Editorial: Broken, But Fixable; New Hampshire’s Mental Health System

Sunday, March 31, 2013
The Concord Monitor series about the state’s broken mental health system — published last week in the Valley News and concluding on this page with reporter Annmarie Timmins’ personal account of living with depression — tells an all-too-familiar story, but that doesn’t make it any less disturbing. The state’s failure to provide appropriate care to residents suffering from mental illness has brought needless hardship to people who already face more than their fair share of difficulties; imposed additional burdens on their already-stressed families; and overtaxed institutions such as courts, police departments and hospitals that have been forced to deal with the consequences. And to the extent that the state’s failures are driven by budget considerations, it’s clear that its unwillingness to spend enough to provide needed services is only forcing it to spend even more to respond to avoidable crises.

The dynamics are well-known. Most people with mental illness are best served by community-based programs that allow them to live as independently as possible by providing treatment, counseling and support services. Those programs allow the mentally ill to live close to their families and friends, who often make up their most critical support system, while also offering services that address a spectrum of needs. Some need fairly intense supervision at residential facilities while many others may require nothing more than occasional access to emergency counseling.

State cutbacks and inadequate reimbursement rates for care provided under government programs have gutted the services at the state’s 10 community mental health centers. Unable to receive the help that gives them a chance to establish stability, New Hampshire residents with mental illnesses are needlessly pushed into crisis and too often require hospitalization. At that point, their plight is likely to be worsened by a statewide shortage of psychiatric beds. That might well force them to wait for an opening in the local hospital, which too often lacks the staffing and expertise to accomplish anything more than provide shelter. And then there are those who never make it to the hospital because their illness has manifested itself in a way that lands them in the criminal justice system.

Some numbers help tell the story, even if they strip it of the poignant personal details that illuminate the magnitude of suffering caused by the state’s negligence. A planned addition of 12 beds at the state psychiatric hospital in Concord this spring will bring the total up to 142 — 110 fewer than existed just three years ago. Demand for emergency hospitalization has increased 41 percent from 2002 to 2011. Beds for mental health patients at community hospitals have dropped from 236 to 150 since 1990, and six hospitals have shut down their psychiatric wings. Group-home beds have dropped from 178 in 1998 to 159 today.

In terms of cost, the state has done itself no favors. According the U.S. Department of Justice, community-based treatment costs $44,000 a year, compared with $287,000 a year for state hospital treatment. Similarly, outpatient treatment services cost considerably less than incarcerating those who have run afoul of the law because of inadequately treated mental illness.

Here’s the good news. Many of the pieces New Hampshire needs to transform its mental health system are at hand. Significantly, the state has a history of successfully delivering those services; it was recognized as a model back in the late ’80s. Its 10 community mental health centers have designed a plan — largely an updated version of the 10-year plan the state embraced in 2008 but never implemented — that identifies which components of the state’s system need attention and how much it will cost ($19 million in each of the next two years). Even while on a starvation diet, innovative and effective services have been developed in recent years, including mental health courts, peer support groups and community-based programs. And Gov. Maggie Hassan’s proposed budget calls for spending $28 million over the next two years on improved mental health services — $10 million less than sought by the New Hampshire Community Behavioral Health Association, but indisputably significant.

Positive signs emerge even from the Legislature. Hassan’s proposed increase in spending on mental health services was one of the few areas where she had proposed higher spending levels that wasn’t cut by the House Finance Committee after it put together a spending plan that didn’t count on casino-licensing money.

For additional motivation, there’s the threat of a lawsuit filed on behalf of mental health patients, and joined by the U.S. Justice Department, arguing that the state has violated the Americans with Disabilities Act by forcing unnecessary hospitalizations through its failure to provide adequate community-based services. Of course, it would be far better if the state recognized that providing adequate care to this uniquely vulnerable group of people — and sustaining that effort — was the right thing to do. But whatever the motivation, this appalling situation needs to be promptly rectified.