Mentally ill patients in ER for weeks

Submitted 3 months ago
Created by
Glynis Hart,

CLAREMONT – Sullivan County Sheriff John Simonds reported to the county board of commissioners Monday, detailing department expenditures on prisoner transports and other expenses. Among the prisoner transports the department does, Simonds said, he found taking mentally ill subjects to be seen at Concord Hospital, which has a behavioral health unit, to be a concern. 

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“We do a number of these IEAs — Involuntary Emergency Admittance — a month,” said Simonds. “It varies.

“There's a huge problem with the lack of beds at the state hospital,” he said. 

Mentally ill patients in New Hampshire have 72 hours to be evaluated by a doctor, and then under the law they should be immediately transferred to appropriate care if they need it. However, the New Hampshire Hospital, the state institute for the mentally ill, has not had enough room to admit them for at least 10 years. Therefore, the patients wait in the emergency room. Simonds said some currently held there have been in the emergency room for five weeks. “When these folks are sitting in the ER for a long time and they're a problem, the hospital has taken to contracting out to hire people to [look after] them. The nurses have been quite relieved that there's somebody that's there,” said Simonds.
Concord is often treated as the state portal for mental health care, due to the city's proximity to the state hospital, as well as the behavioral unit in Concord Hospital. That unit has 15 beds for voluntary patients, and six for involuntary ones. The city also has accessible mental health services. Along with Manchester and Nashua, it has created mobile crisis services to better serve people with mental illness and to divert them from institutions.
In 2014, a lawsuit against the state by mental patients and their advocates was resolved by the state agreeing to take important steps to improve patient care, not all of which have been achieved.
Peter Evers, CEO of Riverbend Community Health in Concord, said, “It's soul-destroying to see that we have people needing treatment, and we are not able to treat them.”

Evers said although the movement to close state psychiatric hospitals in the 1970s and 80s was well-meaning, not all mental illness is appropriately treated on an outpatient basis. “Some people believe nobody should be in a mental hospital, but you wouldn't really say that about a heart attack, would you?” 

Currently, there are 62 people in the state waiting for a bed in a psychiatric treatment facility. Sixteen of them are in the Concord Hospital emergency room. 

“It is not the right place for someone with mental illness,” said Evers. At the New Hampshire Hospital, there are 168 long-term beds, and another 40 in designated receiving facilities that can keep patients for up to 10 days. While mental illness is treatable and has better long-term recovery rates than other serious diseases, treatment can take a long time. 

“If you go to the state hospital, you're usually pretty sick,” said Evers. “We need to properly resource this disease and treat it like what it is, a disease. Mental illness has a similar course in terms of acuity to many other serious diseases, but it is treatable.”

According to the Centers for Disease Control, effective treatment of mental illness requires 50 beds per 100,000 people. In New Hampshire, the capacity is 11 per 100,000.  

Ad-hoc treatment of the mentally ill in emergency rooms also affects the care of patients coming in with other issues, puts stress on people working in ER, and diminishes the standard of care for everybody. 

“It's a problem all over,” said Evers. “I've worked in Boston, where there are more beds than you can shake a stick at, and there are still difficulties depending on the patient's diagnosis. But in New Hampshire, it's everybody, whether they're insured or uninsured.” 


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