Lebanon — An official overseeing a legal settlement that requires New Hampshire to expand community mental health services and find new homes for residents of a state-operated home for seniors with severe mental illness or developmental disabilities has threatened to seek help from a judge if the state fails to make faster headway.
“The pace of change must rapidly increase over the next (three to six) months,” Stephen Day, who was appointed by a federal judge to oversee implementation of a February 2014 deal.
The settlement resolved a lawsuit filed by advocates for the developmentally and the U.S. Justice Department, wrote in a report issued later Friday afternoon.
Day said failure to show substantial progress would prompt him to “consider what other compliance enforcement mechanisms may be necessary, including possible involvement by the court.”
Day noted that the state and the local agencies that deliver care have made progress in some areas, including housing and employment support to some people with mental illness, and that state oversight and management support had improved. Data collection and reporting on progress had also expanded, he said.
But Day said that during the past six months too few new staff and patients had been added to Assertive Community Treatment teams that are supposed to deliver comprehensive care outside of clinics and hospitals to patients with serious mental illness.
While the programs were supposed to have the capacity to treat 1,500 patients as of June 30, at the end of September the teams only had enough staff to handle about 60 percent of that capacity and had only 865 patients enrolled, Day said.
Only nine staff members were added to the teams since June, and only 26 additional patients have been added to the rolls since March, Day said.
As of the end of September, Lebanon-based West Central Behavioral was providing assertive community treatment to only 33 patients, the fewest of any of the state’s 10 community mental health centers. However, West Central’s patient base had risen 21 percent since March, the second highest growth rate in the state, while three community mental health clinics saw their patient base decline during the same period. By the end of December, West Central had more than seven full-time staff members and was treating 50 patients in its team, said Suellen Griffin, executive director. West Central’s goal is to provide assertive community treatment to 70 patients, she added.
Day also found that no residents have been returned to communities from the state’s Glencliff Home, which provides long-term care to elderly patients with mental illness or developmental disabilities. The state had promised to find homes for 10 residents. Although four residents are expected to relocate by the end of this month, Day wrote, “transitions from Glencliff remain exceedingly slow.”
State Health and Human Services Commissioner Jeffrey Meyers issued a release that noted the areas in which Day had seen progress and argued “that during the last 6 months of 2016, the state made additional advancements that are not reflected in (Day’s) report.”
Meyers promised a formal response after a comprehensive review.
A widely followed warning signal of failings in mental health care is the volume of mentally ill adults in crisis who are stranded waiting for care in hospital emergency rooms because space is not available at New Hampshire Hospital, the state’s main facility for providing high-level psychiatric care.
On an average day during the third quarter of 2016, more than 31 adults were boarded in ER’s awaiting space at the state hospital, Day found. That was up more than 30 percent from fiscal 2014, when on an average day 24 patients were boarded in hospital ERs.
As a candidate, newly inaugurated Gov. Chris Sununu was critical of failings in the state’s mental health system. He focused on a contract that transitioned provision of psychiatric services at New Hampshire Hospital from Dartmouth College to Dartmouth-Hitchcock.
Mental health care experts believe that expanded treatment capacity and support services can ease the demand for services at state hospitals and other high-level care facilities.
Day’s report said a new administration brought with it “a significant opportunity for new actions and efforts to reverse (a) longstanding pattern of noncompliance” with some provisions of the lawsuit settlement.
Sununu could not be reached for comment. Rick Jurgens can be reached at 603-727-3229 or firstname.lastname@example.org.