Responding to a greater need for inpatient services and prolonged wait times for emergency psychiatric care across the state of New Hampshire, Portsmouth Regional Hospital has expanded its number of beds for involuntary admissions.
The hospital has a 30-bed Behavioral Health Unit. “About three years ago, we expanded our overall physical beds from 22 to 30,” said Justin Looser, LICSW, director of behavioral health services at Portsmouth Regional Hospital. “We started to see the need increase, both through our Emergency Department and the state.
“About a year-and-a-half ago, we really started to see the backup of involuntary patients, both around the state and in the Emergency Department,” Looser said.
Eight of the 30 beds in the unit were for involuntary patients, but as the waiting list in the state crept up, Looser said, the unit recently increased its number of beds for involuntary admissions from 8 to 12.
Looser noted in late March that the wait list to get into involuntary treatment in the state was at about 45-53 patients per day.
“We really tried to answer that call to provide that service,” Looser said, adding that he has a meeting scheduled with the state every 30 days, to reassess the need statewide and how the hospital can help accommodate that need.
Matt Davis, M.D., medical director for Portsmouth Regional Hospital’s Behavioral Health Unit, said there has been a growing need for involuntary admissions over the past five or six years because of a confluence of factors.
New Hampshire has just under 200 involuntary beds for adults, he said, most located at the state psychiatric hospital, but others located in several hospitals throughout the state, including Portsmouth Regional.
In recent years, Davis said, the state hospital has closed some of its units. “Since then, there’s been a fairly consistent wait for patients to get into those involuntary beds,” Davis said.
Patients can wait in the Emergency Department for days, sometimes weeks, Davis said. “That has gotten worse in the past six to eight months. A year or so ago, maybe there would be 20-30 patients waiting to get into one of those involuntary beds,” Davis said, noting that now, “there are consistently 40-50, sometimes over 60, people waiting to get in.”
“It’s not just the number of people to get in – it’s also the duration. Whereas maybe a year ago, people would wait a few days, some people are waiting literally weeks.”
New Hampshire has been undergoing efforts to expand community-based mental health services, such as supportive housing and mobile crisis teams, in compliance with a 2014 class action settlement agreement.
“(The settlement) mandated that New Hampshire had to implement significant changes to outpatient treatment,” Davis said, including improving community treatment teams, which provide intensive outpatient treatment that help patients maintain stability and avoid hospitalization.
A lot of those changes haven’t gone into effect yet, Davis said, resulting in a current need for inpatient beds and more robust outpatient services.
Looser said Portsmouth Regional is seeking to expand its own services. “The question is where do we expand first and what is the biggest need…Children and geriatrics are two populations that wait the longest (for services),” Looser said. “We do have a proposal on the table to build a child and adolescent unit.”
The hospital also aims to increase outpatient services
Portsmouth Regional’s recently opened 15-seat partial hospitalization program – offering step-down services after hospitalization or services prior to hospitalization – has been completely full since it opened, with a waiting list.