Federal money could be key to building new Secure Psychiatric Unit

A prison fence with a sign for the Secure Psychiatric Unit
The Secure Psychiatric Unit was moved from the state hospital grounds to inside the prison in 1985. (Dave Cummings | New Hampshire Bulletin)

The $17.25 million Gov. Chris Sununu wanted for a new 60-bed Secure Psychiatric Unit was axed from the House budget. But the chairman of a House finance committee knows where he might find it: the state’s nearly $1 billion in federal pandemic relief money.

Rep. Jess Edwards, an Auburn Republican who chairs House Finance Committee Division III, floated the idea in a letter to the Senate Finance Committee. The federal aid may not cover a new forensic unit, he wrote, but it does cover water, sewer, and broadband investments. Move those infrastructure investments to the federal aid wishlist, and there would be money in the state budget for a new Secure Psychiatric Unit, which houses people with mental illness who pose a serious danger to themselves or others. 

“The state CANNOT afford to bond $25 – $40 (million),” Edwards wrote. In an interview Monday, Edwards said the committee also cut the Secure Psychiatric Unit from its budget because it had too many questions about its location, patient population, and size. There has also been debate about who’d manage: a private company or the state.

The Senate Finance Committee is still working on its budget, but federal dollars is something Sununu contemplated in his proposed budget. He hoped to find the $17.25 million within federal pandemic aid if it became available by the end of the year. If not, he directed that money to come from state dollars.

The money would be added to the $8.75 million approved last year for a 25-bed facility in a compromise between Sununu and the Legislature. Current plans call for it to sit on the state hospital grounds in Concord, a neighborhood location Deputy City Manager for Development Carlos Baia told lawmakers the city opposes.

“Right now, in this city, we have a state prison, a women’s prison, a state hospital – a lot of state institutions in this community,” Baia said in an interview Monday. “Now the state is looking to local a facility that is functioning as a hospital, but for all intents and purposes, looks like a prison.”

The Secure Psychiatric Unit was moved from the state hospital grounds to inside the prison in 1985, a location that allows a team of psychiatrists, clinicians, and nurses to provide mental and physical health care and occupational therapy with the protection of prison-level security, said Tina Thurber, Department of Corrections spokeswoman.

A new unit would be under the oversight of the state Department of Health and Human Services. In the 2019 budget talks, Democrats insisted it be managed by the state, not a private operator. Pending legislation, Senate Bill 156 would prohibit the state from contracting with a private company to build or operate a new forensic hospital, but there was a question at the bill’s public hearing on whether the state could contract with an outside provider for psychiatric services.

The 66-bed unit for men and women is used by jail and prison inmates, people involuntarily committed by a court to a psychiatric hospital, and individuals with developmental disabilities who require intervention for extreme dangerousness. On Monday, there were 58 people there, 35 of them serving sentences and the rest held under the state’s civil commitment law. (The same law is used to involuntarily commit people in a mental health crisis to the state hospital who are not identified as dangerous.)

There’s been widespread agreement that those in the latter group should be treated in a hospital setting, not in a prison. Lawmakers, mental health advocates, and state officials have tried to agree on a new space with the appropriate level of care and security. Disagreements over funding, location, and size have stalled each attempt – and are obstacles now.

Should the unit be small enough to house only those currently at the prison or big enough to relocate some people from the state hospital, thereby freeing up beds for the adults and children who sometimes wait days in emergency rooms for a bed? On Monday, that count was 42 adults and 25 children

“If you are going to go with a new building, just for forensic patients . . . our position is that it should be big enough to take care of civil patients at the Secure Psychiatric Unit and no bigger,” said Mike Skibbie, policy director at the Disabilities Rights Center-New Hampshire. Based on census numbers from the Department of Corrections, a 25-bed unit would provide more than enough beds for that group. 

Sen. Cindy Rosenwald, a Nashua Democrat, agrees. She said housing someone in the proposed Secure Psychiatric Unit on hospital grounds would cost $3,000 a day, twice the cost of a New Hampshire Hospital bed.

Kibbie has argued against the larger 60-bed proposal and favors instead solving the capacity problem by building transitional housing for New Hampshire Hospital patients who are well enough to be discharged but still need treatment. Insufficient transitional housing options are one of the main reasons people who can be discharged aren’t. 

The $8.75 million in the 2019 compromise remains available but falls far short of what the state would need to build a 25-bed or 60-bed unit. Rosenwald is concerned that there is no money in the budget to run a new unit, which she said the state Department of Health and Human Services has estimated to be $27 million and $50 million, respectively. 

Sununu, who issued an executive order Thursday calling for more mental health services, said he remains committed to the larger forensic hospital.

“I support building a new SPU because the stakes are too high not to act,” he said Monday. “When I proposed a transformative facility in 2019, the Democrats dramatically underfunded these costs during budget negotiations during the last budget cycle. Now, we are moving forward full steam ahead so that we can stand up a facility to help our most vulnerable citizens get the mental health care they deserve.”