Sadly, those calling this a win are wrong.

Submitted by BelichicksBurner t3_11dsyjx in newhampshire

https://www.wmur.com/article/new-hampshire-psychiatric-patients-emergency-rooms/43105873

Essentially what just happened is a federal judge said "Figure something else out by next month." Understand: there IS no "something else". Community Mental Health Centers don't have the time, the bodies, or the funding to take that on and shouldn't be expected to even if they did have all those things. They aren't state workers, so they haven't been ordered to do anything...but the state will absolutely lay this at their feet to fix. The vast majority of these individuals have been put on the pod at the ER because there are no available psych beds available at local hospitals. Some have already been deemed unsafe to remain in the community due to being a danger to themselves or others.

So this now means if there are no beds available (which there won't be), unless someone develops an entirely new, fully staffed, extremely specialized unit from scratch within the next 30 days (which they won't)...these people may very well be sent to some understaffed crisis apartment that will be wildly inappropriate for their situation. What's more concerning is that there is also the possibility that doesn't happen either...and they're simply sent home. In case you weren't sure, that's not safe, responsible or even remotely quality care. Get ready, NH. This is gonna be an absolute shit show. Everyone (NAMI included) always has some hot take about the current hospitalization process (I've seen it change like this more than once now) but when it's time to come up with legitimate solutions or new ideas...they have absolutely nothing to say. So once again it will fall to the overworked, unpaid, unappreciated mental health workers of this state to fix another cluster fuck brought on by people who have no clue what they're doing.

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jeff6806 t1_jaaqwfi wrote

To try to clarify this rant,

This is about preventing emergency departments in any hospital in NH from holding patients for an extended time (not sure what timeframe this is, guessing >24 hrs?) in the ED for psych issues which in this case primarily would relate to issues of suicide risk. Ideally such patients would transfer to an inpatient psych unit for appropriate treatment that they can’t receive in an emergency department setting. Unfortunately there are not enough inpatient psych units or beds in those units for the need. Patients in the ED where a physician is concerned about suicide risk may be held in the ED and not allowed to leave because the physician is responsible if they leave the ED and immediately harm themselves or someone else.

As someone in medicine, I don’t think there is an easy answer to this problem and this law may help or may make things worse but if the president of the NH Hospital Association is supporting it, I’d be wary of it. Hospital associations around the country are worried about maximizing profits, not much else.

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-cochise t1_jab3k8o wrote

Hear hear, nothing more to be said about it really. It’s a mandate without a mechanism.

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BelichicksBurner OP t1_jaatbbf wrote

Yeah I'm not gonna explain the entire article to them that's why I posted it, but good on you. As I understand it, they can't be held at all. Once they're medically cleared for hospitalization, they go to the hospital. And wheb there are no beds? Well right now it would seem starting in April they'll just be going home to wait. Of course the president of the NH Hospital association is supporting it. If ever you needed confirmation this was gonna be a cluster fuck, look no further than that endorsement. This "law" isn't going to help anyone because if you know anything about how the state handles mental health you know they have no answers...becuase they've never had answers. Their answer is going to be what it always has been: them looking at the CMHCs and asking "...so what's the answer?" Sadly, given the current state of the local CMHCs I highly doubt they have another rabbit to pull out of their hat this time.

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the_messengers t1_jaarn9m wrote

Start opening up asylums again. Closing them was a huge mistake. We've obviously found out you can't medicate everyone into society.

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stan_milgram t1_jadk726 wrote

Yes, humane asylums -- like the old Chestnut Lodge or Austen Riggs -- or even the old Quaker run hospitals from the 19th century. Places where people aren't drugged into a stupor under the guise of "treatment". Help them heal.

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tylermorris2000 t1_jaatk60 wrote

We basically still have them they're called mental hospitals some people stay in them for life.

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Weekly-Obligation798 t1_jaaycu1 wrote

One. We have one. The rest we shit down years ago which is what led to this issue

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Baremegigjen t1_jab5qjp wrote

You can thank Reagan for doing away with those facilities and jdumping everyone out on the street with no programs to support the transition for those for whom it might be possible or other arrangements/facilities for those for whom it wasn’t. At the same time the severely physically disabled, including those with profound developmental issues were also dumped, including those who couldn’t and would never be able to fend for themselves and had physical disabilities that required specialized care.

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Mu5tBTru3Redd1t t1_jab9hzg wrote

It was a terrible transition yes, but for every legitimate person in need of a facility like that, there were 100 that needed a different treatment / care plan. And let’s not get started on how horrifically they were run, or the egregious abuse (don’t look inside)of so so many patients at those facilities, or the experimentation completed on people without consent. A look back on asylums.

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sledbelly t1_jac4bgf wrote

And that ONE isn’t fully staffed.

How do you propose to open more when there’s what one psychiatrist that treats both the hospital and the prisons? When they can’t get enough techs or RNs to complete shifts? When NH bought Hampstead almost everyone qualified left for better paying jobs in Massachusetts.

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-cochise t1_jab3prh wrote

We have one left for adults and it has fewer beds than ever.

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Lower-Permission4850 t1_jab0kq9 wrote

This is scary. These are people who have not had a mental health crisis in their home with a child or loved one and don’t understand how important it is these people have somewhere even if it is an er bed to stay safe. Not ideal but better than sent back home. Manchester has a huge problem I’ve seen first hand and unfortunately for the people what need somewhere to place someone they’re put in impossible situations.

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Arthur-Morgans-Beard t1_jad2pfk wrote

I have personal experience with this as someone in my home had a psychotic break last year. We brought her to the ER twice in 3 days, but they wouldn't keep her. Local mental health administration ignored my emergency calls, her family wasn't local to us and was unsure of what to do. Took her to an ER 40 miles away and they were able to make arrangements to get her into a facility. It took almost 2 months of inpatient treatment to get her to come out of it. I wish my kids hadn't seen what they had to see but we literally had nowhere to go. Scariest and most frustrating thing that I've ever been a part of.

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Allbluesleeve t1_jabmtf8 wrote

NH mental health is absolutely awful. Ask me how I know. My fiancé is a NP in mass and knows how the system works in mass and nh and told me NH was the last place to go for mental health. When I had my own issues (December - January 2022/2023) I drove to Massachusetts. Emerson was able to get me in quickly and had great programs.

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tylermorris2000 t1_jaatags wrote

A lot of these people if they aren't kept in the hospital's emergency room waiting they'll be kept jail. Also most of the major hospitals in New Hampshire have special emergency rooms for psychiatric patients that are safety-proofed.

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BelichicksBurner OP t1_jaav29k wrote

...did...did you read the article? Keeping psych patients at the ER once they're medically cleared (so once they've been triaged) is now no longer allowed. And as someone who used to work on those units I can tell you with certainty that the vast majority of those people will NOT be kept in jail because they aren't criminals.

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Weekly-Obligation798 t1_jaaz7v6 wrote

I think your misunderstanding something though. “Once medically cleared” means just that. They are no longer being held. When they are on a 72 hour hold when they are “cleared” that means they are allowed to go. Not be held to transfer somewhere else. If they are being held it is because they were not cleared and will be going to a bed when available. If your talking medically cleared while awaiting a bed, as in a medical issue being treated while also awaiting a psych bed, then yes they can be held until one is available. I think your confusing the two.

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Lower-Permission4850 t1_jab21ha wrote

I hope you’re right. We have a kid who’s needed to stay in the ED a few times and it’s a relief to know that’s there because aside from that he comes home to where we can’t always handle him. We need more help but the help is not there

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aredubya t1_jabbcta wrote

The current system is total horseshit. Patients can stay in an ER for weeks or months without hope of a psychiatric bed. While they wait, outside practitioners (current therapist, psychiatrist, etc.) are barred from participating in the patient's care. If the family decides the ER stay is exacerbating whatever mental condition the patient is being held for, discharging to return home removes them from the wait-list for a psychiatric bed.

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tylermorris2000 t1_jabtphd wrote

Most of these patients don't have anything medically wrong with them they need psychiatric help so medically cleared doesn't mean anything. The patients that I'm talking about going to jail are the ones that are trying to cause harm to themselves cuz that's the only place where they'll be able to be restrained.

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thamurse t1_jaawkiu wrote

Just curious as to your background/qualifications on this matter? For what it's worth the state has been trying various things, most recently they've started holding hearings on the EDs which has definitely helped a good bit. There are many brilliant minds in the NH hospital system and the community mental health centers, and this should give them more resources/access to solutions from hospital administrators(VPs CEOs etc) and politicians.

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Raa03842 t1_jab9tyq wrote

So if nothing happens what is the judge going to do? Put state workers in jail?

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aredubya t1_jabbm1k wrote

Perhaps the judge will require the state to allocate funds necessary to support the needs of patients, based on plans offered by the community health houses.

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Raa03842 t1_jad1zsw wrote

He might but that’s ten years of pushback and politics. So in the short run…… nothing.

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phallicide t1_jac4uye wrote

I do not know much about psychiatric services but Massachusetts opened Community Crisis Stabilization (CCS) units which are ER’s for mental health issues.

I believe they’re staffed with nurses, social workers, and nurse practitioners and are open 24 hours per day.

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TekJansen69 t1_jacs6st wrote

Looks like you're past the "live free" part and about to hit the "or die."

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NewEnglandBlueberry t1_jaaolkp wrote

Wait, I'm confused. The order says they have a month to come up with a plan, not fix the issue. Am I misunderstanding what this means? It doesn't sound like they are demanding what you are describing?

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BelichicksBurner OP t1_jaaukee wrote

You're not getting it, this isn't the first go around with a federal judge and the NH mental health system. There isn't going to be a plan. Who's coming up with the plan? The state? The state hasn't had a plan for mental health in decades. One of their most recent plans was literally fewer psych hospital beds. New Hampshire Hospital? They can't even fully staff their units, you think they'll have a plan in the next 30 days? There won't be a plan, so then it will become "Well you're not in compliance with the federal courts, so now you're getting hit with another federal lawsuit (like I said, not the first time we've seen this). Also, you can't keep these people at the ER anymore so even if you don't have a plan, keeping them there is now officially illegal." People are gonna get sent home, dude.

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NewEnglandBlueberry t1_jaaxa1d wrote

Well darn. Correct me if I'm wrong, but it sounds like there isn't enough money to take care of everyone who is seeking emergency mental help so the current policy is to hold them if they seem like a danger to themselves or others at the ER until there are resources available at a hospital. Essentially, there aren't currently enough resources to handle everyone who needs help, no one wants to take responsibility for the unprofitable endeavor and the ERs have been forced to do what little they can. Now, whoever is behind these lawsuits wants to clear them out of ERs entirely.

Edit: I'll be keeping an eye on this and hopefully see where it goes in a month.

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girthemoose t1_jaatxv6 wrote

I read it as come up a plan. There is no easy or straight forward solution to this issue. However boarding patients in the ED for weeks at a time isn't a good solution. I have seen pedi waiting for over a month. This sounds like trying to get pysch involved or providing quick outpatient care rather than boarding them in a room and making their mental worse.

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BelichicksBurner OP t1_jaawb1e wrote

They've done this before, the feds have. I can assure you: there will be no plan and the state will be found out of compliance. I can't say this loud enough: THERE IS NO QUICK OUTPATIENT CARE. Might as well wait for the easter bunny to bring them all candy baskets. Psych is already involved and has been since they started doing this about 12-15 years ago. They're all local community mental health centers, non-profit organizations that haven't been able to keep up with demand for years now. They already have outreach teams that go to the hospital and try to develop a safe discharge solution. They already have staffed crisis apartments for people who aren't safe in their homes. That's the problem: it isn't enough. The local psych providers literally can't handle the numbers and haven't been able to for a very long time. This ruling is basically the equivalent of asking someone with 15 maxed-out credit cards to get another credit card so they can pay off their existing credit card debt. There's nothing more left to provide. It's a simple money and numbers issue. State psych providers have been out of both for years.

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Lower-Permission4850 t1_jab2btf wrote

The crisis teams are really designed to just move the people along I’m sure of this. I’ve watched them do it too many times to believe anything else

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MsTomHardy t1_jabbh71 wrote

This is where the mental health care system breaks down. There is not enough care at a variety of levels. You can not send someone who needs intensive treatment to an outpatient therapist and expect anything good to come of it. It is so, SO broken. No one wants to fund anything appropriately. Most people do not understand what is even going on. It is a dumpster fire.

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Normal-Upstairs-4836 t1_jaed61n wrote

NH has under funded so many "social" issues over the years. Keep kicking the can down the road or find these programs so they don't create bigger problems. We complain about taxes and the " Manny state" forcing the vulnerable to the fringes. This in not what NH should be about.

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greenglasstree t1_jaez2vs wrote

This is what happens when the people of an entire state decide to sit back and do nothing for each other, preferring to depend on other jurisdictions for every critical service.

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Datmuny19 t1_jaamhc9 wrote

Does anyone know which of the 18 New Hampshire hospitals they are talking about?

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