NHPR – April 3, 2025
By PAUL CUNO-BOOTH
A federal judge says New Hampshire is making good progress toward eliminating wait times for inpatient mental health care. Since May 2023, New Hampshire has been working to comply with a court order requiring it to end so-called “ER boarding.” For over a decade, many patients have been forced to wait days or even weeks in the emergency room after being involuntarily held for mental health care, because of a shortage of beds.
The practice – which surfaced amid cuts to the community mental health system and the closure of hospital psychiatric units – has spawned multiple rounds of litigation. The 2023 order was sought by a coalition of New Hampshire hospitals. Speaking in U.S. District court in Concord Thursday, state officials said the waitlist has decreased significantly in that time as they’ve brought more beds online. On some days, the waitlist has hit zero, or had fewer people on it than the number of available beds, said Samuel Garland with the New Hampshire Attorney General’s Office.
But he said another part of the court’s order – which requires patients to be transferred from the ER to a mental health facility within six hours – may need to change. He said that’s hard to meet in many cases for a variety of reasons, including the acuity of a patient’s condition and inefficiencies in the system. “Based on what we’ve seen so far, six hours is probably not achievable across the board,” he said. Garland said the state is in talks with the hospitals about potentially revising that timeframe.
Judge Landya McCafferty said she was “very, very pleased” with the state’s progress in reducing wait times, and gave the parties another 90 days to propose an alternative to the six-hour time limit. According to state data, the waitlist was hovering in the 40s when McCafferty issued her May 2023 order. In the first three months of this year, the waitlist has been averaging in the teens or 20s. As of Thursday, 10 patients were waiting for admission to treatment, while 15 beds were available across different facilities.
Over the past few years, state officials have sought to reduce ER boarding through a combination of investments in community mental health programs, more inpatient capacity and expanded housing options – an initiative they’ve branded “Mission Zero.”