New Hampshire Could Reduce Costs by 1/3 by Lowering Nursing Home Care

How most states could quit confining people and cut mental health care costs by 1/3

This is an expansion of Corinna West’s blog on Please Cut our Budgets, We’ll Tell you How. One of the main problems in mental health care is the outdated assumption that institutional care confining people away from the community is best.

Chris Hansen, fighting against confining people. She's a collaborator with Shery Mead, sporting a "You Bet I'm Noncompliant" T-shirt at Alternatives 2010 in Pasadena, CA.

Chris Hansen, fighting against confining people. She's a collaborator with Shery Mead, sporting a "You Bet I'm Noncompliant" T-shirt at Alternatives 2010 in Pasadena, CA.

In New Hampshire, it has come down to a lawsuit. The Civil Rights Division of the US Department of Justice has threatened to sue the State of New Hampshire for confining people with emotional disabilities, who are medically able to live in the community, in nursing homes.

If true, the state is violating a federal law that says people with disabilities must be housed in the least restrictive environment possible.  Confining people is only OK if they are dangerous to themselves or others, and only until the immediate danger passes.

No fair, say the state attorney general and health and human services commissioner.  We’re trying to stop confining people.  We have a 10-year plan.

Confining people, who are medically able to live in the community, while you work on a 10-year plan to get them out, is not justice delayed or justice denied.  It’s kidnapping.

It is also a foolish waste of the taxpayers’ money since community-based treatment is so much cheaper than confining people in nursing homes.

Confining People Is Not The Whole Picture

The NH mental health system is not a concentration camp. It’s a mixed bag, no worse than other states, and better than many in some ways.

NH was the first state mental health authority to create an Office of Consumer Affairs, a state consumer advocacy council, and a network of independent peer support centers separate from the medical community mental health centers.  It had the first peer-run crisis respite center, started 15 years ago by Shery Mead.

The Winter 2012 edition of the Office of Consumer and Family Affairs’ newsletter reports that the state hopes to expand crisis respite beyond the Claremont peer support center that Shery also started.  And the state’s peer support network is establishing a formal connection with the state psychiatric hospital to provide peer support to inpatients.

Like most states, community mental health centers in NH are choking from lack of resources, and the 10 CMHC directors are not seriously considering cheaper ways of doing things that also produce better recovery outcomes —  that turn high utilizers of state services to low users, or non-users (graduates).

It’s not helpful simply to criticize the mental health system and dump on medication.

At Wellness Wordworks, our mission is to create and demonstrate positive alternatives — non-medical ways for people to overcome distress that are also less dependent financially on government funding. We are working to join forces with organization in Kansas City like The Whole Person and Coalition for Independence. These are organizations funded federally and present in all states, called independent living centers whose job it is to stop confining people.  

A person who lives in their own home with the help of a personal care attendant has costs 1/3 as much as a nursing home, better human rights, and better long term outcomes. Instead of fighting powerful nursing home lobbies that are blocking this change, we aim to help prevent people from initially getting the mental health diagnoses and labels that eventually them to institutions, including young people that are 14% of nursing home populations.

Wordworks Blog Author: Ken Braiterman

Ken Braiterman, Wellness Wordworks board chair, has been an activist, news reporter, opinion writer, and columnist since 1968. From 1997 to 2009, he was New Hampshire's leading advocate for recovery-based mental health services. He is an advanced Wellness and Recovery Action Plan (WRAP) facilitator.

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