Concord's delegation to the Legislature has more clout these days than at any time in recent history. Its members include the president of the state Senate, the majority leader of the state House, leaders of four standing committees and a member of the influential House Finance Committee.
If they were to work toward a single goal, chances are good that they would succeed. So here's our modest suggestion as city lawmakers prepare for the next legislative session: Save the New Hampshire mental health system, and fast.
The public mental health system, like a growing number of the patients it serves, is in crisis. This should be of urgent concern to all 424 state legislators, but particularly those in the capital, which is affected more than other communities when the state's safety net for vulnerable mental patients frays.
A combination of historically low pay and new budget cuts have conspired to hit the state mental hospital and New Hampshire's fragile system of community-based mental health services particularly hard. Consider:
• New Hampshire Hospital recently turned away a half-dozen patients because there wasn't sufficient staffing to serve them. At issue: a shortage of pharmacists that officials attribute to chronic low pay. No pharmacist, no medication; no medication, no treatment. Officials are trying to persuade the state to raise the pharmacists' pay, but meanwhile they can't assure that such a crisis won't reoccur.
• State layoffs forced the shutdown of the hospital's neuropsychiatry unit last week in an effort to save $2.5 million. The program served severely challenging patients: those with acquired brain disorders related to trauma and other neurological impairments, who often struggled with multiple illnesses. Its closure has forced patients and their advocates to scramble for treatment alternatives.
• The community mental health system - services designed to keep people out of the more intensive and more expensive state hospital - is likewise working to do more with less. Last month the state dramatically decreased the amount of money it pays mental health care providers for a range of services. Leaders of the state's 10 mental health centers, including Riverbend in Concord, now speak of "rationing" care.
"There are people that will require medically necessary services but might not be able to get them, or might not get them or might not get them right away," Roland Lamy, executive director of the New Hampshire Community Behavioral Health Association, told the Monitor last month.
All this comes as the number of people seeking public health for mental illness is growing. While the state budget anticipated a caseload increase of 1 percent per year , mental health centers say they are seeing growth of about 8 percent.
In Concord, this means added stress on workers at Concord Hospital and on local police officers, who are often called to respond when patients find themselves in crisis. Because the state hospital is located in the city, the challenge is particularly acute here.
It's been two decades since New Hampshire emptied its enormous mental hospital in favor of a system of thoughtful community care and a small hospital aimed at short-term treatment of those in immediate crisis. It was a humane vision - but one which the state government through its budget apparently no longer supports. That change is unacceptable, for Concord and for the state.
Jim MacKay, a longtime city lawmaker and former mayor, just lost a special election to win his old House seat back. Had he won, he hoped to continue his role in the House as champion of the mental health system. We urge the Concord delegation, including its newest member, Republican Lynne Blankenbeker, to take up MacKay's cause and help stabilize a system in dire straits. The city and some of these legislators' neediest constituents could use their help now.