Community Mental Health Settlement Agreement (Amanda D. Case)

Case Summary:

In 2014, following litigation by our office, the court approved the Community Mental Health Agreement (CMHA). The agreement requires New Hampshire to provide community-based services and supports so that people with serious mental illness can live in the community rather than in institutions like New Hampshire Hospital or Glencliff Home.

These services include mobile crisis teams and crisis apartments, assertive community treatment (ACT), supported housing, supported employment, and peer and family supports. For nearly a decade, compliance with the CMHA has been monitored by an independent Expert Reviewer who issues semi-annual public reports which are available below.

In 2021, we worked with the U.S. Department of Justice and notified the State that it was not meeting certain CMHA requirements, particularly those related to transitioning people out of Glencliff and expanding community-based housing. After working with the State, the court approved a modified agreement on March 29, 2023. The updated agreement requires new long-term community residential options, including housing for people leaving or at risk of entering Glencliff, and caps Glencliff’s population at 75 residents.

Unfortunately, the State has not implemented the modified Community Mental Health Agreement as promised, leaving key obligations unfulfilled. This represents a serious broken promise to people with mental illness and to their families and friends who were told that community-based supports would be put in place to reduce unnecessary institutionalization. We will continue to use every available tool to ensure the State and its leaders meet their obligations under the 2023 modified agreement and deliver on those commitments.

The Twentieth Expert Reviewer Report was issued on March 18, 2026. Some key takeaways include:

• “[T]he ER made determinations across 44 CMHA requirement categories based on the review of historical data and information reported during the current review period. Of those, 20 areas were determined to be Met, 14 were Not Met, and 10 were Unable to Determine due to insufficient or untimely information to support an assessment.” (pg. 8)

• “The findings in this report highlight several areas where continued, focused improvement is necessary to advance the Agreement’s core objectives. Persistent gaps in transition planning consistency, particularly at NHH, combined with insufficient residential and supported housing capacity, continue to delay discharge for individuals who no longer require institutional care.” (pg. 10)

• “NHH provides intensive, restrictive treatment and evaluates ongoing care needs. According to staff, 80-100 patients remain hospitalized because suitable residential or community services are unavailable, or other barriers to discharge have not been resolved. These extended stays cost the State significantly; with daily care estimated at $1,599, the State spends about $127,920 per day on unnecessary hospitalizations. These funds could support the development of additional home and community-based services.” (pg. 10)

Appendix 1. Summary of Determinations by CMHA Requirement (March 18, 2026)

New Hampshire Community Mental Health Agreement Quarterly Data Report (January-March 2025)

Download the modified CMHA 

The State of NH’s own Mission Zero data shows that on any given day over the past 12 months, there have been over 100 people on average at New Hampshire Hospital who do not need to be there but cannot be discharged because there aren’t enough mental health resources in the community to support them. These individuals have been found to be clinically stable enough for discharge for at least 15 days but remain stuck at the hospital without access to critical community-based supports. That figure represents more than half of the facility’s maximum patient population of 185.