I used to work at New Hampshire Hospital. At that time, it was a bed availability issue. Units were full and the availability to bring in patients who needed the help was an issue. Leadership has changed, so I’m not sure how it is now, but there were providers who were not comfortable discharging patients because there were minimal resources for a psych patient to remain stable upon discharge, thus creating this feeling of a “revolving door”. Psychiatry is challenging, patients get stabilized on their meds and start to feel better, so they stop their meds, and then BOOM back in a mental health crisis.
As someone posted previously, we need more resources in the northern part of the state. We need more mental health resources all around, not just hospitals and psychiatrists, but intensive outpatient programs (like cardiac or pulmonary rehab but for MH concerns), and supports for patients to take their meds and report changes sooner so they can prevent worsening of their condition, which leads to escalation of the MH symptoms.
Another barrier was housing. If someone had been in a MH crisis, they might have lost their job and/or apartment. The social workers were golden at finding housing for these patients so they could be discharged, but it still was affecting bed availability. It’s a huge constellation of factors that need to be addressed. Having worked in an emergency department as well, it’s not fair to ED staff to have a psych boarder while waiting for a bed at a facility, nor is it fair to a patient who is having an acute MH flare to be held in the ED. You can’t put 30 lbs of pasta in a tiny colander and expect it to work. The State needs to actually do something to make it work better for it’s residents, not create another task force and hope it all falls in place
ThrowAway03202021 t1_jahrdlj wrote
Reply to New Hampshire ordered to phase out practice of keeping psychiatric patients in emergency rooms by greenhousecrtv
I used to work at New Hampshire Hospital. At that time, it was a bed availability issue. Units were full and the availability to bring in patients who needed the help was an issue. Leadership has changed, so I’m not sure how it is now, but there were providers who were not comfortable discharging patients because there were minimal resources for a psych patient to remain stable upon discharge, thus creating this feeling of a “revolving door”. Psychiatry is challenging, patients get stabilized on their meds and start to feel better, so they stop their meds, and then BOOM back in a mental health crisis.
As someone posted previously, we need more resources in the northern part of the state. We need more mental health resources all around, not just hospitals and psychiatrists, but intensive outpatient programs (like cardiac or pulmonary rehab but for MH concerns), and supports for patients to take their meds and report changes sooner so they can prevent worsening of their condition, which leads to escalation of the MH symptoms. Another barrier was housing. If someone had been in a MH crisis, they might have lost their job and/or apartment. The social workers were golden at finding housing for these patients so they could be discharged, but it still was affecting bed availability. It’s a huge constellation of factors that need to be addressed. Having worked in an emergency department as well, it’s not fair to ED staff to have a psych boarder while waiting for a bed at a facility, nor is it fair to a patient who is having an acute MH flare to be held in the ED. You can’t put 30 lbs of pasta in a tiny colander and expect it to work. The State needs to actually do something to make it work better for it’s residents, not create another task force and hope it all falls in place