End in sight for mental health ER boarding

New federal court ruling gives the state until May 2024 to provide psychiatric care to ER patients within six hours of arrival

A security officer stands by while LNA Karen Johnson works with mental health patients in a make-shift care area in a Concord Hospital Emergency Room hallway.  (Photo by Elodie Reed, Concord Monitor)

Waiting for 11 days in the emergency room was the worst period of Patrick Dowling’s life.

Dowling, like hundreds of other patients with mental illnesses in New Hampshire, had to wait in a hospital emergency department for more than a week before receiving the treatment he urgently needed.

He was taken to Speare Memorial Hospital in Plymouth when experiencing a mental health crisis in 2013.

“I wanted to get help, but no one was helping me and I was just stuck,” said Dowling, 29, diagnosed with schizoaffective disorder, reflecting on his experience in the emergency room. “It felt like a cell almost, because I couldn’t leave or do anything.”

The situation, however, is about to change for patients in New Hampshire who have been enduring long wait times for mental health treatment in hospital emergency rooms.

Last week, the state announced that it would not appeal a federal court’s decision to end the practice of detaining patients in need of mental health care in emergency departments. Patients wait days, if not weeks, for a bed to become available.

According to the federal court ruling, the state has until May 2024 to provide psychiatric care within six hours to those who arrive at an emergency room.

“We are relieved; this came full circle,” said Cheryl Bailey, Dowling’s mother, who has worked as an emergency room technician and has seen rooms in hospitals fill to capacity, as well as patients treated in the hallways.

“ER boarding, it’s not good for the patient, it’s not good for the family, the staff, the security, the first responders. Nobody was benefiting from that,” she said.

The ACLU of New Hampshire filed a federal lawsuit in 2018 challenging the state’s treatment of involuntary emergency admissions, specifically the practice of holding individuals experiencing mental health crises in emergency departments.

Then, the New Hampshire Hospital Association — with several hospitals — intervened in the lawsuit, arguing that the state is unjustly seizing the hospitals’ property and demanding that these patients be immediately transferred to mental health treatment facilities.

While the Department of Health and Human Services notified the court that the state will end the practice, it sought a 2025 deadline and 12 hours to find a hospital bed for a patient stating a shortage of psychiatric hospital beds.

But it takes time to open new facilities, which was one of the main reasons for the request to push back the date.

The expansion of an addiction treatment center in Canterbury could be one of those facilities that helps ease the burden and lower emergency room wait times.

Granite Recovery Center, a provider of addiction treatment with facilities in Maine and New Hampshire, has launched a new residential treatment facility just north of Concord.

This facility is specifically designed to offer comprehensive mental health treatment to cater to the needs of individuals who are not only struggling with substance use disorder but also other mental illnesses.

Eric Ekberg, CEO of the company, said this initiative was pushed forward to ease some of the demands the state struggles to meet.

“We saw it as a way to just lead off with, how do we help the state? How do we take some of the burden out of the ERs out of the psychiatric units as a place to step people down?” said Ekberg. “The folks that come to us don’t meet the medical or psychiatric necessity to be in an inpatient acute setting. This is a step down from that as far as intensity.”

The facility aims to accommodate patients who seek direct access as well as those referred from emergency rooms.

Steve Ahnen, president of the New Hampshire Hospital Association, highlighted the importance of the specialized resources found in New Hampshire after his tour of the Canterbury facility. He said these resources play a vital role in supporting patients as they transition from an inpatient environment or, in some cases, even enabling them to avoid inpatient care entirely.

“We’ve been advocating for additional behavioral health and substance use disorder resources across the continuum of care, and Granite Recovery Centers’ residential treatment facility is a welcome addition,” Ahnen said.

Presently, there are 10 rooms for males and 10 rooms for females within the building. It is also equipped to accommodate between 25 and 30 patients in the recovery space for outpatient care.

As the state takes strides to address the mental health crises, Dowling finds solace and optimism for everyone affected.

With a positive outlook, he looks forward to his future visits to the emergency room, as he understands that his lifelong struggle with his condition will be met with the necessary support and care.

“I know eventually I’m gonna have to go back to the hospital,” said Dowling. “Just knowing that the healthcare system here in New Hampshire is improving and I’ll be able to just be there for a maximum of six hours and I’ll be going to where I can get help is just a huge sigh of relief.”

This article is being shared by partners in The Granite State News Collaborative. For more information, visit collaborativenh.org. 

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