CONCORD — Hoping to heal what he called “a festering wound in our state,” Sen. Tom Sherman, D-Rye, introduced sweeping legislation to address the crisis of mental health patients held in hospital emergency rooms across New Hampshire.
Twelve Senate Democrats signed on with Sherman to co-sponsor legislation that would divert $6 million from the state budget surplus to encourage the construction and staffing of mental health units at various hospitals.
The bill would double the state’s reimbursement rate for such beds, from $750 per day to $1,500, and subsidize necessary renovations to existing facilities, rather than build a new wing on the state psychiatric hospital in Concord.
Sherman said at least one hospital has already indicated it is “shovel ready” for the plan.
The state’s audited financial statement for the fiscal year that ended on June 30 showed a surplus of $95.8 million, after committing $110 million to the state’s reserve or so-called Rainy Day Fund.
The total “unassigned fund balance” for the state stands at $205 million, as revenue from business taxes far exceeded budget writers’ estimates.
By tapping into existing surplus, lawmakers can bypass the laborious budget-writing process that won’t wrap up until June and get the money deployed quickly, assuming the bill, SB 11, passes the legislature and is signed into law by Gov. Chris Sununu.
Sherman, a medical doctor from Rye, is chair of the Senate Health and Human Services Committee, which held a public hearing Tuesday on the bill.
“In my view as a physician, the current process is an affront to patient care, and it needs to be rectified immediately,” he said. “That’s why we’re hearing this bill so quickly and why I want to move it forward so quickly.”
The bill calls for $3 million to pay for the rate increases to cover involuntary and voluntary admissions for psychiatric care; $3 million to cover costs associated with creating new psychiatric units; and $3 million for transitional housing so patients have a place to go after discharge.
Hospital horror stories
One hospital representative after another came forward with horror stories of the dangerous conditions for patients and providers created by the shortage of psychiatric beds at New Hampshire Hospital.
Individuals experiencing a mental health crisis show up at hospital emergency rooms expecting to be transferred to New Hampshire Hospital or a comparable psychiatric facility, only to be held for weeks at a time, sometimes involuntarily, with no treatment.
“This is an issue we have been struggling with for many years, as all hospitals have,” said Alex Walker, chief operating officer at Catholic Medical Center in Manchester.
“We consider this legislation a very big step in the right direction of ensuring that patients languishing in our emergency rooms every single day around the state get to the right place for the right care in a timely way.
“These patients are in harm’s way; our nurses and physicians are in harm’s way. It’s heartbreaking for the families of these patients who are desperate to get them into the right setting for the care they need.”
Walker and other hospital executives described situations in which hospital personnel suffered serious injury trying to deal with mental health patients in an inappropriate setting.
Peter Evers, vice president for behavioral health at Concord Hospital, said walking into the hospital on some days is “like walking into a war zone.”
“We had a 62-year-old woman wait 32 days,” he said. “The damage we did despite our best effort for that individual is unconscionable.”
The average number of mental health patients boarded in emergency rooms on any given day is now about 40, and can go as high as 70, according to Ken Norton, New Hampshire executive director for the National Alliance on Mental Illness. On Tuesday, there were 49 held statewide, including three children.
Little progress so far
After years of reporting on the crisis and high-profile incidents going back to 2013, the state opened a 10-bed expansion at New Hampshire Hospital in 2016 that’s had little impact. Lawmakers last year approved significant investments in new mental health beds, and put out a request for proposals from hospitals, but none responded.
“Unfortunately, the extremely low reimbursement rates offered were simply inadequate,” said Steve Ahnen, president of the New Hampshire Hospital association, representing all 26 community and specialty hospitals in the state. “We believe the significant rate increase in SB 11 is sufficient to attract additional (psychiatric) beds.”
Hospitals that agree to participate in the program would have to commit to creating a unit of at least 10 beds, with appropriate medical personnel and the necessary systems in place to conduct adjudicated hearings for involuntary commitment.
Getting the units built is one thing, but getting them staffed is another, said Don Caruso, CEO of Cheshire Medical Center in Keene, which closed its mental health unit three years ago after its staff psychiatrists retired and couldn’t be replaced.
“We have a crisis in terms of funding, but we also have a crisis in terms of workforce,” he said.
Sununu reacted cautiously to the proposal, according to spokesman Ben Vihstadt.
“Gov. Sununu is committed to continuing the mental health reforms he put into effect over the past two years. A fiscally responsible approach to this crisis is critical to ensure long-term stability,” he said.
“The Legislature must be careful not to use one-time funds for ongoing expenses. Doing so would create a financially unstable system for those who rely on these services.”