Another View -- Karen Prive: Responding to NH’s mental health bed crisisBy KAREN PRIVE
November 30. 2017 9:39PM
I was 6 years old the first time I attempted suicide, followed by more attempts through my teens. While today I enjoy relative stability much of the time, last April, I was in the midst of worsening hopelessness and inner voices were telling me to die. My husband took me to the emergency room where an evaluating psychiatrist determined I must be admitted; however, there were no beds available. I was kept in a room the size of a closet that had been stripped of all furnishings other than the hospital bed. A security officer sat outside my door, and a nurse visited every couple of hours. For three days, I battled the demons inside my head, without medical treatment and often alone. Not surprisingly, my condition worsened. When someone is in a psychiatric crisis, their mind is not their friend — and all I had was my mind. On the third day I finally was admitted and received help.
In the last eight months, not much has changed for those in psychiatric crisis in New Hampshire. On Oct. 23, NAMI NH reported that 56 people waited in New Hampshire emergency rooms that evening for an inpatient psychiatric bed. To be eligible for admission, a person must be deemed to be in imminent danger to themselves or others. Yet these patients will wait in ERs for days or even weeks, for a bed to become available so they can receive treatment for their crisis.
According to analysis of New Hampshire death certificates, there were 223 suicides in 2015 (the last year with complete data reported), and the New Hampshire Bureau of Health estimates that there were more than 2,800 serious non-fatal suicide attempts for which the individual received care in a hospital for treatment of their injuries. It is important to note that there are many more less damaging attempts made as well — there is no mechanism to track non-fatal suicide attempts that do not result in serious injury or death. For youth, the CDC reports that in the last year, 7 percent of all New Hampshire high school students have seriously considered suicide, and approximately 900 of these kids actually attempted suicide during that time.
Yet as a society, we do not like to discuss suicide, nor the importance of adequate mental health care. It is though we assume that if we don’t talk about it, the problem will go away. In the last decade, the number of community-based inpatient mental health beds in New Hampshire has decreased by over half, with psychiatric units completely closing at five hospitals. New Hampshire Hospital has lost a large number beds as well.
Clearly this is a crisis we must treat as seriously as we have viewed the opiate crisis. Over the last few years, services for those with substance abuse services have become more plentiful, more visible, and in some cases, free. This is because the public deemed the opiate crisis an emergency that must be addressed. We ignore, however, that often an addict first used drugs or alcohol as a way to find relief from psychological or emotional distress, sometimes seeking to self-medicate an undiagnosed or untreated mental illness. Only later did the addiction take over and become the driving force in their life. If this addict manages to get into recovery, his or her underlying mental health condition often becomes problematic again, and unless they can get needed mental health care, they are at high risk of returning to substances to relieve their distress.
If we increased the availability of mental health services, including necessary inpatient beds, New Hampshire would likely see a lower suicide rate as well as a downtick in the drug abuse problem. There is outcry over the number of overdoses, but not similar outcry about the number of suicides. While there is still incredible stigma attached to mental illness and the need for mental health care (who wants to be labeled crazy?), we have had societal agreement that addiction is something we must address. Yet, addressing the opiate crisis is a bit like sticking a bandage on a wound and ignoring the infection lying underneath. We must address the issues of suicide and mental illness as well.
Karen Prive is the treasurer of NAMI NH, and lives in Franklin.