The Crisis in NH Mental Health Services
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The Crisis in NH Mental Health Services

Hello and welcome to another episode
of the Disabilities Rights Center presents
I’m your host Cindy Robertson and today we’re going to be talking about the
crisis in New Hampshire mental health services. Our guest today here is Amy Messer, Amy’s the legal director at
the Disabilities Rights Center so Amy welcome to our show. Thank you. Amy today we’re gonna be talking
about this topic because of a lawsuit that was just recently filed
against the State of New Hampshire because of the mental health system Could you just give us a little brief overview
before we get into the topic. sure so about a month ago in fact a month ago today the Disabilities Rights Center
along with our partners filed a lawsuit in
the federal district court on behalf of individuals with mental illness due to really a lack of
community-based services that was causing people to be unnecessarily
institutionalized and one of the people that we’ll
hear from now in fact is one of our plaintiffs Mandy D. hi My name is Mandy I’m 22 years old and I have a mental illness I’ve been in and out of
hospitals more times than I can count I would really like to stay
out of the hospital but sometimes I become so overwhelmed
When I am in a crisis or I am feeling suicidal the only way for me to get help is
to go to the hospital There are a lot of people like me that need services I believe that my greatest need is to live more independently right now I live in my Mom’s house If I had supportive housing I’d have a good chance of
living on my own, be more independent, and get the help I need so I don’t have to keep going into the hospital I did live in a group home for a while run by a mental health center and they closed it down I was doing very well there and I was very disappointed when
they closed it down I went from there into an apartment of my own. But because of no supports I had to
move back in with my Mom. I want people to see me
not just my mental illness Something that I say is my name is Mandy,
not bipolar. I’m an award winning poet
taking an online course
for a veterinary assistant. If i could work at a place that involved animals with support I think
I’d be able to be OK. I would work and be effective but without support I don’t think it’s possible. Just because we have a mental illness
doesn’t make us any different there’s a lot of places out
there that will continuously
if you have cancer or something because it’s a disease mental illness is a disease too so you should give the same chance. That was very interesting it’s very moving to
hear someone tell their own story from that point of view So we’re going to talk about the lawsuit a
little bit, we also want to sort of figure out how it is that we came to where we are
today and why you felt it was necessary to file a lawsuit. So tell us a little bit more about
thelawsuit. well I mean what you heard from Mandy is what she’s experienced as a result
of the lack of community based services available
to people in their home communities that
would allow them to be fully integrated members of their communities out, engaged in things that are so
important to all of us work and independent living and what she experiences as a result of
the lack of services is that she has had multiple and repeated hospitalizations both at New Hampshire Hospital the
state psychiatric hospital but also many many hospitalizations, in emergency
rooms and local community hospitals and what we’ve heard from people all around the state is that the lack of community services has resulted
both in people being institutionalized long-term
at New Hampshire Hospital and also the Glencliff Home which we’ll
talk a little bit more about today which is a state
psychiatric nursing home up in the north country and also people who are continually
revolving in-and-out of the hospital as a result of the unavailability of the kinds of
services that would keep people out of those institutions So the lawsuit to was filed on
behalf of, the class action in federal court, on behalf of all people with serious mental illness
in New Hampshire who are institutionalized at New Hampshire
Hospital or the Glencliff home or are at risk of such institutionalization. and its brought by the
individual plaintiffs who are represented by the Disabilities Rights Center as well as Devine Millimet & Branch a very large law
firm here in the state of New Hampshire, the Bazelon Center for Mental Health
Law that specializes in legal issues on behalf of people with
mental illness, and the Center for Public Representation which also has a long history of legal services to individuals with
disabilities. So, okay so the lawsuit gets filed but
we need to find out how did we end up where we are today with regard
to mental health services that you’ve felt it was
necessary to file a lawsuit Let’s go back and I know at one time New Hampshire actually
was exemplary in it’s mental health services. So how did we get here? Well New Hampshire was considered nationally
considered a leader in community-based services for
individuals with disabilities and in fact in the nineteen eighties New Hampshire was recognized by the
National Institute of Mental Health as a leader in community services. Unfortunately that leadership was short lived and
while we had worked towards closing the Laconia
State School and ensuring that community based services were available
to people with developmental disabilities and for some period of time downsized New Hampshire Hospital at some point in beginning in
around the nineties, actually late eighties we began to
see a rise in institutionalization in fact in nineteen eighty nine we had about
nine hundred admissions to the state hospital and by two thousand eleven we had
twenty three hundred admissions to the hospital each year I’m sorry I should have said that in 1989 there
were nine hundred in that year and by two thousand eleven
we had about twenty three hundred in that year so we could see we can see the rise of institutionalization as we scaled back on community-based
services. And I know that in two thousand eight
about four years ago there was what was put together a ten year plan sort of a strategy paper how do we move forward in the next
ten years and make the mental health system better and what was the findings
in the ten year plan? Right, well before I talk about the ten year plan
let me just say that you know even earlier than that in two
thousand and four and again in two thousand seven then ultimately in two
thousand and eight there were reports and findings by the Department
of Health and Human Services and the legislature and task forces that really looked at the mental
health system saw that it was in crisis and really was reporting out on the
significant needs within the community for improved services. So in two thousand
eight there was what the state calls its ten year plan that described really the
crisis that the mental health system was in is in, in New Hampshire and recommended a number of measures
that New Hampshire had to take to insure that people weren’t unnecessarily
institutionalized, to reduce the unnecessary institutionalization, and to
ensure that people had the community-based serves as that they
needed. Unfortunately here we are four years
later and those measures just haven’t been
implemented and in two thousand and ten the
Community Behavioral Health Association came out with a report that talked
about The aspirations of the ten year plan and
that in fact those measures had not been implemented and again in fact this
month the Community Behavioral Health Association
issued another report indicating that those measures had not been implemented as recommended by the
ten year plan and the result of that is that individuals with mental illness are suffering in our communities and the families are suffering in our
communities as the lack of services continues. Because it when people don’t have community services that will
allow them to remain in the community burdens on other agencies and other institutions
like I know there is, the court ends up with a lot of people in the court system
that probably shouldn’t be there the families have a lot of burden on
them there’s emergency room, the hospitals are overburdened
because they’re expected to deal with people that are in crisis if there’s not
room at New Hampshire Hospital. Are those things that have been shown as well? Oh absolutely I mean there’s a lot of discussion
about individuals ending up in homelessness in homeless shelters as
you’ve described in jails and emergency rooms and it is very very difficult both
on individuals with mental illness but also their family members. I believe we have a clip from
Mandy’s mother now. My name is Louise and I am Mandy’s Mom I watch my daughter missing life because she’s not getting the supports she needs to stay out of the hospital, to get better.
Right now her life is her mental illness.
As a mother there’s nothing worse than having nowhere to go
to get the kind of help
That your child needs.
This lawsuit is not just about the people with
mental illness.
It’s also about the families. There are no words to describe the stress
that we go through as well. I’m not professionally trained I can’t give her the kind of mental health services
that she needs. I’m just her mother. I have spent countless hours in energency rooms and hospitals with my daughter. I recently had to listen to her screaming for over two hours in an emergency room. while she was suicidal. For a mom that’s not an easy thing to go through. An emergency room is a
terrible place for a person who is having a psychiatric crisis. If we had been able to have a trained mental health worker come to our home, things wouldn’t have escalated to that point.
But the mental health center does not have the kinds of services
Mandy needs to recover and to
stay out of the hospital. She only gets medications, a little case management,
and some counseling. If she had a community based service such as mobile crisis services,
supportive housing She wouldn’t have to go through this.
She wouldn’t have to spend her time
in and out of the hospital.
She could lead a normal independent life as other young women her age do. She could be such a productive member of society if she only had the community-based
services that she needs. Thank you. That’s a good example of it affects their
families it can affect everybody in society that that they deal with. But you know we don’t need we
don’t want to lose sight of the realities of people in institutions and relay for
our viewers you know what is it like to be an institution? Why would they
not want to be in there? Right, well, um, I know you ask that
knowing that in many ways that’s pretty evident why people don’t want to be
there but you know i think really we can’t forget that this is you know
it shapes the entirety of their life so they lose all the freedoms that
most of us take for granted everyday you know where they’ll sleep who they’ll share a room with where they’ll live you know how
they’ll spend their time and with whom they’ll spend their time because
individuals in institutions are extremely isolated I mean you know for one thing those
institutions more often than not are not in their home communities their families may have trouble getting
there if they can’t leave there you know their whole life is restricted in every way
and for you know we’re talking about young people here who have their whole life ahead of
them who want to do the things that all of us enjoy doing everyday
recreational activities meaningful work going out with friends all of those things are taken away when
people are institutionalized. So let’s talk about isolation and young
people and tell us about Glencliff. Right so many people have never heard of Glencliff
and Glencliff is an institution here in New Hampshire it has a hundred
and twenty beds it’s in a northern area of New Hampshire
so again for most people that’s far from the communities that they came
in uh… came from and so Glencliff is far from where they were originally living very very isolated and you know it’s very very hard for even for
family members to go visit there because there is not public transportation it is far away and what we’ve seen is that the age of
individuals going there is less and less is younger and younger so in two thousand and ten about twenty
eight percent of all the people that were sent to Glencliff were in their
forties and fifties and Glencliff is a nursing facility for for people who are in their forties
and fifties a nursing home right it’s shocking to
hear that full twenty eight percent of the admissions to a psychiatric nursing
home would be people in their forties and fifties. I
think the average person when you think about nursing homes you
think elderly you know you think that’d where you’re gonna
put your elderly grandmother that’s where you end up at as a certain point you don’t think OK
I’m in my forties and in my fifties and now I’m in a nursing facility. That seems so strange and then what
about leaving getting out leaving the Glencliff
what are the statistics on that? Right. Very very few people ever leave Glencliff
far more people die at Glencliff every year than actually return to
their communities There were it with some
statistics that we looked at around two thousand and ten in the previous five
years only two people had returned to their communities and nine had
gone to other facilities so very very few people actually returned to the
community from Glencliff and if the community based services were
available to them, these individuals could be in their communities could live full meaningful lives and that’s what
they want to do and I think you know the viewers need to know
that oftentimes when if someone does leave Glencliff the actually leave and go
back to New Hampshire Hospital or people leave New Hampshire Hospital and
go to Glencliff and never leave Glencliff it’s basically one institution to
another. Many many of the admissions to the Glencliff home
do come directly from New Hampshire Hospital uh… and there are people who are
sometimes transferred down to New Hampshire Hospital and back up to Glencliff but for the most part people go to Glencliff and then they stay there. Okay so we’re talking community services and we’re
talking institutional services and there’s always a cost issue. Can you talk just a little bit about what goes into consideration
of the cost? Sure so it’s well-known that community-based
services are far more cost-effective than
institutional care so for example New Hampshire Hospital right now has somewhere around a hundred and
fifty four beds and the cost of those beds is about four
hundred and thirty five thousand dollars per year for one bed. One person costs
thirty five thousand… One bed… right that… and so that money could be used far more effectively if it were utilized in the community providing
community-based services and it could provide services to
a much greater number of individuals. So even if you took the exact same four
hundred thirty five thousand dollars and instead of spending on New Hampshire Hospital We
spent it in the community obviously could serve more than one person. Oh
absolutely you could serve a significant number of people and different people require
sometimes different services but there’s no doubt that that money utilized within the
community system would go a lot farther. One of the attorneys who’s
working with me on this case and Steve Schwartz from the Center for Public
Representation was also at the press conference and he
addressed the cost issue and we’d like to hear from him now. There’s one principal that’s important. The federal government shares the cost of most community services. It does not share the cost of state hospitals. So the New Hampshire Hospital’s budget
is paid entirely by the taxpayers of New Hampshire. out of what’s called state only dollars. Community mental health services
is the other way and when the federal government shares the cost, they share at least fifty percent. So for every dollar that’s spent at the New Hampshire State Hospital
if you move the dollar into the community
you would have two. So Amy it’s interesting when Steve
says one dollar spent at New Hampshire Hospital can
actually be two dollars because of the match and it’s definitely
something that should be a consideration because in addition to being more beneficial for people to make their lives more meaningful it
also seems to be just a better deal It is cost-effective and maybe i
should tell you a little bit about some of the services that we
think that the state needs to put into place to serve people in the community so that
they are not unnecessarily institutionalized or cycling in and out of the hospital. So supportive housing is something
that is well-known nationally as an effective service It provides both housing and the
supports that a person needs to be successful in their
community and fully integrated in their community. It is a treatment modality and so New Hampshire clearly needs supportive
housing if people are worried about where they’re gonna sleep at night and
where they’re gonna go the next day it makes it incredibly difficult to work on recovery so it’s a critically important need. It is one of
the things that was cited in the ten year plan as something
that is essential for new hampshire to expand were also looking at New Hampshire needing assertive
community treatment teams they should be those are teams through the mental health teams – otherwise
known as ACT teams – right,
assertive community treatment otherwise known as ACT and it is a multidisciplinary
team of people that work with individuals with mental
illness so it might include, would include a psychiatrist, nurse, provide intensive case management and provide the services both that people need to have again full meaningful integrated lives
within the community but also be available to people when they’re having
a crisis. So rather than having to go to a hospital they contact their ACT team members who
they know well and those ACT team members can meet them in
their homes, in the community, and is a well-known practice to help avoid unnecessary hospital
admissions and it’s been shown both here in New Hampshire
and nationally to significantly reduce the number of hospital bed days that
people utilize. So for example of that is if I
have, let’s say I have severe depression and I’m having a really bad, it’s two
o’clock in the morning and I’m having a really hard time I’m having suicidal
thoughts and instead of somebody taking me right
now I might end up in New Hampshire Hospital to treat, deal with that I can
make a phone call to the ACT team and they would either work with me on the
phone or they would actually come to the house it’s twenty four seven – right –
and worked me – I have somebody there to help me through the crisis ends and
then hopefully I wouldn’t have to go to
New Hampshire Hospital. That’s correct We talked about, you had
mentioned that part of the lawsuit, there are people who go in and out of New Hampshire
Hospital not necessarily have been there for long periods of time but we sort of
call it the revolving door. Statistically do we know,
what are we talking about the number of readmissions in a certain amount of
time? Right well we do know that the readmission rate for people who go into New Hampshire Hospital are
discharged from the hospital and then go back is very very high much higher than the national average So one of the things that would stop that would be something like the
assertive community treatment teams, ACT, We’re also looking for mobile
crisis intervention which would also be able to address
people’s crisis needs. It’s a shorter term intervention than ACT but
also very very effective in keeping people out of hospitals and finally supported employment I mean you know in employment is such an important
way that people spend their time are productive members of the society and
of course gain income to support themselves and that is another critical treatment need that we’re not
just not meeting in the community. Right I think anybody who knows
employment does so much just for your own self-worth and your own value you know people with mental
health issues deal with, a lot of them struggle with that anyway and so it’s
certainly a nice complement it’s another way to help them feel valuable
to the community and part of it. I also know that the
United States Department of Justice also had come into New Hampshire and done an
investigation and tell us a little bit about that. Right so our plaintiffs and counsel are not the only ones who
recognize this problem in New Hampshire. In addition to the work and
investigation that we’ve done the United States Department of Justice did their own
investigation and similarly recognized that New Hampshire is violating
the Americans with Disabilities Act and the Rehabilitation Act some federal laws to ensure that people aren’t
unnecessarily segregated and after their review they too issued a
very lengthy findings letter on their investigation finding that New Hampshire is not in
compliance with those federal laws. So the lawsuit isn’t just you know a bunch of attorneys sitting
around saying i think they need to do this it is actually based on federal law
and they’ve been found to have violated federal law. That’s correct the United States
Department of Justice has issued findings to that effect and I think you know we see there are
newspapers every day we hear it from the people that we meet our neighbors people are really really feeling the impact of the lack of
available services in New Hampshire for people with mental
illness so the time has come I mean people are
really suffering people should not be unnecessarily
segregated and institutionalized and you know we are hopeful that this will
bring about the change that New Hampshire desperately needs. And since 2008 the last four years they’ve known about
it and it just doesn’t seem to be going anywhere that’s right and –
it might even be worse – I think the situation is
worsening, we are hearing a lot from hospitals and what’s happening in
emergency rooms we’re hearing from more and more people within these institutional settings that want to be
back in their communities back at home and are not having there simply isn’t an opportunity for
them to do that and its time for us to make these changes in fact
I’ve met and spoken to many many many people who are in these institutions and you know they are really really waiting for this change to come
so that they can what they see as begin their
life. Amy, it’s very interesting we’re getting
ready at the end of our show here we really appreciate your coming on and
taking the time today. We’re all going to be watching and see how this how this plays out. To end it, we want to show another clip of the
at the press conference about a gentleman you met up at Glencliff
when you went up there. So thank you very much. Thank you. Let me just also say when I I went up to Glencliff many times
and have spoken to many people there and on one visit, in fact when I met Ken R, I walked in the door of the Glencliff home
and there he was sitting i nhis wheelchair and he looked up and said
Can you get me out of here? There are people there who
very clearly want to leave I think sometimes family is concerned about their loved one
returning to the community
because their experience has been years of people living in the community perhaps without the supports they need to keep them safe and to
give them a meaningful life. and the supports that we’re seeking
from the state today would give them the kind of health and mental health
and supportive services
needed to successfully
live in the community which may very well have not been what they received prior to going home.

About Earl Carter

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2 thoughts on “The Crisis in NH Mental Health Services

  1. I can tell you that Mental Health Services vary widely from State to State. Often times, mental health workers abuse their authority and institutionalize people with little merit related to a danger to the community.

  2. One bed "$435,000/year" at NH Hospital! Mental health grounded in wellness is so much more cost efficient. Move the dollar into the community where it equates to $2.00. Find ways for employers to integrate mentoring into the formula. Define "supported" employment. Employers look to follow the law, if that, and not much more.

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