Granite Staters in the midst of a mental health crisis will be able to call a single, statewide number to be connected with mental health and addiction care beginning in January.
In June, the executive council approved a $9 million dollar contract with Beacon Health Options to centralize access to behavioral health care and create what the state dubbed a “no wrong door approach.”
Julianne Carbin, director of the state Bureau of Mental Health Services, said each of the state’s ten community mental health centers currently has their own hotline, which can create confusion for families and individuals trying to reach out for help.
“Those artificial boundaries that we have on based on regions for our community mental health centers kind of dissolve as part of this model,” she said.
The exact number hasn’t been established yet, the new hotline is intended to receive calls, allow for an assessment of the caller’s needs, and then connect that person with resources or dispatch the closest mobile crisis unit. The units are often comprised of a clinician and a “peer support specialist," someone recovering from their own mental illness.
Beacon Health Options, a Boston-based non-profit, has implemented similar hotlines in Massachusetts, Georgia, and Washington.
Hotline employees – who are either trained intake specialists, peer specialists, or licensed clinicians – will answer a wide range of calls from those struggling with substance use, suicidal thoughts, or psychosis, said Wendy Farmer, Beacon’s national crisis lead.
"A crisis is really self-defined by an individual or a family," she said. "Our goal is not to define that, but we're going to listen when the call comes in and come up with the most appropriate resource at the time."
In addition to making access to care easier, state officials are expecting the hotline to reduce unnecessary trips to the emergency room for psychiatric care. For many years, New Hampshire has had far more patients seeking mental health care than there are available inpatient beds at New Hampshire Hospital. As a result, patients often remain at hospital emergency rooms while they wait for an available bed.
The N.H. Department of Health and Human Services has faced pressure to rapidly clear patients from emergency rooms after the New Hampshire Supreme Court ruled in May that psychiatric patients being held involuntarily in emergency rooms must be given a chance to contest their detention within three days of their arrival.
Often, people deemed to be in crisis must wait days or weeks in the emergency rooms for an open bed at a psychiatric facility without an opportunity to challenge their involuntary admission.
In the states where a similar hotline is already implemented, Farmer said a phone call is the only necessary intervention in about 75% of the cases.
"What someone needs is just a warm supportive listening person to help talk through what the problem is at the moment, and help connect them to resources," she said.
Projections in a progress report on the state’s 10-year mental health plan, show that 80% of crisis calls should be able to be resolved over the phone, while most of the remaining calls will require a mobile crisis team. The ultimate result, the report predicted, will be a lower reliance on emergency rooms, jails, and inpatient facilities for mental health care.
Some community outreach and advertising will need to be done to alert people they can call the hotline instead of dialing 911. Farmer said that is often the default response when someone is in crisis. That number doesn’t always connect people with the best resources to handle psychiatric emergencies, however.
"I think we've been trying in most communities to fit a behavioral health crisis into the system that's designed to serve medical emergencies and that's a mismatch. It doesn't fit well," Farmer said.
Carbin said the state is reaching out to local law enforcement so they can refer people to the hotline, printing flyers, and running focus groups to determine the best way to advertise the new 1-800 number in communities.
The state’s ten digit crisis number will transition to a three digit number July, when a piece of federal legislation requires all states to establish an easy-to-dial mental health and suicide prevention hotline.
Carbin said the state has bulked up staff for mobile crisis units to ensure they can handle the estimated 30,000 callers they expect to hear from over the contract’s three-year period.