Advocates hope NH court ruling helps mental health patients waiting in ERs
May 22, 2021
By NORA DOYLE-BURR, Valley News Staff Writer
Mental health advocates, lawmakers and providers say they’re hopeful that changes underway to address the persistent problem of long wait times in hospital emergency departments for patients in need of inpatient mental health treatment will make a difference.
“For patients, they hopefully will pretty quickly see a decrease in wait times and rapid admission to inpatient care when needed,” said Ken Norton, the director of the New Hampshire chapter of the nonprofit National Alliance on Mental Illness.
After the New Hampshire Supreme Court ruled that psychiatric patients being held involuntarily in emergency rooms must be given a chance to contest their detention within three days of their arrival, Gov. Chris Sununu announced at a news conference last Thursday that he was issuing an executive order to try to address the matter.
“There’s an urgent need for the state to accelerate its work in increasing the number of available beds for emergency psychiatric patients,” Sununu said at the time.
Since last week’s court decision and executive order, the Department of Health and Human Services has put forward a series of initiatives to create 50 new “designated receiving facility” beds, which are part of inpatient psychiatric programs that accept people who are in a mental health crisis on an involuntary basis, DHHS spokesman Jake Leon said via email. As of Thursday, 22 children and 10 adults were waiting for such beds in New Hampshire, according to DHHS’s website.
DHHS’ new efforts to make those beds available include: offering $200,000 per bed annually for hospitals that create new DRF beds; $45,000 per bed annually for long-term care facilities that accept patients from New Hampshire Hospital and the Glencliff Home, along with an enhanced daily rate of $289 per day; and $4 million in rate increases for community mental health centers to add transitional housing beds, Leon said.
The department also is talking with out-of-state providers to provide children’s inpatient services in order to open up additional adult beds in the state, he said.
While long wait times for mental health care in New Hampshire are not new, they have been exacerbated by the increased demand for services during the COVID-19 pandemic. It appears that the state, amid the pandemic, has the funds to implement the necessary changes, but it’s less clear whether the state has the workforce it needs.
“Money isn’t really the issue anymore — the state revenue is way better than anyone anticipated and with the (latest federal stimulus package) there is a flood of money,” said Norton in an email this week. “But staffing shortages persist.”
He said he’s hopeful that pending state legislation, HB 187, would help address staffing issues by addressing problems related to credentialing and payment for mental health workers with bachelor’s degrees who are supervised by licensed professionals at community mental health centers, health centers and other approved facilities.
Sununu’s order last week directed DHHS to create emergency administrative rules aimed at “immediately” increasing access to services for patients with mental health concerns who seek care in hospitals. The order also directed the department to review all mental health services in the state to determine if the current services are adequate, as well as to identify new or alternative providers when necessary. The department also is supposed to bolster access and availability of community-based mental health services.
DHHS issued an emergency rule for hospitals last week, following Sununu’s order. Under the rule, in addition to ensuring patients’ safety, hospitals are now required to provide “stabilizing treatment” for patients determined to be at risk of escaping or to be a danger to themselves or others. They also are required to have the staff to address patients’ mental health needs.
“An emergency department shall employ or contract with licensed practitioners in the field of psychiatry or psychology to meet the mental health needs of individuals who present in the emergency department for treatment,” the rule said.
In an emailed statement this week, Steve Ahnen, president of the New Hampshire Hospital Association, did not address the specifics of the new rule but said he hoped the state would take steps to address mental illness across the broader system of care, including outpatient services, crisis services, acute inpatient services, transitional housing and other community support.
“The ruling by the New Hampshire Supreme Court has made it very clear that this problem must be resolved now and presents an opportunity to sit at the table together and formulate both short- and long-term solutions so that patients suffering an acute psychiatric illness are able to get the care they need,” Ahnen wrote.