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Mental Health Math Doesn't Add Up For Hospitals

Todd Bookman

In the 1950s, the state psychiatric hospital in Concord was home to about 2,500 adults. The manicured campus had it all, including a golf course, barber shop, skating rink.

“For some folks, they talk about those days like some of us talk about going to college," says Ken Norton, Director of National Alliance on Mental Illness in New Hampshire (NAMI-NH).

“There was bowling and movie theaters and different events at night. They had their friends there and they were very used to the way that the hospital functioned.”

This was the era before psychiatric medicine, before the idea that mentally ill people shouldn’t be warehoused.


That soon changed.

In the 1960s and 70s, the often terrible living conditions inside of psychiatric hospitals became public, and the movement to deinstitutionalize began.

By the 1990s, only a few hundred of the sickest people remained locked in the state hospital.

Everyone else was receiving treatment at local hospitals, or community mental health centers like Riverbend in Concord.

That’s where Louis Josephson is the Executive Director.

“Twenty years ago, New Hampshire was considered to have the best mental health system in the country.”

But in the past two decades, the system has crumbled. And its crumbled for one reason.

“Well, I think it is money,” says Josephson.

Specifically, a decline in payments from insurance companies and the government. The community hospitals that used to help treat the mentally ill just can’t afford to do it anymore.

Josephson says a patient in a hospital psych ward can cost $1,500 a day. Medicare, Medicaid: they’ll reimburse nowhere near that amount. The math just doesn’t add up for the hospitals.

“They look around and look at their Boards of Directors and say, ‘something’s got to go,’ and they often pick psychiatry.”

Back in 1990, there were more than 230 psychiatric beds at local hospitals. Today, there are fewer than 150, and none left in the North Country.

And there have been cuts to the state psychiatric hospital, the safety net to the system. That facility has half the beds it did 20 years ago.

Patients, with nowhere else to go, now wait in emergency rooms for days on end for a bed to open up. 


“These people are suffering,” says Shawn LaFrance with the New Hampshire Foundation for Healthy Communities. “I believe that people wouldn’t tolerate this if they had a stroke or a heart attack or broken bones, that they would spend a day, two, three days waiting for somebody to help them.”

The waitlist for a bed, sometimes 30 or even 40 deep around the state, means emergency departments must adapt.

At Concord Hospital, they’ve blocked off four rooms and made them safe for people in crisis.

Louis Josephson says the area is called the Yellow Pod.

“It is de-sensitized, everything is secure. There is a television behind Plexiglas, there are blinds also behind glass. There’s soft furniture here that cannot be thrown. This is all costs we’ve absorbed.”

He estimates the hospital is spending $1 million dollars a year temporarily housing people in the ER. That may not be sustainable.

A fix, though, could be coming: Governor Hassan has set aside $28 million in her budget to try to shore up the state’s mental health system. Some of that money could go towards more beds; community-based services and counseling would also see a boost.

Advocates like Ken Norton of NAMI-NH say the funds are a positive step.

But he wants something bigger.

He wants to see an end to the stigma surrounding mental health in America.

“If you look back 30, 40, 50 years ago, no one said the word ‘cancer’. They would whisper it, there was a lot of fear associated with it. We still have these fears and attitudes around mental illness that allow us to think that it is okay to not provide medical care, and to not provide comprehensive insurance.”

Norton says that until the shame surrounding mental illness fades, the resources to treat it won’t arrive.