NASHUA – There was a massive snowstorm the day before Direction opened its doors in the Nashua Millyard. Duncan Gill remembers standing outside trying to spray-paint the front door red while the fierce wind sent paint flying everywhere.

Gill and his two partners had no experience running a business. They weren’t quite sure how to keep the books or do payroll. But it was go time.

Three years later, the trio has created a business that is sustainable, even if it’s not highly profitable. They’ve racked up 600 clients and recently opened a satellite office in Seabrook.

Direction Behavior Health Associates, as it’s called in full, is unlike most of its neighbors in the Millyard. The company isn’t making widgets or selling software; it’s in the business of mental health.

Direction is the state’s only intensive outpatient program for kids, teenagers and young adults with mental health issues.

Gill, a psychiatrist, and his partners Joe Walsh and Bob Cashen, both therapists, decided to team up and fill a void between inpatient mental health programs that pull kids out of their homes and schools, and outpatient programs that counsel kids for an hour each week.

“There’s an enormous amount of kids that fall somewhere in between,” said Gill, the medical director. “We offer the intensity of inpatient services, but kids can still be in the schools, in the community.”

“There was a definite need for this,” Cashen, the director of operations, said. “People have said we should go across the state.”

At first, the trio considered opening as a nonprofit. After some back-and-forth consideration, they decided that structure wouldn’t allow them enough freedom.

“We really struggled at first with whether to be nonprofit or a for-profit. But we didn’t want a board over our heads. We wanted to make our own mistakes; do it our own way,” Gill said.

After the idea for Direction was hatched, Duncan, Walsh and Cashen began meeting in Walsh’s apartment during lunch breaks to talk about how to make their idea a reality. At the time, Gill and Cashen worked for Community Council of Nashua and Walsh was employed at the Nashua Children’s Home.

“We were three mental health professionals who crossed paths because we shared clients,” Gill said.

All three kept their day jobs on a part-time basis until Direction took off. Now, more than a half dozen part-time counselors and therapists are on the payroll, too.

Although profits have been small, the founders say making big bucks really isn’t the point. Gill points out that they have managed to create a sustainable business at a time when many mental health centers across the state are closing.

That’s not to say there aren’t struggles. The founders have spent three years trying to get Medicaid approval, but have run into bureaucratic roadblocks, most likely because the program is the first of its kind in New Hampshire. They constantly face obstacles from insurance companies, which are eager to have kids discharged from the program as quickly as possible, Gill said.

Direction counsels children and young adults ages 11 to 21. They treat a variety of disorders and issues: anxiety, drug addition, schizophrenia and autism, among many others.

The one rule is that patients have to be willing to be there, and committed to the program. They can’t just opt in to avoid jail time because the court says so.

Connecting with the kids on their level is a key component of Direction’s approach. The staff plays sports and music with the kids, and has formed an in-house band. Gill plays guitar and Cashen plays trumpet.

The part-time staffers include a sea captain, opera singer and a marathon runner.

“It’s an energized place. It’s somewhat contagious and uplifting,” Gill said. “People have diverse interests. The place is alive.”

It appears that approach is working. Direction now gets referrals from medical facilities all over the region, including Children’s Hospital Boston, Southern New Hampshire Medical Center and St. Joseph Hospital.

Three years after painting the front door red, Direction’s founders have learned to keep the books and run the business. Gill built a software system for the company when they couldn’t find one to buy. But they’re still working to find that perfect balance between the nonprofit-like mission and the need to meet the bottom line.

“It’s absolutely a balance,” Gill said. “We have to be sustainable and profitable to the best extent we can while maintaining the quality of service. It’s a real tightrope and we’re still figuring it out.”

Ashley Smith can be reached at 594-6446 or asmith@nashuatelegraph.com.

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