal director of the ACLU of New Hampshire.

In 2018, the ACLU initiated a lawsuit against the state, planting the seed to challenge its entrenched practice of involuntarily detaining individuals facing mental health crises in emergency rooms.

“Granite Staters experiencing a mental health crisis should have a robust array of treatment opportunities that meet their needs, including the level of treatment they need, when they need it, and where they need it,” said Bissonnette. “We’ll be watching closely over the course of the next year as stakeholders create the needed changes to build a successful, inclusive system for mental health in New Hampshire.”

Following suit, in January, 18 hospitals in New Hampshire intervened, aiming to put an end to the practice of boarding psychiatric patients in hospital emergency rooms.

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The different experiences between psychiatric patients awaiting treatment in emergency rooms and patients with physical ailments are vast, said Stearns.

“Most often they are windowless rooms, and the expression that is usually used is ‘if you’re lucky,’ there’s a television,” Stearns explained, citing what she has heard from people who had to wait in these hospital emergency rooms for days.

Furthermore, the limited visitation intensifies the already traumatic and isolating nature of the experience.

Despite providing relief to hospitals by reducing the burden of housing psychiatric patients in their emergency rooms, New Hampshire’s mental health sector continues to suffer from staffing shortages.

As per the state’s tracking tool, the number of adults waiting in emergency rooms under Involuntary Emergency Admission stood at 30 on Thursday.

The data also indicates that 38 beds were unavailable due to staffing and renovations. Moreover, there were 19 children awaiting mental health treatment, with 34 beds currently unavailable.

In line with the court ruling, DHHS announced Mission Zero as a plan to eliminate hospital emergency department psychiatric boarding by 2025.

“Building on years of progress, we are hitting the gas to fully eliminate ED boarding and build a mental health system that serves people at the right place at the right time,” DHHS Interim Commissioner Lori Weaver said in a statement. “The strategies employed as part of Mission Zero are bold and proactive, designed to accelerate New Hampshire’s efforts to increase community-based services and reduce the need for, and length of, inpatient psychiatric admissions.”

The plan aims to tackle several issues, including the provision of timely services within the community, addressing the shortage of beds in inpatient psychiatric facilities and addressing situations where individuals with psychiatric needs end up staying in these facilities for longer than necessary due to a lack of appropriate support to ensure a safe discharge.

Stearns expressed optimism regarding the state’s Mission Zero, an initiative aimed at revamping New Hampshire’s mental health care system, and she urges policymakers to support it with the necessary resources and investments.

“This is an issue that has the potential to affect every single one of us,” said Stearns. “This is why it is so critical that we ensure that the resources are in place for a comprehensive plan like Mission Zero in order to ensure ED boarding for people experiencing psychiatric crises comes to an end in our state.”