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State mental health plan praised at hearing amid concerns about funding 



Monitor staff
Sunday, December 09, 2018

Patrick Dowling said he feels more like a prisoner than a hospital patient when he goes to the emergency room during a mental health crisis.

Sometimes, there are police officers standing outside his room, which has no windows, and he gets put in shackles, he said. Dowling said he spends hours sitting on a bed, hoping for a phone call or a visit from a loved one.

“I am afraid; I don’t know what’s going on at all,” he said. “I don’t like going in there because I don’t want to feel like a criminal, nor should I have to feel like a criminal for having (a mental health condition) that I live with.”

Dowling was one of 200 people who testified last week at a public hearing for the Department of Health and Human Services’ proposed 10-year mental health plan. Just a young man, he stood in front of the crowd with his mother and spoke about his experience with psychosis and depression. He said he’s been hospitalized four times in four years.

“It’s been quite the journey,” said Cheryl Bailey, Dowling’s mother.

DHHS’s $24 million, 10-year plan calls for enhanced mental health programs in schools, more integration with primary care and behavioral health services, support between transitions in care and an infusion of peer supports.

The plan also details the need for an increase in alternatives to the emergency department and psychiatric hospitalization.

The number of state residents waiting in hospital emergency departments for admission to inpatient psychiatric treatment has more than tripled since 2014, exceeding 70 across the state on several days in the past year, according to the plan.

Many people at the public hearing took the opportunity to share their own personal stories of waiting in emergency rooms for mental health care.

Stephanie Pelley, a single mother who has been in the emergency room with her children, said the stays often make them feel worse, not better. The rooms they wait in for days are empty, Pelley said. Children are not allowed to have pens, pencils or TV remotes. There are no clocks, because they can be taken apart and used to hurt someone or yourself, Pelley said. 

“This is not a prison, it’s a mental hospital or a psychiatric unit,” she said. “These units were designed for short terms stays. They were never meant to be a place where a person would stay for days or weeks.”

Pelley said that once a child is eventually discharged, often after being away from school for weeks, they have to answer uncomfortable questions from classmates. 

“Do you remember how awkward middle school was? Now imagine you have bipolar disorder, or anxiety or depression. Even worse, imagine your struggles lead you to be hospitalized. You miss two weeks of school because you have to wait nine days to get into the state hospital where you stayed for three days,” she said. “You feel lonely, left out, depressed and angry at yourself.”

Melissa Hinebauch, who wore a hospital gown in protest of hospital wait times, said the fact that mental health patients can be stuck in the emergency room for days or weeks is “horrifying” and “completely unacceptable.”

“You feel such abject terror, pain, despair and confusion,” Hinebauch said. “These situations are dire. They’re truly life or death.”

Laurie Heels, who has a close family member with a mental health disorder, said that it can be incredibly difficult for someone who is suffering to ask for help. Many individuals are deterred by the months it can take to get an appointment with a therapist, or someone who can prescribe medication.

“When an individual is ready for treatment, there is a brief window of time when they’re ready. You need that health care system there, willing to accept that patient to start that patient on a journey back to health again,” she said. “When you access the system and you don’t find that help readily available, there’s this sense of anger, confusion and disappointment.” 

Peter Evers, CEO of Riverbend Community Mental Health, said a great challenge for the mental health system now is a workforce shortage. He said that shortage has been caused in large part by the state’s Medicaid reimbursement rate, which hasn’t changed since 2006.

New Hampshire Medicaid, which funds most services provided through the state’s community mental health system, reimburses mental health providers at about 58 percent of the rates paid for the same service by private insurance, according to the plan. Both Medicaid and commercial insurers pay less for mental health services in New Hampshire than they pay for the same services in surrounding states.

“It clearly states that lower reimbursement rates translate to lower salaries, limited benefits and migration of the needed workforce out of our state,” Evers said of the data in the plan. “Unless we all make solving the workforce our top priority, and an action step, this plan or any version of it has no chance of succeeding.”

The funding of New Hampshire’s mental health system was listed as a top priority for the plan. It allots $10 million to bring Medicaid rates up to the national average, which will be matched with $10 million of federal Medicaid dollars, according to the plan. 

Melissa Bernard, who has a loved one who survived two suicide attempts this year, praised how thoughtful and thorough DHHS officials were in creating the plan. She said she worried about it getting funded, and said she planned to have conversations with her legislators about the importance of passing it.

“The biggest challenge here is the political will to adequately fund this system of services, to get folks the mental health care they need,” she said.

Caitlin League of Keene, who is an admissions coordinator at the Brattleboro Retreat, a mental health facility in Brattleboro, Vt., said New Hampshire is already paying for the mental health services it wants to fund with the 10-year plan. She said it costs around $1,500 a day to house one person in an emergency department.

“We are already paying for the changes we need to make to the mental health system,” she said. “We just need to revert the funds to the proper place so people don’t end up in emergency departments, which I can tell you is the worst place to treat a mental health patient.” 

Many of the initiatives included in 2018’s 10-year plan were also included in the state’s last 10-year plan, in 2008. That plan was never funded, largely due to the recession. 

Donna Stamper, who was a supporter of the 2008 plan, wore a button that said “Transform Mental Health” that she said she got 10 years ago when that plan was going to the Legislature. 

“I’ll be proud to throw this button away,” she said. “Hopefully, this plan will produce more than a button.”

DHHS is accepting written public comments through Dec. 10. Submit comments to: 10yrMHplan@dhhs.nh.gov.