This seems to be missing the core issue. Which is a lack of appropriate facilities, funding and staff in the state for mental health. I work for an ambulance service in the Northern part of the state that often transports psychiatric patients from area hospitals to other facilities. There is no room anywhere. Nearly all of the receiving facilities are in the bottom of the state (Concord, Hampstead, Derry, Nashua) and they are all full.

If a person calls 911 for a mental emergency and an ambulance comes, we have to take them to the closest appropriate facility, which would be the nearest hospital. We legally cannot just say "The better hospital/facility is 2-3 hours away. Let's take them there." We HAVE to go to the nearest hospital. So now that the patient is in the emergency room, the doctor will evaluate them. If they need to go to the better facilities, those places will be called. When they are called, they say that they have no available beds and are full. So the next place is called, and the next, and the next, and the next, until all appropriate options are exhausted.

Now with no available beds at the appropriate facilities and a patient who is considered a danger to themselves or others, the hospital has to figure out how to manage this patient with what they have. All of the hospitals in the state are currently frequently at capacity and have no available beds. So the patient has to stay in the emergency room, with 24h surveillance, until a bed at one of the appropriate psychiatric facilities finally opens up. Then you have to hope that you were caller number 1 and reached them first on your 18th call to them in the last 3+ days.

Now you need to call an ambulance service that can do long distance transfers and have them transport this patient to the new facility. The facility may be over 3 hours from the patient's home and family. Causing untold amounts of additional stress. Let's say you live in and have a psychiatric issue in Littleton, NH. You will go to Littleton Hospital initially and go through that whole process. Then after days of being kept in that hospital, an ambulance with 2 strangers comes and picks you up and takes you hours away to an unfamiliar facility in Hampstead NH, Brattleboro VT, outside of Boston MA. Hours away from family, making it difficult for your support network to be see you. Then after this potentially traumatic experience, you get released, and now have to figure out how to get back home.

This article makes it seem so simple. "Just take them to the appropriate facility." But it completely ignores the issue of why that can't happen. There is not enough available beds, staff, facilities, funding, transportation, in the state of New Hampshire for psychiatric/behavioral care. This order acts like the hospitals were keeping people in the emergency department out of their own convenience. It is a huge burden on the emergency room to manage. They would be much happier to send the person to the appropriate facility. There is simply nowhere to send them.

People are going to die, my mom died after she was discharged because she was 12th in line for a bed

Apparently New Hampshire doesn’t care of people die, as long as it’s sick people. This is so sad.

So what’s actually being argued here is that keeping psychiatric patients in emergency rooms is an illegal seizure of the hospital’s resources. Nothing to do with quality of patient care or outcomes, just businesses complaining about costs.

The psychiatric care system in NH isn’t even a joke it’s unsupported to the point of cruelty and malice, but what’s finally going to wiggle the system a little bit is hospitals taking the most business-oriented PR-blind stance to get more money from the state.

Hey mental health patient here, I live on the boarder of mass and NH. I always make it a point to drive to mass, Beverly mass specially. The level of care is way better. Anyone struggling in NH on a regular basis I suggest moving to mass or the border of mass because it is so bad in Nh right now

I don't see how they can prevent this, staffing issues have almost 50 beds unable to be utilized at the state psychiatric facility and Hampstead and Brattleboro don't have many beds either. They said in a previous article to utilize travel agencies but both Hampstead, NHH, and the state prison already do. People, especially nurses, do not want to work in psych in favor of other specialties that are more lucrative (such as telemetry, ICU, step-down, maternity, and OR/PACU). We have to pull nurses into psych nursing, it's barely a blip in nursing school and isn't sought after.

Not only that especially if you're lower income it's extremely extremely difficult to find a provider especially that would take Medicare and Medicaid. Most definitely though the wait times are outrageous and level of care is subpar.

I understand that this issue is brought up by the hospitals themselves. They do not want to care for or pay for psychiatric care in their er. I understand that. Its a ridiculous place to leave someone in a crisis. Maybe mandate each hospital to have a psychiatric unit that can expand and contract as needed. No easy solutions. The core of the problem is the mental health of our people and the thought that psychiatric care can "cure" the mentally ill. Most psych meds are not very helpful, and often times cause more problems them they solve. the real solution lies in getting individuals to properly care for themselves, this will cut out about 80 percent of the patients. A book called "50 things to do before seeing a Psychiatrist " is a solution. The problem is getting folks to actually do these things, it requires effort, often a lot of effort. current society prefers a quick easy fix, unfortunately good mental health requires a life long commitment and mentally healthy parenting. Sadly I do not see this situation improving at all. It will get worse. Hang on!

This is a major problem and I witnessed it when I worked in Derry.

I used to work at New Hampshire Hospital. At that time, it was a bed availability issue. Units were full and the availability to bring in patients who needed the help was an issue. Leadership has changed, so I’m not sure how it is now, but there were providers who were not comfortable discharging patients because there were minimal resources for a psych patient to remain stable upon discharge, thus creating this feeling of a “revolving door”. Psychiatry is challenging, patients get stabilized on their meds and start to feel better, so they stop their meds, and then BOOM back in a mental health crisis.

As someone posted previously, we need more resources in the northern part of the state. We need more mental health resources all around, not just hospitals and psychiatrists, but intensive outpatient programs (like cardiac or pulmonary rehab but for MH concerns), and supports for patients to take their meds and report changes sooner so they can prevent worsening of their condition, which leads to escalation of the MH symptoms. Another barrier was housing. If someone had been in a MH crisis, they might have lost their job and/or apartment. The social workers were golden at finding housing for these patients so they could be discharged, but it still was affecting bed availability. It’s a huge constellation of factors that need to be addressed. Having worked in an emergency department as well, it’s not fair to ED staff to have a psych boarder while waiting for a bed at a facility, nor is it fair to a patient who is having an acute MH flare to be held in the ED. You can’t put 30 lbs of pasta in a tiny colander and expect it to work. The State needs to actually do something to make it work better for it’s residents, not create another task force and hope it all falls in place

This problem isn’t just young people experiencing a mental health crisis, it involves the elderly awaiting placement in a geriatric psychiatry unit as well.

I work in a Hospital in NH and there have been multiple times where 30-50% of the ED beds are occupied as “psych holds” which puts an unbelievable stress on the ED. Usually it’s 2/3 young people and 1/3 elderly patients. Many times those elderly patients are unceremoniously dropped there by their families “because we can’t manage him/her anymore”. Other times they are sent in because of “altered mental status” from their home nursing facility. Frequently these patients are genuinely dangerous to be around or are a genuine danger to themselves due to progression of their cognitive impairment.

Often these patients have end stage dementia of one sort or another (god forbid Lewy body) and are unfixable. You can quell the symptoms sometimes with antipsychotic medications, but more often than not, you are just sedating them. Even if they move out of the ED and into the hospital for one reason or another, it just moves the problem to a new venue.

I had one patient spend close to 90 days on a general medical floor as their family just refused to take them back home. We ended up having to wait for public guardianship and long term medicaid to place them in a facility for the rest of their life.

This is a society-wide problem, and giving hospitals a month to come up with a plan is laughable. Unless they call out the Army to permanently fully staff a dozen new long term care psych units, this issue isn’t going to go anywhere.

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So fund psychiatric help for people lmao. Why not just order houses to stop burning down to save money on fire departments?