Budget Cuts Close NH's Neuropsychiatry Unit
By: Wendy Thomas, The New Hampshire Challenge Staff Reporter

Perhaps the greatest impact of the New Hampshire State budget cuts and layoffs was the closing of the New Hampshire Hospital neuropsychiatry unit. Closed on October 30^th, the unit had provided short and long term assessment treatment for patients with psychiatric illness who also had additional illnesses like strokes, epilepsy, developmental disorders and acquired brain injury (also called Traumatic Brain Injury, TBI). The closing not only meant lost jobs for workers, but it also meant transfers for some of the patients.

The unit’s closure was one of the repercussions to emerge after state workers rejected a contract that called for 19 unpaid furlough days over two years. Governor John Lynch, who is required under the budget passed in June to cut $25 million in labor costs, stated that 250 people would be laid off and another 60 reassigned to lower-paying positions.

Paula Mattis, New Hampshire Hospital’s acting chief executive officer said that the closing of the neuropsychiatry unit was not a values decision. "What we had to look at was how can we make these budget cuts so that the fewest number of people are affected."

"Last year there were approximately 22 patients on the unit with around 2300 admissions to the hospital. We had to look at the whole picture, we didn’t just pull out a dartboard."

"We are learning to live in the gray." Said Mattis who anticipates more restructuring of the Hospital in the future.

Some patients in the unit had stayed for weeks; others for months as a base-line of their condition was established and a treatment plan was then developed.

"The original intent of the unit" said Dr. Tom McAllister, director of the hospital's neuropsychiatry program and a faculty member at Dartmouth Medical School, "was that it allowed assessment and evaluation related to challenging behavior. It was never meant to be long term but we did have some people who stayed longer."

"There are two reasons for this. Treatment can be very complicated and sometimes the patients are not ready for discharge. In addition when some of the patients came to the hospital they had a base in the community to support them. Not infrequently that support system can go away because of budget or residential living availability or any number of things. The unit had provided a place where these issues could be addressed." McAllister added.

The unit had teams of professionals working together to evaluate each patient. The team typically included a neuropsychologist, a behavioral psychologist, an occupational therapist, a recreational therapist and nursing staff, among others. The group was able to assess patients' problem-solving skills, examine their symptoms and treat them from a multi-discipline perspective.

After the unit closed, patients were either sent home or transferred, and workers were laid off or reassigned.

The closure leaves organizations that deal with brain injury trying to figure out how to help these sickest patients.

Steven Wade, director of the Brain Injury Association of New Hampshire said "From a brain injury perspective, this is a real loss. This is a population that is at high risk for major psychiatric disorders. It’s a real challenging population."

"This is one of the most vulnerable groups. We’re hoping to partnership with the Developmental Disorder program to develop a planning and assessment plan to figure out what do we do now with these patients. We’re trying to pull together a team of the best people to come up with a plan given the closure." He said.

"It’s ironic that the state closed down the one program that vets returning from Iraq and Afghanistan with brain injuries could really use." Wade continued. "Not only is the unit gone but there is the loss of the team. There was a very experienced team in place and that is a real loss."

Mattis stated that the VA system is currently looking at how it can assist those Service men and women returning from the war and how best to serve their complex medical needs.

Many of the patients in the unit suffered from the addition of traumatic brain injury which is not as uncommon an injury as one might think. TBI occurs when an outside force traumatically injures the brain. TBI is a major cause of death and disability worldwide, especially in children and young adults.

According to the Brain Injury Association of New Hampshire:

- Every year, 1.5 million Americans sustain a brain injury.

- In New Hampshire, traumatic brain injury (TBI) is the number one killer and disabler of children, teens and young adults.

- In 1998, 4,617 New Hampshire residents received medical treatment for TBI; 171 people died of their injures.

- In the US, a brain injury occurs every 15 seconds.

- Males are almost twice as likely as females to sustain a brain injury.

- TBI kills one American every 5 minutes.

- Falls and motor vehicle crashes are the leading causes of TBI deaths and hospitalizations.

In the past when more bed space was needed than the 12 beds the New Hampshire Hospital could provide, brain injured patients were transferred to a similar medical psychiatry unit with 10 beds that had existed at UMass Memorial Medical Center in Worcester. However with the budget cuts in Massachusetts that unit has also closed leaving a real gap in how to treat and where to place these patients.

"We’re not sure what’s going to happen now if someone is having significant behavioral challenges deemed from psychiatric illness. In this population, it’s difficult to tell what is causing the illness whether it is because of psychiatric illness, undiagnosed illness, or something awry in the community support. The unit provided a place there his could be addressed." Said McAllister.

"The only other current options are far out of state, said Wade. "With Acquired Brain Injury family involvement is critical. If the patients are placed out of state, that puts a huge burden on the family. We don’t want people to end up in the criminal justice system being placed there as a last resort."

"We are trying to pull together a team of the best people to come up with a plan given the closure." Said Wade.

Dennis Power, Executive Director Community Support Network, Inc. - a not for profit organization that works in support of the 10 Area Agencies throughout the state of New Hampshire providing services to individuals with developmental disabilities and acquired brain injury and their families - is concerned about the unit’s closing. "There is currently no place in New England to serve these complex patients and there is a real void. The State is currently trying to figure out where to send these patients in crisis." He said.