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Mental health suit is settled

State to spend more on services

A $32 million settlement in a class-action suit filed by six New Hampshire residents with psychiatric disabilities against the state is a milestone case for New Hampshire, according to local interested parties who have been following it.

“I think it’s a positive outcome for the citizens, shoring up services that are more humane and less costly than institutionalized care, and I think that’s good for the people of the state,” said Phillip Wyzik, CEO of Monadnock Family Services, which provides mental health services for the Monadnock area.

Advocates Building Lasting Equality in New Hampshire President Linda Quintanilha of Bennington concurs.

The suit claimed that the State of New Hampshire unnecessarily institutionalizes those with serious mental illnesses, which violates the integration mandates of the Americans with Disabilities Act and the Rehabilitation Act. The ADA states that qualified individuals with disabilities should not be denied benefits of services, programs or activities of a public entity, or be discriminated by public entities. That includes state and local governments. The suit argued that the segregation of people with disabilities in institutions is a form of discrimination. The ADA also mandates that people with disabilities should be integrated in general society as much as feasibly possible. States must provide community-based treatment, when community placement is appropriate and transfer from institutional to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated by the resources available to the state.

The Rehabilitation Act also protects against discrimination of those with disabilities, and requires that services be provided in the most integrated setting possible.

All of the named plaintiffs in the case are those with mental disabilities who are institutionalized in the New Hampshire Hospital or the Glencliff Home, or were alleged to be at risk of institutionalization. The plaintiffs claimed that the state — in the form of Governor Maggie Hassan, officials of the Department of Health and Human Services, and the Administrator of the N.H. Bureau of Behavioral Health — were relying excessively on the provision of institutional care to treat mental illness. Community-based care program were under-utilized and did not have enough diversity, as a direct result of underfunding community services and over-relying on institutional treatment.

The plaintiffs hoped to gain an injunctive relief requiring the state to develop and provide a wider array of community-based treatment services, mobile crisis service, Assertive Community Treatment and supported housing and supported employment.

In a press release issued by the N.H. Department of Justice on Dec. 18, it was announced that the Department of Justice had entered into a comprehensive settlement agreement with the plaintiffs.

As part of the settlement, the state has agreed to expand Assertive Community Treatment teams to ensure they are on call 24 hours a day in all parts of the state, instead of the current set hours 7 days per week . It will also create three mobile crisis teams and three crisis apartments to help divert people experiencing mental health crises from emergency rooms and New Hampshire Hospital, expand both supported employment assistance and supported housing opportunities for people with mental illnesses, and seek to divert more people from Glencliff Home and New Hampshire Hospital and emergency rooms into community-based services.

In order to do this, it will require an additional $6 million from the state’s General Fund for expanded mental health services for the current biennium and an additional $23.7 million for 2016 and 2017 fiscal years, according to initial estimates from the Department of Health and Human Services. Under the terms of the settlement, the state also agreed to pay $2.4 million for the plaintiffs’ legal expenses.

“The first priority in this case for the N.H. Department of Justice has been to ensure that the State of New Hampshire is able to develop its own plan for community mental health services that best meets the needs of its residents,” Attorney General Joseph A. Foster is quoted as saying in the release. “This settlement agreement, developed in conjunction with the New Hampshire Department of Health and Human Services, enhances the state’s mental health services to address the concerns of the plaintiffs and protects taxpayers from far greater potential liabilities.”

Phillip Wyzik, CEO of Monadnock Family Services, said in an interview Friday that it’s not clear yet which geographical areas these changes are going to affect. However, there are currently 15 people from the region MFS serves who are institutionalized at the New Hampshire Hospital. Though they will likely be short-term stays, they would be among the people that would get the most use out of these new services, he said.

Wyzik said he was pleased with the effects the settlement would have on programs available in the state. “The ideas presented in the settlement are ones that are proven to be effective,” Wyzik said. “ACT, supported employment, mobile crisis units and supported housing, that’s all good stuff. That’s money well spent. That’s how someone transitioning from Glenncliff or the New Hampshire Hospital is going to integrate back into the community. It makes perfect sense, and they largely stand a chance of helping people.”

Linda Quintanilha, who has a child with autism, said she, too, thinks it’s an important decision.

“Obviously, during state budget talks over the past few [biennia], mental health has been the lowest hanging fruit when it comes to cuts, and clearly it’s taken its toll,” she said in an interview Friday. “I think it’s fantastic that an agreement has been met. I give kudos to the leadership that put this deal together, because things were pretty dire for people with mental health issues in New Hampshire.”

At the same time she said she worries about accountability. It will be the job of advocacy groups such as ABLE to make sure that the funds are being used in the spirit they were intended, she said.

While both Quintanilha and Wyzik said the settlement was a positive thing, it is only a first step. Quintanilha said she would like to see more funding go to train police and first responders on how to recognize and respond to those with mental illnesses or disabilities. As a mother of an autistic child, she said, she knows her daughter’s behavior can come off differently to those who are unaware of her diagnosis.

“Training first responders is a big deal,” said Quintanilha. “If they’re not able to deal with people with mental health issues, or even people with autism which can seem to be a mental health issue, it can be a pretty scary situation.”

Wyzik agreed that there are other areas of the mental health system that still need to be addressed. “This is a helpful step in solving the mental health issue, but will not take care of all the issues. It’s progress, but there’s still quite a ways to go, yet. The state isn’t doing enough to prevent mental health crises occurring in the first place, and I don’t think the funding has kept pace with the high cost of care.”

In a press release issued on Dec. 19, after the decision to enter into the agreement, Hassan is quotes as saying, “Addressing our deeply strained mental health system is one of the most pressing challenges facing our state. The settlement agreement reached today builds on the progress made in our bipartisan budget by further enhancing community-based mental health services and increasing crisis-support services, helping to address the continued trend of acute mental health cases at our hospitals’ emergency rooms.”

Currently, if a commitment order is signed for a patient with mental health issues, and no beds at a psychiatric unit are available, the patient is held in emergency care at a hospital until they can be transferred. On Nov. 4, Hassan ordered a review of emergency room practices when it comes to caring for patients with acute mental illness, after multiple incidents at Elliot Hospital in Manchester, where patients with acute mental health issues had violent outbursts while they were being held for multiple days in the hospital’s emergency department until a bed at N.H. State Hospital became available.

Part of the review will address what acuity of patients can and should be treated by the state’s mental health facilities, and which can be addressed by community-based services like the ones the settlement will fund.

In her Dec. 19 release, Hassan said that the settlement is a fiscally responsible decision, noting that the agreement ensures that it is New Hampshire citizens who are responsible for crafting mental health changes, and not federal judges. It also avoided a potentially costly lawsuit.

The Disabilities Rights Center of Concord, one of the agencies representing the plaintiffs in the case, has called outcome satisfactory. “Today’s settlement agreement is a real leap forward in the renewal of New Hampshire’s commitment to community-based mental health services,” Amy Messer, the legal director of the Disabilities Rights Center and counsel for the plaintiffs, is quoted as saying in a recent release. “Thousands of individuals with serious mental illness will now get the services and support they need and want to live full, meaningful, and productive lives in the community.

Dan Will of Devine Millimet, a law office also representing the plaintiffs, added, “Access to community-based mental health services has long been proven to eliminate or reduce the needless institutionalization of people with serious mental illness. Community services not only leads to a higher quality of life for individuals with disabilities, but are also far less costly than institutional care.”

Linda Mallon, the executive director of the Office of Public Guardian called the agreement “an extraordinary and positive step towards a robust community mental health system.”

According to the Disabilities Rights Center’s release, the agreement will allow New Hampshire to expand its supported housing to include at lease 450 supported housing units, and the Assertive Community Treatment will be able to serve up to 1,500 people.

The settlement agreement will still have to be approved by the United States District Court, and is anticipated to be presented to Judge Steven McAuliffe for final approval sometime in February.

Ashley Saari can be reached at 924-7172 ex. 244, or asaari@ledgertranscript.com. She’s on Twitter @AshleySaari.

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