The presidential primary season is in full swing in New Hampshire, where the state takes pride in its “First in the Nation” status. The citizens of New Hampshire take this responsibility very seriously, knowing the impact their votes and their voices can have on the overall health and welfare of both our state and the nation. One of the most widely debated topics in the presidential primaries is the issue of health care and what the appropriate role is for government to play in this arena. With that in mind, I believe New Hampshire should strive to reclaim a lead role as First in the Nation for mental health care, a position that we once proudly held.
On a national level, some of our past presidents have made this issue one of the hallmarks of success and a standard by which their administration and the very success of the nation should be judged. Note the following quote from President John F. Kennedy, “For one true measure of a nation is its success in fulfilling the promise of a better life for each of its members. Let this be the measure of our nation.”
Kennedy took a significant and bold step to improve the quality of health care by promoting the passage of the “Community Mental Health Act” in 1963. This legislation paved the way for the development of a system of community mental health centers across the nation to allow people suffering from mental illness to receive services in their communities, where they would be close to friends and family, jobs and spiritual and social supports. This, coupled with advancements in treatment and medications, significantly advanced the quality of life for many individuals suffering from mental illness, substance misuse or both.
While we should certainly acknowledge and celebrate the gains made through this landmark legislation, we also should recognize that both as a state and a nation, we still fall far short of the vision that these services would be readily available for all of our citizens who need them:
• One in five adults has a mental health condition (more than 40 million people), but less than 50% of those receive treatment in any given year.
• 20% of all youth between the ages of 13-18 live with a mental health condition, but an even higher percentage are left with no or insufficient treatment (80% of youth with severe depression receive no or inadequate treatment).
• 50% of all lifetime cases of mental illness begin by age 14, but the average delay between onset of symptoms and intervention is 10 years.
• Suicide is the third leading cause of death for youth ages 10-24, and rates for both youth and adults have increased significantly in the past 10 years.
The 2008 Mental Health Parity and Addiction Equity Act increased access to insurance for behavioral health disorders, as did the passage of the Patient Protection and Affordable Care Act in 2010, but gaps in coverage still remain. The MHPAE is typically not well enforced – allowing some insurance companies to continue to discriminate or deny coverage.
New Hampshire has made some significant gains in promoting access to quality health care for those suffering from mental health and substance use disorders. Medicaid reimbursement rates will increase in January 2020, but we still lag behind neighboring states in both access to care and reimbursement – making recruitment and retention of qualified professionals challenging. Vacancy rates for health care professionals at the 10 community mental health centers continue to hover around 10%. We also still see hospital emergency departments boarding of persons with mental health and substance misuse conditions, without adequate care, for lack of sufficient psychiatric beds and acute community care options.
While there is still much room for improvement, New Hampshire has the opportunity to address these concerns and thereby set an example for others in the nation to follow. In 2018, the New Hampshire Department of Health and Human Services led the effort to develop a new 10-year mental health plan, which holds much potential and could provide a path to reinstate New Hampshire as a leader in mental health. The plan’s first recommendation was increasing Medicaid reimbursement rates, which the 2019 Legislature accomplished. Additional recommendations in the plan will require more work and more funding to be fully realized. But the path is now clear, and New Hampshire can reclaim the status as a leader for best practices in mental health care and bring back a mental health system we can be proud of. What’s required are statesmen to step forward and champion both the policy and funding necessary in 2020 and beyond. Let’s urge our state representatives to put party politics aside and strive to be first in the nation for mental health.
Craig Amoth is president and CEO of Greater Nashua Mental Health.