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Letter to Nicholas Toumpas, Commissioner Health and Human Services - Implementing New Hampshire's 10-Year Mental Health Program


Location: Concord, NH

Dear Commissioner Toumpas:

We share a concern for the care and treatment of our New Hampshire citizens suffering from acute mental illness. New Hampshire is moving ahead with implementing the state's 10-year mental health plan in an effort to address one of our most pressing public health challenges: the need to restore our mental health system. The safety of the public and the health and well-being of individual citizens depend upon our efforts, as well as the efforts of our mental health professionals.

The Department recently opened new beds at the State Hospital and opened a designated receiving facility (DRF) in Franklin, NH. It is also working to expand Assertive Community Treatment Teams throughout the state, making more emergency services beds available and expanding community mental health services. However, even these changes do not appear to be alleviating the wait for beds or the crisis in our emergency rooms.

The recent incidents involving patients at the Elliot Health System raise serious concerns and questions about how we are using our existing mental health beds and resources.

To help review these questions, I have asked former Supreme Court Justice Joseph Nadeau to lead a Sentinel Event Review team that will look at both these individual incidents, but also the broader questions they raise. Justice Nadeau will be supported in this effort by Dr. Alexander P. de Nesnera, from the Geisel School of Medicine and the Associate Medical Director of the New Hampshire Hospital, and Senior Assistant Attorney General Michael Brown.

I am directing the review team to consider the following issues concerning both the patient incidents at the Elliot DRF and the patients awaiting care in other emergency rooms:

1) What acuity of patients can and should be treated in the state's continuum of mental health facilities, including community-based services, the Cypress Center, Designated Receiving Facilities, and New Hampshire Hospital?
2) What is our methodology and system for triaging psychiatric emergencies to ensure patients are receiving the appropriate level of care? Is the triage system working? Can it and should it be improved?
3) Are any of the patients who are experiencing acute psychiatric distress at local hospital emergency rooms currently receiving treatment in the community?
4) What environmental/clinical circumstances are leading to the rise in the number of patients experiencing acute psychiatric distress in our emergency rooms?
5) What level of training is provided to staff of local hospital emergency rooms regarding treatment of acute psychiatric distress, including management of the range of behavioral manifestations that such patients can exhibit?
6) Why has the waiting time for transfers to appropriate level of care increased?
7) What action steps are necessary to minimize risk of harm to patients and staff at all of New Hampshire's health care facilities?

We can all agree that our mental health system is deeply strained. We recognize that we will not address all of our challenges at once, and that the significant investment we are making in this biennium is the beginning of the process. But we must continually address and consider what is happening on the ground in our communities, and this review will be an important step in those efforts.
Thank you for your efforts and for this important review.

With every good wish,

Margaret Wood Hassan,

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