Is $100 million enough to keep the New Hampshire Hospital waitlist down? 

  • A security officer stands by while LNA Karen Johnson works with mental health patients in a make-shift care area in a Concord Hospital Emergency Room hallway Thursday. In recent months and especially for the last two weeks, the hospital has experienced a backlog of patients waiting to be admitted to New Hampshire State Hospital. In the meantime, other, medical patients are experiencing longer wait times. Elodie Reed

Concord Monitor
Published: 6/8/2021 9:34:41 AM

Over the last several years, the number of people on the state’s psychiatric hospital waiting list has dipped into the single digits only a handful of times.

This time around, backed by $100 million of funding and bound by a N.H. Supreme Court ruling, Commissioner Lori Shibinette of the N.H. Department of Health hopes it sticks.

Last month, the New Hampshire Supreme Court ruled that psychiatric patients being held involuntarily in emergency rooms must be given a chance to contest their detention within three days of their arrival.

Often, people deemed to be in crisis must wait days or weeks in the emergency rooms for a bed in one of the state’s psychiatric facilities to open up without an opportunity to challenge the involuntary admission.

Following the court’s ruling last month, the state scrambled to clear the waiting list for inpatient psychiatric care.

Within a couple weeks, the state found nursing homes willing to house 25 geriatric patients from New Hampshire Hospital and slashed the waiting list from 33 two weeks ago, to three on Thursday.

But when the number of names on the waiting list drops to zero, which she said will likely happen in the next couple weeks, it might not be indicative of substantive changes to the mental health system.

She knows this because this strategy has already played out in New Hampshire last year, when the state moved kids from NH Hospital to new beds at Hampstead Hospital and the number of children on the waiting list dropped to zero in March.

“Within two or three months, our waitlist came back up again,” she said.

She sees this empty waiting list as a short window to quickly stand up long term mental health infrastructure.

Gov. Chris Sununu announced he would allocate $100 million to do just that at Thursday’s press conference.

Shibinette agrees that there need to be more inpatient psychiatric beds in New Hampshire but she is adamant they are not the ‘silver bullet’ that will solve the state’s mental health crisis.

She said the state tried that approach half a decade ago, when the psychiatric hospital held thousands of patients at a time.

“There used to be 3,000 beds at the state hospital grounds,” she said. “We made that decision 50 years ago, that this is not how we take care of our vulnerable patients.”

The real long term solution, she said, is investing in community mental health resources, to avoid the need for state care in the first place.

One of the first ways DHHS plans to expand community resources is by opening 60 new transitional housing beds, six at each of the state’s community mental health centers, by Jan. 1.

She said there are tens of patients who no longer need the intensive care offered at New Hampshire Hospital but still require a buffer before they return to living on their own.

“They have been there, waiting, sometimes for months and months and months,” she said. “They don’t need psychiatric care anymore but do need a supportive community”

For the last three years, the state has looked for contractors to build the transitional housing program with some success — eight beds have opened in Warner and 14 have opened in Nashua.

DHHS has incentivized these contracts by increasing its daily payments and is now going into contract with the mental health centers.

DHHS is also making moves to bolster mental health resources by bringing in providers from out of state.

“If somebody can provide a good service and they want to be here, then we’re going to open that door and provide that opportunity for our citizens,” Sununu said at a press conference Thursday.

Shibinette said the department plans on applying for a waiver from the federal government by the end of the calendar year that would allow providers to bill Medicaid for inpatient psychiatric care. Currently, Medicaid does not cover care for adults at New Hampshire Hospital.

Several private providers, like hospital chains that specialize in psychiatric hospitals, have expressed interest in coming to New Hampshire if the state is approved for the waiver, she said.

Opening beds is one thing. Ensuring there is enough staff to care for the residents in each bed is another.

New Hampshire has had a longstanding shortage of licensed nurses that has been exacerbated by the risks and stress involved with the profession during the pandemic.

Instead of relying on the existing workforce, Shibinette said the department plans on focusing on cultivating a new source of nurses from other industries or outside the state.

So far, though, the pool of applicants has been much larger than expected.

Shibinette said the exodus from urban centers prompted by the pandemic has drawn a large group of candidates to New Hampshire.

When the department started advertising some of its new positions, Shibinette said they received applications from all over the country.

“We have seen people either coming back to where they grew up, people moving from urban areas back to rural New Hampshire and we are very much going to try to use that to our advantage,” she said.

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