Last year, the state took over Hampstead Hospital – a private mental health facility – with the goal of expanding mental health treatment for young people.
State officials hailed it as a major step toward reforming the youth mental health system, which was struggling to keep up with the rising number of children and teens in crisis. Without enough inpatient psychiatric beds, many were forced to spend days in emergency rooms, waiting for care.
With the help of a private contractor to staff the facility, state officials pledged to significantly increase the number of beds available to young people in crisis.
But 18 months later, that remains a distant goal. The number of patients seen at Hampstead has consistently been below what the contractor, Wellpath, agreed to in its contract – while children continue to wait in ERs for treatment. As of Monday, 14 children were waiting for a bed.
At times since Wellpath took over, staff have also struggled to manage the behavior of some patients at a newly opened residential unit, resulting in increased calls to local police over the summer.
“It clearly has been more of a challenge than I think, a year and a half ago, when the state embarked upon this plan, that folks realized it would be,” Susan Stearns, who leads the mental health advocacy group NAMI-New Hampshire, said of the efforts to open more beds.
The state’s purchase of Hampstead was an important step forward, Stearns said. But the limited availability of treatment there – in part due to low staffing – has led to frustration for families. She said she’s heard from parents whose children have spent more time in the ER waiting to get into Hampstead than they do once they’re actually there, receiving treatment.
“Part of this is, for lack of a better term, a learning curve,” she said, “which is incredibly painful for families who are desperately trying to get this level of care for their children.”
Many treatment beds are still offline
As the state prepared to take over Hampstead in June 2022, they moved quickly to bring in help managing their new purchase. Rather than using a competitive bid process to recruit potential applicants, state officials offered a no-bid, $52.5 million contract to Wellpath. At the time, they said the company was the only one with the “capacity, experience, and resources to quickly and effectively assume inpatient services from the current provider.”
But some mental health advocates questioned whether Wellpath — whose prior work primarily focused on health care and mental health services in prisons, jails and adult psychiatric facilities — had enough relevant experience to care for vulnerable youth not involved in the criminal justice system. Some also raised concerns about allegations of substandard care at other Wellpath-run facilities.
State officials defended their choice, saying they were impressed by Wellpath’s work with youth at a psychiatric hospital in Alaska. In contract materials presented to the Executive Council for approval, the state health department noted that “Wellpath has agreed to increase capacity to reduce the current waitlist for both children and adults.”
Under private ownership, Hampstead treated both children and adults. But staff shortages during the pandemic limited its capacity, down to about 45 beds as of October 2021, according to the state.
In its contract, Wellpath agreed to provide a minimum of 55 beds at the outset, increasing to at least 65 beds – including patients in a new residential treatment facility – after a year.
But data from the state health department, provided in response to a right-to-know request, show the actual patient numbers have never reached those levels – and have typically been much lower.
"We may not be at 65 beds, but we are serving youth who otherwise would have had nowhere to go."Deputy DHHS Commissioner Morissa Henn
In the first year of Wellpath’s management, a little over half of the hospital’s 71 beds were filled, on average. More recently – from Sept. 1 to Oct. 25 of this year – an average of 30 inpatient psychiatric beds were in use, plus another four or five spots in the new residential facility.
Meanwhile, the need for youth mental health beds has remained high. During September and October, an average of 12 children and teens were on the waitlist on any given day.
Morissa Henn, the deputy commissioner at the New Hampshire Department of Health and Human Services, said the “aspiration” is still to get Hampstead up to 65 beds, but that’s not realistic right now.
Henn said Wellpath, like other mental health providers, has struggled to hire and retain staff — but the state is confident in the company’s ongoing recruitment efforts. Meanwhile, she said Hampstead is also seeing patients with more serious and complex mental health conditions than before. Because those patients require more attention from staff, that further limits the available capacity.
“In order to ensure that we are delivering with the highest quality patient outcomes, we need our clinical vendor Wellpath to keep census within an appropriate range, relative to both their current staffing, but also patient complexity,” she said. “And so for right now, that means keeping the census around 35 to 40 patients.”
Henn noted that Hampstead is not turning anyone away based on the severity of their condition, as it could when it was a private facility.
“We may not be at 65 beds, but we are serving youth who otherwise would have had nowhere to go,” she said.
She said Wellpath’s contract is tied to its actual expenses, so it’s not getting paid for beds it’s not operating.
Jeremy Barr, the president of Wellpath Recovery Solutions – the division of the company that staffs Hampstead and other psychiatric facilities – said the facility was at about 40% of contracted staffing levels when they took it over. He said it’s now at about 75% of full staffing, but the higher needs of patients have limited their ability to open more beds.
Barr said the company shares the state’s goal of ensuring every child can access treatment when they need it. He declined to say how long he expects that to take.
“We want to be there as quickly as possible, and with, really, the goal of creating a zero waiting list in the emergency department,” he said.
Police called, at times, to help with ‘unruly’ behavior
The new psychiatric residential treatment facility at Hampstead, which opened in May, has also been off to a mixed start. The unit offers longer-term stays – often three to six months – for children who have significant mental health needs and could benefit from ongoing treatment, sometimes after “stepping down” from psychiatric hospitalization.
Henn said this is the first facility of its kind in New Hampshire, serving families who previously might have had to send their kids out of state.
“Those youth have extremely complex backgrounds,” she said. “They have experienced trauma, adversity, oftentimes abuse and neglect. And their behaviors are challenging at times.”
But at times, Wellpath has also struggled to manage those behaviors without enlisting support from law enforcement. Over the summer, staff called police on multiple occasions because patients had run away, or were engaging in “unruly” behavior, according to records provided by Hampstead police.
Karen Rosenberg, the policy director at the Disability Rights Center-New Hampshire, said those reports raised concerns — and clinicians working at this kind of facility should be equipped to handle difficult behaviors without calling in police. Children with complex mental health issues sometimes act out as a way to communicate frustration or fear, she said.
“It takes someone who’s really skilled and trained to do that,” she said. “But it is something you would expect from an acute psychiatric hospital.”
"It takes someone who’s really skilled and trained to do that. But it is something you would expect from an acute psychiatric hospital."Karen Rosenberg, with the Disability Rights Center-New Hampshire, on managing the complex needs of youth at a treatment facility like Hampstead
The heightened police activity has also caught the attention of Executive Councilor Janet Stevens, who recently questioned whether Wellpath was meeting its contractual obligations when it came to security. (Stevens did not respond to a request for comment for this story.)
Officials with Wellpath and the state health department said they’ve made a series of changes since the summer, including added security measures and support from outside experts in adolescent psychiatry. Hampstead Deputy Police Chief Robert Kelley confirmed that calls have dropped in recent months.
“I think it's been a significant improvement in comparison to the summer months,” he said.
New Hampshire’s Office of the Child Advocate, an independent watchdog, also recommended changes after a visit over the summer. Child Advocate Cassandra Sanchez said kids at the facility had a lot of unstructured downtime, and not enough programming to keep them occupied and out of trouble. She said there also weren’t enough different activities for children of different ages.
“If you have a kid who's 12 and may like something on the younger end, but then you have a 17-year-old,” she said, “the 17-year-old may get agitated waiting to do an activity for a 12-year-old.”
Sanchez said Wellpath was receptive to her office’s recommendations and has worked to improve programming.
Barr, who oversees Wellpath’s work at Hampstead and other psychiatric facilities across the country, said this is Wellpath’s first time managing this kind of residential treatment facility for youth, but argued it’s normal to learn and adapt when implementing any new program. Among other changes, he said the company recently named a new executive director for Hampstead who’s an expert in trauma-informed care.
“It was a new level of care that had never been done in the state,” he said. “And so I think that uptick [in calls to police] was, how do we service this population that, you know, historically, no one in the state of New Hampshire had been providing services to?”
For now, state officials are standing by Wellpath and, they say, monitoring their adherence to their contract. But that agreement expires next summer, and the state is preparing to open the job up to other potential applicants.
Stearns, with NAMI-New Hampshire, was encouraged by Wellpath’s recent efforts to avoid police calls, which she said can be traumatizing to children who are already struggling with their mental health and may have experienced trauma in the past. But she said the work can’t stop there, especially when there are still children in crisis waiting for inpatient care.
“Yes, there are workforce challenges,” she said. “They have to be resolved. I realize that’s a challenge for anyone to do. But especially New Hampshire’s children deserve to have the best care.”
