Independent New Hampshire Journalism · Northfield, NH

New Hampshire’s Involuntary Emergency Admission Law Guarantees Custody. It Does Not Guarantee Care.

Roughly 2,000 times a year the state takes someone into custody in a mental health crisis. Read the chapter that authorizes it and you find the state admitting, in a definition, that the whole thing is not treatment.

Read RSA 135-C:2, XVI and the problem is sitting right there in a definition. New Hampshire law defines “treatment” as examination, diagnosis, therapy, medication, and other services in the mental health system, and then carves one thing out of it. Treatment does not include “examination or diagnosis for the purpose of determining the need for involuntary emergency admissions.” The state wrote that down and put it in the statute books. The thing that happens to roughly 2,000 Granite Staters a year is not, by New Hampshire’s own definition, treatment.

An involuntary emergency admission — everyone in the system says IEA — is a custody law. It is very good at custody. It reliably produces a certificate and a police transport, often under restraint. It produces a court date and a file at the receiving agency that outlives the crisis. What it does not reliably produce is care, and under the same chapter that authorizes the custody, it is not permitted to.

Calling IEAs useless would be a compliment. Useless means nothing happens. Something happens. The state takes custody of a person who has committed no crime and moves them under restraint. It opens a file that outlasts the crisis. Then it has to ask that same person’s permission before giving them medicine.

Anyone can start it, and the emergency can be five weeks old

A person is eligible for an IEA if mental illness has put them in such a condition as to pose a likelihood of danger to themselves or others. That sounds narrow. The definitions are not.

Danger to self covers serious self-injury or an attempt at it, a threat of the same, or an inability to care for one’s own welfare. Danger to others covers inflicting or attempting or threatening serious bodily harm. In every branch the qualifying act need only have happened within 40 days of the petition. New Hampshire’s emergency statute runs on a five-and-a-half-week lookback.

Who starts it matters more than people know. Under RSA 135-C:28, I, a petitioner is any individual who asked a physician, physician associate, or advanced practice registered nurse to conduct the examination. Not a doctor. Not a relative. Any individual. If the person refuses to be examined, a petitioner or a police officer can swear a complaint before a justice of the peace, who may order a compulsory mental examination. Separately, an officer who sees behavior suggesting mental illness and immediate danger can take a person into protective custody on the spot, for up to six hours, until a clinician decides.

So the front door is wide, the clock reaches back more than a month, and the person who opens it can be anyone with a grievance and a phone.

The part where treatment does not happen

Here is what the law promises the person on the other end of that door. Within 12 hours of arriving at the receiving facility they must be told, in writing, that no treatment will be administered during the involuntary emergency admission unless they make an informed decision to consent, or unless a medical or psychiatric emergency exists.

Read that twice. The state can hold a person for up to 10 days on one clinician’s signature. It cannot medicate them. For the 48 hours before the probable cause hearing, the statute goes further and bars medication that would impair the person’s judgment or ability to prepare, absent consent or an emergency.

Those are good rules. Forced medication is a serious thing and the drafters knew it. But set them beside the definition in RSA 135-C:2, XVI and the shape of the scheme comes clear: the evaluation is not treatment and the admission does not deliver treatment either. It delivers a bed, a file, and a hearing date.

For most of a decade, the hearing did not happen

The check on all this is supposed to be speed. Within three days of an IEA, not counting Sundays and holidays, a district court holds a probable cause hearing, and the burden sits on the petitioner.

For eight or nine years it did not work. The New Hampshire Bar Association reported in 2022 that before the courts changed the process, more than half of these cases were dismissed because the three days expired before anyone heard them. Against roughly 2,000 IEAs a year, that is a large number of people held and then released with no adjudication at all. Some, the Bar Association reported, sat in emergency departments two or three weeks first.

The reason was a fight over when the clock starts. The state read the three days as running from the patient’s arrival at a treatment facility, which with beds scarce could be two weeks after the doctor signed. A patient held 17 days took it to the New Hampshire Supreme Court, and in Jane Doe v. Commissioner, 174 N.H. 239 (2021), the court held the deadline is “triggered by the completion of a certificate, not by the person’s delivery” to a facility.

The courts then fixed their end fast. On March 21, 2022, the Circuit Court launched a centralized IEA docket under Administrative Judge David King, hearing cases telephonically while patients were still in emergency rooms. Between that date and July 1, eight of 768 hearings were dismissed for missing the three-day requirement. Four months of work erased a failure rate above 50 percent.

It took a Supreme Court opinion to tell the executive branch when its own three-day clock starts running.

Patients won a hearing. Hospitals won the beds.

The bed shortage was the other half. In 2018 the ACLU of New Hampshire brought a class action for patients boarded in emergency rooms without due process. That case ground on. New Hampshire’s hospitals intervened with a different theory, and it is the theory that moved the state.

On February 23, 2023, U.S. District Judge Landya McCafferty ruled that the commissioner’s practice of boarding IEA-certified patients violated the hospitals’ Fourth Amendment rights. The state was seizing hospital property. In May 2023 she ordered transfers accepted within six hours and gave the state a year. The state dropped its appeal that July.

The deadline then moved. May 2024 became December 2024, which became the end of March 2025. On April 3, 2025, a state lawyer told the court that six hours is “probably not achievable across the board.” The judge praised the progress and gave the parties another 90 days to propose something else. The waitlist has come down hard, with days at zero. NAMI New Hampshire’s guidance to families, updated in May 2026, still tells them a transfer more often takes days than hours.

Handcuffs by county policy

RSA 135-C:29, II tells the transporting agency to decide whether restraint is necessary to protect anyone’s safety. For ambulance transport, that decision must be in writing and must state the factual basis. For law enforcement transport, the statute imposes no equivalent written-basis requirement.

NAMI New Hampshire tells families what that means on the ground: the clinician’s recommendation about restraints carries no requirement that anyone follow it, and six of the state’s 10 sheriff’s departments require restraints on everyone they transport. No crime, no charge, no finding. Handcuffs because of a county policy.

RSA 135-C:29, IV requires every designated receiving facility and the chief executive of New Hampshire Hospital to file an annual report each November on transport modes and restraint use, broken out by adults and children and by whether restraints went on before or during transport. Those reports go to the legislature’s oversight committee on health and human services.

The file that never closes

New Hampshire does have an annulment provision, and on its face it is a good one. If the district court finds the petitioner failed to carry the burden, the court file is sealed, the IEA is annulled, and the person is treated in all respects as though it never happened. On any job or license application, the only permissible question is whether the applicant has been the subject of “an involuntary emergency admission that has not been annulled by a court.”

Now notice what annulment requires: a finding. A court has to hear the case and rule against the petitioner.

That leaves most people out. A case dismissed because the three-day clock expired produces no finding. A certificate rescinded under RSA 135-C:29-a, before an officer takes custody, never reaches a court. And a petition that no clinician ever certifies produces no court file at all. Officers come out and decline. The paperwork still exists. It just does not exist anywhere a court can reach it. Meanwhile RSA 135-C:33, II provides that the petition, police record, transport request, and medical record generated by an IEA “shall remain with the accepting agency,” released only on the person’s written consent.

The paperwork stays. The remedy requires a hearing most people never get. Nobody annuls what a court never heard.

What the legislature has done about any of this

Not much, in either direction. After the November 2023 killing of retired Franklin police chief Bradley Haas in the lobby of New Hampshire Hospital, lawmakers took up “Bradley’s Law,” which would have let the state report certain mental health records to the federal background check system with a rights-restoration process attached. HB 1711 failed in 2024. In 2025, HB 159 was tabled 193-187, a revival motion failed 174-198, and the Senate killed the companion SB 144 the same day, 16-8. In February 2026 the House rejected an extreme risk protection order bill, HB 1642, by 206-153.

One honest note, because it cuts against the easy version of this story: none of those bills reached IEAs. Bradley’s Law was drafted to cover non-emergency commitments ordered by a judge under RSA 135-C:34-54, not emergency admissions. An IEA does not put a name in the federal database. The damage an IEA does is local and unreviewable, which is a different problem and in some ways a worse one. There is no docket to appeal a police narrative.

Four fixes, none of them new law

The state proved in 2022 it can move fast when a court makes it. Three of these edit sentences already sitting in RSA 135-C.

• Publish hearing compliance. DHHS posts a daily bed waitlist. Nobody posts the share of IEAs that got a probable cause hearing inside three days. Bed data measures the state’s convenience; hearing data measures the person’s rights.
• Widen annulment. Extend RSA 135-C:31-a to every IEA that ends without a probable cause finding — dismissal, rescission, or a certificate that never issued — and make it automatic rather than something you have to know to ask for.
• Match the restraint standard. If an ambulance crew has to write down why the restraints were necessary, a deputy should have to write down the same thing.
• Read the restraint reports. They are filed every November and they are public. Someone should be asking what is in them.

None of that turns an IEA into treatment. Treatment takes beds and clinicians and money, and the state is grinding at that under a federal court’s eye. But the statute could at least stop pretending. As written, New Hampshire runs a custody law and calls it an admission. It tells the person in writing that no treatment is coming, then leaves behind a file most of them will never be able to clear.

— Dexter Dow, Granite State Report

Fact check

Editor’s note. Every factual claim above was checked against the statute text, court records, or the named institutional source before publication; see the fact-check table. Two items are worth flagging for readers. First, the Doe holding is quoted as the New Hampshire Bar Association reported it, citing 174 N.H. at 242. Second, the reading that annulment under RSA 135-C:31-a is unavailable where no probable cause finding is entered is this outlet’s reading of the statute’s plain terms, not a court holding; it is argument, and it is labeled as such. This piece is journalism, not legal advice. Corrections: Granite State Report corrects verified errors promptly and appends a note identifying what changed and when.