This week Catholic Medical Center in Manchester officially closed its inpatient psychiatric unit.
They cited underutilization as the reason for the closure, but several studies reveal rising needs for mental health services in New Hampshire.
The problem is severe enough that many patients are heading to Massachusetts to find the help they need.
NHPR’s Dianne Finch has more.
AMBI: emergency room at MGH continues
It’s Friday afternoon at Mass General’s Acute Psychiatric Unit.
Doctors are busy treating patients here that are in mental crisis.
They’re suicidal or have severe symptoms of depression, schizophrenia or psychosis.
In addition many have substance abuse issues.
Christine Finn is director of the emergency psychiatric unit at Mass General Hospital.
She says that it’s always a challenge to help patients find longer term services after they leave ER.
But when they show up from other states –– it becomes even more difficult.
FINN: “….we were paying attention in general to patients who get stuck in emergency rooms and end up staying here for long periods of time and one thing that stood out for me was that a number of them were from out of state and specifically from New Hampshire.”
Finn worries about what happens to those patients once they leave.
FINN: “Why would someone choose to sort of pull themselves away potentially from the care network that might be in place or geography what’s known to them or social supports that are there.”
The only thing they appear to have in common is the need for immediate psychiatric treatment and they can’t find it in New Hampshire.
Finn says it’s not surprisieng. Even she’s run into rodblks when trying to help these patients.
FINN: “I mean sometimes what I’m looking for doesn’t exist. AND that’s what’s hard and especially hard for me to know that it might be available if they did live in a different region geographically....and I have several times tried to access very timely follow up for individuals who we’ve evaluated in the emergency department and are developing a treatment plan for and just sort of been told well that’s not really available.”
But treating NH residents in Massachusetts isn’t always easy.
Finn says even those with health insurance face obstacles because plans restrict coverage geographically.
And most patients can’t afford to pay out of pocket.
FINN: “and similarly patients with Medicaid…that’s a state benefit and does not travel across the border with them. so that also may be diminishing options for care rather than enlarging them.”
A report out of UNH’s disability center shows a 50% increase over 10 years in mental illness and substance abuse rates among people aged 15 to 29.
Yet several hospitals have closed their psychiatric units, including CMC in Manchester, Androscoggin Valley Hospital in Berlin.
In fact over the past decade four other psych units have shut down.
It’s particularly difficult to find psychiatric services for children and adolescents in the state.
AMBI of Patrick and mom
15-yr old Patrick McDevitt is one of those people that needed psychiatric services.
He has Aspergers Syndrome.
He shows off his wooden toys he’s been working on at school.
Patrick: “I built that myself I built the bench with the shop teacher…..it looks like a tank…it is and these are supposed to cover the wheels of the track thing we didn’t have wood that we could put over it….…”
Since he was three years he’s had aggressive outbursts, hyperactivity – and he’s had trouble socially.
His mom, Andrea McDevitt, said she couldn’t leave him alone – and couldn’t find anyone to babysit.
He was on several medications, but had been misdiagnosed his whole life.
So she turned to doctors at MGH and Somerville Hospital in Massachusetts.
And they were the ones who determined for the fist time he had Asperger’s.
The doctors there immediately took him off his medications.
That’s when things began to improve.
And doctors at Somerville helped McDevitt find doctors in New Hampshire.
McDevitt: “She could see the frustration in my face when she said he has to have a psychiatrist or psychologist to see in NH before we can discharge him and I said well he’s going to have to live here because that’s not going to happen.”
But in addition to seeing a trained psychiatrist, Patrick still needed support services to help him with school, his social life and other coping issues.
His New Hampshire doctors were aware that such services are scarce.
So they advised McDevitt to have her son arrested, which she did.
McDevitt: “…..and that’s not what the children or the parents need.”
But it worked.
John McDermott the chief of juvenile probation and parole in New Hampshire is not surprised.
But he’s not happy that children have to be charged with crimes to get help for a mental illness.
John McDermott: “It has always befuddled me as to why a police prosecutor, a defense attorney, a judge and a court clerk, with the parents, are making decisions about the mental health treatment of adolescents.”
While shortages in mental health services have well documented - the problems persist.
Nancy Rollins is Associate Commissioner at the Department of Health and Human Services.
She says she recognizes the needs for mental health services, and points to state budget cuts and other economic issues as primary obstacles.
Rollins: That is also is coupled with what we are facing with the an economic downturn in terms of the housing market…….whether its gas or food of they are all going up ….and it is beginning to have a significant impact on already vulnerable populations and moving up to populations that have always been living on edge but certain circumstances may be enough to push them over the edge.”
Rollins added that she’s working on a 10-year plan to revamp the system and address the shortages and broken links.
Nearly 1000 people used psych units in Massachusets in 2005.
That number may grow until a solid mental strategy in New Hampshire is in place – with funding.
For NHPR News, I’m Dianne Finch
I am a 35 year Psychiatric and Mental Health RN, living in NH and working in Mass. I travel to work here where State of Mass. funded programs exist. When will the people of NH wake up and enact a broad based tax that would support much needed mental health services?? Sadly, probably not before my retirement.
I work as a level of care assessment clinician for a Community Mental Health Center and an accepting psychiatric hospital; this means I seek to admit psychiatric persons to various hospitals. CMC's closure was expected. Re-imbursement rates from insurance is low, unfunded/uninsured persons diminish returns, and most the most frustrating issue is the pervasive culture of denying pt's care due to various internal hospital issues. Psychiatric hospitals provide "Acuity" of either the pt or the "unit" (hospital unit) as being the reason to refuse a person. However, at CMC it was NORMAL to have a 25 or 45 y/o whom was refused b/c they lived 30 minutes away, they may become homeless, or if too many old or young persons were on the unit. RN's and Therapists, and MD's, ARNP's and Directors at the hospitals are all responsible for deferring pts, avoiding hard work, and refusing to place patient care above having a easy shift. The reason CMC closed may have been a organizational (CMC) or service (mental health field) culture that allows them to avoid difficult cases (behavioral issues [anger], insurance, housing, stressors, health issues, failing therapy/medication services, and lack of treatment). I feel that we are the "skilled professionals" that should be able to manage these cases and promote recovery.
Good points but the picture is more complicated.
1. Staffing is a big factor in the acuity algorithm--across the board. Staffing means spending and if the patient population is largely uninsured or underinsured, eventually it becomes impossible to pay salaries.
2. If salary expense is then minimized, this will translate into fewer staff. Plug this into the acuity equation and you've got part of the answer.
3. MH professionals of all stripes are -generally- paid less than other health professionals. They are paid less for many reasons, one of which is low reimbursement rates by insurance providers.
4. Many inpatient admissions happen through a hospital's ED. Many admissions are for substance abuse for which there are even fewer resources in NH and the USA. Acute care psychiatric units are for acute level care--however attempting to find placement for those with substance abuse problems is nearly impossible as those options have gone away.
5. This becomes a much more complex medico-legal-ethical problem because these patients are then discharged to the street where the cycle begins again.
6. Many admissions are homeless people where all of the above problems also present themselves.
7. Behaviorally dangerous/unpredictable patients are another reality that can be very hard to factor into the acuity equation.
8. MH treatment with rare exception is not going to be successful if it is limited to the patient only. MH illness is notorious for having roots in family structures that are high risk. And this then bumps the context into one of family AND society.
9. Finally, successful MH treatment is labor intensive, multidisciplinary, and never ending. Thus, enormously expensive. Statistically, most MH problems are not solved by admission to acute care, by the plethora of medications given, or by substance abuse treatment centers (at least as we know of these centers in today's world).
10. We definitely have major problems in treating those with MH health diseases but these major problems are from A-Z and not simply about CMC or other facilities. Like healthcare in general, we are woefully getting worse, rather than better, for all citizens.