Let’s get it right this time

It is common knowledge that New Hampshire once had a mental health care delivery system that was a model for the entire country. Today, the state continues to be in the midst of a deepening crisis; compounded further by the ravaging opioid crisis that has a stranglehold on New Hampshire citizens of all economic groups and ages. Media accounts of patients, both adults and children, forced to languish in emergency rooms for days or weeks, waiting for a psychiatric bed to become available, are no longer drawing the attention or concern they did when the numbers first began to escalate.

Too many years of neglect through insufficient funding by the Legislature have rendered the once strong community-based system incapable of providing timely care. Unfortunately, many of our legislators know very little about mental health related issues and the impact that they have on people’s lives. Legislators interested in working on these issues generally are those with a personal connection to mental illness and substance use disorders.

Five years ago, mental health advocates were alarmed by the fact that on average, nine people a day sat in New Hampshire emergency rooms waiting for a bed to open at the State psychiatric hospital. Today, 42 people or more are experiencing a mental health crisis necessitating hospitalization but are forced to wait in a local hospital emergency room. In some cases, they have been there for weeks. Where is the outrage about this unacceptable situation?

While everyone agrees that New Hampshire’s mental health system remains in crisis, there is disagreement over the solution. Many who have years of experience in the field say part of the answer can be found in providing more inpatient psychiatric beds in addition to increasing funding for community-based care.

Looking to design a better system, the Legislature passed HB 400 in the 2017 session, directing the New Hampshire Department of Health and Human Services to come up with some solutions. DHHS then awarded a contract to Antioch University’s Center for Behavioral Health Innovation to develop a new Ten-Year Mental Health Plan for the state. The Center was responsible for reviewing existing reports on service delivery; meeting with stakeholders; researching best practice models in other states, identifying the current system’s weaknesses; and offering recommendations for improvement.

The State last created a Ten-Year Mental Health Plan in 2008. That plan included a diverse approach to address a service delivery system once considered one of the best in the nation. When the 2018 Plan for the State’s mental health system is released, any recommendations will require increased funding. While we have still not seen any specific language, it appears the new Plan will concentrate efforts on community care.

As a result of a 2014 settlement agreement stemming from a lawsuit that alleged that patients were needlessly institutionalized when they could not access timely mental health treatment in their local communities, some new funds were allocated to expand the capacity of community-based services, including mobile crisis teams in the southern part of the state, with the goal of avoiding hospitalization. But it appears there is no provision in the new Ten-Year Mental Health Plan to increase the number of inpatient beds. In addition, there is a critical need for a secure psychiatric facility, that will be required to address the needs of civilly committed patients at the Secure Psychiatric Unit at the State prison in Concord.

While we do applaud the Department’s efforts to support expanded community based-treatment, New Hampshire still faces a severe shortage of inpatient psychiatric beds. We really can’t do one without the other: we need more beds and more community services, and we need adequate funding for both.

The time to act to find additional funding is now, before a court forces that issue; and most importantly, to increase access to timely care for children and adults across a state that once was a national leader in the provision of high- quality care. The new 10-Year Mental Health Plan is our next, best chance to start fixing a mental health crisis that is crippling our state. We have some good solutions and most of the answers to solve the problem – we just need the political will to get it done.

Eric Johnson is CEO of Northern Human Services, one of New Hampshire’s ten designated community mental health centers.