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Monday, September 27, 2010 03:15PM

State hospital can't hold more minors

CONCORD MONITOR - With fewer beds available due to budget cuts, the wing of the state hospital that houses mentally ill children and teenagers has suspended admissions for the second week in a row. The Anna Philbrook Unit stopped admitting children Thursday and was still at capacity late Friday afternoon. A week earlier, the unit had to suspend admissions for 48 hours.

That hasn't happened in "a very long time," said New Hampshire Hospital's acting CEO, Paula Mattis. But she said she expects the hospital will be forced to continue suspending admissions now that children and adolescents are being housed in the same wing.

Before this year, children age 14 and under who needed to be involuntarily admitted to the state hospital went to a separate building, the Anna Philbrook Center.

The center, which was outdated and expensive to operate and was closed earlier this year as part of the most recent round of state budget cuts, had the same number of beds - 20 - as the hospital wing does now. But there was no limit on the number of beds for adolescents, who were admitted to a unit within the state hospital.

"Why we've now reached this saturation is because we always had a few extra beds for the older kids," Mattis said.

The situation has mental health providers worried that severely troubled children referred to the state hospital after trying to hurt themselves or others will be forced to wait for days in emergency rooms before they can be admitted.

"It's not ideal, it's not safe, and a lot of these hospitals are not geared up to deal with these kids," said Riverbend Community Mental Health CEO Louis Josephson, who is also the vice president of behavioral health services at Concord Hospital.

Josephson said he thinks people didn't understand the implications of shuttering the Philbrook Center when House lawmakers approved the cut this spring.

"It's really a new world we're going into," he said.

But Mattis described the crunch for children and adolescent admissions as anticipated.

"This is something we knew and made public," she said. "It's not ideal, it's not how we want things to be, but there's a reality in our state right now. . . . We have to make adjustments and reductions just like anyone else."

Besides the number of available beds, other challenges present themselves. The unit must balance its mix of patients, which include children with severe depression, psychotic disorders and uncontrollable aggression.

Some children must have their own rooms. Some require one-on-one supervision. Two weeks ago, Mattis said, the unit had several children that required two-on-one supervision.

Those children were "extraordinarily suicidal, aggressive to others, had assaulted their peers," Mattis said.

The hospital could fit more beds into the unit, she said, "but because of the number of people required to serve children . . . you've got everybody unsafe."

During each of the two periods in which the hospital suspended children's admissions, Mattis said she had one child on a waiting list.

But mental health providers say demand will only increase as fall sets in.

"This isn't the busiest time for admissions," said Jay Couture, executive director of Seacoast Mental Health and the president of the New Hampshire Community Behavioral Health Association.

Couture said her center gets the most calls in October, after children are back in school.

"I'm nervous," she said.

The other week, about an hour after she got an e-mail from Mattis saying admissions to the Philbrook unit had been suspended, Couture said she and her staff were called to the emergency room to see a 15-year-old. Fortunately, she said, the child didn't need to be admitted to Philbrook.

But "we were all holding our breath," she said.

By Maddie Hanna / Monitor staff