Editorial: On the Front Lines; Responding to Mental Health Crisis 

In an ideal world, police officers and hospital emergency departments would not be called upon to provide mental health services on a regular basis.

We do not, of course, live in such a world. It has become ever clearer that with the breakdown of the mental health systems in both New Hampshire and Vermont in recent years, police and emergency departments have become mental health providers of the first resort in far too many cases, even though that is not the primary mission of either.

Efforts are at last under way in both states to reconstruct those systems, including the addition of in-patient psychiatric beds and the rebuilding of community treatment programs. But things are not going to turn around overnight. That’s why the Lebanon Police Department and Dartmouth-Hitchcock Medical Center are both making efforts to better respond to the needs of mentally ill people they are called upon to deal with, and they deserve credit for doing so.

It’s not new news that psychiatric patients are flooding into hospital emergency rooms. Nonetheless, the numbers are startling. As staff writer Chris Fleisher reported Sunday, 1,300 patients who ended up in DHMC’s emergency department last year received psychiatric care. Because the number of in-patient psychiatric beds in both states has decreased over the years, these patients often languish for hours in emergency rooms waiting for a placement. The average is about five hours at DHMC, though occasionally the stay can last longer than a day. All told in Vermont, 37 percent of psychiatric patients admitted to emergency departments wait there longer than a day; the comparable figure in New Hampshire is 32 percent.

Emergency departments can do only so much, including stabilizing violent or suicidal patients, but those people are not getting the psychiatric care they need until an in-patient bed is found for them.

DHMC is moving to do what it can b y hiring more staff — security officers, social workers and licensed nursing assistants — and by undertaking a $400,000 renovation to provide a third patient room with necessary security features to hold psychiatric patients safely and to provide a calmer environment for their stay amid the sometimes chaotic conditions in which emergency medicine is practiced.

Police officers are also required ever more frequently to confront the results of state government’s abdication of its responsibility to the mentally ill. The Lebanon Police Department, as staff writer Mark Davis also reported on Sunday, has done something we have long advocated: providing specialized training to officers in how to defuse confrontations with agitated subjects and get them the treatment they need. This makes all kinds of sense. At the most basic level, it reduces the chances that either the patient or the officer will get injured. The Upper Valley can attest to the fact that many such encounters are fraught with the possibility of tragedy and that several have ended that way in recent years, perhaps unnecessarily.

Knowledge is power in this realm, as in others. Officers trained to know what to look for when they respond to a mental health crisis have a far better chance of resolving it peacefully and effectively, and not incidentally, diverting some cases from the criminal justice system to the mental health system where they belong. That presupposes, of course, that the states follow through, and resolve the crisis that their neglect has engendered so that the doctors, nurses and police officers on the front lines are not out there on their own.