My Turn: Getting priorities in order on mental health funding

For the Monitor
Published: 4/13/2019 12:10:36 AM

As we move into the Senate phase of the state budget, issues have come up over the past week or so that raise concerns about much-needed funding for the mental health system in New Hampshire. These include proposals for building a new forensic hospital, moving children with mental health issues out of N.H. Hospital, renovating existing facilities and standing up new programs.

There are disagreements about which are the highest priority items, in which order they need to be addressed and how they will move the new 10 Year Mental Health Plan forward. Whatever decisions are made regarding these issues, keep in mind that they will be built upon the foundation of the community mental health system that serves tens of thousands of N.H. citizens each year. Without a strong foundation, we can’t stand up any new programs.

The governor has praised the 10-year plan. He is happy with it because there were so many stakeholders who had input to a living document that potentially creates a glide path to fixing some of the issues that have plagued mental health service delivery for some years.

That is why we have to commit to do the responsible thing and make sure that all aspects of the plan are addressed, especially because, on any given day in the Granite State, there are between 30 and 70 people waiting in hospital emergency departments for inpatient care. After all, large numbers of people waiting for care is a symptom of a system that is in need of resources on both the community and the inpatient sides of the equation.

The 10-year plan is careful to describe a continuum of care of many parts, a system that meets the needs of Granite Staters regardless of insurance, geography or indeed the acuity of their illness. The 10-year plan, while not perfect, has, as they say, “something for everyone.” That is the hallmark of an initiative that is inclusive and mindful of all interested parties.

Mental illness is a disease. It is not a choice or a lifestyle. Just writing this seems unnecessary to any of us who have witnessed the bravery and the strength of those who are afflicted with the illness. Like other diseases, mental illness has a pathway to recovery. The arc of that recovery is different for all; but for all it is possible. Indeed, the Centers for Disease Control and Prevention recognize that recovery rates for people with mental illness are better than for other chronic diseases, such as diabetes.

Having established that we are working with people who have a disease, it is important to ensure that we have every level of care available to those citizens. Of course we should. If we consider another disease model – for example, conditions of the heart – it would be absurd to suggest that people in acute phases of their illness do not need a period of hospitalization. That inpatient stay must be as short as possible given the medical necessity, and every effort is taken to restore the person’s health to a state where it is possible to return to their community.

It is exactly the case with mental illness. Some people need hospitalization and some people need longer-term stays due to the refractory nature of their illness or troubling actions precipitated by the disease. We need to stand up as family members, as those who have the disease, and as advocates, to demand that we seize the opportunity that is before us; that is, to resolve the disaster that exists every day in emergency departments around the state when people wait days and sometimes weeks for the care they need.

This problem will be solved in many ways but building adult inpatient capacity at N.H. Hospital must be part of that solution. This can be done by following the blueprint of the 10-year plan and moving the children to a more appropriate setting and creating 48 new adult beds at the state hospital after appropriate renovations. In the meantime, the state should capitalize the funds for a much-needed forensic unit, which adds to the continuum of care necessary for this disease, and create a realistic plan for the building and staffing of this new unit over the next two years.

If we do this and pay attention to ensuring that the community system is adequately funded with rates that can sustain the critical work of the community mental health centers, we will have fulfilled the promise of the 10-year plan, and we will be able to look all stakeholders in the eye and say, “We did what was needed for the people of New Hampshire.”

(Peter Evers is CEO of Riverbend Community Mental Health, Inc., and president of the N.H. Community Behavioral Health Association.)




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