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.

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.

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.

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.

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!

Ha! Don’t worry, they are thinking of themselves plenty!

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?"

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.

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.

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.

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.

Thank you! You said this better than I could.

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.

Why does no one ever think of the billionaires?

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.

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

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.

🤎🤎

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

Very sorry for your loss and the struggles your mom faced.

That's what is scary about this order for sure. Of course the hospitals WANT to get the patients to the appropriate facility to help them. But if none of them have space and the hospitals have a finite deadline to get the patient into them, then do they just boot the patient out? Send them home without receiving any proper care for their mental health crisis?

This seems like such a half-baked, knee-jerk reaction to a lawsuit, and I agree that people's lives/wellbeing are at risk.

Oh gosh I am so sorry to hear about your mom.

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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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.

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.