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Monday, April 18, 2011

Mental health system is failing

Telegraph Editorial

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.