N.H. moving forward on plans to launch mental health mobile crisis unit in Concord region

Last modified: 3/8/2015 1:14:29 AM
New Hampshire is moving forward with a plan to open its first mental health mobile crisis response team in the Concord area.

Essentially, the crisis unit serves a purpose similar to that of the urgent care centers that have otherwise popped up in New Hampshire and across the nation in recent years. Instead of leaving someone in crisis to turn to a hospital emergency room, the unit would offer an on-call team of trained mental health professionals to provide support to someone – on-site, in their in their homes, or elsewhere in the community.

This project stems directly from the state’s Community Mental Health Agreement, the outcome of a class-action lawsuit that alleged New Hampshire needlessly institutionalized people with mental health problems and provided inadequate community-based services.

For the first unit in Concord, here’s what the state was looking for when it released its request for proposals in January: The mobile crisis center would have to be able to respond around the clock, seven days a week, to someone who calls the center looking for help with a mental health crisis – meeting someone at their home or elsewhere in the community, if necessary, or providing on-site services. The underlying goal, the state said, is to avoid “unnecessary hospitalization, incarceration or admission to (an institutional environment).”

The center would operate a phone triage line where a masters-level clinician would be able to talk someone through their options and provide help within an hour. The mobile crisis team, as a whole, would include a peer specialist and an on-call psychiatrist or an advanced practice registered nurse.

The center would also be responsible for operating at least four “community crisis apartment beds” – meant as an additional alternative to sending someone to a hospital or another institutional setting. The crisis team would need to be prepared to help people for up to a week “following the onset of a crisis,” according to the state’s request for proposals, and should provide additional help beyond that one-week window as needed.

Eric Borrin, the health department’s director of contracts and procurement, said the state received only one application. Borrin couldn’t specify the timeline for when that applicant would be evaluated or how soon the department would make a decision to finalize the contract. The state, in its request for proposals, said the contract would go into effect in April (or on another date approved by the governor and the Executive Council) and would run through June 2018.

Peter Evers, CEO of Riverbend Community Mental Health, confirmed that the Concord-based provider applied for that spot to operate the mobile crisis unit. The project would likely be a natural fit for Evers, who arrived in New Hampshire after having spent years working to launch and expand a similar mobile crisis program in Massachusetts.

The value in a mobile crisis unit, as Evers explains it, goes beyond simply acting as a buffer between a person experiencing a crisis and emergency or institutional settings. By connecting that person with someone who can listen to their concerns and talk through their options, Evers said this model restores a level of dignity to an experience that can sometimes feel dehumanizing. A crisis team member ideally would talk someone through a series of questions – How are you feeling? Would you like to come and talk, or would you like someone to meet you? – and give that person more agency in determining their immediate treatment needs.

“You’re constantly giving people options and choices, which by the way is incredibly empowering to people when they’re in crisis,” Evers said. “You offer choices to people. The idea, again, was – well, let’s not send people to higher levels of care when they don’t need to go.”

When someone shows up in an emergency room, on the other hand, Evers said there tends to be an almost “magnetic pull” toward inpatient services or hospitalization. In a community-based setting, Evers said there’s more of an opportunity to help someone without resorting to an institution – and, perhaps, to connect them with services like substance abuse counseling or other needed supports that might alleviate other problems that could be exacerbating their present mental health crisis.

As of January, the state Department of Health and Human Services projected a cost of about $5.6 million between 2015 and 2018, including about $4.05 million in state general funds, for the mobile crisis teams. This reflects the cost not just for the inaugural crisis unit in the Concord area, but also for additional units planned in the coming years in Manchester and Nashua.

Those locations are specified in the mental health agreement, but they are also the areas that represent some of the highest volume of individuals requiring emergency services or admissions to New Hampshire Hospital, according to the state’s Bureau of Behavioral Health Interim Director Geoffrey Souther.

“Concord is a logical first starting place,” said Ken Norton of the National Alliance on Mental Illness, “given its proximity to New Hampshire Hospital, given the numbers of people who come from not just the Concord area but statewide who had been shown to be coming to Concord Hospital emergency department looking for crisis services, given the fact that the executive director at Riverbend has previous experience with running a mobile crisis response unit.”

(Casey McDermott can be reached at 369-3306 or cmcdermott@cmonitor.com or on Twitter @caseymcdermott.)

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