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State tries to prioritize mental health funding to satisfy requirements of lawsuit settlement

Last modified: 3/8/2015 1:14:31 AM
Nineteen adults and one child waited Monday for space to open up at New Hampshire Hospital, the state psychiatric facility in Concord.

That count was up from last Saturday, when 16 people across the state stood by for word that one of the institution’s 152 beds had become available. The numbers may fluctuate, but the reality is the same day after day: It will be a wait.

“I hope that we get on the front page of the Monitor the day there’s no wait list,” said Jay Couture, executive director of Seacoast Mental Health Center in Portsmouth and president of the state Community Behavioral Health Association. “It’s hard on the patient – it’s hard on everyone – to not get what you need.”

In an effort to improve New Hampshire’s lagging mental health services, Gov. Maggie Hassan and the Legislature added $24 million in the last state budget to expand the number of community treatment beds available, increase the number of teams that can support people in crisis and build a new 16-bed short-term inpatient unit, among other things.

While several of those investments have already been made, others, like funding 62 community treatment beds, will not be completed.

In the final months remaining in this two-year budget cycle, the Department of Health and Human Services is switching up how it will spend its money, redirecting the funds from one mental health initiative to another to help satisfy a settlement agreement the state reached after the budget passed. In spite of additional dollars the Legislature appropriated to the department to cover mental health in the tight budget year, it is unclear exactly how much money the state will spend on the system this biennium.

“It’s all about, how do you prioritize the dollars that are available to do what needs to be done,” said Geoff Souther, interim director at the Bureau of Behavioral Health.

One of those things New Hampshire needs to do, officials said, is meet provisions outlined in a recent settlement agreement, the result of a lawsuit filed against the state by the Disability Rights Center and the U.S. Department of Justice.

It accused the state of needlessly institutionalizing people with mental illnesses as opposed to offering adequate resources in their home communities.

And it called for New Hampshire to expand mental health services by investing in programs to help people with mental illnesses live independently. That initiative was set to cost the state roughly $6 million this biennium.

To help pay for it, the Legislature and Hassan signed off on a bill last year that appropriated $6 million for the department on top of its existing budget. But HHS said it wasn’t given extra money to spend.

“It gave us permission, but didn’t give us revenue,” said HHS Deputy Commissioner Marilee Nihan. “It can’t go anywhere because it doesn’t have a funding source.”

The state is funding the provisions laid out in the agreement, officials said, but dropping others.

Some of the changes have led to frustration among providers, like Couture, who wrote a letter on behalf of the Community Behavioral Health Association recently, asking how the dollars are being used.

“There has been no conversation with us,” she said. “I understand I don’t get to make all the decisions for the state, but I also feel strongly I need to advocate for the populations that we serve.”

Under the original budget plan, the state was set to invest about $3.7 million from the general fund in 62 community treatment beds and roughly $3 million in a 16-bed community-based inpatient unit modeled after the Cypress Center in Manchester. Those are both components of a 10-year mental health plan the state adopted in 2008.

HHS is not moving forward with either of those projects in this fiscal year, and they aren’t included in Hassan’s most recent budget proposal that outlines investments in 2016 and 2017. Officials said the projects wouldn’t meet the spirit of the mental health settlement, which puts a focus on expanding community-integrated services over creating new institutional beds.

Instead, the state is funding housing initiatives, a new designated receiving facility and the launch of a mobile crisis unit in the Concord area this year.

The designated receiving facility, located at a hospital, would be able to accept involuntary emergency admissions. The department released few details on that plan.

The mobile crisis unit would provide a 24-hour triage line, which offers a point of contact for people who may simply need information, a referral or psychiatric treatment, and could be dispatched to their own homes.

That unit is one measure laid out in a mental health settlement agreement signed off on in 2014.

“Our landmark mental health settlement has required additional investments in building our community-based infrastructure that has led to refocusing some of our priorities,” said William Hinkle, spokesman for Hassan, who acknowledges that Hassan “knows the state’s strained mental health system remains a pressing challenge.”

Several initiatives outlined in the budget have already been funded, or will be by the end of the fiscal year in June, officials said.

Those include the creation and expansion of about a dozen assertive community treatment teams – known as ACT teams. The teams work with people with mental illness who live independently, helping them maintain a healthy lifestyle and prevent any crises that could send them to a local emergency room or the state hospital.

The budget calls for the expansion of some teams to work 24 hours a day, seven days a week, and for the creation of new children’s and adult ACT teams. The request for proposals was sent out last week, officials said.

The state also increased funding to so-called bridge housing, which helps adults who have severe mental illness and are at risk of becoming homeless pay rent until they can get into government-subsidized Section 8 housing.

In some cases, goals outlined in both the 10-year plan and the settlement align. They each call for investments in bridge housing and ACT teams.

But, providers said, investments in both of the plans are needed, not just one or the other.

“Those resources need to be coupled . . . if you are going to have a proper continuum of care,” said Peter Evers, CEO of Riverbend Community Mental Health in Concord.

In the upcoming budget, Hassan is calling for a $24 million investment in the state’s mental health resources. Her proposal includes funding for the new crisis unit at New Hampshire Hospital, for ACT and mobile crisis teams, and expanded community-based housing, among other things.

Providers said any investments the state makes in the mental health system are appreciated. “In the last budget, we were thrilled so much was added,” Couture said. But it is just a first step.

“It’s not as if we’re coming to the new biennium healthy,” Evers said. “We’re struggling.”

(Allie Morris can be reached at 369-3307 or at amorris@cmonitor.com.)


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