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I wanted to comment on the article “State Hospital Admissions on Unexpected Upswing” in the February 6 issue. New Hampshire is another state that has showed a steady increase in admissions to their state hospital, and we are doing our best to meet this challenge.

New Hampshire Hospital (NHH), a 212-bed state hospital in New Hampshire, has had a consistent increase in admissions for many years. In 1990 NHH had 850 admissions. In 2008 NHH had 2,260 admissions—this, with an increase of 36 inpatient beds over that time period.

The reasons for this dramatic increase are many and include reduced voluntary inpatient psychiatric beds, decreased community crisis-bed availability, reduced designated receiving facility (involuntary) beds throughout the state, reduced funding for outpatient community mental health centers, diminished outpatient treatment options, and limited housing for our most vulnerable mentally ill patients.

Our hospital, for which I am associate medical director, is seen as the inpatient treatment of choice by an increasing number of patients as mental health services are cut back and eliminated in communities. We deal with increasingly diverse patients with complex medical and psychiatric needs. New Hampshire Hospital's adult admission units are acute care settings where half of all patients admitted are discharged within eight days. Rapid stabilization and return to the community is the norm.

The state of New Hampshire and the Dartmouth Medical School Department of Psychiatry have partnered for 20 years to provide comprehensive patient-centered programming at NHH, and this has benefited our patients greatly. The challenges of providing and maintaining excellent psychiatric care, while addressing multiple demands, are many.


ALEXANDER DE NESNERA, M.D.
 Concord, N.H.