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Newport, N.H., man’s case shows difficulty of accessing mental health care

  • Dominick Dephillips (Courtesy photograph)

Valley News Staff Writer
Published: 12/23/2020 8:40:23 PM
Modified: 12/23/2020 8:40:18 PM

NEWPORT, N.H. — Dominick Dephillips’ primary care provider referred him to Dartmouth-Hitchcock Medical Center for psychiatric treatment three times this year, but in November the 48-year-old Newport resident got a letter from the Lebanon hospital saying that it couldn’t offer him outpatient services.

The letter, which Dephillips shared with the Valley News, pointed both to the ongoing challenge Vermont and New Hampshire have in providing outpatient mental health care as well as a “sharp increase in demand for psychiatric and psychological services” due to the COVID-19 pandemic.

“We have reviewed the referral and medical records, and we regret that we cannot serve your mental health needs at this time,” reads the Nov. 13 letter from a staff member in D-H’s psychiatry and behavioral health department. “While we have previously put patients on a waitlist, we have ended that practice. We just could not get people off the waitlist and into care in a timely manner.”

Dephillips’ first reaction upon receiving the letter was a desire to go to DHMC and show the providers there his wrists, which have scars from cutting, a symptom of his mental illness that recurs in times of stress, such as following his mother’s death last January.

“When you have mental issues (it) makes you feel like no one cares,” Dephillips said in a phone interview last week. “Honestly, if I was alone, I probably would have committed suicide.”

Dephillips, a 1991 Newport High School graduate, said he is speaking out about the access issue in hopes of improving the system for himself and others.

Perhaps the hospital could hire more psychiatrists, he said.

“We can’t have all these people walking around that are suicidal,” he said.

It’s not clear how many such letters DHMC has sent out, but D-H providers and others say that the COVID-19 pandemic and associated stressors have compounded the challenges that mental health care systems in the Twin States and around the country were already up against.

“While I cannot give you the exact number of letters we have sent, even one is too many and we are hopeful that in the future there will be societal solutions that will provide greater resources and eliminate a need for such letters,” Dr. Will Torrey, interim chairman of Dartmouth-Hitchcock’s Department of Psychiatry, said in an email to the Valley News on Wednesday.

When D-H has more demand for its services than it can provide, Torrey said it focuses its resources on people who are already receiving other health services such as primary care through D-H. He said D-H shares information about other mental health care providers in the community with patients and referring providers that it has to turn away.

In addition, Torrey’s email noted that D-H offers crisis services 24 hours a day, seven days a week.

D-H is not alone in having more demand than it can meet for mental health services.

The Lebanon-based West Central Behavioral Health also has to refer some patients to other providers, who in turn also have more demand than they can manage, said Dr. Diane Roston, West Central’s medical director.

“I think it would be upsetting to get a letter like this,” Roston said. But, she added, “The information provided is absolutely correct.”

Roston pointed to years of insufficient funding at the state and federal levels and limitations in staffing and available beds for inpatient care.

The gap between the services that are available and what is needed “is enormous,” she said. “It’s getting worse.”

If the letter helps bring attention to the need for more funding for mental health care that would be a “silver lining,” she said.

Ken Norton, the executive director of the New Hampshire chapter of the National Alliance on Mental Illness, said he had not heard about letters like the one Dephillips received.

Given that the DHMC letter acknowledges a lack of capacity for psychiatric care in the region, Norton said it makes him wonder whose responsibility it is — ethically and legally — to ramp up the capacity for the hospital and others to provide needed care.

“I understand that D-H is expanding its inpatient capacity in some areas,” he said, referring to the new patient pavilion currently under construction in Lebanon. “Why not expand psychiatry?”

He questioned whether the same letter would be sent to people in need of care for other types of illnesses and also whether the type of insurance a patient has plays into their being denied care.

Norton also said that he hopes the state’s capacity issues don’t discourage people from seeking care they need. During the pandemic, the use of telehealth has increased access to mental health care, he said.

He also pointed to the passage of federal legislation establishing 988 as a mental health crisis line as a positive step.

The shorter number is slated to replace the current national suicide hotline, 1-800-273-TALK, in 2022.

Jake Leon, spokesman for the New Hampshire Department of Health and Human Services, said that the state got a grant this year to place a coordinator in each of the state’s 10 community mental health centers in anticipation of the need for more acute mental health care during the pandemic.

“We expect that individuals and families who have never sought services will need them as a result of the uncertainty and isolation we all have experienced for the last nine months,” Leon said. He said he hopes the COVID-19 relief package Congress passed on Monday includes more funding for mental health care.

Dephillips said he has struggled with a range of mental health issues including depression, bipolar disorder, borderline personality disorder and attention-deficit/hyperactivity disorder for more than two decades. He said he’s been on disability for years and has health coverage through Medicare.

His treatment history includes several trips to hospitals, inpatient stays at the Windham Center in Bellows Falls, Vt., as well as outpatient therapy in the Claremont and Manchester areas. He attempted suicide in 2006.

Adding to his mental health challenges are several physical health issues, including what he called “bad” knees and stage I esophageal cancer, which is currently in remission.

For the past few years, he said his primary care provider, a nurse practitioner at Keady Family Practice in Claremont, has been prescribing medications such as lithium to help manage his symptoms, but he said would like to work with a psychiatrist who has more experience treating mental illness. That’s why he said his provider made the referral to DHMC.

Fortunately, shortly after he received the rejection letter from DHMC, he heard from West Central Behavioral Health and the agency was able to get him into treatment after initially saying it couldn’t accommodate him, he said.

So far, he has had two intake appointments, he said. In addition, Dephillips said he has a supportive girlfriend and other friends to help him get through particularly rough times, such as navigating the first Christmas without his mom.

But Dephillips said he worries that other people who are struggling may not have that same type of support.

“My concern is those letters are just going to make people go over the edge,” he said.

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




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