Sununu issues ultimatum in mental health crisis

Gov. Chris Sununu warned the state’s hospitals and mental health centers Thursday he will replace them with private providers if their patients continue languishing in emergency rooms without timely treatment. Sununu issued a new executive order giving the state Department of Health and Human Services sweeping authority to assess the system and make changes where needed.

“I just don’t accept folks in that field saying, ‘Not our problem, not our fault, not our issue,’” Sununu said Thursday. “We’ve heard that too much. And I’m not calling out names. I’m not calling out specific individuals, but there are groups out there in all aspects of our services where we just hear that a little too often. And so this executive order says, you have to be part of the solution.”

Sununu said the state is opening more beds at New Hampshire Hospital, increasing the number of “designated receiving facilities” that, like New Hampshire Hospital, offer inpatient psychiatric care. He said he has asked the Legislature for more money to make some of these changes. He will also look at “stipends or enhancements” to interest current providers or outside agencies to increase mental health services. 

In written statements issued after Sununu’s announcement, the New Hampshire Hospital Association and the New Hampshire Community Behavioral Health Association said they are ready to partner with the state – with adequate funding. It’s what both have told the state for years; the question now will be whether this round of conversations leads to a different outcome. 

“We agree with the governor’s observation that the decision emphasizes that we must address our mental health crisis, now, and together, at the community level,” said Jay Couture, president of the behavioral health association. “The 10 nonprofit centers and their boards of directors have steadfastly advocated for adequate and sustained funding for the community-based system, for years, and will continue to do so.”

Steve Ahnen, president of the hospital association, said the ER boarding crisis is a symptom of a long-standing problem: “(One) of not having adequate capacity across our entire mental health care system – from outpatient services, crisis services, acute inpatient services, transitional housing, and other community support services that support patients no longer in crisis.”  

Sununu’s announcement came three days after the state Supreme Court ruled against the state, saying it can no longer detain mental health patients indefinitely in emergency rooms without giving them a hearing within three days to challenge their hospitalization. A shortage of psychiatric hospital beds means some adults and children wait days or weeks for care. (Thursday, 33 adults and 25 children were waiting in emergency rooms.) The dispute came down to responsibility: The state said it belonged to hospitals. The hospitals put it back on the state. 

Rather than appeal the ruling, Sununu said he and DHHS are “embracing” it.

In his weekly press conference Thursday, Sununu did not hide his frustration with what he called a broken mental health system. Several hospitals have closed their psychiatry wings in recent years, citing inadequate reimbursement rates paid by commercial insurers and Medicaid. The community mental health centers, like health care agencies across the state, have struggled to hire enough workers. There are nearly 200 vacancies among the 10 centers. COVID-19 has brought spikes in mental health needs, especially among children and young adults. 

“Despite the traditional obstacles that have been in the way, some of these obstacles have been there for decades,” Sununu said. “And we’re really just not putting up with that anymore.”

He added:  “We’re telling the hospitals, ‘You have to provide the services or have an agreement with the local community health community mental health centers,’” Sununu said. “There’s so many mental health centers in the state that are doing phenomenal jobs, they do a great job. There are some that simply don’t. And for those that don’t, I’m more than happy to go find other providers who will do it.”

Ken Norton, executive director of the New Hampshire chapter of the National Alliance of Mental Illness, welcomed the governor’s directives. 

“The governor is correct. There needs to be more accountability within the system,” he said. That requires insurance providers paying the same rates for mental and physical health care; community mental health centers starting the statewide mobile crisis center proposed years ago; and hospitals offering inpatient psychiatric care. 

“If there were a simple solution, we probably would have done it a while ago,” Norton said. “There’s been a tremendous good-faith effort from a lot of people over the years. Lots of good intentions. It hasn’t necessarily provided all of the outcomes all of us had hoped.”