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DOJ Says N.H. Wrong About Efforts To Improve MH System

Mental Health Weekly���� January 2, 2012

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Clashing views of New Hampshire’s mental health system continue as U.S. Assistant Attorney General Thomas Perez this month responded to the state’s first official response to allegations of violating the Americans with Disabilities Act (ADA) for unnecessarily institutionalizing mental health patients instead of investing in more community services and supports for them.

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New Hampshire Attorney General Michael Delaney and the state Health and Human Services Commissioner Nick Toumpas in a Dec. 6 letter defended the state’s efforts to improve its mental health system. Their letter cited “significant progress” in the state’s 10-year plan, implemented in 2008, to expand community services and programs (see MHW, Dec. 12). Calls to the U.S. Department of Justice were not returned.

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Following the DOJ’s assessment of the state in April (see MHW, May 2) DOJ and state officials had met for several months to develop solutions regarding the DOJ’s findings. Perez responded to state HHS officials in a Dec. 9 letter stating that the DOJ stands by its findings and conclusions in April that the state’s mental health system is “broken” and “in crisis.” New Hampshire forces people with mental illness to obtain needed services at

the state’s institutional facilities, even though those services could be provided more effectively and more inexpensively in integrated community settings, Perez wrote.

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“New Hampshire’s mental health system, as currently configured, not only violates the ADA, but also is an inefficient use of state resources and is bad policy,” Perez said. “New Hampshire is spending about as much to serve 5 percent of people with mental illness in New Hampshire Hospital as it spends to serve the entire remaining 95 percent in the community.”

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Perez said the DOJ regrets that the state’s current position has created “an impasse.” Unable to reach a resolution, the DOJ plans to assess its enforcement options, including litigation, he concluded.

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N.H. Officials “Disappointed”

“Clearly we are disappointed with their reaction but it is not unexpected,” Mike Brown, senior assistant attorney general for the New Hampshire Attorney General’s office, told MHW. “We had differences,” Brown said. “We expressed those differences in that letter to them. The federal government is in disagreement about our 10-year plan.”

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The next steps are entirely dependent on the federal DOJ, Brown said, but expressed concerns about threatened litigation that would ultimately

mean a loss of “time, energy and scarce resources that would be better [directed] to clients in the community.”

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“The obligation HHS has to providing community mental health services is long term; that does not go away,” he said. “HHS has the obligation to develop the budget to provide services in these challenging economic times,” said Brown. State officials are working with legislative leaders,

budget writers, and [looking] at grant funding for providing these services, he added. “That effort does not stop,” he said. “We don’t know the outcome; we would be disappointed if they chose the litigation route,” Brown said.

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