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Plan for mental health patients awaiting admission stalls

State House Bureau

April 15. 2018 9:56PM


CONCORD —­ Mental health patients held in hospital emergency rooms awaiting involuntary admission to the state psychiatric hospital are still being denied due process, despite the fact that Health and Human Service officials said a program would be in place early this year to address the problem.

A 90-day pilot was launched late last year involving four hospitals in the hope that the effort could be expanded to all 26 hospitals in the state in 2018.

But the four hospitals — Catholic Medical Center in Manchester, Dartmouth-Hitchcock Medical Center in Lebanon, Southern N.H. Medical Center in Nashua and Speare Memorial Hospital in Plymouth — decided their emergency rooms could not accommodate a judicial process.

“I don’t think it’s going anywhere at this point,” said Ken Norton, executive director of the New Hampshire chapter of the National Alliance on Mental Illness.

The problem stems from a shortage of mental health beds at the state psychiatric hospital — New Hampshire Hospital in Concord — and at other “designated receiving facilities” for psychiatric patients in Manchester, Portsmouth and Franklin.

Those four locations are set up to conduct hearings in front of a judge in cases of involuntary emergency admissions. If people don’t think they need to be in mental health treatment, they have a right to a hearing.

But many mental health patients are being boarded in emergency rooms at hospitals that are not “designated receiving facilities.” Patients who protest their admission or want out of those emergency rooms can wait for weeks, even months, before they can get in front of a judge.

Held without hearing

Judge Edwin W. Kelly, chief administrator of New Hampshire Circuit Courts, testified last year before the Senate Health and Human Services Committee that somewhere between 3 and 5 percent of hearings that are held result in dismissal of the involuntary admission order.

“That means that if 50 people are sitting in emergency rooms, a couple of them maybe don’t belong there,” said Norton.

“I think the bigger point is that our country was built on protecting civil liberties, and while NAMI doesn’t want to see people who are in need of medical care released on a technicality, neither do we want to see wholesale discrimination against people’s civil liberties because of their mental illness.”

Judge Kelly evaluated some of the dismissals and warned that the state is exposed to potential lawsuits over due process denial.

“I don’t know why there haven’t been any,” Norton said. “The fact is that on any given day, the clear majority of those people want help and are not asking to leave, but that doesn’t mean they should be denied immediate access to crisis care or due process.”


Seeking a solution

Last spring, Michael Skibbie, policy director for the Disabilities Rights Center, wrote to legislative leaders to warn that the issue of due process for involuntary admission can’t wait until the state creates enough new mental health beds.

“We are disappointed,” said Skibbie, referring to the fact that one year later, the situation remains unchanged. “It’s a serious problem that needs a solution both in terms of reducing the number of people (waiting in emergency rooms) and making sure the people who are held there are being treated fairly.”

The 90-day pilot program was ambitious. It called for creation of a new full-time coordinator position within DHHS called Central Involuntary Emergency Admissions Coordinator, based at New Hampshire Hospital.

A nearly $1 million annual price tag would cover an estimated $81,000 for the IEA coordinator position; $540,000 for attorneys; $108,000 for computers and software; $100,000 for technical support; and $50,000 for additional emergency room staffing.

Patients being held in hospital emergency rooms for involuntary admission to the state psychiatric hospital or other long-term psychiatric facilities would get a probable cause hearing in front of a judge within 72 hours, via video link and telephone. 

The hospitals would have been required to provide a space for lawyers to meet with the patients and a secure video link that meets patient privacy standards.

Insurmountable barriers

A few weeks into the pilot, the hospitals decided it couldn’t be done.

According to a memo from DHHS Commissioner Jeffrey Meyers outlining the demise of the project, the concerns centered around security, legal liability and staffing needs.

Lauren Collins-Cline, director of communications for Catholic Medical Center, said CMC viewed the program as a potentially viable, but along with the rest of the pilot team eventually came to the conclusion that the details “presented significant challenges to the hospitals involved.”

“Chief among the hurdles were the privacy and safety of our patients and staff, especially those who would be directly involved in the hearings,” she said. “Most emergency departments, including CMC’s, are not set up to handle the logistics that we have discovered are involved with a court hearing. The emergency department lacks the secure, dedicated space needed for this proceeding.”

The state is now focusing its efforts on reducing the backlog of mental health patients in hospital emergency rooms as the best long-term solution.

New approaches

On Thursday of last week, hospitals around the state were holding 40 patients in emergency rooms awaiting admission to New Hampshire Hospital.

“The numbers are slightly down,” says Norton. “There has been a little improvement. When you are looking at 40 it’s hard to say that numbers are better, but the average was close to 50 a day, and we hit a high point of 70 last August.”

In an attempt to address the situation, the legislature last year funded 20 new mental health beds and a new mobile crisis response team, but got no bidders on the DHHS requests for proposals.

The main reason for the lack of response offered by mental health providers was lack of workforce, according to Norton.

The providers suggested there might be more interest in creating new transitional housing units for patients being discharged from New Hampshire Hospital. The state has had some success in that approach, with 20 new transitional beds created in the past year.

The money that was not used in the unsuccessful request for proposals is being reallocated in a new bill, SB 590, to more transitional housing units.

Health State Government Mental Health

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