Editorial: Relief for New Hampshire’s Mentally Ill

Anyone who has had first-hand experience with mental illness, either personally or through a family member, friend or colleague, understands all too well the insidious nature of the disease — how it corrodes self respect and confidence in the one afflicted while putting relationships under stress and sometimes even shattering them. The costs are measured not solely in dollars spent to stabilize the distressed individual; the disease too often drains the currency out of life itself.

That is why we felt a measure of relief when the state of New Hampshire recently agreed to settle a class action lawsuit over the treatment of state residents with serious mental illness.

The lawsuit, brought against the state in 2012 by six New Hampshire residents with psychiatric disabilities who were later joined in the action by the U.S. Department of Justice, alleged that they were unnecessarily institutionalized or faced unnecessary institutionalization as a result of the state’s lack of adequate community mental health services. Among the plaintiffs was a 24-year-old Upper Valley resident, Mandy Dube, who, according to the Disabilities Rights Center, which launched the class action lawsuit, was denied an education and normal adolescence as the result of 20 psychiatric hospitalizations over a 10-year period at New Hampshire Hospital.

The suit claimed that New Hampshire’s lack of adequate services violated the Americans with Disabilities Act, and it asked a federal judge to order the state to expand community services and crisis intervention programs.

The settlement, announced two days before Christmas, calls for New Hampshire to spend an estimated $30 million on expanding services in the mental health system over the next four years. Among other measures, it requires the state to create new mobile-crisis teams and provide apartment housing in Manchester, Concord and Nashua; provide statewide help to at least 1,500 individuals; and “work to create community alternatives for people with complex health care needs,” according to the Justice Department.

We said measure of relief because we remain uneasy about the circumstances that gave rise to the lawsuit in the first place.

We have noted before that the state’s once-exemplary mental-health system was allowed to erode through years of underfunding. The Legislature’s history of stubborn resistance to court orders — on education funding, to name just one — causes us to wonder how readily the money will be appropriated to fulfill the state’s obligations under the settlement reached in December.

For example, in the circus-like session led by then-House Speaker Bill O’Brien and his apostles, funding for services to help the mentally ill was treated with Dickensian neglect. Fortunately, one of the priorities Gov. Maggie Hassan set out in her first budget was increased funding for services to the mentally ill, including money for reception centers to relieve local hospital emergency rooms — where the mentally ill frequently end up in a crisis — and expanding access to acute psychiatric residential treatment beds along with adding community residence beds.

So the additional money mandated by the settlement is to come on top of the remedial measures lawmakers have already taken. That is all for the better.

We know more money for services does not in itself solve the challenge of making better lives for those suffering from mental illness. The goal, rather, is to utilize and deploy resources that enable the distressed individual to lead as independent a life as possible.

And it is this point that the lawsuit and the settlement address: The order specifically calls for people with psychiatric disabilities to be provided help at the community level rather than be removed from friends and family for treatment in the state hospital. Community-based solutions, where people and surroundings are familiar and in which everyone has a vested stake in the outcome, are more effective — and in the end less costly — than hospitalization.

Working at the local level to make people healthier: Such an approach strikes us as the most efficacious way to help those who are mentally ill in a state that prizes both individual freedom and responsibility.