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NH Hospital faces bed shortage

June 24, 2010
OSSIPEE — Carroll County officials say they need to prepare for a potential crisis because the has cut funding to the New Hampshire Hospital and created a shortage of bed space for the 's most dangerous mentally ill.

The situation can aptly be described as the "perfect storm" because there's an increasing in the number of referrals to the New Hampshire Hospital, in Concord, at a time when there's a lack of bed space brought on by budget cuts, said New Hampshire Hospital's Acting CEO Paula Mattis.

The New Hampshire Hospital's purpose is to provide acute in-patient healthcare — in other words to help mentally ill people who are in crisis and considered to be a threat to themselves or others. There was a 1 percent increase in referrals in fiscal year 2009 over fiscal year 2008. The first four months of 2009 were record-breaking, she said.

The New Hampshire Hospital's budget has been slashed from about $72 million to about $65 million to help the state reduce its $295 million deficit. The $7 million in cuts translates into a loss of about 46 beds and the loss of 49 positions — some of which have not been eliminated yet. This is on top of an earlier cut that eliminated 16 positions, said Mattis.

"Over time, and more frequency of late, we have had to delay accepting multiple referrals in order to allow for a safe and orderly admitting process," wrote Mattis in a letter to stakeholders dated June 8. "Now, in addition we are experiencing a full capacity crisis. Currently we are taking referrals for admission but we may not have any beds available."

Admissions to the New Hampshire Hospital are called Involuntary Emergency Admissions (IEAs).

County Attorney Robin Gordon brought the issue up to the County Commission at their meeting last week. They all agreed that mentally ill people do not belong in the county's jail.

She and Commissioner Chip Albee discussed a situation in another New Hampshire county in which a police officer received a since-discredited opinion from an assistant county attorney that said it would be OK to place mentally ill people in a county jail. But the law only allows the jail to accept people who have been charged with a crime or in need of protective custody because of intoxication.

Because of the cuts, municipalities, hospitals, and counties will somehow have to pick up the slack since the state is trying to shed its responsibility, said Albee.

"The mentally ill aren't going to go away because you don't want to pay for them," said Albee who, like Gordon, wants to develop a plan for how to deal with patients who cannot be admitted quickly.

There are several reasons jail would be an inappropriate place to put the mentally ill — especially those who have not committed a crime. In a jail setting, a person cannot see visitors at will and their freedom of movement is limited. Also, it sets the county up for liability if a civil liberties organization decides it's going to sue on behalf of a mentally ill person who is wrongly imprisoned, said Albee.

"We are looking at the potential for incredible crisis," Gordon said.

The impact of cuts at the New Hampshire Hospital is already being felt at Memorial Hospital in Conway, according to its CEO Scott McKinnon. They have experienced the delays that Mattis wrote about in her letter. Memorial Hospital is evaluating how it manages the process with special care for safety and security, McKinnon said.

"It's concerning," he said.

The Concord Monitor reports that one man had attacked a security guard at Concord Hospital while he was waiting for a bed to open up at the New Hampshire Hospital. That man was taken to Merrimack County Jail. The story goes on to state that patients at Concord Hospital used to wait about seven hours for a bed at New Hampshire Hospital, but now that wait can be 24 hours or more.

The New Hampshire Hospital keeps track of where patients come from by dividing the state into 10 catchment areas. Carroll County is in Region One. Also in Region One are Cos and Grafton Counties. In 2009, 335 people from Region One were admitted to the Hospital. Typically admittance will last less than seven days, said Mattis.

The process begins when a police officer brings a mentally unstable person to a local emergency room for an evaluation. If the person is deemed to need treatment at the New Hampshire Hospital, the authorities call to see if a bed is available. If not, the person is held at the emergency room until space opens up at the New Hampshire Hospital — an officer may need to stay while the evaluation is done. If the person needs to go to the New Hampshire Hospital and there is room, a sheriff's deputy will do the transport.

The process can be very time consuming, said Carroll County Sheriff Chris Conley. From the initial contact with law enforcement to the certification could take up to seven or eight hours.

Northern Human Services, based in Conway, is the organization that does the IEA evaluations in Carroll County. Its CEO, Dennis MacKay, says there already have been a handful of times in Carroll County when his organization has made a referral only to be told there's no room available at the New Hampshire Hospital. In those cases, his staff tries to seek alternatives. MacKay said a heavy burden falls on the emergency room workers and police who need to care for that person while performing their other duties.

Interestingly, it's not just a "front door" problem of getting people in to the New Hampshire Hospital, said MacKay. Releasing patients can also be challenging because some have no place to go. This problem was forecasted two years ago in a Department of Health and Human Services report called "A Strategy for Restoration." It focused on the need to help patients once they are released and the potential for community treatment, which might help prevent people from becoming acutely psychotic in the first place.

Carroll County House of Corrections Superintendent Jason Johnson said he's heard conflicting opinions about whether the jail can receive people in need of an IEA at New Hampshire Hospital. Two weeks ago, at a superintendent's meeting it was discussed that jails could be receiving destinations for people on an IEA.

However, that opinion raised "red flags" with Johnson because people can only be sent to jail for protective custody if they are on drugs and alcohol.

Johnson said last week a lawyer from the New Hampshire Hospital said that jail wouldn't be an appropriate place to send someone with mental health issues. If there's no room at the New Hampshire Hospital, patients will be sent to Elliot Hospital in or the Cypress Center. Both facilities are in Manchester.

Garnett Hill
Martin Lord Osman
Garnett Hill
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