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|Scorecard with no winners: 44 wait for mental health care|
By Jay Couture
We live in an era where records, particularly when they are shattered or just barely missed, are in the news on a daily basis. We hear of high-scoring basketball stars, record-tying golfers and quarterbacks, and death-defying feats of athleticism. We hear which movies grossed the most ticket sales over the past weekend, which actors and actresses are making the most money, and who has won the most awards and gold statues. We are regularly apprised of the most recent political polls and the approval and disapproval ratings for the president, our governors, members of Congress and others in elected office. Everybody loves a winner, as the saying goes.
Here in New Hampshire, we broke another record this week, too, but this is one that won't make headlines and that most people won't hear about. It wasn't in the world of sports, entertainment or politics. It was in the world of treatment, or lack thereof, for people in acute psychiatric crisis. It is one that is nothing to celebrate, or be proud of.
On Monday, Feb. 4, there were 44 people stuck in hospital emergency departments throughout our state awaiting a bed at New Hampshire Hospital. These were 44 adults and children who have been deemed to meet the criteria for an involuntary emergency admission, which must be made to a designated receiving facility (DRF). These individuals are not safe to discharge as they have been determined, according to state statute, to be a danger to themselves or others. This situation generally means that an individual needs to be admitted to the state's one psychiatric inpatient facility — NHH — because there are only eight DRF beds remaining, at Elliot Hospital.
Despite the fact that NHH recently converted four visitation rooms to patient rooms to increase capacity by up to eight beds, our community-based mental health system of care has been eroded so much over the years that we simply cannot keep up. And because there were no DRF beds at Elliot, or elsewhere, on Feb. 4, there were 44 people languishing in hospital emergency rooms, not receiving the care they needed in a timely, humane or cost-effective way. In what other segment of health care would we, as a society, accept this? If you had a family member or friend with cardiac disease or kidney failure, would you be complacent when told, "Sorry, there is no care available," or that there is a lengthy waiting list before your loved one can even see a doctor?
It costs far more to get to the point where people in a psychiatric crisis require the acute services of an emergency department and an inpatient bed than it does to provide adequate funding for community-based mental health services. It goes without saying that services provided in a timely manner in the least restrictive environment have the double benefit of being more clinically effective and less costly.
The state's Ten-Year Mental Health Plan, "Addressing the Critical Mental Health Needs of NH's Citizens: A Strategy for Restoration," was released in 2008, but has not been adequately funded. It still provides a valid framework for our state, and there is still time to rebuild our community-based system of care by funding the plan now. We need to do better for the 44 adults and children who sat in hospital emergency rooms on Feb. 4 because the system had no room for them. We need to commit to moving the Ten-Year Plan forward this year.
Jay Couture, MHA, is executive director of Seacoast Mental Health Center in Portsmouth and president of the New Hampshire Community Behavioral Health Association.