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My Turn: Funding the state’s 10-year mental health plan is the fiscally responsible course

Since the Sandy Hook Elementary School tragedy in December, there has been a national discussion about our failing mental health system and how adults and children with behavioral health issues in our country are treated. The president’s recently announced plan for addressing the Connecticut shootings would increase access to mental health services – but it would also add controls on some types of guns, so we can expect an emotional, expensive and difficult debate in Congress.

It is also time for a more public discussion about New Hampshire’s community mental health system, once a model for other states, which has been all but decimated by years of state budget cuts. The effects of this neglect can be found in the wait times for outpatient community mental health services; the extended stays that adults and children are experiencing in hospital emergency rooms; the frequent closures of admittances at New Hampshire Hospital; the loss of beds due to inadequate reimbursement of residential facilities; the lack of designated receiving facilities for those in a mental health crisis; and the human tragedies that are happening every day in our state.

On Jan. 14, a month before Gov. Maggie Hassan will present her budget to the Legislature, the New Hampshire Community Behavioral Health Association released an outline for restoring the system, based on the state’s 2008 Ten-Year Mental Health Plan. As leaders in the mental health field in New Hampshire, we believe it is our responsibility to present a proposal for addressing the crisis now, before the community-based system falls into further collapse.

The 10-year plan was released almost five years ago after extended study and evaluation by a broad group of stakeholders, including our association, the state Department of Health and Human Services, New Hampshire Hospital and others. It was hailed as a great step forward for both the state and the community-based system. But while some small efforts have been made to begin the investments outlined in the plan, the reality is that, at almost every level, we have actually fallen backward since 2008.

Need is urgent

The New Hampshire Community Behavioral Health Association strongly believes that the governor and Legislature must take the appropriate steps to correct this situation now, by funding recommendations made in the 10-year plan to the levels recommended for the 2014-15 state fiscal year. Further, we believe that measures for funding children’s mental health and substance-abuse programs also need to be addressed and funded in this year’s state budget.

But as we have discussed the urgency of funding the 10-year plan over the past few weeks with policy-makers in Concord, there has been some push-back from those working to craft a state budget. There is a reluctance to promise too much, too soon in any area of the budget. And there is an equally strong reluctance to promise restoration of state programs that were cut or eliminated two years ago. The official mantra is, “Be innovative and be fiscally responsible.”

The public and our elected representatives need to be mindful of the fact that the lack of investment in community mental health services is driving costs in other areas of state, county and local government. Taxpayers’ money is already being spent – but in the wrong places and with less timely, effective and humane results than if it was being directed appropriately. Money is being consumed in a fragmented “system” that has grown up in place of a community-based one that actually worked once – and that can work again.

Solid framework

The Ten-Year Mental Health Plan still provides a solid framework for restoring our community-based mental health system, and its recommendations should be funded now. The areas of state investment that New Hampshire Community Behavioral Health Association believes should stand as the baseline for adequate public health, safety, and humanity include: increasing community residential supports and community-based inpatient psychiatric care; developing assertive community treatment teams; retaining and developing our community mental health workforce; and working closely with the state Department of Corrections on mental health housing, training, and specialized services.

In 2008, this list of investments was seen as reasonable and necessary; five years later, it still is. The current default model for providing mental health services is the opposite of innovation and fiscal responsibility, and benefits no one – not taxpayers, citizens, communities, or the adults and children who need and deserve these critical services the most. It’s time for our state leaders to act in a truly fiscally responsible manner and fund the Ten-Year Mental Health Plan.

(Louis Josephson is CEO of Riverbend Community Mental Health Inc. in Concord.)

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