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State okays contracts to build out mental health facilities, amid ongoing waitlist concern

New Hampshire’s inpatient mental health system could expand significantly next year, under a pair of contracts the state’s Executive Council approved Wednesday.

The largest deal gives SolutionHealth — the hospital system that includes Elliot Hospital in Manchester and Southern New Hampshire Medical Center in Nashua — up to $15 million to help it build a 120-bed behavioral health hospital in Southern New Hampshire.

The New Hampshire Department of Health and Human Services is also putting $1 million toward creating five new emergency psychiatric beds at Dartmouth-Hitchcock Medical Center in Lebanon.

Both deals use federal money from the American Rescue Plan Act and expect construction to finish by the end of next year.

New Hampshire’s shortage of mental health beds has long forced some people in crisis to be held in emergency rooms for days or weeks before being transferred to appropriate treatment. Patients and hospitals have sued over the practice in state and federal court. A federal judge recently ruled it illegal and ordered the state and hospitals to work out a timeline for proposing a solution.

Twenty-eight adults and seven children were in hospitals waiting for an emergency psychiatric bed as of Tuesday, according to state data. Another six adults were in correctional facilities.

In his most recent proposed state budget, Gov. Chris Sununu has put forward legislation that would require hospitals to operate involuntary psychiatric beds. It would also allow patients who are involuntarily admitted because of a mental health crisis to be held in ERs for longer before being transferred to treatment.

Hospitals strongly oppose the proposal, and have argued in court that the state is not meeting its obligation to maintain enough capacity in the mental health system. The state’s main psychiatric facility, New Hampshire Hospital in Concord, has about 30 beds going unused right now due to renovations and staff shortages.

State health officials have said they’re working to expand the system, but can’t create more capacity overnight or immediately improve the hiring situation. They’ve also said the hospitals could do more to be part of the solution.

The new behavioral health hospital, estimated to cost between $55 million and $60 million, would include 72 beds for adults admitted voluntarily or involuntarily; 24 beds for children and adolescents; and 24 geriatric beds. Because it would consolidate some of SolutionHealth’s existing mental-health services, the facility would create a net increase of around 80 beds.

The hospital would have to maintain those beds for at least 10 years and commit to serving at least 30% Medicaid patients.

The Joint Legislative Fiscal Committee approved funding for the proposal in September. A previous plan to partner with HCA Healthcare on a mental health facility in Epping fell through last year.

In a statement, a SolutionHealth spokesperson said the new hospital could open "as early as 2025."

The state has also been offering federal money to any hospital willing to create new emergency mental health beds. Dartmouth-Hitchcock Medical Center is the first taker so far.

Dr. William Torrey, chair of psychiatry at Dartmouth Health, said in written answers to questions that hospital officials responded to the state’s initial request “and have been working internally on renovation needs and planning.”

The renovation will combine two separate units into one, with 19 voluntary and five involuntary beds. It is expected to be up and running in summer or fall of 2024, he said.

“Being able to admit people directly needing involuntary care means that they can get care more quickly and locally, spending less time in our ED and their families and other supporters will not have to travel as far to see them,” he said.

The contract before the Executive Council Wednesday says Dartmouth Health must operate the beds for at least six years.

Susan Stearns, the executive director of the National Alliance on Mental Illness’ local chapter, welcomed the plans to expand inpatient capacity. She said more beds — including for children and adolescents — are sorely needed as people continue to wait for care.

But she also called for more community-based mental health services and supportive housing.

“We can't think that just expanding inpatient capacity is the solution,” she said. “We have to continue that investment into those community-based resources upstream that help prevent people from needing that level of care.”

Acting health commissioner Lori Weaver echoed that at Wednesday’s Executive Council meeting, saying the state sees inpatient beds as just one piece of the puzzle.

Some patients at New Hampshire Hospital no longer need to be hospitalized, but can’t be discharged because of a lack of housing options and community-based services, including transitional housing and residential treatment.

“We have 60 patients that could probably leave the hospital,” she said. “So if we had those 60 patients leave and [they] had a place to go, that waitlist would be zero.”

Paul Cuno-Booth covers health and equity for NHPR. He previously worked as a reporter and editor for The Keene Sentinel, where he wrote about police accountability, local government and a range of other topics. He can be reached at pcuno-booth@nhpr.org.
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