Of mice and mental health

Building our state’s budget can feel a bit like Hasbro’s Mouse Trap. Somewhere in there the green plastic boot that is “spending targets” sets a roll on an efficiency budget. Then come multiple recommendations, hearings, and conference committees, all sliding, leveraging, leaping to capture New Hampshire priorities and values.

And for those of us in mental health, each biennium represents a chance to strengthen a system that is critical not only to the tens of thousands of employers and employees, educators, seniors, veterans, and children we serve but also to the million or more we don’t. Thankfully the 2-year, $13 billion state budget that the House and Senate committee of conference agreed on last week is a step in the right direction for all those who call the Granite State home.

I am pleased that per the recommendations of the New Hampshire 10-Year Mental Health Plan, the 2020-2021 budget will include a Medicaid reimbursement rate increase (3.1%) in each year of the biennium. Despite inflation, NH has not raised this rate since 2006, and doing so now increases our ability to improve and maintain an environment of care for clients. The field of mental health treatment is as dynamic as the population we serve. Consequently, the cost of keeping Evidence-Based Practices current (i.e., impactful) can be challenging. Because of reimbursement rate increases, children affected by trauma or a veteran experiencing PTSD is able to receive the right therapy at the right time by a highly-trained staff.

Because of historical low reimbursement rates, NH’s Community Mental Health Centers struggle to recruit and retain bright young talent. Those beginning their careers choose to practice in other states and turnover rates are higher than in other fields. As illustrated by Improving Child & Community Health: Addressing Workforce Challenges in Our Community Mental Health Centers, “staff turnover disrupts quality of care.” I am thrilled, however, that listed among the many priorities of the new budget is expanding the State Loan Repayment Program (SLRP). This is a proven program that provides loan repayment funds to health care professionals who commit to a 36 month-New Hampshire service obligation. A more robust SLRP allows organizations like ours to aggressively pursue qualified candidates and retain staff already engaged in the work of helping others improve quality of life.

Further, I am heartened that budgetary considerations did not stop with loan repayment. SB 308 – the omnibus workforce bill, broadens the definition of “Telemedicine” and where it can be used. Also called “Virtual Health,” telemedicine employs new communication platforms to allow health care professionals to evaluate, diagnose, and treat patients. Practically speaking, SB 308 fosters a care environment that is both flexible enough to accommodate staff life events (e.g., child birth or a change in residence) and constant enough to promote continuous client recovery and resilience.

Perhaps that word that best describes NH’s 2020-2021 budget: RESILIENCE. Whether you’re already working in the field, a member of our Mobile Crisis Team, say, responding to an overdose where a child is present. Or maybe you’re in crisis yourself – resilience is the currency of wellness. Healthy communities require it. A healthy New Hampshire requires it. And we are best served to remember resilience is something that can be built.

My hope is that two years from now, in the next biennium, when once again the shiny ball of our state budget begins to rattle, we are reminded that building a strong, resilient New Hampshire demands continued investment in mental health. Yes, we’re committing more resources now than in years past to an urgent mental health need, but when dealing with crisis there is a tendency to address only the square you’re on.

Mouse Trap allegory aside, I’m proud of the steps New Hampshire is taking to recognize mental health as integral to overall health care. I’m proud of the quality and effectiveness of our state’s system. And I am proud to talk openly about mental illness and related stigma so we may expand access to treatment for all New Hampshirites. If this budget is any indication, New Hampshire has begun to lift its gaze to glimpse a prosperous, not to mention colorful, path to total wellness. Rock on, Granite State.

Bill Rider is president/CEO of The Mental Health Center of Greater Manchester and a member of the National Council for Community Behavioral Healthcare.