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In the last six to 12 months, the state of New Hampshire has not
lost any mental health beds.
That sounds like good news and it is, but the story goes deeper.
At this time one year ago, a study conducted by the state's Department
of Health and Human Services (DHHS) found that during the two prior
years, the state had lost 116 beds.
"We lost a variety of acute care beds, both hospital and non-hospital
based," says Geoff Souther, acting director of the DHHS Division
of Behavioral Health, "just none of them in the last six months."
Souther pointed to financial shortfalls as the reason for the reduction
in beds. In both private and public facilities, medical insurances
generally don't reimburse the full cost of care, leaving the hospital
or other program to make up the shortfall. In many cases, they can't
and the programs cannot support themselves.
The state's Medicaid rates are part of the problem, he adds. With
budget problems similar to those faced by legislatures across the
country, the state is not able to increase the amounts paid, leading
to a loss or reduction of programs. "We lost a number of acute patient
residential treatment programs," Souther says. "They were closed
because they were not financially viable. They didn't get rates
of reimbursement commensurate with the costs of doing business."
Portsmouth Hospital's mental health unit, the Portsmouth Pavilion,
shut down a number of beds, he explains, because the system was
losing money on them. Elliot Hospital, in Manchester, did the same.
Another hospital, the community-based Androscoggin Valley Hospital,
in Berlin, was set to close its doors completely at the end of 2003
but was saved by a special appropriation from the state legislature.
The state faces a growing population, especially along the southern
tier, and a shrinking number of inpatient alternatives, Souther
says. "We are at a critical point. The demand continues to increase.
We try to increase capacity without increasing the budget but all
available beds are filled."
And, while the hemorrhaging of beds seems to have stopped, the
situation is not really getting any better…at least not yet. As
Souther points out, New Hampshire is not alone in its dire straits.
"We are in retrenchment. We have taken reductions over the past
few years in funding and in what we are able to offer. It's a national
problem. It's not just New Hampshire," he says.
Catherine Robertson Souter
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