Lori Weaver, the Commissioner of the New Hampshire Department of Health and Human Services, lives in Concord.

Just two years ago, it was common to find 50 or more patients sitting in New Hampshire emergency departments (EDs) each day waiting for admission to psychiatric hospitalization. Distressed and situated in fluorescent-lit, noisy, non-therapeutic settings, many were experiencing the very darkest time in their lives. If someone breaks their arm, it would be unacceptable for them to sit in an ED for days or weeks while they wait for treatment. Yet until recently, it was routine for people in mental health crisis – our family, friends or neighbors – to wait that long for the appropriate care they need.

Today, thanks to concerted, data-driven effort by the partners in the Department of Health and Human Services Mission Zero initiative, that waitlist is regularly hitting zero, and when patients do have to wait for care, their wait time has been cut in half. Led by a collaborative, multi-stakeholder, multi-sector steering committee and workgroups, Mission Zero is making huge strides.

Yet these strides are challenged. The New Hampshire Legislature is developing the next state budget with less money than in the recent past. Building on the progress made through Mission Zero is critical so we do not return to 60 to 70 people waiting in ED hallways on any given night because no better option exists.

If there are cuts to mental health services enabling our Mission Zero progress, vital programs could be impacted.

Rapid Response Access Point. People experiencing mental health and substance use disorder crises can contact the professionals in the Rapid Response Access Point, which is linked to the federal 988 system. In 2024, the Access Point responded to more than 46,000 phone, chat and text contacts from people seeking behavioral health support. People who call the Access Point have most issues resolved through conversations with a caring professional or referrals to other services. Only 3% of people calling the Access Point end up in a hospital ED.

Crisis Response. Sometimes a person experiencing a psychiatric crisis requires more than a phone conversation. Of those 46,000 phone, chat and text contacts in 2024, more than 7,000 resulted in a dispatch for mobile crisis response teams to deploy to homes, schools, and other community locations.

Community Mental Health Centers. New Hampshire’s 10 Community Mental Health Centers (CMHCs) serve about 39,000 of our most vulnerable citizens each year. The CMHCs are the bedrock of the State’s mental health system.

Crisis Stabilization. To remain safe and get connected with care, some people need an actual physical place to go that isn’t an ED or jail. One of Mission Zero’s biggest accomplishments was opening our state’s first crisis stabilization centers. In December 2024 alone, one of these centers served 89 people, many of whom were walk-ins. This service has been critical to helping people in need that don’t necessarily require an ED to receive care.

Suicide Prevention and Peer Support. At hundreds of trainings each year conducted by NAMI New Hampshire, community members learn about best practice approaches to help families and communities have the comprehensive and concrete skills to intervene effectively before, during, and after crises.

Housing Help When You Leave the Hospital. Recovering from a mental health crisis or substance use disorder is hard, and it’s that much harder if you don’t have a safe place to live. Investments to date have enabled more than 1,000 people with mental health conditions to move into supported and specialty housing, including 645 in 2024.

The last time DHHS experienced major budget impacts in 2011, there were immediate consequences with a long-term negative impact. One was the beginning and fast growth of ED boarding due to reductions in community-based programs. For the past 14 years, we have been working to rebuild and strengthen our continuum of services. Brick by brick, we have worked with our partners including the Legislature to fund key investments that have not only reduced ED boarding, but just as critically, improved and saved lives.

Mission Zero is founded on a commitment that every person deserves timely care in the face of urgent need. All of us have family and friends facing mental health challenges — all of us, and them, could be the ones to need the essential services we have worked so hard to establish. When we are so close to achieving and sustaining the mission, we can’t afford to start over.