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Mark Hayward's City Matters: State's mental health resources still overstretched

By MARK HAYWARD
August 19. 2017 1:08AM
In a photo taken in February 2016, Nancy Duhaime is seen at her tent site on the West Side of Manchester. (MARK HAYWARD/UNION LEADER)

EIGHTEEN MONTHS ago, I met Nancy Duhaime.

She had recently become homeless, and in early February, none of her options were good. It was obvious that mental illness and alcohol had weighed down on the 5-foot-1-inch-tall woman.

Yet she spoke in a disarming, melodic voice that conjures up notions of an aging flower child. That belied an eruptive personality that got her in trouble back then. It still does.

Two weeks ago, Duhaime invited me to visit her at the psychiatric ward of the Elliot Hospital emergency room. Twelve days earlier, the 63-year-old had allegedly taken pepper spray to someone in a simmering dispute over an apartment. The mobile crisis response team brought her to the Elliot Hospital, where a doctor had determined she should be in the state psychiatric hospital.

But this is the fourth year of a mental health crisis in New Hampshire. No end appears in sight, and quick admission to the New Hampshire State Hospital is about as likely as finding a cheap Red Sox playoff ticket.

So if you’re Nancy, you wait. In her case, at the Psychiatric Evaluation Program — or PEP — unit, located beside the Elliot emergency room.

When we spoke, she had been in the PEP unit for 12 days. It’s a locked ward, with a security guard on staff.

A hallway leads to her 9-foot-by-9-foot room with a bed, a TV, a remote and wall-mounted cameras.

She has a window. It is 4 feet long by 3 inches wide and at the very top of a 10-foot-high wall. So even if she stood on her bed she couldn’t look outside.

“I feel like I’m suffocating to death, claustrophobic,” she said. “Here, I only have time to think of my problems.”

Mornings are the worst, she said, when she wakes up and realizes she can’t get away from the walls. Twice, panic attacks resulted in security guards strapping her to the bed, she said.

She hasn’t been outside. She said she can’t get books or a Bible, which the hospital disputes. In a journal she records her ups and downs.

For example, on Day 11, she called the ward a torture chamber, and drew a crude sketch of an angry, crying face saying “Help me (us) please.” Later that day, she writes, “We settled our differences. We will be fine with each other but the walls remain the same.”

“The emergency room is not an ideal place for any patient for a long period of time,” said Meghan Baston, a master’s level nurse and director of behavioral health services at the Elliot Hospital.

The Elliot knows the problems with psychiatric patients in emergency rooms. It endured two tragedies during a three-month period in 2013. Longtime emergency room nursing assistant Don Wyman was severely injured when beaten by a patient who was waiting four days for admission to the state hospital. And city resident Fern Ornelas, also an ER psychiatric patient, was paralyzed sometime between his stays at the Elliot and the Valley Street jail.

Those tragedies prompted state government to recommit itself to resolving the mental health crisis.

But in July 2015, the Elliot changed its approach to psychiatric care in the ER: The hospital sends its psychiatrist to check on the ER patients, it constantly reassesses patients to see if they can be released, and it hired a staff of psychiatric nurses ’round the clock, Baston said.

She said a chaplain has access to the unit, and hospital workers do what they can — board games, cards, occupational therapy — to help patients cope with idleness.

“We try to make (idleness) as little as possible,” Baston said. She dismissed a couple of my suggestions, such as exercise equipment (not practical when people are in a crisis, she said, but patients may walk the halls), and escorted walks outside (“My job is to keep the patient safe,” Baston said).

Ken Norton, the director of the New Hampshire chapter of the National Alliance on Mental Illness, said Elliot is probably better than many hospitals, noting that the hospital psychiatrist sees the ER patients.

But the system has problems that face all hospitals, including Elliot. Hospitals are quick to hire security guards, less likely to bring in peer support, Norton said. And everyone — including judges, lawyers and hospitals — ignores a 72-hour deadline (not including holidays and weekends) to bring someone like Duhaime before a judge, he said.

And more people are waiting longer in ERs for psychiatric care. Earlier this week, 68 adults and children were in emergency rooms awaiting admission, he said. One had been waiting at Concord Hospital for 25 days.

“If someone put me in a room with a TV ... nothing else and no window, I would probably be on the verge of psychosis or aggression in a week,” Norton said.

As for Duhaime, two days after inviting me for a visit, she was transferred to the State Hospital after 14 days at the Elliot.

I can’t determine how long she was in the state hospital. But within eight days, she was back in Manchester. On Thursday, she turned herself over to police to be arrested on the charges related to the pepper spraying and was released on bail.

On her last day at Elliot, she wrote: “Today I smile but I need all the help from God. I know this path is my learning how to be a better, stronger soldier.”

Mark Hayward’s City Matters appears Saturday in the New Hampshire Union Leader and UnionLeader.com. He can be reached at mhayward@unionleader.com.


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