New Hampshire Hospital plans to add beds in new crisis unit, plus other renovations


Monitor staff

(Published in print: Sunday, August 24, 2014)


The new 10-bed crisis unit will be staffed by a psychiatrist, a nurse practitioner, nurses, mental health workers, social workers and rehabilitative services staff, New Hampshire Hospital Chief Executive Officer Robert MacLeod said.

It’s meant to be more of “a swing space” than the rest of the 152 beds currently in use at the institution, Director of Support Services Philip Wright said. Patients, ideally, will not remain there for more than 36 hours at a time.

In concert with these changes, Wright said the institution also plans to streamline its admission and discharge process. The admitting area will be enclosed by a fence, he said, and those leaving the hospital will be able to exit through a separate discharge area that has its own private parking.

Wright said the existing procedure – in which patients walk out of the main entrance, sometimes holding all of their belongings in trash bags – “is not very dignified.”

“This dedicated area will allow a lot more dignity and privacy for patients being discharged,” Wright said.

With this new unit, MacLeod and Wright said, the state hospital’s goal is to reduce wait times at community hospitals’ emergency units for behavioral health patients and, in turn, lighten the overall need for emergency mental health treatment.

The theory, MacLeod said, “is that the sooner someone gets treated, the less protracted their stay here will be.”

At this point, the project is expected to get under way in December and be completed by the beginning of June, Wright said. About $2.15 million has been allocated for the project.

Officials at Concord Hospital, where patients can routinely expect to wait between three to 15 days before being placed into a psychiatric facility, said they’re also hopeful that this would decrease delays for those waiting in their emergency department.

“For a person who’s watching this from across the street, any additional resources would be a help,” Concord Hospital Chief Operating Officer Joe Conley said.

At Concord Hospital, patients experiencing mental health emergencies are placed into the institution’s “Yellow Pod” – a holding area, essentially, meant to keep them safe until space opens up at a treatment facility.

When it was conceived, Conley said, Yellow Pod was designed for “pretty short turnaround times.” As available space in treatment facilities (including New Hampshire Hospital), outpatient settings and elsewhere shrank over the years, the wait times at Yellow Pod went up, Conley said.

“Now, two or three or four hours has become two or three or four or five or six or seven or eight days,” Conley said.

Concord Hospital has an especially high volume of behavioral health patients because of its proximity to New Hampshire Hospital, Conley and others said.

Patients and their families have criticized Concord Hospital for, among other things, not administering medication or other treatment to patients. Conley and Peter Evers, chief operating officer of Riverbend Community Mental Health Center, said the hospital is not designed to act as a psychiatric treatment center.

“An emergency room is the last place a person in a psychiatric crisis should be and should be evaluated, because there are so many other external pressures and influences on that illness or that agitation,” said Evers, who also serves as vice president for behavioral health at Concord Hospital.

Concord Hospital would be “in danger of making some very bad decisions if we began medication regimes,” he said.

“We can’t treat,” Conley said. “We will try to keep everybody safe while the state hospital is trying to free up a bed.”

Other changes planned

A new rehab unit, security changes and updates to the facility’s recreational space are also in the works at New Hampshire Hospital.

The new rehabilitation unit will be housed on the institution’s second floor, Wright said, and both that and the new recreation space should be completed around mid-November. The renovations to the lobby and security units are slated to be completed next summer, he said.

Efforts to make the lobby area more secure are a response to “some of the patient safety issues we’ve seen across the country,” MacLeod said.

Elsewhere, Wright said, some areas of the building – a corridor adjacent to the kitchen, for example – that are for the most part open at the moment will be restricted to staff only.

The hospital is also adding a recreation area to make it easier for patients in two of its units to access outdoor space, Wright said, and the renovations will include more multi-purpose space.

Overall, Wright said, the hospital is aiming to maximize space and create a warmer environment for patients within the 25-year-old building.

“We are just busting out of the walls,” he said, “and we’re trying to make the most of every little bit of space we have.”

(Casey McDermott can be reached at 369-3306 or or on Twitter @caseymcdermott.)