N.H. Still Missing Deadlines to Fix Mental Health Care

Valley News Staff Writer
Published: 7/10/2016 12:28:44 AM
Modified: 7/10/2016 12:28:57 AM

Lebanon — New Hampshire state and nonprofit social service agencies, including Lebanon-based West Central Behavioral Health, have continued to miss deadlines to improve key elements of mental health care, according to a court-appointed monitor.

Stephen Day, the expert reviewer overseeing reforms called for in the settlement of a 2012 lawsuit by patients and advocates, said the state’s failure to keep its promises had left some patients without treatment, waiting in hospital emergency rooms for high-level care or institutionalized when they could otherwise be receiving care through community clinics and services.

“The time for patience on these issues is over,” Day wrote. He noted “the need for the State to be more aggressive, assertive, planful, and timely in its implementation and oversight efforts” of the lawsuit settlement.

Day, who in January issued his last assessment, said the state “has been and currently remains out of compliance” with its obligation to expand and upgrade so-called Assertive Community Treatment teams. Such teams are made up of caregivers with a range of skills and training and provide high-level, ongoing treatment in community settings to patients with serious mental illness.

The state had also failed to meet its obligation to develop community services that would enable 10 patients to move out of the Glencliff Home, a state-operated nursing facility, he wrote.

In addition, Day found that while the state had surpassed its goal of having at least 18 percent of its seriously mentally ill patients in supported employment, some regions fell well short of the target rate because the statewide rate was increased by placements in the Manchester area, which had a supported employment rate of about 37 percent.

Supported employment refers to services that help patients find and retain jobs.

Studies at Dartmouth and elsewhere have found that such services enhance and complement other treatments for serious mental illness.

West Central reported supported employment for 15 percent of its patients.

Day called for the state to have in place by Aug. 1 detailed plans for expanding and upgrading ACT teams, widening access to supported employment services and moving residents out of Glencliff. He also urged the state to begin issuing monthly progress reports on those plans.

Aaron Ginsberg, a lawyer for the New Hampshire Disability Rights Center, which represented the lawsuit plaintiffs, welcomed Day’s recommendations for action: “We hope the state follows that.”

Jeffrey Meyers, the state health and human services commissioner, acknowledged the shortcomings in the key areas identified by Day, but said his department “is committed to meeting the milestones set out in (Day’s) report and to continuing to implement the (settlement agreement).”

Meyers noted that Day had seen progress in data gathering and analysis, supported employment and efforts to find housing for mentally ill patients outside of institutions. “Access to quality mental health services is the (Health and Human Services) Department’s priority,” Meyers wrote in an emailed statement.

But Ken Norton, the executive director of the New Hampshire affiliate of the National Alliance on Mental Illness, an advocacy group for patients and their families, said the state’s deficiencies in mental health care extend beyond the issues addressed in the lawsuit settlement.

The state lacks “a clear strategic plan for mental health services and where we need to go,” Norton said. “The state has looked at the settlement agreement as the goal line but it’s really the starting line” for reform of mental health care, he added.

By one key measure, the state, which has an estimated 45,000 adults with serious mental illness, remains a long way from either line. The number of patients waiting on an average day in hospital emergency rooms for space in facilities that offer high-level treatment of serious mental illness rose to 28 in fiscal 2016, from 24 two years earlier, Day found. By comparison, the daily average in Vermont of patients waiting was less than one in 2015.

Day saw progress toward some goals of the settlement agreement, which was formalized in February 2014. For example, the state was “at or very close to compliance” with its obligation to expand the supply of so-called supportive housing for people with serious mental illness, Day found. There were 423 individuals in leased units and 26 approved for subsidies but not yet placed., which fell just short of the Settlement Agreement’s target of 450 placements by June 30, he said.

But the state fell far short of its goal for expanding the role of Assertive Community Treatment teams, which include psychiatrists and others with various caregiving skills. Such teams, which were a centerpiece of the reforms called for in the lawsuit settlement, promised to expand the availability of services and reduce the need for institutional care by reaching patients in their homes and communities.

But only 839 patients were receiving care from such teams, far below the 1,500 the agreement set as the June 30 target for ACT capacity, Day found. In addition, staffing at many teams fell short of the agreed-upon standard of seven to 10 professional caregivers.

West Central had the thinnest ACT staffing of any the state’s 10 community mental health centers, Day found, with only four full-time-equivalent positions on the team. West Central also had the fewest patients receiving care from its team — 26.

Suellen Griffin, the executive director of West Central, said the Lebanon-based nonprofit now has money in its budget to boost its ACT effort to the level called for in the settlement agreement — roughly, seven team members treating 70 patients. West Central is seeking to recruit the caregivers who would actually provide the services, she said.

Griffin, who heads a statewide organization of community mental health clinics and in the past had balked at the pressure to expand ACT services without being provided necessary financial support, said West Central and other groups now support the effort to expand and upgrade ACT teams: “We get that we need to share this responsibility.”

Meyers, who took over at HHS in January, had set a new tone in relations with the community mental health clinics, Griffin said. “We have a partner. We don’t have somebody lecturing us. That’s different.”

Day’s review was the product of visits to some state and community mental health facilities and meetings with parties to the lawsuit, which alleged that scores of patients were needlessly institutionalized because the state had illegally failed to provide sufficient community mental health services and care.

Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.

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