Group: N.H. Kids Need Better Care

As adult mental health attracts attention in New Hampshire, a coalition of health organizations and advocates say children’s needs have gone unnoticed and yesterday released a “road map” for reforming the system.

The plan, developed over the past two years, is the first of its kind and involved more than 50 organizations from around the state, including Dartmouth-Hitchcock and the Geisel School of Medicine.

It described a fragmented system in which frustrated parents navigate a maze of state agencies, school programs and other resources while their children’s problems go untreated.

The New Hampshire Children’s Behavioral Health plan proposes a sweeping overhaul of the network of mental health providers and programs so that problems can be identified sooner and addressed.

“What we’re really after is a model that is much more integrated where physical health and mental health, behavioral health, substance abuse are all viewed together and not as these separate entities,” said Ken Norton, executive director of The National Association of Mental Illness in New Hampshire, in a conference call yesterday with reporters.

New Hampshire Gov. Maggie Hassan has included more money for community-based care in her budget proposal and she also supports a 10-year plan to rebuild the state’s mental health system. But those initiatives are largely focused on adults.

Currently, one in five children in New Hampshire — from preschool years through teens — has an emotional disorder, according to the report. But getting effective treatment is difficult because the network of behavioral health services, which include mental health as well as substance abuse programs, is so disjointed.

A lot of New Hampshire organizations deal with childhood behavioral health issues, but they tend to operate as distinct entities, Norton said. These include schools, primary care providers, mental health and the juvenile justice system. The plan rolled out yesterday seeks more collaboration among those disparate groups.

“They are highly fragmented systems and families describe their experiences with these systems as feeling like they were lost in a maze,” said Kim Firth, program director for the Endowment of Health, who also worked on the report.

Heidi Matthews, a parent from Strafford, said her 18-year-old son has been hospitalized 10 different times, mostly for suicide attempts, since he was diagnosed as having bipolar disorder when he was 8 years old.

As she searched for help, doctors recommended programs for which her son did not qualify. She would spend her free time calling around to organizations, only to be told that they couldn’t help. Other times, she and her son would “settle for programs that we really didn’t need” in the hopes that it would make their lives a little bit better.

“We never knew what services were available to us,” she said. “We never knew what we were qualified for.”

Matthews heard similar stories from other parents as she conducted focus groups as part of the project. The families were frustrated with spending time researching programs and running into bureaucratic roadblocks, she said.

The report made several recommendations, including improving coordination between agencies and programs “that don’t talk to each other,” creating support teams for families, focusing on early diagnosis and prevention, and boosting awareness about the importance of children’s behavioral health and treatment.

The plan has widespread support among state agencies and health organizations, Firth said, and many of the reforms would not require policy changes. However, there remains a lot of work to do in figuring out the details of what this new system would look like.

One of those details is money.

No one yet knows how much this new system would cost, Norton said. Policy leaders would be getting together over the coming months to look at how to streamline financing children’s behavioral health services in New Hampshire. The changes might not require any new spending and could even lower costs, Norton said, but those questions are only beginning to be explored.

“It’s hard to even put it in terms of additional spending because there are so many systems involved, it’s hard to get a handle on what is being spent now in terms of children’s behavioral health,” Norton said. “Certainly we understand from research that prevention is much more cost-effective than intervention and treatment. The fact that the plan really focuses more on prevention will hopefully result in less costs in the long run.”

The report doesn’t address the implications from expanding the state’s Medicaid program. But Norton said his organization, NAMI, believes Medicaid expansion would go a long way in supporting more families that need help.

Generally, the plan is a good start to addressing a severe need in New Hampshire, said Suellen Griffin, president and CEO of West Central Behavioral Health in Lebanon.

West Central staff helped develop the recommendations and Griffin said she was impressed at how the coalition was able to pull such a “daunting” project together.

However, implementing it will be difficult, she said.

“I think it’s a great plan. It’s comprehensive,” Griffin said. “But getting all the players in the room to come together and agree on how they’re going to share limited resources. ... The biggest hurdle to get over is how are we going to finance it.”

The report will be discussed in public presentations starting today in Manchester and planned around the state through May 29. So far, nothing has been scheduled in the Upper Valley.

Matthews, the parent from Strafford, said her son finally received the help he needed and was able to graduate from high school last year. But something needs to be done to help other New Hampshire families, she said. She was optimistic that the coalition’s goals could be achieved.

“We need change,” she said. “We need change for New Hampshire’s children.”

Chris Fleisher can be reached at 603-727-3229 or