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GRASSTOPS REPORT ON NH HOSPITAL WAIT LIST
March 19, 2012
The following news report appeared in the Concord Monitor this weekend, less than two weeks after the Community Behavioral Health Association issued its update on the 2008 State Ten-Year Mental Health Plan. As Louis Josephson of Riverbend states in the article, what is happening in our hospital emergency rooms does not provide good care for individuals with mental illness. And we must disagree with the comments of NH Hospital’s chief executive: this is a crisis.
State hospital wait list hits historic high
Mentally ill stay in emergency rooms
By Annmarie Timmins / Monitor staff
March 17, 2012
The number of mentally ill people waiting in local emergency rooms for a bed at the state hospital has reached a historic high, sources said yesterday.
Yesterday morning, a North Country mental health center alerted the state’s other centers that 21 people were awaiting a state hospital bed as they headed into the weekend, the busiest time for admissions. The waiting list is typically four to six people, said Bob MacLeod, chief executive officer at New Hampshire Hospital.
“The waiting list and times are certainly trending upward,” said MacLeod, who said the wait was down to about 15 by yesterday evening. “I don’t use the word crisis. I think crisis is overstating it. I think we do have challenges.”
MacLeod said March tends to be a busier time for mental health admissions, even outside the state. Louis Josephson, chief executive officer of Riverbend Community Mental Health Center in Concord, said that confirms what he’s seen. Three weeks ago, the waiting list had 19 people on it, he said.
The state hospital is down 24 beds from last year because of budget cuts in July. And those cuts followed years of bed reductions, according to Josephson.
Three years ago, he said, the state hospital had 202 psychiatric beds for adults and children in a psychiatric crisis. Now there are 130.
“Three years ago, a long wait was six hours, and eight hours was a really long wait,” Josephson said. Now it’s not unusual for people to be in an emergency room a day or longer waiting for a bed.
“It is definitely a huge burden on hospitals and on mental health centers,” he said.
Concord Hospital’s emergency room, for example, has only four rooms for psychiatric patients waiting for a state hospital bed, Josephson said. There are two other rooms Riverbend can use for waiting patients, but because there is hospital equipment in those rooms, they are not appropriate for every patient.
The rooms do not have beds because they were not designed for long waits. When there are five or six people waiting one or two days in the emergency room, security becomes a concern, Josephson said.
Recently, Riverbend had an 8-year-old in need of help, a 17-year-old who had made a serious suicide attempt and an older man suffering from untreated schizophrenia, Josephson said. And there were no beds available at the state hospital.
“By day two, the (8-year-old) starts banging his head on the wall and cries out,” Josephson said. “That agitates the man, who kicks a hole in the wall, and that scares the 17-year-old.”
MacLeod said he has not discussed the increased waiting list with staff at the state’s mental health hospitals or emergency rooms. He’s not convinced the response should be asking the Legislature for more money.
“I’m not sure that is an option at this point, and I’m not sure that’s the only answer,” he said.
MacLeod said this uptick is recent and may reverse direction after March. He also said the state hospital is seeing more people from the criminal justice system, who can be harder to relocate in the community. That can delay freeing up bed space, he said.
“I think we have to look at how we can do things better, more efficiently,” he said. “And doing it in a fashion that doesn’t build unnecessary infrastructure but better infrastructure. I see this as a challenge that we all need to put our heads together on and come up with ideas that heretofore haven’t quite developed.”
Meanwhile, community mental health centers are also adjusting their approach to care – and not for the better, Josephson said. He said staff are spending more time with fewer patients at the emergency room, waiting for bed space. In addition, Josephson said, the state hospital is discharging people quickly, sometimes too quickly.
“Twenty-five to 30 percent of patients are out within 24 hours,” Josephson said. “That is a historic high. They are not even starting them on new meds. They are looking at them and saying, ‘You look safe to me. Goodbye.’ ”
Josephson continued: “The state saves money, but we are all paying for it, and it’s not good care.”