Flanked by an armed security guard and two nurses, Sarah was escorted through the hallways and waiting rooms at Elliot Hospital after she overdosed in January. She was held involuntarily and moved to a secure holding area with two separate doors, each equipped with a set of locks and surveillance cameras. Sarah described the experience as entering a prison, finding it embarrassing and demeaning.
Sarah’s story is one of many individuals who have been detained in emergency rooms or holding areas in hospitals across New Hampshire due to concerns of a mental health crisis. Previously, individuals with mental illnesses were confined to emergency rooms for extended periods, waiting for a hearing that should have taken place within three days. However, a new centralized system for involuntary emergency admissions was implemented in March 2022 to provide more timely hearings. Despite the improvements in the hearing process, conditions in emergency rooms remain problematic.
Patients can be detained against their will when an Involuntary Emergency Admission petition is filed. This legal process occurs when there are compelling reasons to believe the individual’s mental health condition poses a potential danger to themselves or others. The American Civil Liberties Union New Hampshire has filed a lawsuit challenging the lack of due process in these situations, and many individuals have shared their harrowing experiences of being locked in solitary confinement in windowless rooms.
Sarah’s three-day stay in the secure area of the hospital had a lasting impact on her. She was asked to strip and change into paper scrubs while two nurses checked for potential weapons or drugs. Sarah felt like a criminal, with everything bolted to the floor and constant surveillance. Even with a timely hearing, individuals often have to wait for a bed in a mental health facility to become available, which can be days or weeks without proper treatment.
Improvements in the waiting times for hearings have been made, but the proceedings themselves still raise concerns. Approximately 75% of hearings are conducted solely over the phone, leaving patients with doubts about the fairness and effectiveness of these arrangements. Before the centralized system, patients would attend face-to-face hearings in a courthouse. Now, the hearings take place in hospital emergency rooms with participants joining remotely.
Judge Ryan Guptill, who presides over the state circuit court’s mental health docket, acknowledges the desire for in-person hearings but believes the current process meets the obligations of due process under the Constitution. The New Hampshire circuit courts receive the petitions prior to the hearing, and all parties are virtually connected through phone or video. The patient is given the opportunity to speak on their case, and Judge Guptill ensures written decisions are issued promptly.
However, there is a disparity in video capabilities among facilities, limiting access for some patients. Despite the improvements in the hearing process, the conditions in emergency rooms and the challenges faced by those in crisis highlight the need for understanding and compassion in these critical settings.