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N.H. Health and Human Services Department Releases $24 Million Hub-and-Spoke Plan For Mental Health Care



Valley News Staff Writer
Wednesday, November 21, 2018

West Lebanon — The New Hampshire Department of Health and Human Services has proposed creating a hub-and-spoke model to better coordinate mental health care across the state, improve access and reduce the number of people waiting in emergency departments for treatment.

The concept is outlined in a draft of a 10-year mental health plan, including a price tag of $23.95 million for the first two years, that the state released on Tuesday.

This new model for delivering mental health care — featuring a centralized phone number and regional access hubs — aims to improve services available for people struggling with mental illness in their communities. It “could be aligned” with a hub-and-spoke model the state is in the process of rolling out for addiction treatment, which will include a hub in Lebanon operated by Dartmouth-Hitchcock, the plan said.

“If we make strategic investments, (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 draft plan said. “Fewer people will need to seek mental healthcare at hospital (emergency departments), and none of them will wait there for extended periods until specialty care becomes available.”

Wait times for inpatient mental health care has become a problem in recent years. The average monthly waitlist for New Hampshire Hospital, which provides intensive treatment for patients with acute mental illnesses, included 49 adults from September 2017 to May 2018, according to a July report on the implementation of a community mental health agreement. That agreement was the result of a 2014 settlement of a lawsuit filed against the state on behalf of people with serious mental illness, including Upper Valley resident Mandy Dube.

Earlier this month, the persistent problem of prolonged wait times for mental health care was underscored by another lawsuit, this time filed by the ACLU against DHHS and Southern New Hampshire Medical Center, alleging that mental health patients are being held in hospital emergency departments involuntarily without due process.

The draft 10-year plan acknowledges the persistence of these long waits and recognizes that the waits delay necessary treatment. It also notes that improvements need to be made to reduce the readmission rate to New Hampshire Hospital. Last fiscal year, a third of patients admitted to New Hampshire Hospital were readmitted within six months of discharge, the plan states.

West Central Behavioral Health CEO Suellen Griffin, reached by phone on Wednesday, commended the state for accurately describing the challenges the state faces in this draft plan. West Central is the Lebanon-based community mental health center serving the Upper Valley.

“Before you can solve the problem, you have to at least get it and understand it,” Griffin said.

To help address these challenges, the plan proposes to increase Medicaid reimbursement rates, which currently reimburse mental health care providers at a rate of about 58 percent of the rates paid for the same services by commercial insurers.

“The common perception of the combined effect of these fiscal realities is to attach less value to mental health in (New Hampshire) than our neighboring states do, less value to mental health than to other aspects of health, and the least value of all to the mental health of our most vulnerable citizens,” the plan says.

At least in part as a result of these low reimbursement rates, the state struggles with a mental health workforce shortage. As the plan notes, more than 10 percent of clinical positions — 244 — in New Hampshire’s mental health system were vacant as of April.

Surrounding states fare better in this regard, the plan says. Connecticut, Massachusetts and Vermont have three to six times as many psychiatrists and about twice as many clinical psychologists, social workers and mental health counselors as New Hampshire.

While Griffin commended the state for accurately describing the challenges it faces, she said her concern remains the same as it has been with previous plans: “If they don’t fund it, it’s all for nothing.”

To get this work off the ground in the 2020-21 biennium, the plan proposes a total investment of $23.95 million. The money would be directed toward increasing Medicaid rates, establishing a centralized mental health portal; increasing education, prevention and early intervention efforts; developing the mental health workforce, as well as increasing supported housing and transitional services for those leaving or at risk of requiring inpatient treatment; and expanding mobile crisis services and peer support programs.

The proposal also would create six new state-level positions in 2020-21. One would oversee the system’s expansion and quality-monitoring efforts. Others would include a housing specialist; a liaison with the Department of Corrections; an infant and early childhood mental health specialist; a liaison with the Department of Education; and an access coordinator.

Hiring someone to guide the plan’s implementation at the state level will be key to its success, Griffin said.

“If they don’t get somebody who is ... able to provide strong leadership on this thing, it’s going to go nowhere,” she said.

As a result of the initial two-year investment, the plan says that by the end of 2021, “wait times in the (emergency departments) should be reduced significantly, if not eliminated altogether.”

A final public meeting on the 10-year plan — which can be found online at dhhs.nh.gov/ocom/documents/proposed-10-year-mh-plan.pdf — is scheduled for 5-7 p.m. on Dec. 3 at the Howard Recreation Center Auditorium, Hugh J. Gallen State Office Park Campus on Pleasant Street in Concord. Written feedback also can be submitted through Dec. 10 via email to 10yrMHplan@dhhs.nh.gov.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.