Some encouraging developments have emerged in the effort to improve availability of mental health care in the state and locally. There’s still much road to be traveled for mental health needs to be fully met, but the progress is essential and welcome.
At its meeting held Wednesday in Keene, the Executive Council heard from state Health and Human Services Commissioner Lori Shibinette on the state’s recent steps to address the extreme shortage of psychiatric beds for those experiencing mental health crises and needing inpatient care. The problem resulted when a double whammy of inadequate insurance and Medicaid reimbursement and a dearth of licensed professionals led several hospitals, including Keene’s Cheshire Medical Center, to close their psychiatric wings in recent years, a situation only worsened over the past 18 months by stress, disruption and isolation during the pandemic. Out of this drop-off in inpatient capacity came a shameful practice of involuntarily detaining those in mental health crisis in emergency rooms across the state, in some cases up to four weeks, while waiting for psychiatric beds to become available at N.H. Hospital and other designated receiving facilities, a horrifying warehousing better suited to the plot of a Dickens novel than present-day New Hampshire.
It took a resounding state Supreme Court ruling in May that the involuntary detentions were violating patients’ rights to shock Gov. Chris Sununu and his administration into serious action. But, to their credit, take action they did, although it will be with a considerable boost from federal aid. Sununu issued an executive order calling for an increase in the number of emergency beds at designated facilities and additional capacity at N.H. Hospital, and directed action by DHHS to increase access to mental health services and take other action to address what he called a “mental health crisis.”
At the Executive Council meeting, Shibinette reported significant progress since May in ending the ER boarding practice, telling the council the average wait time is now less than a day. The council also approved some of the administration’s steps to address the so-called “back-door” problem. This has kept patients at N.H. Hospital beyond when their psychiatric condition has stabilized because there’s no other place to provide them less-acute care, and the council signed off on contracts — paid for with federal COVID relief funds — with eight long-term care providers to make 27 additional beds available around the state, including three at Alpine Healthcare Center in Keene, for transfer of elderly patients to free up beds at N.H. Hospital. And Shibinette also announced this week that DHHS will be requesting an expansion of a federal waiver to seek Medicaid coverage to reduce ER stays, improve availability of crisis stabilization services and address other needs to improve delivery of mental health services, including helping to address the ER boarding situation.
As promising as these steps are, another significant nut that must be cracked in addressing the mental health crisis is the ongoing shortage of mental health professionals. The problem is nationwide in scope, and recent data from the Kaiser Family Foundation indicate that, at only 45 percent last September, the needs of New Hampshire residents for such care are well short of being met. Welcome news it is, then, that Cheshire Medical Center has brought a psychiatrist on board and begun offering outpatient psychiatric services. Dr. Michael O’Shea, the medical director of emergency care and ambulatory services, says the plan is to expand the department by hiring two behavioral nurse practitioners later in the year and a second psychiatrist, though he acknowledges that may take some time due to the nationwide shortage in the profession.
At least during the ramp-up, Cheshire Medical is offering services to only its primary-care patients. Still, there’s a clear need to provide psychiatric services to those whose mental health issues don’t require inpatient treatment, with waits for outpatient care in the state extending to months, according to Ken Norton of the state chapter of the National Alliance on Mental Illness. And if this step by Cheshire Medical is for now only a beginning one, it’s significant. As Phil Wyzik, CEO of Monadnock Family Services, told The Sentinel, “Any time our community can find ways to add psychiatric or mental health providers to the hospital or any treatment setting, we are all better off.”