Editorial: Twin State Progress on Mental Health

The sorry record of both New Hampshire and Vermont in meeting the needs of the mentally ill argues for extreme skepticism when evaluating any promise they make to change course. Nevertheless, we are cautiously encouraged by signs that both intend to undertake significant improvements and begin meeting their responsibilities.

Both states’ failures in this regard are well known. In fact, each has drawn the disapproving attention of the federal government. In Vermont, the state hospital in Waterbury was so antiquated and ineptly operated that it lost federal certification in 2003 after the suicides of two patients. New Hampshire, once lauded as an innovative leader among states in delivering community-based care, is being sued by the U.S. Department of Justice for violating the American with Disabilities Act for failing to deliver the appropriate level of care. More specifically, New Hampshire has been accused of being too quick to institutionalize people who could be better and less expensively served in their own communities.

Although their shortcomings are obvious, both states have managed to do precious little about them for a very long time. New Hampshire’s failings were identified as far back as 2004, when the state Department of Health and Human Services noted that too many people were being forced to seek care at New Hampshire Hospital, the state’s central institution for treating people with severe mental illness. After a succession of similar findings by several committees and panels, the state put together a 10-year improvement plan in 2010 for reviving its community mental health system. Alas, the plan never received funding — the result of the Great Recession and the state’s habit of producing impressive plans but not the necessary revenue.

Vermont has been talking about replacing its state hospital for more than a decade now. Although making decisions about location, size and funding have all contributed to the state’s dilatoriness, a lack of commitment to providing adequate services to some of the state’s most vulnerable residents has been the core of the problem. The Waterbury facility is finally and thankfully shuttered now, thanks not to a sense of shame but rather to flooding during Tropical Storm Irene.

The result in both states has been patients languishing for hours or even days in hospital emergency rooms, waiting for a suitable placement.

At long last, New Hampshire officials signaled last week that something would be done besides hand-wringing. Health and Human Services Commissioner Nick Toumpas called for spending an additional $10 million to expand community-based services by, among other things, increasing the number of residential beds, spending more on housing subsidies and providing additional resources to local teams that respond to people who are experiencing mental health crises and help them avoid hospitalization. Acknowledging that the shortage of community care is overtaxing the state hospital, Toumpas also said he’ll add 12 more beds there, review admissions to give priority to the most pressing cases, make additional psychiatric consultation services available to local hospitals and implement better follow-up procedures to prevent discharged patients from needing to be readmitted.

In Vermont, the overhaul of the state’s mental health system is progressing. Last month, the state received approval to construct a 25-bed hospital in Berlin to replace the Waterbury facility. Also planned are smaller, community-based psychiatric units in Brattleboro, Rutland, Burlington and Morrisville. The hope is that the Berlin hospital will be operating in about a year. Particularly encouraging is that the Shumlin administration has not used problems with funding — the federal government has indicated that it will provide significantly less than originally hoped for — to make excuses for additional delay.

But while we look forward to future improvement, let us not lose sight of what has occurred and will continue to occur until steps are actually taken: Because the plight of people coping with mental illness has not sufficiently moved either state to provide adequate care, far too many people are being forced to seek help at hospitals that lack the expertise to do much more than monitor them. That places immense burdens on those patients’ families, on the hospital staffs and on law enforcement agencies that are often called in to deal with crises — not to mention the patients themselves, who are not receiving treatment in an appropriate setting. We cannot help but suspect that the states’ toleration of the intolerable is rooted in outdated attitudes about mental illness, including giving it less priority than physical disease. Those who have direct experience know how wrong and harmful that is.