In Sununu's Budget Address, Health Spending is Front and Center

Feb 14, 2019

When Gov. Chris Sununu outlined his budget proposal to lawmakers at the State House on Thursday, much of the speech centered on health care, including some proposed fixes to issues that have simmered for years.

[Main Story: Governor Sununu Kicks Off Budget Season With State House Address]

Access to Acute Mental Health Treatment

One of the most expensive pieces of Sununu’s proposed budget is a $40 million investment to address two long-standing issues with the way the state handles mental health care. The first issue is a practice known as emergency room boarding.

When a person shows up at an emergency room in a mental health crisis and a doctor decides they could be a harm to themselves or others, they are supposed to be transferred to what’s known as a Designated Receiving Facility. A DRF, like New Hampshire Hospital, can provide a more in-depth assessment and develop a treatment plan. The patient is also supposed to receive a hearing before a judge within three days in case they want to contest the doctor’s opinion that they pose a threat to themselves or others.

But because of an existing shortage of DRF beds in the state, that process is often delayed for days or even weeks. In the meantime, patients are held at emergency rooms across the state, sometimes against their will, without rigorous psychiatric treatment or a due-process hearing. As of the end of January, there were more than 30 people being boarded in emergency rooms awaiting a DRF bed.

Emergency room boarding is currently the subject of a lawsuit filed by the ACLU-NH against the state.

The second issue that figures in Sununu’s budget plan centers on the state’s only secure forensic psychiatric unit, or SPU.

"Today, caseloads are still too high for our front line workers, which is why we need to refocus our resources on these efforts," Governor Sununu said.

For decades, that facility has been a part of the state prison. Most of the population treated there are inmates who have been convicted of crimes or people who have been found not-guilty by reason of insanity. But there are also patients in the SPU (currently 9 patients out of 41 total) who were transferred to the SPU from New Hampshire Hospital after they are deemed too dangerous to be treated there.

Mental health advocates and lawmakers have argued for years that the state should not force people who were civilly committed to receive treatment behind prison walls. The practice has also been the subject of lawsuits against the state.

In his budget, Sununu proposes a $40 million plan to address both the ER boarding issue and the civilly committed population at the SPU.

“This multi-pronged effort we will undertake is, quite frankly, the single largest step this state has ever taken to reform our mental health system,” Sununu said in his budget address.

The plan is made up of three parts:

1.] Build a new, 60-bed forensic psychiatric unit on the grounds of New Hampshire Hospital. This would move the civilly committed population out of the SPU at the state prison, meaning that people who have not committed crimes would no longer be forced to receive treatment inside a prison.

2.] Build 40 new transitional beds for people who are released from in-patient mental health treatment. These beds are designed for people who are released from a DRF like New Hampshire Hospital. Health officials say one of the reasons NHH remains at capacity is that patients who are released are often quickly readmitted because they lack stable living spaces and mental health supports in their community.

3.] Build or purchase a new adolescent-focused treatment space for children who are currently being treated at New Hampshire Hospital. This would free up existing space within NHH for more DRF adult beds.

Altogether, the governor says these efforts would result in 108 new DRF beds, which is more than double the current waiting list.

Democrats in the Legislature have already put forward their plans for these two issues in separate bills. One would spend $9.5 million for more DRF beds and transitional housing. Another would transfer control of the SPU to the Department of Health and Human Services and direct the department to oversee the construction of a new facility. To what extent these proposals are compatible with Sununu’s vision will become clearer over the coming months.

DCYF Staffing Levels

Another topic Sununu addressed is staffing levels at the Department for Children, Youth, and Families. In recent years the department, which investigates allegations of child abuse, has been strained by a surge in such claims and the high-profile deaths of two children the agency had contact with.

Right now, DCYF caseworkers juggle an average of between 30 to 40 cases each. That's down from a high of over 90 cases in recent years but still well above the nationally recommended level of 12 cases per worker.

In his speech Thursday, Sununu proposed adding 62 new positions at DCYF.

“Today, caseloads are still too high for our front line workers,” Sununu said, “which is why we need to refocus our resources on these efforts.”

The projected cost of those positions wasn’t immediately clear.

Democrats have already offered their own proposal to add 77 new caseworkers and supervisors at DCYF. Their plan would cost roughly $5 million in state funds over the next two years.