Uneven Efforts​ series.)Over the past decade, Vermont far..." /> Uneven Efforts​ series.)Over the past decade, Vermont far...">
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Vt. Spends More, but Impact Is Unclear



Valley News Staff Writer
Friday, April 22, 2016

 

(Editor’s Note: This article was published July 19, 2015. It’s part of the Uneven Efforts​ series.)

Over the past decade, Vermont far outpaced New Hampshire in its rate of spending on mental health care, but an objective assessment of the impact of that resource disparity remains elusive.

The disparity, as shown by the National Outcome Measures, compiled by the federal Substance Abuse and Mental Health Services Administration from data reported by state mental health agencies, was clear: For every $1 that New Hampshire spent on a per capita basis for mental health care in 2013, Vermont spent $2.

Each of the Twin States spent about $183 million on mental health services in 2013. But the Census Bureau that year estimated that there were 1.3 million residents of New Hampshire and only about 630,000 in Vermont. So Vermont spent $292 per resident on mental health care, compared with New Hampshire’s $138. (Maine led the nation at $345 per resident.)

But because there is no widely accepted measure of the quality of mental health care in different states, the impact of that additional spending was anything but clear. The National Alliance on Mental Illness, an advocacy group, noted recently “an alarming lack of reliable data that can accurately reflect states’ activities and help guide improvements” in mental health care.

Still, there are some measures. For example, the National Outcome Measures include state-reported implementation of certain “evidence-based practices” — mental health therapies that have demonstrated their effectiveness in scientific studies. The measures found that New Hampshire, unlike Vermont, offered some “Assertive Community Treatment,” an approach in which teams of about a dozen professionals provide a range of services, 24 hours a day, seven days a week, to groups of seriously ill individuals in their homes and communities.

In 2013, New Hampshire’s Assertive Community Treatment program reached one in 40 patients, according to the national measures. Vermont reported no ACT activities. But on closer examination, it appears there was less than met the eye to New Hampshire’s investment in the program.

Consider West Central Behavioral Health, a community mental health organization serving the New Hampshire side of the Upper Valley that has an Assertive Community Treatment team that cares for 17 patients in the Claremont and Lebanon areas.

West Central Executive Director Suellen Griffin noted that these teams “are extremely expensive.” West Central can’t afford the $1.3 million a year it would cost to field a full-fledged team if it included a full-time doctor, nurse, therapist, substance abuse care provider, case manager and vocational rehabilitation specialist and offered 24/7 coverage, she said.

Instead, West Central committed $225,000 a year to support a “hybrid” team that included a full-time therapist who is the team leader, one full-time and one half-time case manager, a four-hour-a-week doctor and a nurse, substance abuse provider and vocational rehab specialist, each working one day a week.

While that doesn’t match the official “best-practice” criteria for an Assertive Community Treatment program, the hybrid version “can be very valuable to our clients,” who are chronically mentally ill but not receiving outpatient services otherwise, Griffin said. The doctor can prescribe medication, the vocational specialist can handle job issues and the nurse can help with medication management and other physical health issues, she said. Others on the team can address housing and substance abuse problems.

Vermont is ahead in other areas. It provided medication management services to 86 percent of its patients, far more than the nationwide coverage of such programs, which reach about 25 percent of patients. New Hampshire had no such program.

Vermont also provided supported employment services to nearly one in three patients, while New Hampshire reached one in 10.

Vermont also performed well in a comprehensive ranking, funded by a pharmaceutical company, of state mental health care systems. Parity or Disparity: The State of Mental Health in America by Mental Health America, an advocacy group, ranked Vermont best among all 50 states in providing overall access to mental health care. New Hampshire was 16th, the lowest of the six New England states.

The same study found mental illness and substance abuse more prevalent among adults and youth in Vermont than New Hampshire but found that Vermont provided care to a higher share of its adults with mental illness — 57 percent — than any other state. New Hampshire ranked seventh at 50 percent. Similarly, Vermont ranked third in the number of residents per mental health care worker, at 329, while New Hampshire had one provider for every 493 residents.

Twin States residents west of the Connecticut River may enjoy slightly better odds for finding effective treatment, according to a 2014 survey by the Substance Abuse and Mental Health Services Administration. About 73 percent of Vermont patients reported improvement after receiving mental health care, a little better than the national average of 70 percent. New Hampshire care lagged a little, with slightly less than 60 percent reporting improvement after treatment in the public network.