emergency department wait resources

It’s difficult to predict. Some individuals are transferred to inpatient psychiatric beds at designated receiving facilities (DRFs) after a very short time (hours), but more often it’s days before a transfer. Timing is based on medical acuity and availability of beds.

A Designated Receiving Facility (DRF) is an inpatient psychiatric program which can accept individual who are in a mental health crisis on an involuntary basis

The designated receiving facilities (DRF) queue, also referred to as the waitlist, is the list of individuals waiting in Emergency Departments across the state for inpatient psychiatric beds.

The queue operates on a triage basis where those who are determined to have the most severe symptoms are admitted first. That may mean that even though an individual has been waiting days – that someone who comes in today may be admitted before that person who has been waiting if their symptoms are more severe. The decision is made by New Hampshire Hospital in conjunction with the Emergency Department and if they are going to someplace other than NHH that Designated Receiving facility. Changes result when someone else in the state is admitted and determined to be in greater crisis (has higher medical acuity). Cases are triaged and place on the list can change when individuals determined to be in more crisis come into the system.

Individuals who are waiting on a voluntary basis are free to leave at any time. If after the assessment the Emergency Department team has determined that the person is a danger to themselves or others, and meets the criteria for an involuntary emergency admission (IEA), and the accompanying paperwork is filled out, they can not leave unless they are assessed again by the Emergency Department Team and found to no longer meet the IEA criteria. If the paperwork has been completed for an IEA, it requires that the individual be notified and provided a copy of the petition. If you are uncertain, please ask whether you are on a voluntary or involuntary status. The statute covering Involuntary Emergency Admission (IEA) can be read in full at this link – the portion applicable to IEA begins at Section: 135-C:27. The Disability Rights Center (DRC) wants to hear from individuals impacted by ED boarding – the individual, or a family advocate, can call DRC at 1-800-834-1721.

Senate bill 590 passed in June of 2018 does allow for this to occur in certain circumstances. Contact the local community mental health center to see if you, or your loved one, is eligible for those services.

If family member is under the age of 18, they may be eligible for FAST Forward wraparound services.

To learn more, contact Daryll Tenney at the NH Bureau of Children’s Behavioral Health at 603-271-5075

Contacting the provider of your/your loved one’s health insurance, including Medicaid, has been helpful in some situations. Some family members also choose to contact public officials – it’s unclear if this outreach has been effective in securing a faster transfer from the Emergency Department.

Beginning in 2020, the law changed regarding transport from a hospital to New Hampshire Hospital or other DRF.  The new law allows a Physician or APRN to make a recommendation, based on their assessment, regarding transport by ambulance or by law enforcement (sheriff’s department) without the use of restraints (handcuffs, wrist to waist, or rarely leg shackles).  However, there is no requirement the recommendation be followed, and ambulance companies may not be available and/or may refuse to transport.  The law clearly indicates the final decision regarding use of restraints lies with the transporting officers.  (Currently 6 of NH’s 10 sheriff’s departments require mandatory use of restraints on anyone being transported.)

For youth under age 18, alternative transportation, such as an ambulance or other medical vehicle, may be used if the physician or APRN feels it is safe to do so, and the service is available at the time it is needed, and the person, guardian or legal custodian provides authorization. Keep in mind that if an ambulance or other medical transportation is used, there will likely be a cost associated, and that may or may not be covered by health insurance.

Note that this is only for people who are being transported to a designated receiving facility under an Involuntary Emergency Admission petition.  Individuals being voluntarily admitted to a private hospital or unit that is a Designated Receiving Facility may use other options including ambulance or transport in personal vehicles depending on the circumstances.

You can definitely talk to your loved one’s clinician and share your concerns. It may be helpful to provide specific details as to why you do not think they are ready or safe to be released. For example, perhaps your love shared vital information with you that they did not share with the emergency services staff. If you are not the parent or guardian, the clinician may indicate they cannot speak to you without a release. However, they can listen to you even if you’re not the parent or guardian – though due to confidentiality laws, they cannot respond. If the individual is returning to your home and you are not comfortable with that (feel that you/other family members or the person being released will not be safe) if they are an adult you are under no obligation to have them return. If it is a youth, some hospitals have threatened to report a family for neglect to the Division of Children Youth and Families if they refuse to have the person return.