Originally published in the December 12, 2011 issue of Mental Health Weekly, available electronically to subscribers at publication. In the first official response to the U.S. Department of Justice (DOJ) about allegations of violating the Americans with Disabilities Act (ADA), New Hampshire’s attorney general and the Health and Human Services commissioner last week sent a letter to DOJ saying they disagreed with the findings and that they are already working to implement changes to its mental health system.
In a Dec. 6 letter, New Hampshire Attorney General Michael Delaney and the state Health and Human Services Commissioner Nick Toumpas, said the state has made “significant progress” in its 10-year plan to expand a series of services and programs designed to enhance community integration, citing the development of Assertive Community Treatment (ACT) teams and development of a community psychiatry program.
State officials were responding to the DOJ’s report in April of New Hampshire’s mental health system, referred to as in “crisis.” U.S. Assistant Attorney General Thomas Perez, who issued the report, noted that the state’s decline in recent years had led to unnecessary institutionalization for persons with mental illness (see MHW, May 2, 2011).
State officials noted in its letter to Assistant Attorney General Thomas E. Perez that they deferred submission of a written response last April due to ongoing discussions with DOJ. Kris Neilsen, spokesperson for New Hampshire’s Department of Health and Human Services (DHHS), told MHW that all calls regarding the DOJ response should be directed to the attorney general’s office. Calls to Delaney’s office were not returned.
In the April letter to state officials, the DOJ chided the state for “needless and prolonged institution-alization of individuals with disabilities who could be served in more integrated settings in the community with adequate services and supports.” In spite of a challenging fiscal environment, the state has continued to fund costly institutional care at New Hampshire Hospital (NHH), the state psychiatric hospital and Glencliff, a long-term care nursing home facility, the report stated.
In last week’s letter, Delaney and Toumpas said they disagreed with the allegations that it is violating the ADA and said the state’s system of community-based mental health services fully complies with the ADA and Olmstead. The state’s 10 community mental health centers are in the process of implementing Electronic Medical Records, according to the letter. Additionally, the state’s Bureau of Behavioral Health is working with NHH to develop a community psychiatry program to expand access to psychiatry services at the community mental health centers, particularly in the area of child psychiatry services, they wrote.
The DOJ had also threatened litigation against the state for its alleged violations. “We urge the U.S. DOJ to withdraw its erroneous findings and allow New Hampshire to continue its implementation of the ten-year plan without the distraction and expense of needless litigation,” officials concluded.
Advocates weigh in
Amy Messler, legal director of the Disability Rights Center in Concord, N.H., said advocates agree with the DOJ’s assessment of the state’s mental health system. The readmission rate to New Hampshire Hospital within 180 days of discharge is close to twice the national average, Messler said. “In 2010, the readmission rate was 36 percent,” Messler told MHW.
In 2010, two-thirds of the admissions to GlenCliff were for people 64 years or younger, including individuals were in their 40s and 50s, Messler said about the facility that houses people with mental illness and developmental disabilities. The nursing facility is located in an isolated part of the state with no public transportation or services for discharging patients back into local communities, she said.
Messler added, “Most of the people are actually spending the rest of their lives there.”
The budget for NHH for FY 2012 is $67 million, Messler said. It costs the state $474,000 annually per bed, she noted. “Institutional care is the most costly form of care,” Messler said. “Money can and should be reallocated to serve individuals in the community.”
Disability Rights Center had also conducted its own assessment of the state’s mental health system last November, said Messler. The investigation included the support of the Judge David L. Bazelon Center for Mental Health Law, the Northampton, Mass-based Center for Public Representation, and Devine, Milliment and Branch, a local law firm. “Our findings pointed to a violation of the law as well,” she said.
The state has not formally responded the letter submitted by the Disability Rights Center, which has not been made publicly available, said Messler. “We have made efforts to resolve these issues with the state with no resolution to date,” she said. “We’re looking at all avenues, including litigation if necessary.”
During the 1990s New Hampshire had been rated number one in the country for mental health services, said Ken Norton, executive director of the New Hampshire National Alliance on Mental Illness (NAMI). “The state was a pioneer in mental health services,” Norton told MHW. The state’s community-based system has been greatly impacted by the economic crisis, he said.
Advocates have seen a reduction in private hospital beds and in supported housing, said Norton. “That places a lot of stress on the system as a whole,” he said. These issues, no doubt, inform concerns expressed in the DOJ letter, Norton added.
Discussions meanwhile between state officials, DOJ and legal advocates aren’t moving forward, said Norton. “That’s disappointing,” he said. “NAMI is concerned about the state’s ability to [implement] its 10-year plan, given the continued reductions in funding.”
The New Hampshire Community Behavioral Health Association (NHCBHA), which represents the state’s 10 community mental health agencies, on Dec. 6 issued its own response to the attorney general’s letter to the DOJ. Roland Lamy, executive director of the association, said he believes that the DOJ report and the state’s response to it comprise a very serious matter.
Lamy said the state has made some small progress on its 10 year plan since it first released it more than three years ago. However, since that time, millions of state and federal dollars have been cut from the system, enrollment has increased, access to community and inpatient beds has decreased, and the day to day state of the system remains in crisis, Lamy wrote.