New dashboard tracks mental health performance in New Hampshire, spotlighting the need for more systemic improvements

DHHS Dashboard that focuses on emergency department boarding challenges

DHHS Dashboard that focuses on emergency department boarding challenges

By SRUTHI GOPALAKRISHNAN

Monitor staff

Published: 10-03-2024 5:01 PM

The wait time across the state for inpatient psychiatric beds in emergency rooms has consistently remained under five days since January. This sign of improvement is one of the many metrics the state is now tracking more comprehensively with the launch of a new dashboard aimed at enhancing its mental health system.

Morissa Henn, deputy commissioner of the state’s health and human services, described the dashboard as a pivotal element of Mission Zero, an initiative focused on reducing emergency department boarding in New Hampshire.

The dashboard tracks prevention, access, inpatient care and discharge barriers in the state’s mental health system and is a collaborative effort among various stakeholders, including the New Hampshire Alliance on Mental Health, the New Hampshire Hospital Association, community organizations and others.

“We want to be able to look at the data to see how are we performing as a system that is made up of many moving parts,” said Henn. “I think just the launch of the dashboard is such a huge milestone for being able to look at this problem holistically and analytically together.”

One limitation is the data focuses solely on adults, leaving a gap in understanding the experiences of younger patients.

While waiting times have generally decreased from what previously was a week or two, Susan Stearns said the process still isn’t moving as quickly as it should. But she is pleased that the state is moving in the right direction.

“My opinion is that it should be as quick as possible and we should be talking hours versus days,” said Stearns, the executive director of NAMI NH. ” I also recognize it took us over a decade to get here.”

The challenges within New Hampshire’s mental health system date back are deeply entrenched.

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Psychiatric facilities designated for involuntary patients by the state struggle with a shortage of beds, while many of the patients who are stable and ready for discharge remain stuck in the system due to the scarcity of transitional housing or step-down facilities.

At New Hampshire Hospital in Concord alone, at least 70 patients on average remain in limbo — medically stable but unable to be discharged due to the overwhelming shortage of appropriate housing options across the state.

Ellen LaPointe, the chief executive officer of New Hampshire Hospital, said that the diverse needs of individuals at the hospital make it challenging to determine the specific types and amounts of housing required across the state.

“We are working on trying to find better ways to assess that, not only from a New Hampshire Hospital perspective but also a statewide perspective,” said LaPointe. “It’s really been about incremental gains and trying to make progress in the long run.”

Inpatient psychiatric bed wait times
Infogram

Through the Mission Zero initiative that was launched in May 2023 to eliminate emergency room psychiatric boarding, the state expects to transition 25 patients at the state hospital to supportive housing by the end of the year. Currently, five patients have successfully been discharged from the hospital and placed in transitional housing. Six more have completed their applications and are waiting for approval.

Prior to 2024, the state did not track how long patients waited in emergency rooms for an inpatient bed at a psychiatric hospital to become available.

However, NAMI NH has been closely monitoring a different figure: the daily number of patients waiting for beds, which remains a critical issue for their mission and the people they serve, according to Stearns.

Over the past three years, an average of 24 patients — both adults and children — have been waiting each day in emergency departments for these beds. This year, this number surged, reaching as high as 50 patients on a single day.

“For over a decade we have heard directly from folks about the negative impact ED boarding had upon them and their families – delaying lifesaving treatment and increasing risk for patients and ED staff,” said Stearns.

Apart from the long waiting times in emergency rooms, the state’s new data portal reveals that the Rapid Response Access Point helpline, launched in January 2022, has successfully diverted several New Hampshire residents from emergency visits.

This helpline provides 24/7 support for individuals experiencing a mental health crisis or substance use disorder, allowing them to call, text, or chat for assistance.

Each month, between 1,500 and 2,000 residents who reach out to the helpline are referred to community organizations and others, while many situations are de-escalated, ensuring individuals do not need to be sent to emergency rooms or other inpatient facilities.

“It’s exciting to have New Hampshire be at the forefront of what is happening nationally to strengthen crisis systems to meet people much more early than waiting for things to get worse and for them to need care in a more intensive setting,” said Henn. “I think just the volume of service is pr etty remarkable.”