A year of change, momentum for mental health in New Hampshire

Last modified: Monday, February 17, 2014
One year ago last week, Gov. Maggie Hassan implored legislators to help fix a mental health system that was leaving dozens of patients languishing for days in hospitals unable to treat them.

She proposed a biennial budget with $28 million to address “one of our most pressing public health challenges,” the lack of space for treating patients in crisis, exacerbated by a lack of ongoing community support. Legislators from both parties and both chambers disagreed with the governor on other issues, but that funding survived the budget process unscathed.

In the year since, more than $6.3 million has been spent or allocated for improving mental health services statewide. A handful of new beds for crisis treatment opened, and dozens more people are now able to afford a stable home. Still, last week, 16 adults and 10 children waited in emergency rooms for unavailable psychiatric treatment.

“There are good things that have happened,” said Jay Couture, executive director of Seacoast Mental Health Center in Portsmouth and president of the state Community Behavioral Health Association.

“But there’s been nothing so far that has put a big dent in or ended the wait list. That, to me, is one of the absolute worst indignities, that we are warehousing people who need care when they are at their most ill, rather than being able to treat them effectively. It’s stressful for the clients, it’s stressful for their families, and it’s stressful for the providers, who have no good answer as to why it’s happening.”

Yet Couture and other mental health care officials in the state are optimistic, one year after the governor directed the state’s attention to mental health, that the funding and attention for their clients has started positive momentum for the system.

The first year

Most of the funding that has been spent this year was focused on building supports for people within their communities.

The state’s 10 community mental health centers used about $3.3 million to create or expand assertive community treatment teams. The teams work with people with mental illness who live independently, checking in frequently, going beyond the traditional definition of outpatient services.

Every center has funding for a team now, and next year, all will receive funding for an additional team dedicated to children.

Smaller amounts were set aside for residential facilities, where people with mental illness can live semi-independently but with support available around the clock. About $625,000 went toward renovating and staffing a home in Bethlehem that should open this month with capacity for eight residents, according to Geoff Souther, interim administrator for the state Bureau of Behavioral Health.

Souther plans to convene a group in March to define what services should be available at another, larger new residential facility, slated to receive $3 million in the 2015 fiscal year. Once the scope of services is determined, the project will go out to bid, and the location will be determined.

Because the scope of services hasn’t been determined yet, and more complex services cost more per client, Souther couldn’t say last week how many people that facility might serve. Initial estimates envisioned up to 60 or 70 people.

The budget also included help for people with less complex needs to find housing in their community.

Using $720,000 available for the current fiscal year, by June, 100 additional people will have received money to help pay rent until they were able to get space in government-subsidized Section 8 housing, according to program administrator Michele Harlan.

“We’ve been able to assist in ending some of the revolving door for people” who are discharged from New Hampshire Hospital with nowhere to go, Harlan said.

“We’ve been able to get people on our program, get them stable and get them connected to services they need.”

Next year, the program is slated to receive another $1 million.

Next steps

More than $1.7 million was allocated this year for inpatient services that could alleviate pressure on local emergency rooms.

Souther estimated the request for proposals for that project will be published by the end of March, and will likely call for a 16-bed facility. He couldn’t say when the facility would open.

More change and more treatment options are expected to come in the next few years, in the aftermath of a settlement among the state, the federal Department of Justice and a handful of patients.

Approved by a judge last Wednesday, the settlement’s terms could cost an additional $6 million in funding in this biennium and $23 million more in 2016-17, state officials have said.

Legislators began discussing Thursday how to meet the terms, which largely call for more community treatment team coverage and supported housing, as well as supported employment and mobile crisis teams.

Outside of the budget process and the state Health and Human Services Department, advocates are trying to improve other parts of the system.

Legislators heard testimony last week on a bill encouraging and providing guidance for circuit and superior courts interested in starting dedicated programs for people charged with crimes related to a mental illness.

The courts help nonviolent offenders access treatment for the underlying mental illness that caused the illegal behavior – often shoplifting, disorderly conduct, criminal threatening or simple assault – instead of sending the person to jail, where they’re unlikely to get treatment.

Since the state doesn’t pay for the courts, some counties have started them using federal grants for the first three years and then absorbing the costs into their operating budgets. Merrimack County’s delegation will vote next month on a budget including about $100,000 to continue the program after its grants run out in April.

The proposed bill doesn’t include any state funding, the main concern of the only speaker opposed to the idea at a hearing.

“It’s a wonderful advancement in the arc of justice to want more individualized attention, for these cases especially,” said Christopher Keating, executive director of the state Judicial Council. “If this bill passes, it’s the expressed policy of the state of New Hampshire that we want more individualized treatment. That’s a good thing, but it costs me more money to provide adequate representation . . . if we are going to have more meetings and more appointments.”

At that same hearing, Ken Norton spoke about the experience he saw a family member with a mental illness endure through the court system. She would be arrested and released on bail, but being homeless, she would be unable to maintain her treatment and would be quickly re-arrested for a bail violation.

“Justice is supposed to be blind, but people who live in areas that don’t have mental health courts simply don’t have access to these services,” he said. “Without them, the justice system is long on punishment and short on protection, deterrence and rehabilitation.”

Looking ahead

Despite that, Norton, who is the executive director of the state chapter of the National Alliance on Mental Illness, said in a later interview he joins Couture and other mental health leaders who are optimistic.

“We have momentum,” he said. “We still have significant challenges that we face, but there is a coming together of people. . . . Everybody recognizes there’s a lot of hard work in front of us, but everyone feels positive about the leadership from Gov. Hassan and the bipartisan support from the Legislature.

“The settlement really capped the positive news of the year. . . . The reaction from so many corners of this world was, ‘Yes, we really can work together. There’s a lot to be done, but we’re moving forward.’ ”

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)