CONCORD – In a landmark decision released Tuesday, the New Hampshire Supreme Court ruled that people with mental health crises who are involuntarily detained in hospital emergency rooms must be given due due process in a timely manner. According to the ruling, court hearings must take place within 72 hours of arrival.
The decision culminates in the ‘Jane Doe’ lawsuit against the state Department of Health and Human Services, brought by a woman who was held against her will for 17 days in August 2020 in the emergency room at Dartmouth Hospital. Hitchcock. The process is known as psychiatric pension, being detained without access to a lawyer or the ability to challenge the suspension.
“I am certainly delighted that the court has made its decision,” said Gary Apfel, the woman’s lawyer, whose name is protected for reasons of confidentiality. “What this case means is that people can no longer be held in emergency rooms while the state determines what to do.”
The ruling forces the state to make changes to ensure people in mental health crisis receive timely mental health care, Apfel said.
Apfel said these changes could include more beds at the New Hampshire Hospital, State Mental Hospital and other hospitals, additional state resources dedicated to moving patients to settings faster. and community-based treatment options, more mobile crisis teams throughout the state, more assertive community treatment teams to respond locally, more funding to expand services in state community mental health centers and planning transition for patients leaving the NH hospital.
Ken Norton, director of NAMI-NH, the national chapter of the National Alliance on Mental Illness, said stakeholders, including Governor Chris Sununu, plan to meet next week and will likely address responses to this. decision.
Norton said he hopes the move will force changes in what has become the involuntary admission process over the past eight or nine years. “I hope this will bring us back to greater progress in ensuring people with mental health emergencies have urgent access to mental health treatment.
This goal led to the creation of mobile crisis response units in 2014 in Concord, Manchester and Nashua that travel to respond to people with mental health crises wherever they are. If created statewide, they could mitigate crises before people go to the emergency room, where they are held until they can be transferred elsewhere for treatment, or eventually released back into the community. with follow-up care options. It is a system bogged down by the lack of sufficient resources. This clogs the system, blocks treatment and often results in a revolving door of emergency room admissions with no solutions for people with severe and chronic mental illness.
“NAMI-NH doesn’t want to see people who have been determined to be a danger to themselves or to others released prematurely,” Norton said. The state currently has four designated reception facilities, hospital units that provide short-term treatment of up to 10 days to people with mental illness transferred from emergency departments. They are located at Franklin Regional Hospital, Parkland Hospital in Derry, Portsmouth Hospital and Elliott Hospital in Manchester. Patients can also be referred to Hampstead Hospital, NH Hospital or the Cypress Center in Manchester for stabilization and hospital care. The problem that exploded for many years was finding beds available in appropriate treatment programs.
Before the court ruling, “people only got there after being detained in the emergency room after X days” – which NAMI says violates the intent of the law, which requires prompt treatment for those in need. mental health crisis, Norton said.
“NAMI-NH believes that the responsibility for the treatment and care of people with serious mental illnesses rests not only with the state of New Hampshire, but also with hospitals and health insurance. It is a systemic problem. We all need to put our heads together – the governor, the legislature, the courts, the DHHS and the hospitals. It focuses us to do it and speeds up the process, ”Norton said.
In a statement prepared Tuesday, Steve Ahnen, president of the New Hampshire Hospital Association, said, “We are pleased with today’s Supreme Court ruling. The court made it clear that when a patient goes through a mental health crisis and receives an involuntary emergency admission designation (a procedure that requires a notarized declaration of need and urgency, usually by family members or guardians), that patient should be immediately transferred to the appropriate setting to receive the specialized care and due process they need and deserve. “
Ahnen said the NHHA will work with state leaders to ensure the decision is implemented and the needs of mental health patients in crisis and their families are met.
Apfel said a pilot program to better address this issue had been launched at four New Hampshire hospitals, but was halted in November, for reasons that remain unclear, but likely related to lack of staff or space. sufficient.
“The ultimate need is for more community services,” starting with statewide mobile units, Norton said. “Locally and nationally, they’ve been shown to turn people away from hospitalization as well as law enforcement,” Norton said.
The ruling may impact the 2018 American Civil Liberties Union lawsuit pending in federal district court, brought on behalf of those detained without due process in a timely manner.
In April 2020, a federal judge ruled that the 72-hour deadline for due process and a hearing begins when a patient is involuntarily admitted to the emergency room. “The state has not fully complied and we continue to argue the case,” said Gilles Bissonnette, legal director for the ACLU of New Hampshire.
“Today’s landmark decision is a major victory for the defense of mental health: it recognizes that people in hospital emergency rooms are human beings entitled to expeditious due process,” said Bissonnette in an ACLU-NH press release. “For too long, the lack of community-based mental health treatment options has meant that some people, including our clients, have been held without probable cause for weeks in emergency room hearings, without access to a lawyer appointed by the State or without the possibility of doing so. timely challenge their detention ”, which has resulted in patients being separated from work and their families for unnecessary periods.
Bissonette said Tuesday’s state Supreme Court ruling will “have a significant impact” on the ACLU class action lawsuit, depending on whether the state complies with it.
“Our position is that the state must take immediate action to comply with this order. From our point of view, the state has already had ample time. Two judges agree with our interpretation, ”said Bissonnette. “If not, we will argue that it violates the Federal Constitution.”
He said there are streamlined and proven effective ways to ensure expeditious due process, including by videoconference or transfer to a nearby location for the hearing.
“There are solutions. What we need is the will to do it, ”said Bissonnette. “We cannot have the situation that we had for eight years, namely people detained for weeks without due process.”
“We are currently reviewing the decision and are working with our legal counsel to determine how to comply with the court’s opinion,” said Jake Leon, DHHS director of communications.
“We are reviewing the decision and will help our clients comply with their obligations under the law,” said Anthony Galdieri, senior assistant attorney general, civil office, at the New Hampshire Department of Justice.
Advocates for people with mental illness are optimistic about forcing the state and providers to act.
“The state knows how to solve the problem that too many people with mental illness end up in emergency rooms,” said Pamela Phelan, director of litigation at Disability Rights Center NH. “We’ve seen what services and supports are working, including mobile crisis teams, dynamic community treatment and other community services. We also know that safe housing enables people with mental illness to live stable lives in their communities.
The Sunshine Project is funded by grants from the Endowment for Health, New Hampshire’s largest health foundation, and the New Hampshire Charitable Foundation.