Communty-level care is key to help patients return home

Last modified: Tuesday, April 30, 2013
By the time Bert Shaw arrived in New Hampshire nearly 10 years ago to be nearer his daughter, he’d been hospitalized 15 times and had had a few run-ins with the police, all a result of his bipolar disorder.

Upon moving here, Shaw, 66, had another hospitalization after Main Street merchants – concerned about his behavior as he wandered downtown – called the police.

That was Shaw’s last hospitalization, and he knows why.

For the last decade, Shaw has lived in Twitchell House, a group home on Pleasant Street for people with serious mental illness. It is run by Riverbend Community Mental Health and staffed 24 hours a day, seven days a week.

“If I had to live on my own, I’m sure I’d be back at the hospital,” he said.

Twitchell House is one example of the community-level mental health care that advocates and Gov. Maggie Hassan want to expand in the next state budget.

It’s also the sort of housing the federal government has told New Hampshire it needs to increase to avoid violating the Americans with Disabilities Act. A pending lawsuit filed by patients and joined by the federal government accuses the state of illegally hospitalizing people instead of helping them live in supportive community settings.

Twitchell’s 15 beds are reserved for people with the most serious mental illnesses. Riverbend and another agency, Fellowship Housing Opportunities, own other apartments around the city, some for people with severe mental illness like Shaw and others for people who need less supervision.

In some locations, staff is on the premises several hours a day or only sporadically. In most cases, residents contribute to their rent, which is subsidized by the federal government.

Riverbend and Fellowship Housing rely on Medicaid to cover the cost of care; they receive $120 a day per resident for services, although the daily care actually costs closer to $200 a day, said Ruby Van Loan, program director at Twitchell House.

Still, that’s cheaper than the nearly $1,000 a day it costs to keep someone at the state hospital for a day. The problem, staff from Riverbend and Fellowship Housing say, is that there’s not enough of this housing for the people who need it.

Shaw comes and goes as he wants from Twitchell House – to Bible study, to see his daughter and to visit his favorite restaurant, the Windmill on Loudon Road. He attends a day program at Riverbend, does his own laundry and, like Twitchell’s 14 other residents, helps pull together a family-style supper each night.

But Shaw needs daily help taking his medications and keeping up with his counseling appointments, and he knows he couldn’t manage an apartment on his own. When he becomes concerned the people on television are speaking to him or trying to a pick a fight, there’s always a staff member nearby to reassure him.

“I’ll go in and ask, ‘Is everything alright?’ ” Shaw said. “And they say, ‘Everything is wonderful, Bert. The TV is not against you.’ ”

Shaw knows that sounds like a small thing, but it’s the kind of help he needs.

“I feel like I have to be supervised,” he said. He’s so convinced of this that when his daughter left New Hampshire for Rhode Island, he considered going but decided to stay at Twitchell House.

“Because of the people who are involved in my life now, I have a life,” Shaw said. He was referring not only to Twitchell House staff but also to the people he visits with at Bible study and church. “I’m 66, and I feel like I’m 18. When I was 18, I was confident in myself, I was proud of myself, and I had a lot of friends.”

(Annmarie Timmins can be reached at 369-3323, atimmins@cmonitor.com or on Twitter @annmarietimmins.)