Return on investment is a fundamental business principle that guides businesses and organizations large and small. New Hampshire has made a significant investment in transforming its mental health system through Mission Zero — a statewide effort to ensure that no person experiencing a mental health crisis waits unnecessarily in a hospital emergency department for the care they need. Thanks to unprecedented collaboration among state leaders, hospitals, Community Mental Health Centers (CMHCs), first responders and health care providers, meaningful progress has been made in reducing wait times for essential care.
Mission Zero was built on the principle that people should receive the right care, in the right place, at the right time. That vision cannot become fully realized if patients have nowhere to go home to once they are ready to leave the hospital. The critical shortage of supportive and transitional housing for individuals with serious mental illness is a challenge that continues to undermine our state’s Mission Zero investment.
Every day, New Hampshire’s ten CMHCs work to help individuals recover, regain independence and live successfully in their communities. For many, treatment alone is not enough. Recovery requires something fundamental that too many Granite Staters lack: a safe, stable place to live.
CMHCs have historically stepped forward to fill that gap by developing and operating supportive housing, transitional residences and supervised community living programs that provide far more than a roof overhead. These programs consistently improve outcomes and reduce reliance on costly institutional care. Yet despite their proven value, supportive housing remains in critically short supply. In fact, sustainability of existing resources is increasingly difficult.
For people living with serious mental illness, housing is an essential component of treatment. Without stable housing, it becomes far more difficult to manage medications, attend appointments, maintain employment, reconnect with family or avoid repeated crises. Individuals with no stable housing are far more likely to cycle through emergency departments, inpatient psychiatric units, shelters or even the criminal justice system. Successful discharge from a psychiatric hospital depends on more than clinical care. It depends on whether a person has a safe place to call home.
For many, finding housing is not simply difficult, it is nearly impossible. The consequences extend well beyond behavioral health.
Without appropriate housing options, individuals who are clinically ready for discharge remain in hospital beds because there is nowhere safe for them to return. As a result, hospital capacity is reduced, emergency departments become increasingly overcrowded and patients experiencing behavioral health crises wait longer for admission and treatment. Every occupied bed that cannot be freed creates a bottleneck that delays care for another person in crisis, disrupting patient flow and placing additional strain on hospitals already operating under significant capacity constraints.
These system-wide challenges extend well beyond healthcare facilities. Both law enforcement officers and first responders spend more time responding to behavioral health crises, and communities bear the growing financial and human costs of a system that cannot move people into the least restrictive, most therapeutic setting. Until New Hampshire addresses its housing shortage, these pressures will continue to cascade across the continuum of care, reducing access to timely treatment, increasing costs and compromising outcomes for individuals, families, providers and communities alike.
The state’s broader housing crisis has only intensified these challenges. Rising rents, limited vacancy rates, workforce shortages and escalating operating costs have made it increasingly difficult to develop new housing options or preserve existing ones. Individuals living with mental illness often face additional barriers, including limited incomes, discrimination, transportation challenges and the need for accessible services located near treatment providers.
New Hampshire must invest in expanding housing options that are integrated with behavioral health services. Communities need housing models that allow individuals to receive the level of support appropriate for their recovery while maintaining dignity, independence and community connection. Building housing capacity should not be viewed as an expense, but as a strategic community investment that delivers better health outcomes, reduces long-term healthcare costs and strengthens New Hampshire’s behavioral health system for the benefit of all.
Mission Zero has demonstrated what is possible when committed people and organizations in New Hampshire work together to solve complex challenges. But the next phase of that work is going to require further collaboration and must include expanding the housing infrastructure, to allow recovery to continue beyond hospital walls.
Housing is the bridge between treatment and recovery. New Hampshire must invest and fully understand the return on that investment. The lives of many depend upon it.
Maggie Pritchard is the president of the NH Community Behavioral Health Association and the CEO of Lakes Region Mental Health Center. She lives in Boscawen.