1 Pillsbury Street, Suite 200 Concord, NH 03301-3570 603-225-6633 FAX 603-225-4739 FOR IMMEDIATE RELEASE Contact: Jay Couture, Seacoast Mental Health 603-431-6703 ext 5709 STATEMENT FROM THE NH COMMUNITY BEHAVIORAL HEALTH ASSOCIATION December 11, 2012 - The NH Community Behavioral Health Association says that today s NH Department of Health and Human Services announcement that NH Hospital will temporarily re-open twelve additional psychiatric beds, as well as other stop-gap measures, is an acknowledgement of the problem of adults and children with serious mental illness waiting for treatment in local hospital emergency rooms, but not a permanent solution. NHCBHA has cautioned for some time that the adults and children waiting in ERs are at risk of causing harm to themselves, to hospital staff, or to other patients. While the Association is still evaluating whether the DHHS plan will have a meaningful impact, Jay Couture, NHCBHA President said, The added bed capacity at NH Hospital is a stop-gap. The larger problem is too little state investment in community supports. Until there is a commitment to fully invest in community-based mental health services, through the 2008 Ten-Year Mental Health Plan or some critical pieces of it, there will continue to be places where people who are seriously ill will fall through the cracks and not receive timely, appropriate care. We urge policymakers to not dismiss the problem of those waiting for treatment in ERs as now solved because of this plan, but to dedicate themselves in 2013 to addressing this critical public health and safety problem head-on, Couture said. Today s press reports: NH Union Leader December 12, 2012 State takes steps for mental health services More beds: Many patients spend days in emergency rooms while waiting for space to open at the state hospital. By PAT GROSSMITH CONCORD A dozen beds will reopen at the state hospital, a key part of an improvement plan for mental health services announced Tuesday by the state Department of Health and Human Services. 1
Since 2009, three adult units with a total of 60 beds were closed at New Hampshire Hospital because of budget cuts. That, along with the shutdown of local hospital inpatient psychiatric units, has led to a waiting list for patients seeking care. Sometimes, the patients spend days in emergency rooms at local hospitals because a bed is not available at the state hospital, according to state and federal officials. State health officials said the plan, announced on Tuesday, was not in response to a classaction lawsuit filed in March that claims the state does not do enough to care for the mentally ill. The U.S. Justice Department has intervened in the suit and argued some of the points made Tuesday that people in a crisis can languish for days in a hospital emergency room. This is of critical concern to me personally and DHHS as an organization, said Commissioner Nicholas Toumpas in a prepared statement. It is unacceptable for someone experiencing a psychiatric crisis to have to wait this long for critical inpatient care for both the individual as well as their concerned family members. State health officials will seek additional funding in the next two-year budget to accelerate the progress of its existing 10year plan to improve mental health treatment in the state, he said. He also wants to fund innovative programs that support individuals so they can live in their communities. Community mental health centers said the announcement represents an acknowledgement that adults and children with serious mental illness are waiting for treatment in local hospital emergency rooms. The New Hampshire Community Behavioral Health Association said it has cautioned that patients waiting in emergency rooms are at risk of harming themselves, hospital staff and other patients, The added bed capacity at New Hampshire Hospital is a stop-gap. The larger problem is too little state investment in community supports, said Jay Couture, president of the association. Building the community (mental health treatment) capacity is essential to keeping people out of the hospital and getting people who are there out, said Amy Messer, legal director of the New Hampshire Disability Rights Center, which brought the lawsuit against the state. Assistant Commissioner Nancy Rollins said a 12-bed unit will reopen as a temporary measure. The said cuts totaled $5.3 million over the past two budget cycles, which resulted in the additional loss of $2.2 million in federal funds. She said the 12 beds will cost $2.3 million annually. The state plan, Rollins said, is in response to increasing concerns related to the numbers of people waiting in emergency rooms for a bed to open. She said the day-to-day count varies from a low of 4 to 5 people to as high as 15 people. DHHS plans to: 2
Track all individuals waiting for a bed at the state hospital on a daily basis. Have state hospital psy chiatric staff consult with local emergency room physicians in managing patients behavioral health crises. Add another seven teams to its Assertive Community Treatment Teams for a total of 17 statewide. Expand its peer-run services to help another 400 adults annually. Nearly double the size of the Housing Bridge Subsidy program, which helps discharged, stabilized patients find and pay for housing, from 110 to 210 units. And add another 48 supervised residential beds in the community. Let me be clear, we cannot do this on our own, said Toumpas. He said coordination is needed from community mental health centers, family and consumer groups, advocates, local police and local hospitals. Twenty months ago, the U.S. Justice Department faulted the state for not living up to its 10- year plan to meet the needs of the mentally ill. The New Hampshire Community Mental Health Centers Association said the state had less capacity in January than in August 2008, when the 10-year plan called for additional investment. Last March, the Justice Department intervened in the class-action Lynn E. v. Lynch lawsuit. At that time, U.S. Attorney John P. Kacavas said New Hampshire residents in crisis spent days in local emergency rooms at great cost and then were transported to the state s psychiatric hospital. This costly and traumatic process could be avoided if New Hampshire offered proven and effective services in the community to prevent and de-escalate crises, help people maintain safe housing and assist them in finding and holding employment, Kacavas said at the time. Lawrence Eagle Tribune - December 12, 2012 N.H. to add 12 more psychiatric beds By John Toole jtoole@eagletribune.com New Hampshire is aiming to reduce the wait for emergency psychiatric admissions to the state hospital. Patients are now enduring waits as long as several days. It is unacceptable for someone experiencing a psychiatric crisis to have to wait this long for critical inpatient care, for both the individual as well as their concerned family members, said Nicholas Toumpas, Health and Human Services Commissioner in announcing the plan yesterday. The delays affect communities, too, because advocates say those experiencing mental health crises end up stuck in hospital emergency rooms, in trouble with the law or they simply stop trying to get help. It s wrong medically, legally, ethically and morally. We don t do this with any other medical condition, said Ken Norton, executive director of the National Alliance for the Mentally Ill - New Hampshire. 3
Toumpas blamed budget reductions, the closure of local psychiatric units and the loss of 60 beds at the state hospital since 2009 for the waiting list. The issue came up in Salem last month when Deputy police Chief Shawn Patten blamed the state s mental health system for failing a man police have dealt with repeatedly over many years. We ve had over 40 contacts with him over eight to 10 years, Patten said at the time. In our opinion, the mental health system in the state of New Hampshire is failing him. And with that failure, he said, comes a great physical risk to the man s family, police officers and the community. This is eventually going to have tragic consequences if this isn t dealt with, he said last month. We re in fear for his family, his friends, the safety of our officers who have to respond to these calls on a regular basis. In response, Dr. Robert MacLeod, the CEO of New Hampshire Hospital, said times have changed. We re truly an acute care, short-stay institution, he said last month. The days of institutions keeping people indefinitely are over. Yesterday, Toumpas said the Department Health and Human Services will be seeking more money in the state budget to help alleviate the problem, but, in the meantime, announced intermediate steps to reduce the wait. These include daily tracking of people awaiting a bed at the state hospital, using psychiatric staff to help emergency room physicians in managing behavioral crises, providing better community follow-up and temporarily reopening 12 beds at the state hospital. Let me be clear, we cannot do this on our own, Toumpas said. This is a very complex subject and involves the coordination of many partners. He is looking for support from community mental health centers, NAMI-NH, law enforcement, local hospitals and others. The New Hampshire Community Behavioral Health Association said the announcement acknowledges the problem, but isn t a permanent solution. The association s president, Jay Couture, said until the state invests in community-based services, there will continue to be places where people who are seriously ill will fall through the cracks and not receive timely, appropriate care. Victor Topo, executive director for the the Center for Life Management in Derry, one of the state supported regional mental health centers, said the remedial effort by DHHS is welcome and hopefully will lead to a more permanent solution. This has been a significant issue, no question about it, Topo said. I know for a fact patients have been stuck for days. That s the case for centers throughout the state, and for both adults and juveniles seeking mental health care, he said. Norton said advocates and health care organizations will have more to say next month when they push for better state funding for mental health services. We particularly want to highlight this issue, he said. 4
Topo agreed there needs to be an injection of more state funding into community services. Norton characterized the situation as complex. He said New Hampshire has gone from the topranked state for mental health care in the 1990s, a model for community-based services, to a situation where federal regulators and advocates are pressing in court for the state to do better. Now, we re not doing real well, Norton said. The waiting list for state hospital admission can discourage people from getting the help they need, he said. It s so important for people to get help, he said. Concord Monitor December 12, 2012 HHS Commissioner Toumpas calls for $10 million investment in mental health care By ANNMARIE TIMMINS - Monitor staff The commissioner of Health and Human Services announced yesterday that he will ask lawmakers for about $10 million to improve mental health care, mostly at the community level so patients can remain close to home and in settings less expensive than the state hospital. Commissioner Nick Toumpas said he s also temporarily adding 12 beds to the hospital s existing 130 beds to shorten the increasingly long wait to get into the hospital until he has the money to expand community services. On weekends especially, it s not uncommon for 20 people to be waiting in local emergency rooms across the state, all in a mental health crisis, for a state hospital bed, according to mental health providers. In rare cases, patients have waited two weeks at an emergency room for a state hospital bed. This is of critical concern to me personally, and DHHS as an organization, Toumpas said in a statement. It is unacceptable for someone experiencing a psychiatric crisis to have to wait this long for critical inpatient care for both the individual as well as their concerned family members. Gov.-elect Maggie Hassan is open to Toumpas s request, according to her spokesman. Hassan believes we must take steps to improve New Hampshire s mental health system and address the waiting list for mental health services, which has put an enormous strain on families throughout the state, Marc Goldberg said in an email. The governor-elect is currently in the process of bringing people together to make the difficult, fiscally responsible decisions needed to balance our budget while protecting New Hampshire s priorities, including providing high quality health services. She looks forward to working with Commissioner Toumpas. Community mental health providers have been raising concerns about long waits and diminishing mental health care for nearly a year and were planning a Jan. 7 press conference to sound that alarm again. After learning of Toumpas s plan yesterday, which they didn t know was coming, they expressed cautious optimism. We really welcome this by the department, said Ken Norton, executive director of the state chapter of the National Alliance on Mental Illness. I think there may have been hope (by state 5
officials) that what was happening was a temporary situation, and I think people are now seeing that it is not. A $10 million investment in mental health care would be a real change, they said, in a state that has cut services for the last several years to balance the state budget. Louis Josephson, president of Riverbend Community Mental Health in Concord, said Toumpas s plan will improve mental health care only if it truly increases the treatment at the community level. That means increasing the number of people providing care as well as residential housing in local communities. Of the additional 12 beds at the state hospital, Josephson said, I ll take it, but it s a short-term Band-Aid. Erik Riera, administrator of the state Bureau of Mental Health, said yesterday s announcement was not a direct response to the federal lawsuit pending against the state over its mental health care system. That lawsuit, which names Toumpas, Gov. John Lynch and other state officials, alleges the state discriminates against people with mental illness by keeping them in state hospitals instead of investing in community treatment that would be better and less restrictive. Riera said he and others in his agency have been working on a plan to improve mental health care at Toumpas s request since the spring when there became a waiting list to get into the hospital. We are very much trying to be proactive, Riera said. When we identified the issues out in the community hospitals, the commissioner asked that we develop a plan. He wanted to release that plan as we were going into the (state) budget sessions. We want to get this out for public discussion and hopefully garner significant public support. Amy Messer, the legal director for the state Disabilities Rights Center, which is involved in the federal lawsuit against the state, said she too was glad to see the state beginning to address its mental health system. She said Toumpas s ideas come from the state s 10-year-plan to improve mental health care, which was written in 2008 but has largely languished because of budget cuts. Whether the proposal here is a sufficient array of services and of sufficient capacity, we ll have to look more closely at that, Messer said. The plaintiffs (in the federal lawsuit) continue to be open to discussions with the state regarding the resolution of the case. Those discussions are not happening at this juncture. Toumpas divided his plan into two parts: immediate action and improvements he ll seek through budget requests. Immediate action Starting now, Toumpas s office will do the following: Track all people waiting for a bed at the state hospital on a daily basis and admit those in the greatest need first, ahead of others on the list in less of a crisis. 6
Finalize a plan to use state hospital psychiatry staff to provide additional counseling at local emergency rooms. Concord Hospital, for example, spends $1 million a year just caring for the people awaiting mental health care, Josephson said. Reopen the 12 beds at the state hospital. Three years ago, the hospital had 202 psychiatric beds, but that number has dropped, largely because of budget cuts. Mental health providers, though, said the state could reduce the number further if it increased the amount of care at the community level. Doing so would not only be better for the patient, they said, but also cheaper. It costs the state $1,000 a day to care for a patient at the state hospital. It costs $200 a day to care for someone in a community residential setting. Within 10 days, finish introducing a new discharge process that requires the hospital to more closely follow up with patients after discharge to reduce re-admissions. Expand the number of peer-run crisis beds, which are beds in local community settings staffed by volunteers who have expertise with mental health crisis. The state currently has just two of these, said Riera. Long-term plan The longer-term plan will depend on what Toumpas does with the following budget requests: Increase the number of residential, inpatient beds at the community level. Expand other peer-run services to serve an additional 400 adults with severe mental illness annually, at the local level. Continue expanding the local Assertive Community Treatment Teams, which have proven effective in responding quickly to people in crisis so they don t have to be hospitalized. There are seven teams in the state now. Toumpas wants 17. Expand residential options for people with mental illness, including day programs. This includes doubling the size of a housing subsidy plan by the end of the 2015 fiscal year. Roland Lamy Jr., the executive director of the New Hampshire Community Behavioral Health Association, learned of Toumpas s plan late yesterday, although it called for the support and collaboration of community mental health centers. Lamy said it s a good start because it acknowledges the problem. The press release was a surprise to us, he said. We are happy that we are listed as part of the solution. We do want the opportunity to talk to the governor-elect and some of the Legislature as well to give them facts and details about what we believe is a crisis. Boston Globe December 11, 2012 NH seeks to reduce wait time for psychiatric beds CONCORD, N.H. (AP) New Hampshire s health department is taking steps to reduce the time patients spend waiting for a bed to become available at the state psychiatric hospital. Health Commissioner Nicholas Toumpas says it s unacceptable that people in crisis are waiting several days in hospital emergency rooms before being admitted to New Hampshire Hospital. His department announced a plan Tuesday to address that, including having the state hospital track individuals awaiting a bed and temporarily re-opening a dozen beds that currently are closed. The department also is working on a plan to have New Hampshire Hospital staff provide 7
consulting services in local emergency rooms and improve community follow-up to reduce readmissions. Steve Ahnen, president of the New Hampshire Hospital Association, praised the effort, saying it was the first step in a long process. DHHS Press Release December 11, 2012 DHHS Releases Plan to Reduce Wait Times for Patients Seeking Inpatient Psychiatric Care Contact: Public Information Office (603) 271-9391 Concord, NH The New Hampshire Department of Health and Human Services (DHHS) is announcing the release of its plan to help reduce the wait time for patients in local hospital emergency rooms for inpatient psychiatric care. Budget reductions, the closure of local hospital inpatient psychiatric units and since 2009 the loss of 60 beds at New Hampshire Hospital (NHH) has led to a waiting list for patients seeking inpatient psychiatric care. Many patients are now waiting several days in a hospital emergency room for a bed to become available at New Hampshire Hospital. This is of critical concern to me personally, and DHHS as an organization, said Commissioner Nicholas Toumpas. It is unacceptable for someone experiencing a Psychiatric crisis to have to wait this long for critical inpatient care - for both the individual as well as their concerned family members. As we develop our budget request for the next two years, we will be seeking additional funding to continue to accelerate progress on our 10-year Olmstead Plan, but also fund new and innovative programs that are designed to support individuals so that they can live in their communities with the supports that they need. In the meantime we have some immediate steps we are taking to reduce the waitlist. DHHS immediate plan of action includes: NHH tracking all individuals awaiting a bed at NHH on a daily basis. These are reviewed and triaged by the Physician in Charge at NHH. Finalize a plan to utilize psychiatry staff at NHH to provide additional consultative services to local ER physicians on the management of behavioral health crises. Finalize a plan for Commissioner approval to temporarily reopen 12 beds at NHH that currently are closed. Within the next 10 days, finalize implementation of Project RED (Re-engineered Discharges) to provide better community follow-up after discharge in order to reduce readmissions, which will also increase the availability of beds at NHH. Expand peer-run crisis respite beds. DHHS s budget submission contains requests for additional funding to continue building community capacity, including: Establishing additional inpatient capacity available on a statewide basis to allow individuals to receive care on a local basis. 8
Expanding peer run services, including peer crisis beds in the community, to serve an additional 400 adults with severe mental illness annually, through a peer run model. Continuing to expand the number of Assertive Community Treatment Teams by adding an additional 7 teams, bringing the total to 17 teams for the State of NH. Expanding residential options for consumers, including a doubling of the size of the Housing Bridge Subsidy program from 110 to 210 by the end of FY 15, and adding an additional 48 supervised residential beds in the community. Let me be clear, we cannot do this on our own, stated Toumpas. This is a very complex subject and involves the coordination of many partners. We will continue to reach out to our Community Mental Health Centers, consumer and family members, the NH state Planning Council, NAMI-NH, the law-enforcement community and local hospitals to develop and most importantly advocate for the supports and services that are needed today and in the future here in New Hampshire. 9