A group of New Hampshire hospitals is suing the state over its practice of boarding people who are held involuntarily due to a mental health crisis in emergency rooms for days or weeks until psychiatric beds are available.

The 15 hospitals are seeking an order that would force the New Hampshire Department of Health and Human Services to start transferring such patients to designated mental health facilities “immediately,” saying that’s required by state law.

The state “lacks the discretion to leave (involuntary emergency admission) patients in the Hospitals’ emergency departments” and “must accept their immediate transport,” the lawsuit states.

So-called “ER boarding” has long been an issue in New Hampshire, with too few beds for the number of people who need emergency psychiatric care, and the state’s mental health system is already stretched to capacity. As of Wednesday,there were 30 adults and 15 children in emergency departments waiting for psychiatric beds, according to state data.

The state has taken steps in recent years to expand its mental health system, including launching a mobile crisis service and purchasing Hampstead Hospital to provide mental health care for children and youth.

But pandemic-related mental health challenges and workforce shortages have exacerbated the problem. As of Wednesday, 31 of the 185 beds at New Hampshire Hospital — a state-run psychiatric facility — were not being used due to “patient acuity and staffing challenges,” according to Jake Leon, a spokesperson for the state health department.

“While New Hampshire Hospital faces the same staffing challenges as other facilities, it continues to work to increase bed capacity,” he said in an email Thursday. “For example, as of January 9th, total bed capacity increased 9 beds, from 145 to 154 beds.”

The latest lawsuit is one of at least three in recent years involving psychiatric boarding. In May 2021, the New Hampshire Supreme Court ruled that patients held in emergency rooms are entitled to probable cause hearings within three days to review their detention.

The hospitals say ER boarding takes resources away from treating other patients and burdens them with the state’s responsibilities, including facilitating remote access to probable cause hearings.

Citing the pending litigation, the state health department declined to comment on the lawsuit or how the system would absorb more patients if a judge ruled for the hospitals. A hearing in the case is scheduled for Feb. 15.

Susan Stearns, the executive director of the National Alliance on Mental Health’s New Hampshire chapter, said staffing challenges would likely make it difficult for the state to immediately expand capacity at New Hampshire Hospital.

She said solving the ER boarding crisis will require efforts on multiple fronts, including bolstering the mental health workforce, adding inpatient capacity at state and private hospitals, expanding community-based services that help people avoid the need for hospitalization and creating more supportive housing for people with mental illness.

“It requires, really, all hands on deck,” she said. “It is everyone's business, how we resolve this mental health crisis.”

People experiencing a mental health crisis in New Hampshire can call or text 833-710-6477 for support from the state’s Rapid Response Access Point, or 988 for the National Suicide & Crisis Lifeline.

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.

]]>