Despite new process, mental health emergency hearings remain flawed

After Sarah overdosed in January, she was escorted through the hallways and waiting room of Elliott Hospital by an armed guard and two nurses.

She was involuntarily detained and moved to a secure holding area with two separate doors, each with a set of locks and surveillance cameras.

“It felt like I was in prison,” Sarah recalled of the time she was admitted to a hospital emergency room, suffering a mental breakdown from the pain of ending an eight-year relationship. “It was a very embarrassing and very humiliating situation.”

Sara, who agreed to be interviewed unless her real name be used, currently lives in Puerto Rico. Her story is one of many people being held in emergency rooms and hospital jails across New Hampshire who she believes may be in the midst of a mental health crisis. It is.

Until New Hampshire introduced a centralized system for involuntary emergency admissions in March 2022, people with mental illnesses were confined to emergency rooms for long periods of time and required to attend within three days. Waiting for hearings, sometimes lasting weeks.

Since the new system was implemented, processes have been streamlined to provide timely hearings, but the emergency room situation remains problematic.

When a request for involuntary emergency admission is filed, a patient may be detained against his or her will. This legal process occurs when there is compelling reason to believe that an individual’s mental health condition poses a potential danger to themselves or others.

In a lawsuit filed by the American Civil Liberties Union of New Hampshire alleging a lack of due process in such situations, many people described their harrowing experiences being detained in emergency departments across the state. Sometimes they were kept in solitary confinement in windowless rooms, isolated from other patients.

These experiences were repeated by three attorneys across the state representing clients facing involuntary emergency hospitalizations.

“My clients have told me over and over again that this is worse than going to prison,” said Lauren Valari, one of the few attorneys in the state who represents them. “They handcuff you to take you to the emergency room or take you to the hospital. [Designated Receiving Facility]”

“I feel like a criminal.”

When a person facing a mental health crisis arrives at the emergency room, whether they come alone or accompanied by a family member, police, or paramedics, preliminary tests are conducted to assess their mental health status. receive.

The process of initiating a request for involuntary emergency admission can be initiated by the attending physician or the family member involved.

After a petition is filed, a mental health and physical evaluation is conducted, and the individual is determined to be a danger to themselves or someone else, the patient is placed in the legal custody of the state Department of Health and Human Services. Masu.

By law, all patients with a petition for involuntary hospitalization are required to have a hearing within three days of signing the petition. That rarely happened, so the New Hampshire chapter of the ACLU filed a lawsuit against the state.

Sarah’s three-day stay in the emergency room may seem short, but for those who experienced it firsthand, it was a traumatic ordeal.

Once she entered the secure area, two nurses approached her and asked her to undress and change into paper scrubs in the bathroom. The situation became more dangerous and her distress increased as she was carefully searched for possible weapons and drugs.

During her stay, Sarah faced intense emotions and challenges that left a lasting impact on her and emphasized the importance of understanding and compassion in such critical situations.

“You feel like a criminal, that’s the only way I can explain it to you,” Sarah said. “The furniture is bolted to the floor, the bed is bolted to the floor. They’re not even allowed to hold pens, they use video cameras.”

Even with a timely hearing, you may have to wait for a bed in a mental health facility to become available, potentially leaving you days or weeks without proper treatment.

“Many of our clients talk about their declining health during that time, and sometimes they’re alone in it,” attorney Ellen Purcell said. “They are literally trapped.”

Until a new, centralized process for involuntary emergency admissions to mental health facilities was introduced in March last year, Patrick Dowling lived in Plymouth’s Speer Memorial Hospital in 2014 while awaiting a hearing. He was confined in one room for 11 days.

Ms Dowling said it was the “worst time” of her life as she sought help but received nothing.

“The only thing I was looking forward to was taking a shower, and I couldn’t even control that,” Dowling said. “There was a security guard watching me at the door, but I didn’t feel like I was a health patient and the whole thing felt wrong.”

From March 21, 2022 to August 18, 2023, a total of 3,488 emergency admission hearings were held for patients outside of mental health facilities.

According to the New Hampshire Circuit Court, only 11 of those cases were dismissed for not having a timely hearing.

“The voice on the other end of the phone”

Although waiting times for public hearings have improved, the hearings themselves remain problematic.

Patients cannot be interviewed in person, and video calls are rare. Lawyers say about 75% of hearings are conducted only by telephone, raising questions about the effectiveness and fairness of these arrangements.

Lawyers report that clients often have difficulty trusting telephone hearings.

“These are voices on the phone. Some people are concerned about the voices they’re hearing,” Purcell said. “I really don’t have confidence in judges who make decisions based only on their voices without meeting with the judge. There’s no sense of reality.”

Previously, after patients waited in their beds, they would be taken to a courtroom on the second floor of New Hampshire Hospital for a face-to-face hearing with a presiding judge.

Since the introduction of the centralized system, these hearings are now held in hospital emergency rooms, with judges and lawyers participating remotely.

Judge Ryan Guptill said he understands individuals’ desire to be heard in person, but that the process is evolving and meets constitutional due process obligations.

“I wish we could do more, but I think we also have to think about achieving the other goal of providing a timely hearing for everyone,” Judge Guptill explained. “I don’t want to see a scenario where the sheriff goes out and handcuffs people and takes them to court for a hearing.”

virtual court

The New Hampshire Circuit Court, which is responsible for overseeing these cases, receives petitions one to two days before the required hearing.

A notice with the hearing date will then be sent to both the complainant and the hospital. A lawyer will also be appointed to represent the patient.

Mr. Guptill exclusively presides over mental health cases in state circuit court and conducts daily involuntary hospitalization hearings.

Guptill said he stayed cold and stayed away from the bench.

“I review all petitions in advance. I review both the facts alleged to ensure I understand what the allegations are and the legal issues I find on the face of the petition. “I’m doing it,” he explained.

During the hearing, all parties will connect virtually via telephone or video. Clinicians and family members of the complainant may then be called to testify and questioned by their attorney. If you have witnesses, you may call them to testify.

Patients are then given the opportunity to tell their case.

“This is my main document. This is what I do every day. It’s not something I sneak in for five minutes in between other cases,” Guptill said. “I feel like one of the best things we can do is to let people express themselves, which may be a luxury we haven’t had before.”

Guptill said he doesn’t usually make decisions from the bench. Instead, he will take the time to consider the case and issue a written decision, preferably by the end of the business day, but no later than the next business day.

Opportunity gap

Only certain facilities, including Portsmouth Hospital, Concord Hospital in Franklin, Parkland Emotional Wellness Unit, Elliott Hospital and Cypress Center, have video capabilities, and not all patients have access to them.

Once an application is submitted and a bed in a treatment facility becomes available, patients will be transferred accordingly. However, the type of hearing they receive depends on where the petition is filed, not where it is forwarded.

Further complicating matters, the state only has four attorneys who represent clients in these cases. They try to visit multiple hospitals every day, even during telephone hearings. However, there are times when this is not possible.

“It’s really hard to explain what we do, and it’s not very profitable,” said attorney Amy Davidson. “So for a variety of reasons, they haven’t been able to get any other players and probably never will.”

Sarah was expecting a video hearing, but instead it was a telephone hearing.

“My feeling is that criminals are given higher priority than people with mental illness. If you have a mental illness, you have less of a chance to prove your case,” Sarah said.

Last week, state officials announced a series of investments and partnerships called “Mission Zero” aimed at eliminating the practice of admitting mentally ill patients to hospital emergency departments by 2025.

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