New Hampshire will mandate substance abuse treatment if you get a DUI. It will do nothing if your mother is losing her mind.

Get behind the wheel drunk and this state will pull your license, mandate a formal substance abuse evaluation through the Impaired Driver Care Management Program, require completion of a 20-hour education course, and potentially put an ignition interlock device on your vehicle so you physically cannot drive impaired again. Fail to comply and the suspended jail sentence kicks in. The state has built an entire infrastructure of intervention, accountability, and treatment — because it decided that a drunk driver represents a preventable danger, and prevention is worth the cost.

Now let’s talk about what happens when someone in your family is suffering a severe psychiatric breakdown.

Under RSA 135-C:34, the law governing involuntary psychiatric treatment in New Hampshire, the standard for intervention is whether a person poses “a potentially serious likelihood of danger to himself or to others.” Not suffering. Not deteriorating. Not destroying relationships, jobs, and years of their own life. Danger. Imminent. Documented. Only then does this state act.

The Double Standard Encoded in Law

The hypocrisy here is not accidental. It is structural.

RSA 135-C:2 — the definitional section of New Hampshire’s entire mental health services statute — excludes substance misuse and extended periods of intoxication from the legal definition of mental illness. The state has drawn a hard legal line between addiction and psychiatric illness, not for medical reasons, but for legal ones: legislators did not want criminal defendants to use mental illness as a defense for crimes committed while intoxicated.

So New Hampshire split the problem in two — and then only built a response for one half of it.

For DUI offenders, there is mandatory treatment. Mandatory evaluation. Mandatory follow-up. A state-administered program, the IDCMP, with teeth: non-compliance means your license stays gone and your sentence gets imposed. The state has decided that substance-impaired driving is preventable, and it acts before the next crash happens.

For families watching a loved one deteriorate from a psychiatric illness — psychosis, severe bipolar disorder, untreated schizophrenia — the state offers nothing like it. There is no mandatory evaluation triggered when a family files complaint after complaint and nothing happens. There is no mechanism to compel treatment until that person crosses the threshold of “likelihood of danger.” You are legally obligated to watch someone you love fall apart, and the law tells you: not yet.

That is not a civil liberty framework. That is state-sponsored negligence.

The System That Was Never Built

For over a decade, people in psychiatric crisis in New Hampshire were held in hospital emergency rooms for days — sometimes weeks — because the state lacked enough inpatient psychiatric beds. Not a temporary gap. Not an isolated incident. A decade of documented ED boarding, multiple rounds of litigation, and a federal court order in May 2023 requiring the state to fix it.

In the three years before 2024, an average of 24 patients — adults and children combined — were waiting every single day in emergency departments for an inpatient psychiatric bed. At New Hampshire Hospital in Concord alone, approximately 70 patients on average sat medically stable and unmoving — not because they needed acute care, but because the state had so little transitional housing there was nowhere to send them.

In February 2023, NAMI New Hampshire and community mental health center directors told lawmakers plainly: “The system is broken.” They were asking for $30 million just to add workers and maintain basic treatment capacity.

This is the system that asks families to wait for “a likelihood of danger” before it will act. There is no danger threshold for a patient rotting in a hallway bed. There is no danger threshold for a family that spent years watching the mental health system shrug. The danger threshold only appears the moment the crisis explodes — at which point the state suddenly has all kinds of resources available: police, ERs, courts, hospitals.

The Question No One Wants to Answer

Why does New Hampshire mandate intervention, evaluation, and treatment for a DUI — an impaired judgment that may create danger — but refuse any comparable obligation to a person in active psychiatric crisis whose impaired judgment is not a risk factor but a daily reality?

The answer cannot be cost. The cost of untreated psychiatric illness — in ER visits, in policing, in lost productivity, in lives — dwarfs the cost of any prevention program this state might fund.

The answer cannot be civil liberties. New Hampshire has no problem restricting a drunk driver’s liberty, mandating treatment, and installing devices in their vehicle. It is not a civil liberties state when it comes to DUI. It only becomes a civil liberties state when the person suffering is mentally ill and the political cost of acting is higher than the political cost of doing nothing.

The answer is that the mentally ill do not have a lobby. They cannot organize. They cannot threaten a politician’s reelection. Their families are exhausted, isolated, and trapped inside a system explicitly designed to defer action until the situation is too catastrophic to ignore. So the state does what it always does when a problem has no political consequence: it writes a threshold into the law, labels it “protection of rights,” and waits for the body count to become a headline.

This Is Personal

My mother is mentally ill. I have watched this state’s indifference work in real time — watched a person I love fall apart inside a legal system that tells families to document, to call, to file, and then to wait while the clock runs on a fuse the state will not cut.

The gap between how this state treats impaired drivers and how it treats the psychiatrically ill is not a policy nuance. It is a moral failure encoded in law. Thirty-one states have enacted Assisted Outpatient Treatment laws — court-ordered community psychiatric care that intervenes before someone becomes a danger. Massachusetts has Chapter 123 §35, which allows family members to petition a court for emergency involuntary treatment for both substance use and psychiatric conditions. New Hampshire has had every opportunity to build something similar. It has chosen not to.

New Hampshire can change the law. It can fund the infrastructure. It has simply decided not to — and every family in this state who has been told “there’s nothing we can do” deserves to know that the decision was a choice, not a constraint.

That ends, or it doesn’t. And every legislator who has funded ignition interlock devices while voting against mental health infrastructure should be asked why. Loudly. On the record.