VAHHS Statement on New Hampshire Ruling About Patients in Emergency Departments

The Vermont Association of Hospitals and Health Systems (VAHHS) represents Vermont’s network of entirely non-profit hospitals. We work tirelessly with state leaders, lawmakers and other health care stakeholders to improve Vermont’s mental health system. Our focus is to ensure every Vermonter gets the care they need when they need it and in the right care setting. Too often, patients languish in our emergency departments for lack of access to appropriate and therapeutic mental health services. This impacts their care as well as the care of other patients in need of those emergency department beds. It also impacts our staff greatly and drives up costs for hospitals.

We have been following the recent federal ruling in neighboring New Hampshire regarding the boarding of patients in need of inpatient mental health treatment in hospital emergency departments. A federal judge declared the state's practice of involuntarily holding psychiatric patients in emergency departments unconstitutional. We experience the same challenges with patients who need inpatient psychiatric care, but are being boarded in our emergency departments, unable to be transferred for lack of available beds. We are working hard to find solutions that can benefit the patients and staff who deal with these situations daily.

In Vermont, our state leaders understand this challenge and are committed to increased funding for workforce and other investments to expand access. For example, the Brattleboro Retreat has been able to increase its number of available beds from a low of approximately 45 to nearly 98 with the financial support of the Agency of Human Services (AHS) to help offset the staggering cost of traveling nurses and other staff to care for patients. In the past year, AHS, hospitals and health care leaders have also done the following:

• supported the development of outpatient urgent care settings

• expanded mobile crisis supports in the community

• worked with the Vermont Program for Quality in Health Care to develop a state telepsychiatry network

• established a daily rate to increase financial support for hospitals caring for patients waiting in emergency departments

• proposed the development of dedicated forensic mental health beds to reduce gaps in the system

• continued to support suicide prevention efforts

This has been an incredible help to patients, provided much needed relief to providers and staff and assisted hospitals greatly, but it is still short of what Vermonters in mental health crisis need. There is much more work to be done in this area. VAHHS will continue to push for solutions alongside our partners for as long as it takes. Our communities deserve the best care we can possibly deliver and that is what we are striving to achieve.