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Hello and welcome to another episode of
the Disabilities Rights Center presents I'm your host Cindy Robertson
and today we're going to be talking about the crisis in New Hampshire mental health
services.
Our guest today here is
Amy Messer, Amy's the legal director at the Disabilities Rights Center so Amy
welcome to our show. Thank you.
Amy today we're gonna be talking about this topic because of
a lawsuit that was just recently filed against the State of New Hampshire because of
the mental health system
Could you just give us a little brief overview before we get
into the topic.
sure so about
a month ago in fact a month ago today
the Disabilities Rights Center along with
our partners filed a lawsuit in the federal district court
on behalf of
individuals with mental illness
due to really a lack of community-based services that was
causing people to be unnecessarily institutionalized
and one of the people that we'll hear from
now in fact
is one of our plaintiffs Mandy D.
hi
My name is Mandy
I'm 22 years old
and I have a mental illness
I've been in and out of hospitals more times than I can count
I would really like to stay out of the hospital
but sometimes I become so overwhelmed When I am in a crisis or I am feeling suicidal
the only way for me to get help is to go to the hospital
There are a lot of people like me
that need services
I believe that my greatest
need is to live more independently
right now I live in my Mom's house
If I had supportive housing
I'd have a good chance of living on my own,
be more independent, and
get the help I need
so I don't have to keep
going into the hospital
I did live in a group home for a while
run by a mental health center
and they closed it down
I was doing very well there
and I was very disappointed when they closed it down
I went from there into an apartment
of my own. But because
of no supports I had to move back in with my Mom.
I want people to see me not just my mental illness
Something that I say is my name is Mandy, not bipolar.
I'm an award winning poet taking an online course for a veterinary assistant.
If i could work
at a place that involved animals
with support I think I'd be able to be OK.
I would work and be effective
but without support
I don't think it's possible.
Just because we have a
mental illness doesn't make us any different
there's a lot of places out there that will continuously if you have cancer or something
because it's a disease
mental illness is a disease too
so you should give the same chance.
That was very interesting it's very moving to hear someone tell their own story from
that point of view
So we're going to talk about the lawsuit a little bit, we also want to sort of figure out
how it is that we came to where we are today and why you felt it was necessary to file
a lawsuit. So tell us a little bit more about thelawsuit.
well I mean what you heard from Mandy is
what she's experienced as a result of the
lack of community based services available to people
in their home communities that would allow them to be fully integrated
members of their communities
out, engaged in things that are so important to all of us
work and
independent living
and
what she experiences as a result of the lack of services is that she has had
multiple and repeated hospitalizations
both at New Hampshire Hospital the state psychiatric hospital but also many
many
hospitalizations, in emergency rooms and local community hospitals
and
what we've heard from people
all around the state
is that
the lack of community services has resulted both in
people being institutionalized long-term at New Hampshire Hospital
and also the Glencliff Home which we'll talk a little bit
more about today which is a state psychiatric nursing home
up in the north country
and also people who are continually revolving in-and-out of the hospital as
a result of
the unavailability of the kinds of services that would keep people out of
those institutions
So the lawsuit to was filed on behalf of, the class action in federal
court, on behalf of
all people with serious mental illness in New Hampshire who are
institutionalized at New Hampshire Hospital or the Glencliff home
or are at risk of
such institutionalization.
and its brought by the individual plaintiffs who are
represented by the Disabilities Rights Center
as well as
Devine Millimet & Branch a very large law firm here in the state of New Hampshire,
the Bazelon Center for Mental Health Law that specializes in
legal issues on behalf of people with mental illness, and the Center for Public
Representation which
also has a long history of
legal services to individuals with disabilities.
So, okay so the lawsuit gets filed but we need to find out how did
we end up where we are today with regard to mental health
services
that you've felt it was necessary to file a lawsuit Let's go back
and
I know at one time New Hampshire actually was exemplary in it's mental health
services.
So how did we get here?
Well New Hampshire was considered nationally considered a leader in
community-based services for individuals with disabilities
and in fact in the nineteen eighties
New Hampshire was recognized by the National Institute of Mental Health
as
a leader in community services.
Unfortunately
that leadership was short lived and while we had
worked towards closing the Laconia State School and ensuring
that community based services were available to people with developmental disabilities
and for some period of time downsized
New Hampshire Hospital
at some point in beginning in around the nineties,
actually late eighties we began to see a rise in institutionalization in
fact
in nineteen eighty nine we had about nine hundred admissions to the state
hospital
and by two thousand eleven we had twenty three hundred admissions to the
hospital each year
I'm sorry I should have said that in 1989 there were nine hundred
in that year and by two thousand eleven we had about twenty three hundred in
that year
so we could see
we can see the rise
of institutionalization as we
scaled back on community-based services.
And I know that in two thousand eight about four years ago there was what
was put together a ten year plan
sort of a strategy
paper how do we move forward in the next ten years and make the mental health
system better and what was the findings in the ten year plan? Right, well
before I talk about the ten year plan let me just say that
you know even earlier than that in two thousand and four and again in two
thousand seven then ultimately in two thousand and eight there were
reports and findings by the Department of Health and Human Services and the
legislature and task forces
that really looked at the mental health system saw that it was in
crisis
and really was reporting out on the significant needs within the
community
for improved services. So in two thousand eight there was
what the state calls its ten year plan
that described really the crisis that the mental health system
was in
is in, in New Hampshire
and recommended a number of measures that New Hampshire had to take
to insure that
people weren't unnecessarily institutionalized, to reduce the
unnecessary institutionalization, and to ensure that people had the
community-based serves as that they needed.
Unfortunately here we are four years later
and
those measures just haven't been implemented
and in two thousand and ten the Community Behavioral Health Association
came out with a report that talked about
The aspirations of the ten year plan and that in fact those measures had not been
implemented and again in fact this month
the Community Behavioral Health Association issued another report indicating that
those measures had not
been implemented as recommended by the ten year plan and the result of that is
that
individuals with mental illness
are suffering in our communities
and
the families are suffering in our communities as
the lack of services continues.
Because it
when people don't have community services that will allow them to remain in the community
burdens on other
agencies and other institutions like I know there is, the court ends
up
with a lot of people in the court system that probably shouldn't be there
the families have a lot of burden on them there's emergency room,
the hospitals are overburdened because they're expected to deal with
people that are in crisis if there's not room at New Hampshire Hospital. Are those
things that
have been shown as well?
Oh absolutely I mean
there's a lot of discussion about individuals ending up in
homelessness in homeless shelters as you've described in jails
and emergency rooms
and it is
very very difficult both on individuals with mental illness but also
their family members.
I believe we have a clip from Mandy's mother now.
My name is
Louise and I am
Mandy's Mom
I watch my daughter
missing life because she's not
getting the supports she needs
to stay out of the hospital, to get better. Right now her life
is her mental illness. As a mother there's nothing worse
than having nowhere to go to get the kind of help That your child needs. This lawsuit is
not just about the people with mental illness. It's also about the families.
There are no words to describe the stress that we go through as well.
I'm not professionally trained
I can't give her
the kind of mental health services that she needs.
I'm just her mother.
I have spent countless hours
in energency rooms and hospitals with my daughter.
I recently had to listen to her screaming
for over two hours in an
emergency room.
while she was suicidal.
For a mom
that's not an easy thing to go
through. An emergency room is a terrible place for a person
who is having a psychiatric crisis.
If we had been able to have a trained
mental health worker
come to our home, things wouldn't have
escalated to that point. But the mental health center does not
have the kinds of services Mandy needs to recover and to stay out of the hospital.
She only gets medications,
a little case management, and some counseling.
If she had a
community based
service
such as mobile crisis services, supportive housing
She wouldn't have to go through this. She wouldn't have to spend her time in and out of the hospital. She could lead a normal independent life
as other young women her age do.
She could be such a
productive member of society
if she only had the community-based services that she needs. Thank you.
That's a good example of it affects their families it can affect everybody in
society that that they deal with.
But you know we don't need we don't want to lose sight of the realities of
people in institutions and relay for our viewers you know what is it like to
be an institution? Why would they not want to be in there?
Right, well, um, I know you ask that knowing that in many ways that's
pretty evident why people don't want to be there but
you know i think
really
we can't forget that this is you know it shapes the entirety of
their life so
they lose all the freedoms that most of us take for granted everyday you
know where they'll sleep
who they'll share a room with
where they'll live you know how they'll spend their time and with whom
they'll spend their time because individuals in institutions are extremely
isolated I mean
you know for one thing those institutions more often than not are not
in their home communities
their families may have trouble getting there if they can't leave there
you know their
whole life is restricted in every way and for you know we're talking about
young people here
who have their whole life ahead of them who want to do the things that all
of us enjoy doing everyday recreational activities meaningful work
going out with friends
all of those things are taken away when people are institutionalized.
So let's talk about isolation and young people and tell us about Glencliff.
Right
so many people have never heard of Glencliff and Glencliff is an institution
here in New Hampshire it has a hundred and twenty beds
it's in a northern area of New Hampshire so again for most people that's
far from the communities that they came in
uh... came from
and
so Glencliff is far from where they
were originally living
very very isolated and you know
it's very very hard for even for family members to go visit there because
there is
not public transportation it is far away
and
what we've seen is that the age of individuals going there is less and less
is younger and younger
so
in two thousand and ten about twenty eight percent of all the people that
were sent to Glencliff were in their forties and fifties and Glencliff is
a nursing facility
for for people who are in their forties and fifties a nursing home
right it's shocking to hear that full twenty eight percent of
the admissions to a psychiatric nursing home
would be
people in their forties and fifties. I think the average person when you think
about nursing homes you think elderly
you know you think that'd where you're gonna put your elderly grandmother that's where you end up at
as a certain point you don't think OK I'm in my forties and in my fifties and
now I'm in a nursing facility.
That seems so strange and then what about leaving
getting out leaving the Glencliff what are the statistics on that? Right.
Very very few people ever leave Glencliff far more people die at Glencliff
every year than actually return to their communities
There were it with some statistics that we looked at around two
thousand and ten in the previous five years
only two people had returned
to their communities and nine had gone to other facilities so very
very few people actually returned to the community
from Glencliff
and if the community based services were available to them, these individuals
could be in their communities could live
full meaningful lives and that's what they want to do
and I think
you know the viewers need to know that oftentimes when if someone does
leave Glencliff the actually leave and go back to New Hampshire Hospital
or people leave New Hampshire Hospital and go to Glencliff and never leave Glencliff
it's basically one institution to another. Many many of the
admissions to the Glencliff home do come directly from New Hampshire
Hospital
uh... and there are people who are sometimes transferred down to New Hampshire
Hospital and back up to Glencliff
but for the most part people
go to Glencliff and
then they stay there.
Okay so
we're talking community services and we're talking institutional services and
there's always a cost issue.
Can you talk just a little bit about
what goes into consideration of the cost? Sure so
it's well-known that community-based services are
far more cost-effective than institutional care
so for example
New Hampshire Hospital right now
has somewhere around a hundred and fifty four beds and
the cost of those beds is about four hundred and thirty five thousand dollars
per year for one bed. One person costs thirty five thousand... One bed... right that...
and so
that money could be used
far more effectively
if it were utilized
in the community providing community-based services
and it could provide services to a much greater number of individuals.
So even if you took the exact same four hundred thirty five thousand dollars
and instead of
spending on New Hampshire Hospital We spent it in the community obviously
could serve more than one person. Oh absolutely you could serve a
significant number of people and
different people require sometimes different services
but there's no doubt that
that money utilized within the community system
would go a lot farther.
One of the attorneys who's working with me on this case and Steve
Schwartz from
the Center for Public Representation
was also at the press conference and he addressed the cost issue and we'd like to
hear from him now.
There's one principal that's important.
The federal government
shares the cost
of most community services.
It does not share the cost of state
hospitals. So the New Hampshire Hospital's budget is paid entirely by the taxpayers of New Hampshire.
out of what's called state only dollars.
Community mental health services is the other way
and when the federal government shares the cost,
they share at least fifty percent.
So for every dollar that's spent at
the New Hampshire State Hospital if you move the dollar into the community you would have two.
So Amy it's interesting when Steve says one dollar
spent at New Hampshire Hospital can actually be
two dollars
because of the match and it's definitely something that should be a consideration
because in addition to being
more beneficial for people
to make their lives more meaningful it also seems to be just a better deal
It is cost-effective and maybe i should tell you a little bit about some
of the services that we think that the state needs to put into
place to
serve people in the community so that they are not unnecessarily
institutionalized or cycling
in and out of
the hospital.
So supportive housing is something that is well-known nationally as an
effective
service
It provides both housing and the supports that a person needs
to be successful in their community and fully integrated in their
community. It is a treatment
modality and
so
New Hampshire clearly needs supportive housing if people are worried about
where they're gonna sleep at night and where they're gonna go
the next day
it makes it
incredibly difficult to
work on recovery
so it's a
critically important need. It is one of the things that was
cited in the ten year plan as something that is essential for new hampshire to
expand
were also looking at
New Hampshire needing assertive community treatment teams they should be
those are teams through the
mental health teams - otherwise known as ACT teams - right, assertive community treatment
otherwise known as ACT
and it is a multidisciplinary team of people
that work with individuals with mental illness
so it might include,
would include a psychiatrist,
nurse,
provide intensive case management
and provide the services
both that people need
to
have
again full meaningful integrated lives within the community but also be
available to people when they're having a crisis.
So rather than having
to go to a hospital
they contact their ACT team members who they know well
and
those ACT team members can meet them in their homes, in the community,
and is a well-known
practice
to
help avoid unnecessary hospital admissions and it's
been shown both here in New Hampshire and nationally to significantly reduce
the number of hospital bed days that people utilize.
So for example of that is if I have, let's say I have severe depression
and I'm having a really bad, it's two o'clock in the morning and I'm having a
really hard time I'm having suicidal thoughts
and instead of somebody taking me right now I might end up in New Hampshire
Hospital to treat, deal with that I can make a phone call to the ACT team and
they would either work with me on the phone or they would actually come to the
house it's twenty four seven - right - and worked me - I have somebody there
to help me through the crisis ends and then
hopefully I wouldn't have to go to New Hampshire Hospital.
That's correct
We talked about, you had mentioned that part of the lawsuit, there
are people who go in and out of New Hampshire Hospital not necessarily have been there
for long periods of time but we sort of call it the revolving door.
Statistically do we know, what are we talking about the
number of readmissions in a certain amount of time? Right well we do know that
the readmission rate for people who go
into New Hampshire Hospital are discharged from the hospital and then go
back
is very very high
much higher than the national average
So
one of the things that would
stop that would be something like the assertive community treatment teams, ACT,
We're also looking for mobile crisis intervention
which would also be able to address people's crisis needs. It's a
shorter term intervention than ACT but also very very effective
in keeping people out of hospitals
and finally supported employment I mean
you know in employment is such an important way that people
spend their time
are productive members of the society and of course gain income to support
themselves and that is another
critical
treatment need that we're not just not meeting in the community.
Right I think anybody who knows employment does so much just for your
own self-worth
and your own value you know people with mental health issues deal with, a lot of them struggle
with that anyway and so it's certainly a nice complement it's
another way to help them feel valuable to the community and part of it.
I also know that the United States Department of Justice
also had come into New Hampshire and done an investigation
and tell us a little bit about that.
Right so our plaintiffs and
counsel are not the only ones who recognize this
problem in New Hampshire.
In addition to the work and investigation that we've done the United
States Department of Justice did their own investigation
and similarly recognized that
New Hampshire is violating the Americans with Disabilities Act and
the Rehabilitation Act some federal laws
to ensure that people aren't unnecessarily segregated
and
after their review they too issued a very lengthy findings letter
on their investigation
finding that New Hampshire is not in compliance with those federal laws.
So the lawsuit isn't
just you know a bunch of attorneys sitting around saying i think they need to do
this it is actually based on federal law and they've been found to have violated
federal law.
That's correct the United States Department of Justice has issued
findings to that effect
and I think you know we see there are newspapers every day we hear it from the
people that we meet
our neighbors
people are really really
feeling the impact of the lack of available services
in New Hampshire for people with mental illness so
the time has come I mean people are really suffering
people should not be unnecessarily segregated and institutionalized
and
you know we are hopeful that this will bring about the change that New
Hampshire desperately needs.
And since 2008
the last four years they've known about it and it just doesn't seem to be going
anywhere
that's right and - it might even be worse -
I think the situation is worsening, we are hearing
a lot from
hospitals and what's happening in emergency rooms we're hearing from more
and more people within these
institutional settings that want to be back in their communities back at home
and are not having
there simply isn't an opportunity for them to do that and
its time
for us to make these changes in fact I've met and spoken to many many
many people who
are in these institutions
and you know they are really
really waiting for this change to come so that they can
what they see as begin their life.
Amy, it's very interesting we're getting ready at the end of our show here
we really appreciate your coming on and taking the time today.
We're all going to be watching and see how this
how this plays out. To end it,
we want to show another clip of the at the press conference about a
gentleman you met up at Glencliff when you went up there.
So thank you very much. Thank you.
Let me just also say
when I
I went up to Glencliff many times and have spoken to many people there
and on one visit, in fact when I met Ken R,
I walked in the door of the Glencliff home and there he was sitting i nhis wheelchair
and he looked up and said Can you get me out of here?
There are people there who very clearly want to leave
I think sometimes family
is concerned about their loved one returning to the community because their experience has been
years of people living in the community
perhaps
without the supports they need
to keep them safe and to give them a meaningful life.
and the supports that we're seeking from the state today would give them
the kind of health and mental health and supportive services needed to successfully live in the community
which may very well have not been
what they received prior to going home.