N.H. Mental Health Centers Grapple with Staffing Challenges

  • Photographed on November 28, 2007, Suellen Griffin is the CEO of West Central Behavioral Health, which works with adults and children who have a range of emotional, behavioral and addictiion problems. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Published: 10/23/2016 12:01:54 AM

Lebanon — The 10 community mental health centers that serve as the front door to New Hampshire’s array of services for people with mental illness continue to struggle to recruit and retain trained and credentialed caregivers.

In August, there were 173 unfilled jobs in nine community mental health centers surveyed by the state Community Behavioral Health Association.

That meant more than one of 13 positions were vacant in those centers.

The number of vacancies has risen since, said Suellen Griffin, chief executive of West Central Behavioral Health and president of the state association.

In August, even as a contract dispute at the state hospital grabbed headlines, three doctor and five advanced practice nurse positions were open in the community centers, according to the survey.

That was down from February, when seven physician and four nurse jobs were open and March, when there were six vacancies in each category.

Those centers provided care to 34,700 adults and 10,700 children in the fiscal year that ended in June 2015, according to a tally by the state Health and Human Services Department.

The association’s report noted that physician salaries, which ranged from $165,000 to $191,000 in its member centers, lagged behind the statewide average of $213,000, as did advanced practice nurse salaries, which at community mental health centers ranged from $91,000 to $102,000 — below the statewide average of $106,000.

The wage gap was even wider for master’s degree-level therapists, whose salaries in community centers ranged from $37,000 to $43,000, far below the statewide average of $58,000.

The survey found that the statewide turnover rate was 19 percent annually, or about one in five positions in community mental health centers, while the average time it took to fill a position was 113 days.

Griffin said measures that her association thinks could help ease the staffing crunch include an increase in Medicaid reimbursement rates, student loan forgiveness for caregivers, easier licensing for providers coming to New Hampshire from other states and a reduction in administrative paperwork.

Financial Challenges

Some of the challenge facing the centers is financial. Eight of those centers posted deficits in fiscal 2016, according to Ken Norton, executive director of the National Alliance on Mental Illness’ New Hampshire affiliate.

Red ink flowed after an interval of at least 10 months during which those centers lacked contracts with the managed care organizations that now pay for Medicaid patients. As a result, Griffin said, community mental health centers have been reimbursed at rates at or below those in effect a decade ago.

A 2014 lawsuit settlement looked to the community mental health centers to help develop a statewide network of crisis-response teams as well as employment support services and subsidized housing for people with mental illness.

A centerpiece of the lawsuit settlement was a commitment to put in place assertive community treatment teams with a range of professional and support staff in order to deliver high-level care in community settings. In July, a court-appointed reviewer found that the state had so far failed to meet its commitment to staff and reach patients with care through these teams.

At West Central, which serves the New Hampshire side of the Upper Valley, salaries trail those of such prominent local competitors as Dartmouth, D-H and the VA Medical Center in White River Junction, Griffin said.

West Central had an 18 percent turnover rate and filled empty positions, on average, after 90 days. “We can’t recruit new people and we have a hard time retaining people,” Griffin said.

That can affect patient care. Right now, new patients wait four to six weeks for a first appointment at West Central, she said, noting that those with critical needs can be seen by West Central’s 24/7 emergency services team or in a hospital emergency room.

Despite the staffing shortage, West Central has begun working with a consultant to institute a program that will enable the agency to schedule same-day or next-day first appointments, Griffin said. Such consultants analyze data and work flows and look for ways to reduce time wasted by staff and patients due to redundant documentation and no-show or canceled appointments.

The new system, which Griffin described as “changing the model of care,” should be ready to roll out in late spring, she said.

Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.

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