Year in review: State restructures its mental health system 

New Hampshire Hospital provides acute, inpatient psychiatric services. (Hadley Barndollar | New Hampshire Bulletin)

New Hampshire Hospital provides acute, inpatient psychiatric services. (Hadley Barndollar | New Hampshire Bulletin) Hadley Barndollar


Monitor staff

Published: 12-27-2023 5:25 PM

Longstanding deficiencies with the state’s mental health system may have reached a turning point in 2023 as government and industry leaders worked to address issues such as timely access to care and a new investment of resources.

One lingering problem that’s been boiling over is the practice of boarding individuals with mental illness in hospital emergency rooms for days or weeks without appropriate care until a bed becomes available at a treatment facility for inpatient psychiatric care.

But an end is in sight, as a federal judge ruled that the state must ensure psychiatric care within six hours for individuals arriving at emergency rooms by May 2024.

This landmark decision stems from a 2018 ACLU lawsuit scrutinizing the state’s handling of involuntary emergency admissions, specifically confining individuals in mental health crises to hospital emergency rooms for days or sometimes weeks.

The New Hampshire Hospital Association — with several hospitals — intervened in the lawsuit, arguing that the state is unjustly seizing the hospitals’ property and demanding that these patients be immediately transferred to mental health treatment facilities.

Frequent trips to the emergency room are a familiar experience for individuals like Patrick Dowling, a 29-year-old diagnosed with schizoaffective disorder. He was held for over a week in the emergency room, waiting for an available bed. Now he’s optimistic that future mental health care visits will be more streamlined and expedited with the recent ruling.

“I know eventually I’m gonna have to go back to the hospital,” Dowling said earlier this year. “Just knowing that the healthcare system here in New Hampshire is improving and I’ll be able to just be there for a maximum of six hours and I’ll be going to where I can get help is just a huge sigh of relief.”

The state Department of Health and Human Services, responding to the court’s directive, acknowledged the need to end the practice but sought a 2025 deadline and 12 hours to secure a placement at a treatment facility. The obstacle to an immediate fix was a statewide shortage of psychiatric beds.

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The department introduced “Mission Zero,” a comprehensive plan developed in collaboration with the National Alliance on Mental Illness NH and the NH Hospital Association. This initiative focused on expanding early intervention resources, increasing the availability of inpatient psychiatric beds, and creating smoother transitions for individuals with acute mental health conditions back into the community.

One critical component of “Mission Zero” involves establishing community-based crisis stabilization units, serving as accessible points for those in need of behavioral health care during crises. These units aim to offer up to 23 hours of care, acting as alternatives to hospitals and assisting individuals in connecting with community resources.

The Center for Life Management in Derry and the Lakes Region Mental Health Center in Laconia have already opened two such units.

“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,” said DHHS Deputy Commissioner Morissa Henn.

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

Addressing the need for additional facility beds, the state has committed to adding 125 more at a total cost of $16 million. SolutionHealth, the parent organization of Elliot Hospital and Southern New Hampshire Hospital, plans to open 120 of these beds in early 2025, while Dartmouth Health will contribute five beds in the fall of 2024.

Simultaneously, efforts are underway to identify rental property owners for expanding existing programs that have demonstrated success in assisting complex populations, aiming to free up space in acute psychiatric facilities by providing transitional housing and outpatient step-down care.

In addition, a new forensic psychiatric hospital, set to be completed by the end of the summer of 2025, signals a departure from the practice of treating civilly committed individuals within the prison system.

This 24-bed facility, adjacent to the New Hampshire Hospital, represents a step forward in prioritizing specialized care for those in the criminal justice system with mental health needs.

Despite these positive strides in mental health reform, challenges persist in the interactions between police officers and individuals with mental health illnesses.

On the first day of the year, 17-year-old Mischa Fay from Gilford was shot by police responding to a 911 call from his parents’ home.

Despite the Gilford police department’s knowledge of his history of mental health illness, within two minutes of their arrival, Fay was shot dead in the chest.

The Attorney General’s Office is investigating to determine whether the use of deadly force was justified. The office will release a report once the investigation is completed.

In another incident last month John Madore, 33, a former patient at the New Hampshire Hospital, entered the facility and shot the on-duty security officer, former Franklin police chief Bradley Haas.

Madore, who had struggled with mental health issues and had a history of armed encounters with police, was subsequently shot and killed by a state trooper.

While acknowledging these challenges, Susan Stearns, executive director of NAMI NH cautioned against treating everyone with a mental health issue as a threat. She said the state needs to foster its community-based services and make sure they are accessible and available in a timely manner.

“The vast majority of people with mental illness are not violent,” Stearns said. “People with mental illness are more likely to be victims of violent crimes than perpetrators.”

As of January, only 16% of all 2,900 sworn police officers in New Hampshire have received Crisis Intervention Team training.

The training is a 40-hour program designed to reduce the risk of serious injury or death during interactions between police officers and individuals suffering from mental health issues. The program includes scenario-based instruction and role-playing to teach officers how to de-escalate different situations.

Gaps in training for law enforcement in interacting with individuals with a mental health illness is also being addressed, with the state announcing last week that prison officers will receive training from NAMI NH to better support incarcerated individuals facing mental health challenges, including CIT training.

“We want to help people and their family, certainly while they may be incarcerated, but we really want to help them be successful with their reentry into the community,” said Stearns.