Earlier this month, the U.S. Department of Justice (DOJ) and the New Hampshire attorney general’s office fired off letters over New Hampshire’s mental health system.
U.S. Assistant Attorney General Thomas Perez of the DOJ wants to see improvements in the state’s management of its health care system, stopping the mentally ill from having short-term stays at places like New Hampshire Hospital, and getting them into consistent community care, where they can get treated and interact more with people who don’t have mental illnesses.
Not good enough, says DOJ’s Perez. He claims New Hampshire could be doing better with the money they already have—treating six patients more effectively with what they are now spending on one.
“New Hampshire could clearly spend its dollars more effectively,” Perez writes in the latest letter.
Now, the DOJ is threatening to sue the Granite State if it doesn’t comply. That would mean a potentially lengthy and expensive trial.
“The threatened litigation by the federal government and federally funded advocates will waste precious state and federal taxpayer dollars that could be better spent on providing services,” writes Delaney, who jointly issued the letter with N.H. Department of Health and Human Services Commissioner Nicholas Toumpas.
Turning the Clock Back
The sticky situation between the DOJ and the State of New Hampshire is probably best understood by going back to Feb. 5, 1963, when President John F. Kennedy delivered a speech to Congress titled “Mental Illness and Mental Retardation.”
It was the beginning of the federal government’s involvement in Americans’ mental health care—something that was previously the responsibility of the state and local governments. On that day, Kennedy proposed a program that would close state psychiatric hospitals, shift patient care to new community mental health centers (CMHC), and finance the centers with federal funds.
A new report released by the Heritage Foundation earlier this week analyzes the history of these CMHCs and the dysfunction that continues in the mental health systems throughout the United States today.
It finds that the federal government’s involvement in state mental health care systems had a negative effect. States were already moving mental patients out of state hospitals and into community programs, coinciding with the discovery of Thorazine, an antipsychotic medication, in the 1950s. The report cites data showing that between 1955 and 1963, the population at state psychiatric hospitals had already decreased significantly from 559,000 to 503,000.
But, in 1963, everything changed.
“Once the federal CMHC program got underway, the development of programs by state and local officials effectively ceased,” reads the report, authored by E. Fuller Torrey, a psychiatrist and researcher.
“State officials were essentially being told that they were no longer responsible for patients being released from state psychiatric hospitals, since the federal government was taking over this responsibility. This was fine with most state officials, who viewed the shift to federal control as a way to save state money.”
Indeed, saving money appears to be at the heart of the fight now being waged between the DOJ and New Hampshire today.
The problem, the report concludes, is not a lack of money, it is a leadership deficit and the answer is returning the responsibility back to states, who would then have to answer more directly to the people.
While it doesn’t directly address New Hampshire, the report’s recommendation would, in theory, end the bickering between the DOJ and New Hampshire. The DOJ would have no basis to sue New Hampshire and residents, and advocates could hold their locally elected leaders directly culpable for any perceived problems in their own local mental health system.
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