New Hampshire Hospital

Nearly two-thirds of treatment beds for mentally ill adults and children statewide -- 175 of 255 -- are in the state-run New Hampshire Hospital complex in Concord.

When it comes to expanding the number of treatment beds to care for mentally ill adults and children, New Hampshire Gov. Chris Sununu said he is losing patience.

“I don’t want to hear from the lobbyists that say it can’t be done, from the providers that say that’s nice but it’s not possible,” Sununu said. “We are doing this. Don’t give me 10 reasons why we can’t be doing something. This is a crisis.”

Sununu’s critics maintain it’s the governor who, while dealing with an unprecedented public health pandemic, took his focus away from the problem which, thanks to COVID-19, got much worse.

Dan Feltes of Concord, Sununu’s Democratic opponent for governor in 2020, wasn’t impressed after reading the governor’s new executive order which spelled out out how the state would respond to a Supreme Court order that the state must give all mental health clients more timely treatment.

“Let’s be clear: Everything in this ‘order’ (and then some) was already authorized, directed, and fully funded by the last Legislature on a bipartisan basis back in 2019, well before COVID, and, if anything, COVID should have prompted expedited action on mental health,” Feltes said.

When Sununu’s father, John H. Sununu, was governor in the mid-1980s, New Hampshire had a robust network of community hospitals and health care centers with acute psychiatric beds located across the state. This contributed to the state’s number-one ranking in the nation for mental health services.

New Hampshire now has only seven places where adults or children can be involuntary committed due to mental illness.

And nearly two-thirds of all those beds currently — 175 of 255 beds statewide — are in the state-run New Hampshire Hospital complex in Concord.

The other so-called designated receiving facilities and their bed counts include Hampstead Hospital (16-bed child unit), Elliot Hospital (16), Portsmouth Hospital (16), Franklin Hospital (10) and Cypress Center in Manchester (16).

Currently, New Hampshire is ranked 18th in the nation for mental health services, according to a Mental Health America survey.

All other New England states were ranked better, led by Vermont (1st), Massachusetts (3rd), Rhode Island (12), Connecticut (13) and Maine (14).

When it comes to access to that care, New Hampshire was 10th, joining all New England states in the top 10.

60 waiting for a bed

As of last Friday, there were 35 adults and 25 children waiting for a mental health treatment bed.

State spending for mental health services has significantly gone up in recent years from $97 million in 2013 to $164 million in 2019.

But as Sununu noted, money alone has not solved this problem.

“We put millions of dollars and contracts out ... to provide more community services a few years ago. Do you know how many bids we received? Zero,” Sununu said. “I can’t tell you how frustrating that was for all of us.”

Health and Human Services Commissioner Lori Shibinette said the state is in talks on how to increase beds in the short term.

“We have already put several things in motion in the last 24 hours that will hopefully open (more) capacity in the next five to seven days,” Shibinette said.

After Sununu issued his executive order, providers pledged to create more partnerships to expand services.

The New Hampshire Hospital Association called the crisis “a symptom of a much broader problem of not having adequate capacity across our entire mental health care system — from outpatient services, crisis services, acute inpatient services, transitional housing and other community support services that support patients no longer in crisis.”

Review provider contracts

Jay Couture, president of the New Hampshire Behavioral Health Association, said those running mental health centers are committed to improving the system.

“The 10 nonprofit centers and their boards of directors have steadfastly advocated for adequate and sustained funding for the community based system, for years, and will continue to do so,” Couture said. “We are well-positioned to deploy the right investments and look forward to being a critical part of the planning and implementation of the governor’s Executive Order.”

Sununu said a key part of his initiative will be for the state to perform quality control on all existing contracts.

“When you come into an emergency room there is an expectation that you are going to be given care. We are telling the hospitals you have to be part of the solution,” Sununu said.

“Some community mental health centers do a phenomenal job. There are some who frankly don’t. I am more than happy to go out and find other providers who can better get the job done.”

The state’s 10-Year Mental Health Plan released in 2019 concluded New Hampshire needed to spend more money to expand access to treatment beds.

The plan called for converting the Sununu Youth Services Center in Manchester into a 36-bed unit for children and adolescents needing care. The House-passed state budget proposes to close the Sununu center as a correctional site for juvenile offenders.

To get hospitals and other providers to open beds, the plan suggested doubling the rate the state now pays, which would cost $750,000 more a year.

The state should create a capital construction fund to pay for the renovation or new bed space in exchange for a hospital’s agreement to keep those beds open for at least seven years, the plan said.

While Sununu downplayed the issue, the 10-year blueprint also noted that a work force shortage remains a barrier.

“The inability to recruit psychiatrists, in particular, is a constant concern, cited among the reasons why community hospitals have eliminated inpatient psychiatric beds and why agencies have not come forward to serve as designated receiving facilities for people with urgent psychiatric needs,” the plan concluded.