Surplus eyed to address psychiatric boarding crisis

CONCORD, N.H. (AP) — Lawmakers are considering a proposal to encourage construction of hospital psychiatric units to address what the Democratic sponsor calls a “festering wound” in New Hampshire: mental health patients languishing in emergency rooms. But Republican Gov. Chris Sununu said spending the state surplus is the wrong approach.

The average number of adults waiting in emergency departments for inpatient psychiatric admission each day has quadrupled to more than 40 in the last six years, according to the state chapter of the National Alliance on Mental Illness. That number has spiked to 70 several times, and while numbers are lower for children, one day in May 2017 saw nearly 30 children waiting for beds, the group’s director, Ken Norton, told the Senate Health and Human Services Committee on Tuesday.

While many factors contribute to the crisis, the bill seeks to address a key element: a lack of designated receiving facilities, typically hospitals with psychiatric units, to which patients could be transferred. Lawmakers approved funding for new beds last year and put out a request for proposals from hospitals, but none responded.

The bill sponsored by Sen. Tom Sherman, D-Rye, would spent $3 million to double the state’s reimbursement rate for such beds and $3 million to subsidize renovations associated with creating new psychiatric units. Sherman said he knows of at least one hospital that is “shovel ready” should the legislation pass.

Sherman, a gastroenterologist, said his patients would never wait for days or weeks in an emergency department and neither should those suffering from mental illness.

“My view as a physician is the current process is affront to patient care and it needs to be rectified immediately,” he said.

The goal, he said, is to create units with at least 10 beds.

“One or two beds in a hospital that does not have psychiatric capacity, especially when they are not reimbursed at a rate where hospitals can break even, is not a sustainable model,” he said.

Norton said access to inpatient care in local hospitals would be much less stigmatizing than going to the state psychiatric hospital in Concord. That could encourage people to seek treatment earlier, he said, which in turn could lead to shorter hospital stays and better outcomes.

“Local treatment keeps people close to their homes, families, communities and natural support systems,” he said.

Officials with several hospitals backed the bill, as did the New Hampshire Hospital Association, saying the current situation is unsafe for both staff and patients. Peter Evers, vice president for behavioral health at Concord Hospital, described a 62-year-old woman who waited 32 days for a bed.

“The damage we did despite our best effort for that individual is unconscionable,” he said.

Sununu said Wednesday he supports further investments in the mental health system, but that it should be done through the state budget process, taking into account all the various factors contributing to the problem.

“You have to be careful about where the funds are coming from and if they’re sustainable,” said Sununu, who suggested Democrats are “usurping a process to score some political points.”

“It has to be done smart, and in a way that doesn’t create a long-term liability,” he said. “Because at the end of the day, it’s the individuals that rely on those services that will suffer.”