Republican leaders in the New Hampshire Senate propose to increase by 68 beds the state’s capacity to treat people suffering from mental illness, contracting with private hospitals and nonprofits to do so. This proposal is meant to address an urgent issue — the growing number of patients who are forced to languish for days or even weeks in hospital emergency rooms waiting for treatment. But while increasing this kind of psychiatric treatment capacity is certainly part of the answer, it doesn’t address the underlying issue: chronic underfunding of mental health services in New Hampshire.

It’s not hard to trace the source of the immediate problem: The number of psychiatric beds in the state shrank from 526 to 384 between 2005 and 2013, the Concord Monitor has reported. The bed count at New Hampshire Hospital, the state’s sole psychiatric hospital, fell from more than 200 to about 160 over the past decade because of budget cuts, and private hospitals closed psychiatric units because of difficulty in hiring and retaining skilled workers. As a result, New Hampshire now has just 11.9 psychiatric beds per 100,000 people, while mental health professionals suggest that states should have at least 40 to 50 beds per 100,000 residents.

On a single day in February this year, a record 68 people were being boarded in hospital emergency rooms around the state waiting for treatment beds to open up. “Boarded”  is perhaps not a precise description, but it’s hard to think what else to call it, given that patients cannot receive in this setting the swift intervention or skilled treatment they need. And, of course, emergency rooms have to employ scarce physician and nursing resources to monitor these psychiatric patients for however long it takes to secure a place for them.

Under the Senate plan, the state would contract with private hospitals and nonprofits to establish 68 new beds that would provide care for patients on a continuum of need from those in acute psychiatric crisis to those transitioning back into the community. Senate Majority Leader Jeb Bradley, prime sponsor of the legislation, estimates preliminarily that this would cost about $6 million. Unless Bradley can work miracles of the loaves-and-fishes variety, that figure seems improbably low.

Whatever the price tag ends up being, there has to be enough money to address the shortage of available skilled workers. And, we suspect, hospitals and nonprofits will want some guarantee that the money will not disappear over time as the crisis recedes — a scenario that has played out time and again in New Hampshire. A question that also needs answering is why contracting for these services makes better sense than expanding the number of beds at the state hospital itself. 

It’s unclear, too, how the Senate plan meshes with New Hampshire’s obligations under a 2014 settlement of a federal class action suit in which the state agreed to greatly expand and enhance community-based  mental health treatment so as to “significantly reduce visits to hospital emergency rooms and . . . avoid unnecessary institutionalization at State mental health facilities.” The court-appointed overseer of this agreement has found the state’s implementation of its provisions so slow that he warned in January that he might seek judicial intervention unless the pace of change picks up quickly. Although it seems clear that the state lacks enough psychiatric beds in absolute terms, one also wonders whether devoting more resources to implementing the settlement’s commitment to greater community-based treatment might ease the need for them.

Nearly a year ago, Ken Norton, the executive director of the New Hampshire affiliate of the National Alliance on Mental Illness, an advocacy group, told the Valley News that the state lacks “a clear strategic plan for mental health services and where we need to go.” Nothing that has occurred in the past year suggests to us that this is not still the case, and it’s hard to imagine that much lasting progress will be made until such a plan is in place and it is fully funded.