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NJP220 t1_jah06xw wrote

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.

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lacnibor t1_jahbcwd wrote

Well said. I work in a Southern New Hampshire hospital. I work in surgical nurse role but to pick up extra hours I sign up for 1:1 with psych patients, also known as a “sitter”. No room at the inn is exactly the problem. People that don’t understand this problem don’t realize that this is the best available option. It’s very sad to see. Many off these patients are quite young. I’ve sat with a number of preteens. From my experiences probably 25% or more are minors.

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dj_narwhal t1_jah74b4 wrote

You mentioned the bad but did you ever think of all the money we saved billionaires when Reagan cut all the mental health facilities?

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Quirky_Butterfly_946 t1_jahdvta wrote

While Regan closing mental health institutions left little to no safety net for people, you have to admit that those facilities had been in steady decline for decades. It got to the point where care was non existent, people languishing, abused, neglected.

The mental health industry did not pick up the pieces, and often times non profits had to do what little they could to get people into group homes.

So to lay this at the feet of only Regan, is a disservice to all other segments of society that did nothing to provide needed services.

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dj_narwhal t1_jahpc2e wrote

I am aware Reagan was only the face of a much larger problem. Your comment reads like if DeSantis gets elected and closes every single public school on the first day of his presidency and you said "well you can't blame this all on DeSantis schools were already bad" because other right wingers before him spent a lot of time intentionally destroying the public school system. I also don't fully blame Reagan since his brain was mostly pudding for 3/4 of his presidency.

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Baremegigjen t1_jaipc3p wrote

The “great communicator” could read a script with the best of them and for the most part memorize many of his lines. Little if any of what he said publicly was original.

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occasional_cynic t1_jahv8ip wrote

You want to go back to asylum's? Really? Also, they were in the process of closing when he was elected. Hyperbole that he waved his hand and cut funding for them is ridiculous.

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ZacPetkanas t1_jahzsln wrote

> You want to go back to asylum's? Really? Also, they were in the process of closing when he was elected. Hyperbole that he waved his hand and cut funding for them is ridiculous.

Forty years on and Reagan is still the shallow-thinker's boogeyman. If only there had been a Democrat president with a majority Democrat congress since 1988. Oh well, what could of have been I guess.

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NHDraven t1_jah5jh5 wrote

Very well said. I'd have to read the actual order to understand what 'solution' the judge thinks they're actually providing because I don't see this order being a solution at all. If there isn't a facility with room, what is the hospital supposed to do?

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Fraggle-of-the-rock t1_jahffiq wrote

NH social worker here! To add to all the accurate things you said…when the hospital gets tired of these psych patients taking up space, they are suddenly at baseline and discharged. Then they call BEAS and it expect it will be dealt with that way. Wash, rinse, repeat.

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vorrhin t1_jahobdd wrote

Same with DCYF. And then the child goes back to school or foster care, hurts someoneand it's DCYF's fault. They very conveniently get better as soon as the hospital gets full.

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perkinslumbago t1_jahibhf wrote

You are absolutely right, but it’s not the point of the lawsuit. This lawsuit came out of years of the state claiming they would make changes. It was not a surprise lawsuit, nor is it the first lawsuit of its type to push the state for change. The lawsuit doesn’t hit the heart of what you are saying because it’s. It meant to find a solution, it’s meant to order a solution.

The comparison I think of first is the Laconia state school litigation. The state said for years they would phase out the institute but never did. They claimed it was impossible to find the funding, impossible to place people, impossible to abolish the institute. Then a lawsuit came and the court ordered they do it. And they did. The services still aren’t perfect but it’s a step that has helped thousands be functional within their community.

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NJP220 t1_jahoclh wrote

That makes sense. Thank you for the info. It sucks that these are the avenues that need to be used to try to change a broken system. I worry this push for change will unfortunately negatively impact patients at least in the short-term though. Like a game of chess that is for a good cause. The ultimate win may be for the best, but pawns are going to be thrown at the enemy.

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Acanthaceae_Square t1_jajs2qj wrote

Yes. This. Just like w every other social issue, NH has known for decades this was a problem. 10 years ago a state mental health plan was developed that didn’t get carried out. NH will never do anything it should unless it’s forced. I also work in the ED and applaud this decision because DHHS is like a child who needs a parent to ensure they’re doing their homework and who’s been given way too many second chances to be trusted. Hopefully the fed court stays on them to make sure the solution is also appropriate and not another half assed smoke screen

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FaustusC t1_jahij8l wrote

I had a (nonpsych) medical emergency and got taken to a Hospital in Maine. I went to sleep, woke up on a helicopter, fell asleep and woke up outside Boston. My first thought: "How the fuck do I get home?"

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nyx_moonlight_ t1_jahvo2i wrote

Went thru this, can confirm. That long distance trip from Portsmouth ER/pod was disturbing. I was a suicide risk so I had to be bound in the stretcher and then in the back of the ambulance alone in the dark. I had been in the holding area for days which had been highly stressful - a tight space with nothing to do but watch the TV in your room, no windows, you share one bathroom, a lot of the other people are screaming and throwing things. After finally getting loaded up in the back of the ambulance, I asked if they could play music from the front to soothe me, they said I wouldn't hear it. I sang to myself to ease my anxiety. By the time I got to the treatment center in Derry, I was throwing up from stress and empty stomach. New Hampshire is TRASH for mental health.

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NJP220 t1_jahxhwd wrote

As far as the music in the ambulance, unfortunately a lot of the trucks don't have great speaker setups. Ambulances have completely custom bodies usually and music isn't a priority in their design. That being said, the service I work for has speakers in the back and we try to provide music to our psychiatric patients whenever we can. We also have provided a laptop with Netflix open before. Anything to make the process easier and less stressful for all involved.

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nyx_moonlight_ t1_jaib917 wrote

That is amazing! I sang to myself the whole time in the Pod and so forth. I almost didn't get help because I didn't want to be without my phone and music. You don't know how much that is appreciated 💖

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reptilianhook t1_jakq43m wrote

Out of curiosity when was this? We would absolutely never transport an interfacility psych pt bound nowadays outside of very extreme circumstances, and being a "suicide risk" would certainly not be one (most of my psych transfers would qualify lol). I understand that this sort of thing was more common in the past, however.

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everyoneisnuts t1_jahqb8o wrote

All exactly on point. It is like that almost everywhere too. There needs to be a significant investment in A LOT more psychiatric triage and inpatient facilities if they want to be able to circumvent the ER. Only possible way to do it. It is needed on every angle imaginable too. Better for the overcrowding of ERs, better for the patients, as they are going to a facility and triage center that would ideally specialize in psychiatric disorders, and also ideally would at least hold them there where they can get treated by specialists instead of at hospitals. It’s all about the almighty dollar and how insurance does not pay well for behavioral health. That is why nobody wants to open up psychiatric facilitates. If they incentivized it that way, you better believe you would see more facilities.

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DemonDuo t1_jaiyx0j wrote

I am currently on the construction team for the State Prison and the NH Mental Hospital. I am in these facilities daily updating infrastructure to modern day standards with future proofing in mind. Special Patient Unit will be added to the mental hospital within the next two years. This will be appropriate housing for the criminally convicted insane which frees up resources at the prisons and opens more beds for the mentally ill at the appropriate state hospital facilities. Most of the beds at normal hospital psychiatric units are being taken by inmates who cannot be helped within the prisons. The hospitals therefore cannot take in average person having a mental health crisis who need care for over a couple days. Soon there will be changes!

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giap16 t1_jahemmj wrote

Thank you! You said this better than I could.

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Allthefeels95 t1_jakilnw wrote

This is so well said and I can attest to all of it. Today I finished my mental health clinical that had us working in multiple inpatient psychiatric units at a local hospital. I saw some patients that have been on these units for months, including a patient who has been in the behavioral emergency department for 6 months.
The oversimplification of this systemic nationwide issue is so misleading. Yes, it’s awful these patients are not getting the treatment they desperately need and deserve, but where do we send them when every other facility they could go to has no open beds? Unless we get an influx of funding, staff, and facilities (both inpatient and outpatient clinics in the community) nothing is going to get better.

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