NYAPRS Note: A settlement agreement in NH highlights the increasing legal pressure on states to treat persons in the most integrated settings possible. This agreement will remit funds that could have been saved by avoiding hospitalization in past years and reinvest it into community based services that divert preventable admissions. This litigation sets an important precedent for states that are considering or are in the process of implementing an Olmstead plan, and for states—including NY—that are building up community services in anticipation of hospital restructuring. This news should also further encourage NY safety net hospitals and public providers in the process of building DSRIP collaboratives to include BH providers in their projects, as they prepare to reduce avoidable hospitalizations. Not only does appropriate community BH care save money, but it fulfills legal and policy obligations of NYS.
New Hampshire Reaches $32.1 Million Settlement Over Unnecessary Mental Health Hospitalizations
Open Minds; 2/24/2014
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On December 19, 2013, the State of New Hampshire reached a $32.1 million settlement over unnecessary mental health hospitalizations, in the class action lawsuit Amanda D., et al. v. Hassan, et al.; United States v. New Hampshire (Civ. No. 1:12-cv-53-SM). Under the agreement, the state will spend $32.1 million over the next four years on expanding services for individuals with serious mental illness (SMI). The state will spend an additional $6.3 million in the current budget, and an additional $23.7 million in the next two-year spending plan to support more community housing and employment opportunities, as well as all-the-time care for people in crisis. The settlement builds on additional money that Governor Margaret Hassan pushed in the current budget for mental health services.
On September 17, 2013, the court certified a class comprised of all persons with SMI who are unnecessarily institutionalized at the New Hampshire Hospital in Concord or the Glencliff Home in Benton, or who are at serious risk of unnecessary institutionalization in these facilities; and individuals “at risk of institutionalization.” These individuals are defined as persons who, within a two-year period:
- Had multiple hospitalizations
- Used crisis or emergency room services for psychiatric reasons
- Had criminal justice involvement as a result of their mental illness
- Were unable to access needed community services
The negotiated settlement agreement will expand and enhance the community-based mental health services available to eligible class members at New Hampshire Hospital and Glencliff, as well as those living in the community. Specifically, the agreement will provide:
- Mobile crisis services: Over the next four years, mobile crisis teams will be implemented in the Concord, Manchester, and Nashua regions within the state.
- Assertive Community Treatment (ACT): Over the next four years, the state will develop and implement ACT teams with the capacity to serve at least 1,500 individuals at any given time.
- Housing: Over the next four years, the state will develop and maintain 450 integrated, supported housing units, apply for funding for an additional 150 units through federal programs, and add additional permanent, scattered-site, supported housing, if necessary.
- Supported employment: Over the next four years, the state will increase the percentage of individuals with SMI receiving supported employment services to help them find and maintain competitive employment at integrated job sites from approximately 12% to 18.6%.
- Family and peer supports: The state will maintain its system of family support services and ensure that peer support services are offered through peer support centers open at a minimum of eight hours per day, five-and-a-half days per week, in each mental health region in the state.
- Transition planning: The state will develop and implement a transition planning process for individuals with SMI at New Hampshire Hospital and the Glencliff Home and create a central team to assist in addressing and overcoming any barriers to discharge identified during the transition planning process.
- Quality assurance, performance improvement, and quality service reviews: The state sill develop and implement a quality assurance and performance improvement system, with the goal of ensuring that community services described in the settlement agreement are of good quality and are sufficient to provide reasonable opportunities to help individuals achieve increased independence, gain greater integration into the community, and obtain and maintain stable housing.
The settlement agreement further provides that an independent expert review will be assigned to evaluate and issue public reports on implementation of the agreement. In a fairness hearing on February 12, 2014, the court issued a final order approving the class action settlement agreement for expanded community mental health services for individuals with SMI. The order allows the state to implement new service provisions to enhance and increase the availability of crisis services, Assertive Community Treatment, supported housing, and supported employment.
The original class action suit was filed on February 9, 2012 in the U.S. District Court of New Hampshire, by six individuals and the Disability Rights Center alleging New Hampshire’s administration of its mental health system violates the rights of individuals with serious mental illness (SMI) under the Americans with Disabilities Act, the Rehabilitation Act, and the Nursing Home Reform Act. The plaintiffs claimed that the state failed to provide individuals with sufficient community-based services to avoid unnecessary institutionalization at New Hampshire Hospital and the Glencliff Home, and services, programs, and activities at other sites. The federal Department of Justice moved to intervene in the matter as Plaintiff-Intervenor in March 2012, and the district court granted this request in April 2012. The state denied all alleged violations.
New Hampshire Hospital is a state operated, publicly funded hospital providing a range of specialized inpatient psychiatric services. It provides acute treatment services for children, adolescents, adults, and elders with SMI. Most people are admitted to the Hospital on an involuntary basis, because they have been found to be dangerous to themselves or others, although a few people are admitted voluntarily for the same reasons. There were over 1,800 adult admissions to the Hospital in 2010, nearly 800 of which were readmissions of individuals who had been at the hospital within the last 180 days.
The Glencliff Home is a state-operated, 120-bed nursing facility that provides a continuum of long-term psychiatric and medical services for New Hampshire’s developmentally disabled or mentally ill population in a home-like, supervised therapeutic environment. Between 2005 and 2010, there were only 13 discharges from Glencliff; 11 of them were to New Hampshire Hospital or other facilities.
A link to the full text of “New Hampshire Settlement Agreement In Amanda D. v. Hassan” may be found in The OPEN MINDS Circle Library at www.openminds.com/market-intelligence/resources/121913nhmhsettlementamandad.htm.
OPEN MINDS also reported on this topic in “DOJ Joins Lawsuit To Force New Hampshire To Provide Additional Community-Based Mental Health Services.” The article is available at www.openminds.com/market-intelligence/premium/omol/2012/042312mhcd4.htm.