How NH’s housing crisis is linked to availability of beds at psychiatric hospitals

Without adequate housing supply, transitional programs are stretched thin
Paul Dann

Paul Dann is executive director of NFI North, which provides transitional housing throughout the state.

With limited affordable housing and rental options, the current housing shortage in New Hampshire is felt across the state. And with it comes a domino effect that extends all the way to New Hampshire Hospital.

For some individuals who leave Concord’s acute psychiatric hospital, a transitional housing program can be the first step on a sustainable path to recovery. Transitional housing provides support, through case management, to help reintegrate people back into their community, with plans in place for medication, jobs and housing.

But without ample housing, these programs quickly find themselves at capacity.

This can mean that for current New Hampshire Hospital residents who want to be discharged into these supportive services, a bed isn’t available for them to do so, extending their stay in the state facility, which only adds to the bed shortage. When there is not a stable flow of residents out of the hospital and into transitional housing, and then out of transitional housing and into their community, a backlog begins.

“The system can get very backed up very quickly, if there’s not appropriate places for people to transition out to,” said Paul Dann, the executive director of NFI North, which provides transitional housing throughout the state.

With Gov. Chris Sununu calling on hospitals to increase the number of emergency psychiatric hospital beds, expanding the state’s current transitional housing program may offer a similar reprieve, providers say.

Benefits of transitional housing

On New Year’s Eve in 2011, Dann and his team from NFI North were at the state hospital. When the clock struck midnight in New Hampshire, NFI North officially took over a residential treatment program on the hospital grounds.

“We took the keys and ran the program. And what’s been remarkable during this time is the way that we’ve been able to help those people that were there,” he said.

The transitional housing program NFI North provides is a temporary residential setting for people who are discharged from New Hampshire Hospital. In living in the transitional housing program, the hope is that with case management services, residents will be successful when they reintegrate into their community.

This case management can include medication management, individual and group counseling and help in finding employment and their own housing. Peer support, where people with lived experience help residents in their transition, is also offered through a contract with New Hampshire National Alliance on Mental Illness.

“Some folks are at a place where they really can participate in group therapy and or support groups and find real benefit from that. Other folks, maybe they’re not there yet,” said Susan Sterns, the executive director for NAMI in New Hampshire. “And certainly the piece of accompanying folks to events in the community, and assisting them with determining if and when they’re ready, where they want to transition to. So it really is based on the individual needs.”

Typically, individuals stay 14 to 16 months before moving out. But again, it’s a case-by-case determination.

“We’re able to fulfill our mission of helping them reach their potential, live in their own home and community, inspiring them along the way,” said Dann.

These supportive models follow a similar approach taken by service providers in the state working with people experiencing homelessness, where housing is the first priority, and then from there, residents can succeed with other assistance.

Based on the success of the initial program in Concord, which houses 40 residents across six houses, NFI North contracted with the state to expand. Over the past decade, they’ve opened transitional housing programs in Bradford, Bethlehem, Ashland and Manchester, as well.

Across their five programs, they serve 76 residents statewide.

In 2020, the Department of Health and Human Services also opened the Philbrook Adult Transitional Housing, a 16-bed program where residents stay an average of 90 days.

But demand for the program far exceeds available beds. Expanding transitional housing options could help thin out the waiting lists.

Connected crisis

Two items in the governor’s biennial budget signal states of crisis in New Hampshire – funds to address the affordable housing shortage and a call on state hospitals to provide more emergency psychiatric beds.

And in his State of the State address, Sununu provided a clear connection between the two.

“We have folks in New Hampshire Hospital right now that should be discharged, but we have nowhere to discharge them,” he said. “We have a lack of housing, which is why I’m so adamant about creating more housing. We have a lack of the transitional housing … But if you can get them into that transition, the bed opens up.”

Currently, across the state not only are transitional housing programs at capacity, but the availability of emergency psychiatric beds in the hospital is in the single digits due to a backlog of discharging residents, he said.

“We have folks unfortunately that New Hampshire Hospital is almost like an apartment for some of them, because we were having so much trouble getting them out of the system,” said Sununu.

As of March 31, nine out of the 231 total beds across the state are available. Six of these are at the Cypress Center and two are at Elliot Hospital, both in Manchester, while the final bed is at the Parkland Emotional Wellness Unit in Derry.

And with the limited number of available beds, state leaders are not only calling on hospitals to provide more options, but also drawing a clear connection to the lack of housing in the state currently.

“We have 60 patients who could probably leave the hospital. If we had those 60 patients leave and have a place to go, the waitlist would be zero,” said DHHS Commissioner Lori Weaver, at an Executive Council meeting in March.

Currently, statewide, the rental vacancy shortage lingers at 0.5% for all units. With limited apartments available, it is a near impossible task to find an available unit for someone leaving New Hampshire Hospital.

“It’s so important for us to name and know the problem. It’s really hard to address it. So kudos to Commissioner Weaver and her staff that they are laying out the dimensions of the problem so that we can all come together and try and work on a solution,” said Sterns.

Instead of expanding the number of emergency beds available, these intermittent programs like transitional programs, could provide a way to still allow residents to leave the facility and move into a residential setting.

“The answer isn’t just building those beds,” said Sterns. “The answer is always other beds that either help people leave the designated receiving facility beds and also help prevent people from needing the designated receiving facility beds.”

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