State, hospitals agree to end boarding of psychiatric patients in emergency rooms
CONCORD, N.H. — The state has reached an agreement with a group of hospitals in longstanding litigation over boarding practices in emergency rooms, where individuals in psychiatric crises have been held for days or weeks while awaiting mental health care.
That means the Department of Health and Human Services commissioner won’t be able to appeal an order from this May, ruling that by May 2024 a patient’s transfer must be accepted within six hours of arriving at the emergency room.
A federal lawsuit was brought by patients alleging their civil rights were violated when they were held involuntarily in emergency rooms. A group of hospitals intervened in that lawsuit, and argued the state must immediately transfer these patients to mental health treatment facilities.
As a part of the agreement, the group of hospitals, called the New Hampshire Hospital Association, agreed to drop its other lawsuits in federal or state court that have not yet been resolved. They will remain involved, but not in an adversarial way against DHHS, according to a spokesperson for the attorney general.
The group also agreed to stop trying to get the state to pay for its legal fees in the case.
“For the hospitals, this case has always been about ensuring patients suffering from an acute psychiatric crisis are able to receive the care they need by immediately being transferred to a health care facility specially designed for that purpose,” said Steve Ahnen, the president of the New Hampshire Hospital Association in a joint statement about the agreement released with the attorney general.
Ahnen said the organization would work with the Department of Health and Human Services in the coming year to ensure there are sufficient clinical and community behavioral health resources “to end hospital emergency department boarding once and for all.”
He called the agreement with the commissioner “an important step to ensure that patients in an acute psychiatric crisis will get the specialized care they need, when and where they need it.”
In May, the state released a plan to eliminate hospital emergency boarding by 2025, which it called “Mission Zero.” It came two days after a federal judge ruled the state will be required to do so a year ahead of that schedule.
The plan looks to increase people’s access to mental health care in the community before it reaches a crisis level requiring a trip to the emergency room, and to increase the supply of beds and to make sure support and housing is available so people can leave inpatient psychiatric facilities. The plan also includes increased funding for community mental health centers around the state.
The state has taken other steps to address mental health care in recent years, like purchasing Hampstead Hospital to provide youth mental health treatment and creating mobile crisis response teams. But state officials say a workforce shortage remains a problem.
“I am committed to eliminating this state’s waiting list,” said Department of Health and Human Services Commissioner Lori Weaver in a statement. “We will achieve this important milestone by working with our partners throughout the healthcare system to increase access to mental health services for all residents.”
As of July 12, there were 47 adults and 4 children waiting in emergency departments for an inpatient psychiatric bed, according to state data.
“Granite Staters experiencing a mental health crisis should have a robust array of treatment opportunities that meet their needs, including the level of treatment they need, when they need it, and where they need it,” said Gilles Bissonnette, legal director for the ACLU of New Hampshire, in a statement.
“As this resolution is implemented, we’ll be watching closely over the course of the next year as stakeholders create the needed changes to build a successful, inclusive system for mental health in New Hampshire,” he said. And the ACLU is continuing to pursue another lawsuit, arguing that patients held involuntarily should either have video or in-person access to a judge at their due process hearing.
Susan Stearns, the executive director of National Alliance on Mental Illness, said it’s heartening that the hospitals and state have agreed to work together on this issue.
“It is going to require a cooperative effort to make that oneyear deadline,” she said. “We’re all going to have to help support this effort.”
Stearns said emergency room boarding is a problem that dates back over a decade in New Hampshire. She attributes it to a lack of investment in mental health treatment, as well as the closure of the Anna Phibrook Center for Children, reducing the number of available beds.
“It is an inhumane practice,” she said about emergency room boarding. “In many cases, (patients) are in windowless rooms. They have none of their belongings. They don’t necessarily have visitors, although that depends on hospital policy and can change from day to day.”
According to New Hampshire law, patients are supposed to be “immediately” transferred from the emergency department to a facility where they can receive mental health treatment.
She said that the one-year timeline to limit ER boarding is tight but remains hopeful the state and hospitals will be able to work together to reach that deadline.
“The reality is the state alone could not do this,” said Stearns. “This is a systems issue, so it really requires that everyone be part of the solution.”