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Tuesday, March 6, 2012

Statewide mental health forum gives NH failing grade for lack of progress

CONCORD – Community mental health leaders gave New Hampshire a failing grade for improving care for adults and children with mental illness.

The Community Behavioral Health Association of New Hampshire sponsored a forum Monday that looked at how state government has responded to the goals of a 10-year plan crafted in 2008.

“There is not a single one where I can confidently say we have made significant progress,” said Jay Couture, executive director of the Seacoast Mental Health Center.

Speakers blamed state budget cuts and a lack of coordination for the state failing to meet the top priority of keeping the mentally ill in the community and out of emergency rooms or state institutions.

Ken Norton, executive director of the National Alliance for the Mental Illness, said society would not tolerate the lack of care if these residents had medical problems rather than psychiatric disorders.

“It is just very painful to read this status report; it confirms anecdotally what NAMI is experiencing from family members,” Norton said. “Why do we continue to discriminate against people with mental illness?”

Rochester Police Chief David Dubois said his team, with specialized training in mental health, saw a 27 percent increase in people served last year; more than a third of them were potentially suicidal.

The forum surely provided ammunition for the Disabilities Rights Center that last month filed a class-action suit against the state for failing to provide appropriate care for the mentally ill.

The suit charges that the state’s treatment of adults at the New Hampshire Hospital and the Glencliff Home are in violation of the Americans with Disabilities Act, the Rehabilitation Act of 1973 and the Nursing Home Reform Act.

New Hampshire Hospital has an admission rate 40 percent higher than the national average. Its readmission rate is nearly double the national average.

In 2010, more than 15 percent of the patients discharged by the hospital were readmitted within 30 days. Nearly one-third were readmitted within 180 days, and some patients are essentially in and out of the hospital all year.

A federal audit last year criticized New Hampshire system, noting that people in psychiatric crisis can wait for hours in a hospital emergency room before they receive help, which is costly and inadequate.

The federal report noted that the state could treat these adults in the community for much less than it now spends to treat them.

Here are some of the recommendations in the 2008 plan and the state’s response since then:

Community Residential Support: The plan envisioned an increase in group homes and a housing bridge subsidy. The state served 36 people in the bridge program that was not an increase, community mental health centers have closed 44 beds, and the state’s transitional housing unit was cut from 49 to 35 beds.

Inpatient Psychiatric Care: The plan sought to add 12-16 bed units at hospitals in all four corners of the state. Last July, Southern New Hampshire Medical Center in Nashua cut its psych unit from 30 to 10 beds, and New Hampshire Hospital closed its 15-bed continuing care unit. Over the past decade, admissions to the state hospital have gone up 104 percent.

Assertive Community Treatment Teams: This goal was to create 12 new teams that intervene with the mentally ill who are in crisis. There have been no teams added to the five now in existence.

Better Care of those with Mental Illness and a Developmental Impairment: The priority here was to create residential treatment in the community for this population. The closure of the state’s neuropsychiatric unit forces these individuals to seek out-of-state or private institutions.

Workforce Retention: Invest more training in staff, create electronic medical records and increase the numbers of those who want to enter the field. A state budget cut of 6 percent in the case management rate forced many centers to eliminate positions or cut salaries. Centers have seen turnover rates as high as 23 percent in the past year.

Kevin Landrigan can reached at 321-7040 or; also check out Kevin Landrigan (@KLandrigan) on Twitter and don’t forget The Telegraph’s new, interactive live feed at