NH's mental health system violates the Americans with Disabilities Act & NH's Medicaid Raid

"Federal Report Blasts NH's Mental Health System"
WMUR.com - April 12, 2011

CONCORD, N.H -- A new report from the federal government confirms what New Hampshire officials have acknowledged for years: The state's mental health system is broken, failing and in crisis.

The U.S. Department of Justice's civil rights division recently investigated the state for possible violations of the Americans with Disabilities Act. It concluded that the state is violating the federal law by failing to provide adequate community-based services to people with mental illness, leading to needless and prolonged stays at New Hampshire Hospital, the state mental hospital, and Glencliff Home, its nursing home for those with serious mental illness or developmental disabilities.

"Reliance on unnecessary and expensive institutional care both violates the civil rights of people with disabilities and incurs unnecessary expense," Assistant Attorney General Thomas Perez wrote in a report sent to the state last week. "Community integration with appropriate services and supports will permit the state to support people with disabilities, including mental illness, in settings appropriate to their needs in a more cost effective manner."

As the report noted, the state has long acknowledged most of the failings and offered detailed plans to fix them in a 10-year plan it developed in 2008. But progress has been slow, and lawmakers also are considering cuts to the community mental health system that could make enacting the plan more difficult.

Under the budget recently passed by the House, the state would save $6.7 million a year by reducing the number of adults eligible for mental health services and $5.8 million a year by changing eligibility rules for children. The state's 10 community mental health centers say that will eliminate treatment for 3,500 children and more than 4,000 adults.

The federal report concluded that the community mental health centers should be seeing more patients, not fewer. It said the average cost of institutionalizing someone at the state mental hospital is $287,000 per year, while serving someone in the community costs $44,000. Too many people end up at the hospital because community resources are lacking, the report said, and they stay longer than necessary because there aren't appropriate settings in which to continue their care after they leave.

The report was particularly critical of the Glencliff Home, which it said puts virtually no focus on discharge planning. In recent years, far more residents of Glencliff have died each year than have been returned to their communities.

"Other than age in some cases, it does not appear that the individuals at Glencliff present any novel or different set of disabilities than their peers at (New Hampshire Hospital) - all of whom are at least nominally in the active, state-endorsed pipeline toward placement in a more integrated community setting," the report said. "Given this, it is unclear then why similar placement efforts are not, and have not been, underway for the individuals at Glencliff."

Perez also wrote that he is concerned that the state relies too much on group housing once people leave the hospital. About 10 percent of those discharged last year were sent to homeless shelters, jail or other institutional settings, he said.

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"Mental health system is failing"
The Nashua Telegraph, Editorial, April 17, 2011

The U.S. Department of Justice didn’t mince words in its recent report on the state of mental health care in New Hampshire. “The state acknowledges, and we agree, that its mental health system is broken, failing, and that it is in crisis,” wrote U.S. Assistant Attorney General Thomas Perez.

A yearlong investigation by the federal government confirmed what mental health advocates in the state have long maintained: New Hampshire does not have adequate community support systems for people with mental illness.

As a result, individuals are institutionalized in more expensive and more restrictive settings, primarily the New Hampshire Hospital in Concord and Glencliff Home, a nursing home for people with mental illness in Benton.

“In spite of a challenging fiscal environment, the state has continued to fund costly institutional care, even though less expensive and more therapeutic alternatives could be developed in community settings,” the study found.

The situation is particularly frustrating because the state could actually be spending less money to get better results for people struggling with mental illness. As the report points out, reliance on institutional care is not only less effective and more expensive, it violates the civil rights of people with disabilities.

While some may see this as another example of federal overreach, the fact is that Congress did pass the Americans with Disabilities Act, and the Department of Justice has to enforce it. If New Hampshire does not take appropriate action, it could face a costly federal lawsuit.

None of this comes as a surprise to lawmakers and state officials. New Hampshire already has a blueprint for improving mental health services – a 10-year plan released in 2008.

The plan called for creating “supporting housing,” where individuals get housing subsidies and community treatment, expanding residential treatment programs, providing additional mental health beds in community hospitals, and developing “Assertive Community Treatment teams,” which provide services like nursing and case management in the community.

But as is often the case, the plan has never been funded. There has been no money for adding community mental health beds; additional treatment teams were never created; no additional community hospital beds have been provided.

The roadmap is there, and it must be implemented.

“Many of the things the Department of Justice cites as ways that the state is falling short of its obligations would be remedied by simple adherence to the 10-year plan as it was outlined,” Jeff Fetter, president-elect of the New Hampshire Psychiatric Society, told the Concord Monitor.

Instead, the state is moving in the opposite direction. The recently passed House budget recommended major cuts to community mental health centers, removing eligibility for about 7,000 community mental health patients. Many of them would end up in institutions, costing the state more money and impeding their chances for recovery.

The budget is now pending in the state Senate, which must restore the mental health center funding, especially in light of the federal report.

Gov. John Lynch has proposed closing a New Hampshire Hospital unit and using the money to create two community treatment teams. This is exactly the approach the state needs to take on this critical issue, not just to avoid costly federal sanctions, but because it’s the right thing to do.

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"Elliot Hospital’s parent lays off 182, in Medicaid fight"
By JOSEPH G. COTE, Staff Writer, The Nashua Telegraph, July 27, 2011

MANCHESTER – It what is likely to be the first of several announcements of health care layoffs, one of the hospitals suing the state over Medicaid funding announced today that it has laid off almost 200 employees.

Elliot Health Systems, which includes Elliot Hospital in Manchester, released a statement Tuesday that it has cut a program, cut expenses and benefits, and laid off 182 employees.

The cuts, it said, were due to the $17 million deficit the hospital is facing as the result of a Legislative plan to cut Medicaid reimbursements to hospitals by $250 million over the next two years.

“The action we have been forced to take today is as a direct result of the state’s cuts and we are outraged and sad. We hold the state and every legislator accountable for what is taking place today. Good people are forever harmed,” Doug Dean, the hospital’s president and CEO, said in a statement.

Dean said the cuts came in nearly every department of the company and at all levels of seniority. The only groups not cut were doctors and nurses, he said.

The 182 employees represents about 4 percent of Elliot’s workforce.

The hospital’s Elliot On-Call, a 24-hour scheduling and advice hotline, was cancelled, the hospital’s contributions to employee retirement saving accounts have been frozen and its policies regarding vacation time have been altered, Dean said.

All of the employees received out-placement counseling and will continue to receive pay and benefits for periods determined by the length of their employment, Dean said.

On Monday, Elliot Health System, Southern New Hampshire Medical Center and St. Joseph Hospital and seven other hospitals filed suit against Nicholas Toumpas, commissioner of the state Department of Health and Human Services, over a plan that uses more than $200 million in Medicaid funds to balance the two-year state budget.

The suit, filed in U.S. District Court in Concord, alleges that the plan violates federal law and threatens “immediate and irreparable injury to the public.” It asks that the plan be immediately halted.

The suit is over whether lawmakers can keep the $115 million annually in so-called bed tax payments that hospitals make so the federal government will make a matching payment.

Since 1991, hospitals have been reimbursed once the state got the federal payment. This year, the Legislature decided to not only keep the federal money, and also the initial $115 million it collected from hospitals.

“The consequences of the state’s failure to pay us for taking care of the poor are truly devastating, particularly as the state changes its course from the past twenty years and walks away from needed matching federal dollars,” Dean said in the statement.

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"Hospitals sue NH on Medicaid"
By JOSEPH G. COTE, Staff Writer, The Nashua Telegraph, July 26, 2011

CONCORD – Nashua’s two hospitals joined eight others in New Hampshire on Monday to sue the state over a plan that uses more than $100 million in Medicaid money to balance the budget.

Lawmakers’ decisions to raid Medicaid coffers to balance the budget amounts to a violation of federal law and endangers equal access to health care for low-income patients, according to the lawsuit.

Southern New Hampshire Medical Center and St. Joseph Hospital, two of the city’s largest employers, and the eight other hospitals are suing Nicholas Toumpas, commissioner of the state Department of Health and Human Services, over a plan that uses more than $200 million in Medicaid funds to balance the two-year state budget.

“This action by the governor and the Legislature is the most significant threat to our community’s health that I have seen in my 23 years at SNHHS,” Tom Wilhelmsen, president and CEO of Southern New Hampshire Health Services, said.

SNHMC stands to lose about $10 million annually, Wilhelmsen said, which will force the hospital to lay off employees.

The suit alleges that the plan violates federal law and threatens “immediate and irreparable injury to the public.” It asks that the plan be immediately halted.

Senate President Peter Bragdon, R-Milford, and House Speaker William O’Brien, R-Mont Vermon, declined to comment on the lawsuit before their lawyers could review it.

“Neither the House nor Senate have received a copy of what the hospitals filed today. We will have to hold off on commenting until the speaker/senate president have been briefed,’’ said Carole Alfano, Senate communications director.

The suit is over whether lawmakers can keep the $115 million annually in so-called bed tax payments that hospitals make so the federal government will make a matching payment. Since 1991, hospitals have been reimbursed once the state got the federal payment.

This year, the Legislature decided to not only keep the federal money, but also the initial $115 million it collected from hospitals.

“The state has broken a long-held promise to New Hampshire hospitals by this action,” Wilhelmsen said.

That makes payments a new tax, according to health care leaders, and combined with what were already some of the lowest Medicaid reimbursement rates in the country, it means hospitals will pay the state more than they get from the state for treating Medicaid patients, Wilhelmsen said.

“Therefore the state is no longer funding hospitals as they are obligated to under federal regulations. That’s the essence of the suit,” he said. “I think the point is that all of a sudden, the state has turned this into a tax.”

SNHMC and its network of primary care physicians, Foundation Medical Partners, treated more than 12,000 Medicaid patients in 2010, spending $21.8 million and was reimbursed $9.3 million by the state. If those numbers hold steady and the hospital’s $10.4 million bed-tax payment isn’t reimbursed, the hospital would lose more than $22 million, according a supplemental court filing written by Michael Rose, SNHMC’s chief financial officer. Other state Medicaid reductions since 2008 have cost the hospital more than $7.7 million already, according to Rose.

Because of the cuts, the hospital is exploring cutting its pediatric beds in half, from eight to four, and eliminating its 30-bed behavioral health unit, as well as rationing its treatment of Medicaid patients, according to the Rose.

St. Joseph Hospital spent $8.3 million on Medicaid patients last year and was reimbursed $2.9 million. That loss, plus its $3.1 million bed-tax payment, would cost the hospital about $8.5 million, according to chief financial officer Richard Plamondon.

Dr. William Stephan, St. Joseph’s vice president of medical affairs, said without changes, the hospital will have to lay off a “significant piece” of its support staff and shutter a number of optional programs, such as daycare, home care programs and ambulance service, that lose money but are valuable to patients.

The longer term effect will be that hospitals will have to arrest any development, ending investment in new programs and technologies, Stephan said.

“It’s going to freeze our growth, and we’ll lose those services that don’t make money but are valuable,” he said.

The suit asks the court to bar Toumpas from implementing the reimbursement reductions and to set new rates that recognize the “efficiency, economy, and quality of care, and equal access” to health care. If the suit fails, hospitals will be forced to cut services and limit access to programs and facilities for Medicaid patients, according to the suit. SNHMC is examining changes to its behavioral health and pediatrics units, according to spokesperson Judith Bennett. It may also have to delay access to non-emergency services, she said.

“This is not a single moment in time that we have to weather; this will require a permanent change in the way that we do business,” Wilhelmsen said.

Wilhelmsen said no patients needing urgent care would ever be turned away, but elective procedures and waits to get appointments with primary care physicians could get longer and longer.

Other hospitals are considering closing their associated doctors offices to new Medicaid patients or terminating those Medicaid contracts with the state altogether, according to the suit.

Dartmouth-Hitchcock’s Children’s Hospital is considering closing or suspending its neonatal intensive care unit. DHMC might need to ground the DHART rescue helicopter, according to the suit.

Since the budget plan was proposed, health care leaders have said it would eviscerate hospitals’ services, forcing them to cut services, employees and programs, as well as increasing patient costs.

A spokesperson for Gov. John Lynch stressed that the four-term Democratic chief executive did not favor such a deep cut to the hospitals.

“This doesn’t come as a surprise. The budget proposed by the governor was very different from the one passed by the legislature. The governor took a more balanced approach and did not propose such a drastic cut to hospitals,’’ Lynch press secretary Colin Manning said.

The proposed budget Lynch offered in February would have cut $20 million in payments to the hospitals and used the savings to support health care spending elsewhere in the Department of Health and Human Services’ budget.

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"Hospital op-ed didn’t get facts straight"
The Nashua Telegraph, Letters, August 22, 2011

Sens. Gary Lambert, R-Nashua, and Jim Luther, R-Hollis, argue New Hampshire’s hospitals can afford a new $115 million tax because they have profits of $200 million (Aug. 7: “Hospitals shouldn’t be immune to state budget cuts”).

Those numbers don’t tell the whole story, however, because health care has developed beyond the old inpatient model. Hospitals have become part of integrated health systems, and our health systems are not anywhere near as profitable as the senators claim.

New Hampshire’s health system profit margins for 2010 slid from 2.9 percent to 1.8 percent. For 2010, the statewide profit margin projection was approximately $88 million – way below the $115 million tax increase hospitals will have to pay under the Republicans’ budget. It is clear they will lose money this year and must reduce expenses significantly.

The senators criticize the hospitals for turning first to layoffs and service cuts to reduce expenses. However, they fail to mention our hospitals have actually been making administrative cuts for the past three years in response to the recession.

Both Lambert and Luther campaigned on their experience as business owners. They must know that when they ask Nashua’s two hospitals to pay $36 million more in taxes, narrow profit margins mean layoffs and service cuts must be part of the solution. If they believe businesses should be market-driven and free from state overregulation, they shouldn’t criticize how these private businesses are run.

The Republicans pledged to boost the economy and create jobs. But so far, their budget has cost more than 1,100 health system employees their jobs.

Rep. Cindy Rosenwald
D-Nashua

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"NH Responds To Report That Blasted Mental Health System"
WMUR.com - December 6, 2011

CONCORD, N.H. -- The attorney general and Department of Health and Human Services commissioner are disputing the United States Department of Justice’s claim that the state’s mental health system is failing and violates federal law.

In April, the Department of Justice concluded that the state was failing to provide adequate community-based services to those with mental illness, leading to prolonged stays at New Hampshire Hospital, the state mental hospital and Glencliff Home.

The report said Glencliff Home, the state’s home for those with serious mental illness or developmental disabilities, put little focus on discharge planning.

The report acknowledged the state’s 10-year plan to fix the system which was developed in 2008 but said progress had been slow.

Attorney General Michael Delaney and health commissioner Nicholas Toumpas released a response Tuesday after six months of discussions with the Department of Justice.

The response claims the Department of Justice only spent two days in New Hampshire assessing the state’s mental health system, including a one-day visit to the Glencliff Home and a partial day visit to New Hampshire Hospital.

Delaney and Toumpas said Tuesday that significant progress had been made in the 10-year plan.

Toumpas also argued that New Hampshire Hospital has a significantly lower-than-average stay compared to the rest of the nation. They are asking the department of justice withdraw its findings.

“The threatened litigation by the federal government and federally funded advocates will waste precious state and federal taxpayer dollars that could be better spent on providing services,” the letter says.

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"N.H. sued over its lack of mental health services"
By Lynne Tuohy, Associated Press, February 10, 2012

Advocates for the mentally ill filed a lawsuit against New Hampshire yesterday, saying the state needlessly confines the disabled in mental wards because it lacks services to treat them in the community. The plaintiffs and their lawyer, led by the Disabilities Rights Center, want a federal judge to order the state to expand community services and crisis intervention programs. “People who are institutionalized are isolated from loved ones,’’ said Attorney Amy Messer, legal director of the Disabilities Rights Center.

(Note: This news article came from a pay-site. Only the first paragraph is printed.)

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"Advocates For Mentally Ill Sue State: Lawsuit Claims State Doesn't Provide Enough Community Services"
WMUR.com - February 9, 2012

CONCORD, N.H. -- A lawsuit has been filed against the state by people with severe mental illness who said New Hampshire is falling short in providing services and assistance.

Those who filed the class-action lawsuit said they hope the state will expand community mental health services.

The lawsuit makes claims that are similar to those in a federal study from almost a year ago that said the state has failed to provide adequate mental health services.

"Mental illness can be helped," said plaintiff Mandy Dube. "It is a disease, but it can be helped."

Dube she and other could be helped if the state provided adequate services.

"I've been in and out of institutions since I was 11," she said. "I've never gotten the right services, and I feel that if me and my friends and everybody got the right services, we could do well in society."

The plaintiffs said that one of the major problems with current care is that the state relies on facilities such as the state hospital and sends people there rather than taking care of them using specialized in-home and outpatient health care services.

"The state fails to provide sufficient mental health services in the community to allow people to remain fully integrated with their families, friends and peers," said Amy Messer of the Disabilities Rights Center.

The governor's office released a statement saying that changes are being made.

"The state itself undertook a process to improve the system," the governor said in the statement. "The recession has meant that change has not gone as quickly as the state would have liked, but progress has still been made, including new community-based teams and the closing of units at the New Hampshire Hospital so that we can further invest in community-based housing."

Dube's mother, Louise Dube, said she hopes the lawsuit allows her family to live more normal lives while coping with her daughter's illness.

"It's time for me to be her mom and not her therapist, and so far, I've missed that," she said.

Attorneys for the plaintiffs said the lawsuit aims to raise awareness of what they claim is a lack of resources and obtain more funding to add resources for the state's mentally ill.

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"Mentally ill residents sue state over lack of care"
By GARRY RAYNO, New Hampshire Union Leader, February 9, 2012

CONCORD — Six individuals with serious mental illness believe they are needlessly being forced into New Hampshire Hospital and the Glencliff Home, when they should be receiving services in their communities.

The individuals, through the Disabilities Rights Center and other advocacy organizations, filed a class- action lawsuit Thursday in U.S. District Court in Concord Thursday claiming the state is violating the federal American with Disabilities Act, the Rehabilitation Act and the Nursing Home Reform Act by failing to provide community-based care.

The suit seeks to force the state to expand community-based services plaintiffs need to avoid future institutionalization.

Amy Messer, legal director for the Disabilities Rights Center said the individuals' lives have been interrupted, disrupted and even destroyed by their prolonged and needless stays at state institutions. “They share a common goal to be integrated into community life and not segregated from their peers,” she said at a press conference Thursday announcing the suit.

The suit comes less than a year after the U.S. Department of Justice found the state mental health system did not meet the needs of those it was intended to serve and violated their civil rights.

The state maintains it is in the early stages of a 10-year plan to address the issues raised by the federal investigation and the suit filed Thursday.

But one of the plaintiffs, Mandy D., a 22-year-old woman from Newport, said she has been “in and out of hospitals more times than I can count.

“I'd really like to stay out of hospitals, but sometimes I get so overwhelmed, the only place to go is a hospital because there are no community services,” she said.

She said with the proper community-based support, she could be a productive citizen. “Just because we have mental illness, doesn't mean we are any different,” Mandy said.

Messer said the state has known for some time its mental health system has been a failure.

She said reports by the Department of Health and Human Services in 2008 and 2009 acknowledge the system's failings and the impact that has had on individuals, families and communities.

She noted that in the 1980s, New Hampshire was at the forefront of delivering community-based services to people with disabilities, but has since reneged on its commitment and rates of institutionalization have risen.

Messer said from 1989 to 2010, the rate of institutionalization has risen 150 percent, going from 900 admissions to NHH, to 2,300.

She noted more die at the Glencliff Home than leave it.

“New Hampshire knows how to fix the problems,” Messer said, through community-based services including supportive housing, mobile crisis intervention, assertive community treatment and supported employment.

Instead, she said, the state has chosen to use much more expensive institutionalization instead of the less expensive, but more effective, community-based programs Attorneys for the plaintiffs said the state could be receiving a 50-percent federal match for community-based services, but the match is not available for institutionalized care.

The suit names Gov. John Lynch, Health and Human Services Commissioner Nicholas Toumpas and other administrators at the Department of Health and Human Services.

“The state itself undertook a process to improve the system. The recession has meant that change has not gone as quickly as the state would have liked, but progress has still been made — including new community-based teams and the closing of units at New Hampshire Hospital so that we can further invest in community-based housing,” said Lynch press secretary Colin Manning. “We will defer to the Attorney General's Office on the actual lawsuit, but the state remains committed to continuing to make progress for people with mental illnesses.”

Associate Attorney General Anne Edwards said her office is in the process of reviewing and analyzing the suit. “We will be defending the state,” she said.

Steve Schwartz of the Center for Public Representation said negotiations between the state Department of Health and Human Services, and advocacy groups broke down and as result the lawsuit was filed.

He said similar negotiations with Delaware and Georgia resulted in agreements, but New Hampshire chose to spend the next few years in federal court with no control over the outcome.

Messer said recent budget cuts have contributed to the cuts to community mental health centers. “The budget is not (the only) problem, it is how the state spends the money it has,” Messer said.

Roland Lamy, Executive Director of the New Hampshire Community Behavioral Health Association, which represents the 10 mental health centers, said the state's 10-year plan was issued three-and-a-half years ago, saying the system was in crisis.

“While some small progress may have been made since then, millions of state and federal dollars have been cut from the system, enrollment has increased, access to community and inpatient beds has decreased, and the day-to-day state of the system remains in crisis,” Lamy said.

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"Mental health providers: No progress in NH"
By Holly Ramer, Associated Press, March 5, 2012

CONCORD, N.H.—Assessing New Hampshire's progress in improving mental health services, Louis Josephson offered a vivid example Monday of how things have gotten worse instead of better.

The CEO of Riverbend Community Mental Health described what happened at Concord Hospital a few weeks ago when a young child, a suicidal 17-year-old girl and a psychotic man all spent several days in the emergency room waiting for spots to open up at the state mental hospital.

"You put an 8-year-old in a safe, secure windowless room for a couple of days, bad things happen," Josephson said, describing the child's head banging and biting. "We had to restrain the child. Well, that upset the gentleman next door who was already agitated. He started kicking holes in the walls. And of course, the girl on the other side of the wall was very upset because she was feeling scared and threatened."

Joined by hospital, law enforcement and corrections officials, Josephson and other community mental health leaders gathered in Concord to give a status report on the state's 10-year improvement plan. The plan released in September 2008 outlined goals for the next decade ranging from expanding inpatient psychiatric care in hospitals to increasing the number of group home beds to support people in their communities.

But a third of the way in, those who provide services say the state not only has failed to make progress, but has in some cases gone backward. For example, the 10-year plan recommended adding four 12-to-16 bed inpatient treatment facilities at hospitals around the state, but since the plan's release, the state hospital has closed a 15-bed unit, another hospital has decreased its behavioral beds from 30 to 10 and no additional facilities have been added elsewhere.

"There's not a single (goal) where I can confidently say we have made significant progress," said Jay Couture, director of Seacoast Mental Health and president of the New Hampshire Community Behavioral Health Association, which worked with the state Department of Health and Human Services to develop the plan.

Nancy Rollins, associate commissioner of the state Division of Community Based Services, attended Monday's meeting but declined to comment, citing pending litigation. Last month, advocates for the mentally ill filed a lawsuit against the state, saying it needlessly confines people in mental wards because it lacks services to treat them in the community.

Those allegations echo federal investigators, who last year accused the state of violating the Americans with Disabilities Act. The state was criticized for failing to provide adequate community-based services to people with mental illness, leading to needless and prolonged stays at the state mental hospital. In its response, the state noted the median length of stay at the state mental hospital is seven days, compared to a national average of 47 days.

But once those patients are discharged, they often have no place to go, providers said Monday. Dr. Mary Valvano, an emergency room physician in Concord, said her department sees 4-to-6 mental health patients in significant crisis each day. If a restaurant sent five people a day to the ER with life-threatening food poisoning, that would be big news, she said. But the mental health patients she sees are in just as much danger.

"They're fragile. They can't advocate for themselves. They're trying to exist in the system, and the system is not serving them," she said.

Several of those who attended Monday's meeting said those patients lamented that mental illness is not taken as seriously as any other medical condition.

"Can you imagine a hospital saying, we know you have diabetes but we don't have the services to provide you? Maybe if you lived in another part of the state, you could get something different?" said Brian Collins, director of Community Partners in Dover. "We tell those individuals, we tell their families, we tell the other services they find themselves in -- police, prisons, hospitals -- `It's up to you to take care of them.' We know how to do it. We don't have the resources to do it."

Getting more resources from the state is unlikely, if legislative interest in Monday's meeting is any indication. Just two lawmakers attended the session, though all 424 were invited.

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"Mental health advocates: NH facing access crisis"
By HOLLY RAMER, Associated Press, January 7, 2013

CONCORD, N.H. (AP) — New Hampshire residents seeking help with personal mental health emergencies have become engulfed in the much larger crisis of access to critical treatment, advocates and medical providers said Monday.

Emergency rooms are filling up with patients waiting for beds to open up at the state psychiatric hospital, and many patients wait for days or even a week. On Monday morning alone, there were 31 adults and five children in emergency departments around the state waiting for admission, said Kenneth Norton, executive director of New Hampshire chapter of the National Alliance on Mental Illness. Two adults at Concord Hospital had been waiting for four days, and a teenager had been waiting for two.

‘‘We do not categorically delay essential treatment for cancer, heart disease, stroke or any other life threatening medical illness,’’ he said. ‘‘And while it is morally wrong to do this to any person, it is unconscionable to do this to our children.’’

Norton was joined by representatives from more than a dozen other groups, including the New Hampshire Hospital Association, New Hampshire Medical Society, community mental health centers and law enforcement. Participants said the growing problem not only endangers those with mental illness but hospital staff and other emergency room patients.

On Wednesday, for example, nearly half of the 27 beds at Elliot Hospital in Manchester were taken by psychiatric patients, leaving patients with chest pain, head injuries and broken bones stranded in the waiting room, said Dr. John Seidner, president of the New Hampshire chapter of the American College of Emergency Physicians.

Dr. Jeffrey Fetter, president of the New Hampshire Psychiatric Society, said days spent idle in an emergency room represent wasted opportunities to prevent suicide, assault and suffering. Someone in the midst of a psychiatric crisis needs to be surrounded by safety, not chaos, he said. ‘‘We've all been there — flashing lights, alarms, staff rushing urgently to stabilize a crash victim. These rooms were designed for patients suffering from heart attacks, not hallucinations,’’ he said.

Monday’s news conference followed last month’s announcement by the state Department of Health and Human Services of a new plan to reduce the wait time for inpatient psychiatric care. That plan includes reopening 12 of the 60 beds that have been closed at the state hospital due to budget cuts in recent years, improved tracking of individuals waiting for beds, using state hospital staff as consultants in emergency rooms and providing better follow-up after patients are discharged from the state hospital to reduce readmissions.

The department also plans to seek additional funding for community-based services, which participants at the news conference said would do more to solve the problem than adding state hospital beds.

‘‘We need more support, and we need more resources to get the job done in the community,’’ said Louis Josephson, CEO of Riverbend Community Mental Health Center.

The state is about halfway into a 10-year plan to improve mental health services, but Josephson and other advocates argue little has been accomplished so far. And the state still faces a lawsuit filed on behalf of individuals with mental illness accusing it of needlessly confining disabled residents in mental wards because it lacks services to treat them in the community.

Gov. Maggie Hassan met with Norton on Friday, a day after she took office. He said he was encouraged by the meeting but it remains unclear whether she and the Legislature will boost funding for mental health.

Hassan said Monday that she considers the mental health system a pressing challenge.

‘‘We must take steps to improve access to mental health services and help those desperately in need of care,’’ she said. ‘‘Over the coming weeks, I will be bringing people together to make the difficult, fiscally responsible decisions needed to balance our budget while protecting New Hampshire’s priorities, including providing high quality health services.’’

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"Make mental health a budget priority in NH"
The Nashua Telegraph, Editorial, January 18, 2013

If ever there were a time for mental health organizations to pitch the need for more funding to state lawmakers, now would appear to be it.

So it made perfect sense that a Concord-based organization representing 10 community-based mental health centers chose Monday – the one-month anniversary of the tragic Sandy Hook Elementary School shootings in Connecticut – to issue a position paper detailing its budget priorities for the next two years.

That it also came a month before Gov. Maggie Hassan is expected to present her two-year budget for fiscal years 2014-15 didn’t hurt, either.

But whether the nation’s renewed focus on mental health issues in the wake of Sandy Hook will translate into a renewed commitment by cash-strapped state lawmakers to expand mental health services remains an open question.

“The last month has seen a horrific escalation of crises in mental health and the failings of our community-based system,” said Jay Couture, president of the New Hampshire Community Behavioral Health Association, in a prepared statement. “A month ago today, the shootings in Newtown, Conn., shocked our community and also raised the public’s concerns about mental health issues.”

In order to offset the damage done by the state’s inability to invest in mental health services in recent years, Couture put forward an ambitious plan that calls for spending $37.6 million over the next two years to fund 132 new treatment beds, Section 8 rental subsidies and more outpatient caregiver teams, among many other provisions.

Specifically, the plan calls for spending roughly:

* $10 million for 38-48 new beds spread among four regions of the state.

* $1.5 million for 20 new beds to treat individuals facing mental health and substance abuse problems.

* $900,000 for 12 new beds to care for those most in need of treatment and otherwise destined for hospital emergency rooms.

* $11.6 million to double to 12 the number of teams that provide outpatient services with the goal of keeping patients out of hospital emergency rooms and jails or prison.

* $1.8 million to offer a rental subsidy to those individuals on a waiting list for a Section 8 federal housing voucher.

Sadly, even lawmakers sympathetic to the problem may be powerless to do much over the next two years, given the state of the budget.

Speaking at the Greater Nashua Chamber of Commerce’s annual Economic Outlook Luncheon on Thursday, Charles Arlinghaus, president of the Josiah Bartlett Center for Public Policy, told Nashua business leaders that the state could be looking at a $25 million deficit in the two-year budget cycle that ends June 30.

If that weren’t bad enough, he projected it will cost more than $200 million over the next two years just to maintain the current level of services, while state revenues only will increase by about $10 million.

If true, lawmakers will have to be extremely diligent in setting budget priorities for 2014-15. When they do, some additional resources for mental health treatment should be near the top of the list.

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"Hassan proposes $28 million for mental health"
AP / February 14, 2013

CONCORD, N.H. (AP) — Gov. Maggie Hassan says New Hampshire is long overdue for residents in desperate need of mental health care, and she wants to invest $28 million over the next two years to change that.

The state is nearly halfway into a 10-year mental health plan. But those who provide mental health services say the state not only has failed to make progress but has in some cases gone backward, with people waiting days in emergency rooms for psychiatric treatment.

The budget Hassan outlined Thursday includes a new designated receiving facility to take the pressure off local emergency rooms, 75 new community residence beds, more housing and support services and new community treatment teams to help adults and children in crisis.

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