A federal judge has again given the state more time to end its practice of holding mental health patients in emergency departments for prolonged periods.

For over a decade, people held involuntarily for mental health treatment have faced lengthy waits in the emergency room – often days or longer – before they’re transferred to an appropriate inpatient facility, because the state has too few psychiatric beds.

Last year, Judge Landya B. McCafferty ordered the state to end so-called ER boarding by May 2024, saying those patients should not spend more than six hours in the ER before getting into treatment. This spring, McCafferty extended the original deadline through December 2024 when the state said it needed more time to comply. Last month, McCafferty again pushed that deadline back, giving the state until the end of next March.

McCafferty’s original court order came about after litigation from New Hampshire’s hospitals. In a statement this week, the New Hampshire Hospital Association said it agreed to the latest deadline extension because the state is making progress.

“In light of the progress achieved and the work that continues, as well as our belief that the ED boarding crisis must end in order to provide our patients and their families with the care they need and deserve when in acute psychiatric crisis, we agreed to an extension of the compliance deadline into next year,” Steve Ahnen, the association’s president, said in the statement.

The state has rolled out an ambitious plan to fix the problem – called ”Mission Zero,” in reference to the goal of having zero patients on the waitlist for mental health beds – but said from the beginning it would take two years, not one.

That plan includes three broad goals: adding more inpatient beds, improving community-based mental health services to keep more people out of the hospital, and creating more housing options for people with serious mental illness, so that more people can be discharged from the hospital when they’re ready.

Jake Leon, a spokesperson for the New Hampshire Department of Health and Human Services, said the state has made progress on each of those fronts in the past year. That includes reopening some beds at New Hampshire Hospital, the state’s main psychiatric facility, and launching a walk-in crisis center in Derry.

The state has also opened two new specialized residential properties, each with space for five residents, and helped 19 people transition from New Hampshire Hospital to apartments thanks to a landlord incentive program, Leon said.

He credited those efforts with reducing the average length of time that involuntarily held patients are spending in the emergency room. People waited an average of 2.4 days in September, compared to 4.8 days in January, according to state data.

But what would have been the biggest expansion of inpatient beds – a private 144-bed behavioral health hospital in Londonderry, which was slated to open in 2026 – recently fell through. The town and the SolutionHealth hospital network, which was building the hospital with a $15 million investment from the state, failed to agree on terms.

Leon said the news was disappointing, but the state remains committed to improving mental health access in various other ways.

“We remain hopeful that creative public-private partnerships will continue to develop to right-size the intensive services our mental health system needs,” he said in a statement. “In the meantime, thanks to Mission Zero, we are continuing to expand all parts of the behavioral health continuum.”