Simply adding beds won’t solve state’s mental health crisis
Concord Monitor - 3/11/2017
For the Monitor
Clearly, people in mental health crises need treatment. They should not be stuck in a chaotic emergency room for days or weeks waiting for help. Inpatient care is part of the necessary array of services for some people with mental illness, but rushing to add additional beds is not the best long-term solution for the state.
Most people with mental illness want to live in the community and can successfully do so with an array of appropriate community-based supports. Effective community-based services can reduce emergency department and inpatient admissions and the psychiatric boarding problems in two ways.
First, certain community-based services, such as mobile crisis intervention and assertive community treatment, can help resolve a psychiatric crisis in the community without the need for emergency department or inpatient care. New Hampshire’s two mobile crisis teams prevent hundreds of emergency department and inpatient admissions every month. Second, community-based services can also help people that have been admitted for inpatient treatment discharge more quickly, because they can receive more intensive community-based services. Earlier discharges free up an inpatient bed for someone else who is waiting.
Simply adding inpatient beds may, at least temporarily, relieve psychiatric boarding pressures in the emergency department, but it will not expedite discharges or help people remain in the community. When someone must receive inpatient treatment instead of treatment in their community, they are at risk of losing their housing, their jobs and their community relationships, making it much more difficult to return home when they are ready.
While New Hampshire has made significant gains in community-based mental health services over the last several years, there is still room for improvement.
Mobile crisis services are available only in Concord and Manchester. Presently, the Legislature is considering House Bill 400, which calls for mobile crisis services to be implemented statewide. Further, the state has more capacity to provide assertive community treatment than is actually being provided. The most recent data suggest that there is capacity to provide assertive community treatment services to 1,162 people, but only around 840 people are receiving the service.
Community-based services are also fiscally responsible. These services are far more cost effective than inpatient treatment (over $1,300 per day at New Hampshire Hospital) and serve many more people.
It is critical that the state promptly and thoughtfully addresses the issue of people waiting in emergency rooms. We urge state officials to examine the full array of community-based options, such as mobile crisis services and apartments, to reduce the need for inpatient services rather than moving immediately to add more beds at New Hampshire Hospital or other inpatient treatment facilities.
(Stephanie Patrick is the executive director of the Disability Rights Center-New Hampshire..)