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After ER attacks, a call for more care

New Hampshire Union Leader

January 28. 2014 9:04PM

Here’s what report recommends
Here are some recommendations from the Mental Health Sentinel Event Review Report:

• Each hospital should develop a plan to expand the number of beds.

• Hospitals should establish a network to assign critical patients to available beds.

• Provide additional affordable community housing and consider restructuring of group homes.

• Better training of hospital workers, including all emergency room workers.

• Better assessment and treatment of mentally ill people who have drug and alcohol problems.

• “Weigh the benefit to the delivery of mental health care that would occur with an expansion of Medicaid.”

• Obtain a waiver of Medicaid rules that require a psychiatrist to approve all psychiatric care rather than a nurse practitioner.

• Create a tax-exempt Mental Health Trust, which would be supported by both taxpayer funds and private donations. It’s unclear exactly what the trust would do, but a non-partisan, independent board would control how the money is spent.

• Consider data-sharing between the New Hampshire Hospital and community mental health centers.

• Encourage more physicians to enter psychiatry.

All New Hampshire hospitals should consider adding acute-care beds for psychiatric patients, according to the recommendations of a trio of experts who reviewed the state’s mental health system following two violent attacks last year at Elliot Hospital.

The recommendation is the first among nearly three dozen spelled out in a 25-page report. (See related story, Page A8.) Gov. Maggie Hassan released the report Tuesday. It was compiled by a judge who chairs the state’s Board of Mental Health Practice, a psychiatrist who is associate medical director of the New Hampshire State Hospital, and an assistant attorney general.

The Mental Health Sentinel Event Review Report adds another set of recommendations for the state’s beleaguered mental health system, which has come under scrutiny following complaints about days-long waits at hospital emergency rooms.

That chokepoint was highlighted last year by two separate incidents between Elliot Hospital emergency room workers and psychiatric patients. Alleged patient attacks and response resulted in serious, life-altering assaults.

The report said 228 sentinel events — described as unexpected occurrences such as death, abuse, rape, serious injury or neglect — occurred at acute care facilities in New Hampshire last year, up from 196 the previous year.

Previous recommendations have called for a renewed focus on community-based care, such as placing teams of mental health workers on call to help someone going through a crisis.

The review released Tuesday makes note of earlier recommendations, but it reports that in-patient psychiatric beds in the state dropped from 526 in 2005 to 384 last year.

“There must be additional capacity, whether arrived at by adding beds or increasing efficiency, or creating satellite campuses of New Hampshire Hospital to treat patients closer to the communities to which they are connected,” the review reads, quoting one person who responded to a survey.

The review involved surveys and interviews with unnamed hospital chiefs, clinicians and emergency room workers.

The report said hospitals find mental health care is not economically viable because most patients are poor and lack insurance.

“Hospitals have tended to lose money treating these patients,” said Steve Ahnen, president of the New Hampshire Hospital Association.

But he said some hospitals have taken steps to add psychiatric beds. Franklin Regional Hospital is opening 10 beds for involuntary patients; Elliot Hospital in Manchester is the only other hospital in the state with such beds.

At least two other hospitals are in discussion with the state about adding such beds, Ahnen said. Meanwhile, Parkland Medical Center in Derry and Portsmouth Regional Hospital have applied with the state to add voluntary psychiatric beds, he said.

He said the state remains in a crisis; 26 people were in hospital emergency rooms Tuesday waiting for admission to the New Hampshire State Hospital.

In releasing the report, Hassan noted that Medicaid expansion would provide mental health services for many uninsured people.

The review was led by former Supreme Court Justice Joseph Nadeau, who was joined by Dr. Alexander P. de Nesnera and Senior Assistant Attorney General Michael Brown.

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