The state health department on Friday announced plans to stop holding psychiatric patients in hospital emergency departments by 2025 — two days after a federal judge said the practice must end by May 2024.
In a news release, the New Hampshire Department of Health and Human Services outlined a series of planned expansions to community-based services, inpatient psychiatric treatment and transitional housing options. Officials said those investments will fully eliminate the waitlist for inpatient psychiatric care over the next two years.
This would, in turn, eliminate the need to hold patients experiencing mental health crises in emergency rooms for long stretches of time, sometimes known as “ER” or “ED boarding.”
“Building on years of progress, we are hitting the gas to fully eliminate ED boarding and build a mental health system that serves people at the right place at the right time,” Lori Weaver, the department’s interim commissioner, said in the release.
For years, New Hampshire has struggled to meet the demand for mental health care, with some people in psychiatric distress forced to spend days or weeks in the emergency room, until a bed opens up at a treatment facility. As of Friday, 32 adults and 17 children were waiting in emergency departments for an inpatient psychiatric bed, according to state data.
The boarding of psychiatric patients in emergency departments has been the subject of several lawsuits. On Wednesday, Chief Judge Landya McCafferty of U.S. District Court in Concord ordered the state to end the practice within one year, after ruling it an illegal seizure of hospitals’ property.
State officials did not immediately say how they planned to comply with the court’s 12-month deadline. Speaking before the Legislature’s Fiscal Committee Friday morning, DHHS Associate Commissioner Morissa Henn referenced the just-announced plan and the health department’s “commitment to achieving a zero waitlist in the next two years.”
Henn did answer directly when a lawmaker asked if the state could accelerate those plans to comply with the court order.
“I can't speak to issues related to litigation,” she said. “But what I will say is that there are many things that will be implemented even in the next few months, and we're continuing to review the court order and the implications of that for our work.”
Jake Leon, a spokesperson for the department, said the plan — dubbed “Mission Zero” — has been in the works for months and was not a response to the court’s order this week.
“While this work cannot be done overnight, the Department intends to comply with the court[’]s order and will continue its efforts into the future to accomplish Mission Zero’s ultimate goal of resolving this issue permanently,” he said in an email Friday.
The state plan laid out Friday — some parts of which have been previously announced — aims to both expand bed capacity and reduce the number of people who need hospitalization in the first place.
That includes a proposed increase in funding in the next two-year budget for community mental health centers to help address workforce shortages. The state is also helping some centers become certified community behavioral health clinics that offer more comprehensive care.
Other efforts would tackle what state officials call the “back door issue” — people who no longer need to be hospitalized, but can’t be discharged due to a lack of suitable housing. The department says it will expand transitional housing and programs that help people “step down” from hospital settings, as well as developing incentives for landlords to create more supportive housing.
Friday’s release also highlights previously announced plans to add inpatient capacity. Five new emergency psychiatric beds are slated to open at Dartmouth Hitchcock Medical Center in fall 2024, and SolutionHealth is building a new behavioral health hospital in southern New Hampshire. The 120-bed facility, which is receiving $15 million in American Rescue Plan Act funds toward its construction, is expected to open sometime in 2025.
State officials have worked to expand New Hampshire’s mental health system in recent years, including the rollout of mobile crisis response teams and the purchase of Hampstead Hospital for youth mental-health treatment. But officials say labor shortages have limited capacity at state facilities, even as mental health challenges have increased.
The court order issued this week is part of an ongoing federal lawsuit brought by patients who allege their civil rights were violated when they were held involuntarily in emergency rooms. A group of New Hampshire hospitals intervened in the lawsuit, arguing the state has an obligation to immediately transfer such patients to appropriate mental health treatment facilities.
McCafferty sided with the hospitals earlier this year, kicking off an additional round of litigation over how quickly the state should be required to stop boarding involuntarily admitted psychiatric patients in ERs.
At a hearing in federal court Monday, Senior Assistant Attorney General Samuel Garland asked for two years, saying state officials’ efforts to make improvements across the mental health system will take longer than a year to pay off. If more people continue to show up at the ER in acute crisis, he said, adding beds alone won’t fix the issue in the long term..
The goal “is to solve boarding once and for all,” he said.
James Harris, a lawyer for the hospitals, argued one year was long enough for the state to bring more beds online and solve a problem that “has gone on for 10 years.” He said the state can add more beds in the short term, while also moving forward with broader reforms.
“Two years would be unacceptable to the hospitals,” he said.
A representative for the New Hampshire Hospital Association was not available Friday to comment on the state’s announcement.
