Officials Seek Plan to Bolster Mental Health

Valley News Staff Writer
Sunday, December 31, 2017

West Lebanon — A new report emphasizing the importance of community-based mental health services held few surprises for New Hampshire service providers and advocates. Now they’re looking for a comprehensive plan — funding included — for improving the state’s mental health system.

The recommendations included in the report, which was released last week by the New Hampshire Department of Health and Human Services and was conducted by the Massachusetts-based research firm Human Services Research Institute, include increasing peer support and crisis services, and adding permanent supportive housing.

Instead of adding inpatient psychiatric beds, the report said the state would be better off targeting its limited resources to prevent severe mental health crises, and support and housing to allow patients to be discharged more quickly from New Hampshire Hospital, the 168-bed state-run acute psychiatric hospital in Concord.

There are a total of 458 inpatient psychiatric beds in New Hampshire, according to the report, which was required by legislation signed by Gov. Chris Sununu in June and relied on interviews with people around the state as well as documents and data from previous reports.

“The general takeaway was that we really do need to approach the challenges we’re seeing in the inpatient setting from two sides,” said Julianne Carbin, the director of the state’s Bureau of Mental Health Services.

The report offered a comprehensive snapshot of the current state of the mental health care system and “now we’re ready for this collaborative problem-solving process,” Carbin said.

The report is intended to provide a starting point as the state works to create a new 10-year plan for its mental health system, which is due out next summer, she said. The previous plan was published in 2008.

“We have a long way to go to figure out where to go forward,” Carbin said.

The state is still working to come into compliance with a 2014 mental health settlement agreement, the result of a lawsuit against the state by people with severe mental illness that spelled out the state’s responsibility to move away from treating people with mental illness in large institutions and to improve community-level mental health care, said Andrew Milne, a staff attorney for the Disability Rights Center, which brought the suit.

In the meantime, people in crisis are regularly waiting in the state’s emergency rooms for inpatient psychiatric beds elsewhere. One day in September, 70 people were waiting for beds at New Hampshire Hospital, according to the report. There have been as many as 72 people waiting on one day, according to the report.

On average, 21 adults and five children were waiting in emergency rooms for beds at New Hampshire Hospital, according to a survey conducted in 2014. Those averages have only increased since, the recent report said.

Three or four patients in crisis were waiting for more than a week in Valley Regional Hospital’s emergency room in Claremont recently, said Suellen Griffin, the president of West Central Behavioral Health, the Lebanon-based community mental health center which provides services in Sullivan County and southern Grafton County.

The emergency services “director was, like, pulling his hair out,” said Griffin, whose organization provides services at Valley Regional. “It’s just a nightmare for people to be housed over there like that.”

Part of the problem, noted Ken Norton, who directs the New Hampshire chapter of the National Alliance on Mental Illness, and was interviewed for the report, is that for patients there’s little choice between utilizing community-based services and inpatient treatment.

“People generally only have two choices: either survive with the usual (community mental health center) services, or, if that doesn’t work, go to an (emergency department) or seek an inpatient bed, even though an inpatient bed might not be truly needed,” according to the report. “While some partial hospitalization programs do still exist, transportation issues often bar individuals from accessing those programs if they are not in the immediate geographical area.”

Though the report points to consensus around the need to expand community-based services, obstacles to doing so remain, said Griffin, who also was interviewed for the report. In particular, low Medicaid reimbursement rates that haven’t changed since 2006, and a shortage of mental health service providers hinder further expansion of services, she said.

“It’s all tied to dollars,” Griffin said.

Increasing the Medicaid rates and adding money to the loan forgiveness program might help with recruitment and might enable community mental health providers to expand services, she said.

Cameron Ford, the director of the Lebanon-based Headrest, a nonprofit which provides residential drug treatment and a crisis hotline, said he struggles to recruit employees because people can often make more money working in the private sector. He currently has three openings, he said.

Ford pointed to the low Medicaid reimbursement rate as the crux of the problem.

“Every year you have to do more with less,” Ford said.

To continue its services, behavioral health care providers such as Headrest have to either “raise more money or cut back on what you do,” he said.

Ford said the report left out at least one key area that could use additional investment, that of job training. Participants in Headrest’s drug treatment program finish the program with jobs, but they are often low-paying positions that do not pay enough to support their families, he said.

The report also did not focus on capacity issues in state government, particularly at the Bureau of Behavioral Health, Norton said.

“I’d start there,” he said, noting that when New Hampshire’s mental health system was functioning well it had more people within state government working as leaders in the field. “We need that level of leadership.”

Though Sununu has said he aims to increase money available for the loan repayment program, Griffin said the state needs a comprehensive plan that includes a detailed accounting of the cost of running a fully functional mental health system.

New Hampshire spent about $183 million on mental health services in 2013, according to the most recent data available from the National Association of State Mental Health Program Directors. Vermont spent a similar amount, but has a smaller population.

“It is a system,” Griffin said. “One thing relies on another.”

Norton echoed Griffin’s statements about the need for a more integrated system of mental health care.

He said such integration is particularly important for populations with co-occurring conditions such as substance use and mental illness; developmental disabilities and mental illness, and medical conditions and mental illness.

“We have had for a long time now a segmented system of mental health care,” Norton said. It “hasn’t been particularly effective.”

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