Editorial: New Hampshire’s Mental Health System Needs More Than a Plan

Tuesday, November 27, 2018

The New Hampshire Department of Health and Human Services has drafted a new 10-year mental health plan in which it acknowledges that currently the state’s mental health system “can be hard to access and difficult to navigate.” That’s not exactly news.

Nor is it a mystery what it would take to remedy the situation — money. “If we make strategic investments,” the plan declares, “New Hampshire can reduce stigma, eliminate inequities in access to care, and offer all of its citizens a coordinated continuum of high quality services.” The cost of those strategic investments, as staff writer Nora Doyle-Burr reported last week, would be nearly $24 million for the first two years.

If the Legislature and the governor can muster the political will to make those investments, it will be something of an upset. Previous mental health initiatives have foundered for lack of sufficient funding. As the draft plan puts it, “A steady stream of highly regarded policy recommendations, dating back at least to the 2008 10-year Mental Health Plan, historically stalled against a deep national recession and other factors.” In our view, those other factors have too often included willful blindness to the state’s obligation to provide services for the mentally ill. Call it the New Hampshire Disadvantage.

The result?

* As Doyle-Burr reported, in any given month from September of 2017 to May of this year, an average of nearly 50 adults were waiting to be admitted for treatment at New Hampshire Hospital, which cares for patients with acute mental illness.

* On several days during the past year, more than 70 patients needing inpatient mental health treatment were being held in hospital emergency departments, which are not equipped to provide therapeutic mental health care. Many patients languish in emergency departments a week or more before being transferred to settings that provide the specialty psychiatric care they need.

* In the past fiscal year, a third of patients discharged from inpatient care were readmitted within six months because the community services needed to keep them well were not available.

* Low rates of reimbursement from New Hampshire Medicaid, which funds most services provided through the community mental health system, translate into lower salaries, limited benefits and difficulty in recruiting and retaining psychiatrists and other skilled clinicians compared with other New England states. One study found that as of April, 10 percent of clinical positions in the New Hampshire’s public mental health system were vacant — a total of 244 jobs.

The larger backdrop is that the state is in the midst of an opioid drug-overdose crisis that is among the nation’s worst; suicides have risen by more than 30 percent in New Hampshire in the past five years; and the state’s Division for Children, Youth and Families has received intensive scrutiny for failure to adequately protect children in its care. Homelessness is a persistent problem.

The overall picture is one of a mental health system and population in distress.

The draft of the new 10-year plan envisions something better and recommends nothing less than the reorganization of the entire system into a “hub and spoke” model, the heart of which would be a centralized mental health “portal” directing people to information and to a “robust spectrum” of evidence-based services and promising practices in their own communities.

Those on the front lines will believe it when somebody shows them the money. Suellen Griffin, CEO of Lebanon-based West Central Behavioral Health, the community mental health center serving the Upper Valley, told Doyle-Burr that the previous 10-year plan was a good one, “but it was never funded.” As result, a class-action suit was brought against the state for failing to provide adequate mental health treatment and support. That suit was settled five years ago, and while some progress has been made, the state has failed to make good on many of the promises it made in the settlement.

Throwing money at a problem isn’t always the best way to solve it, but in this case, there’s every reason to think that a big and sustained financial commitment by state government is just what is required.