NH to apply new ‘single portal’ approach to mental health

New Hampshire will have a single “portal” that residents can use to access services for both substance abuse and mental health issues.

That’s part of the “new vision” outlined in the Department of Health and Human Services’ 10-year mental health plan, released on Wednesday.

The product of numerous working groups and a series of listening sessions held around the state last year, the plan recommends transforming the state’s mental health system into a “hub and spoke” model, integrated with the new system the state has been building to help those with substance abuse disorders.

And it proposes spending $21.7 million in the next two fiscal years to get that work started.

That includes $3 million each year to raise the Medicaid reimbursements for mental health services.

“If we make strategic investments, NH can reduce stigma, eliminate inequities in access to care, and offer all of its citizens a coordinated continuum of high quality services,” the plan states.

Under the proposed system, fewer people will need to seek mental health care at hospital emergency departments, waiting for specialty care. Instead, they’ll have access to regional hubs that will help them access services in their local communities.

“The right care at the right time will reduce more severe manifestations of distress, manage them more effectively when they do arise, and nudge more of our population toward a state of personal well-being,” the plan states.

The proposal calls for integrating mental health services into primary care settings, and creating programs to intervene, particularly with adolescents or young adults, at the earliest signs of mental illness. There would be more money for crisis services including mobile crisis for children; housing supports; community education; and prevention and early intervention for youngsters.

There are two options proposed to reconfigure beds at New Hampshire Hospital. The first would involve establishing a psychiatric residential treatment facility at the Sununu Youth Services Center, which would allow the existing Philbrook Wing to be renovated to add 48 new adult beds.

The second option would involve moving 30 “justice-involved” patients into a new “forensic hospital,” freeing up those beds for adult patients. The new hospital could be operated by the state or a contracted vendor in either a new or renovated facility, according to the proposal.

The plan proposes addressing the “boarding” crisis in hospital emergency rooms through a combination of additional mobile crisis services, increased bed capacity and better screening for involuntary emergency admissions. And it recommends using peer support specialists in emergency rooms and practice settings.

“Our concern has been around due process for these people and hospitals probably are not the place to hold that conversation,” said Dr. Joanne Conroy, chief executive officer with the Dartmouth-Hitchcock Medical Center. “We acknowledge that solving this issue is very difficult.”

Dr. Joseph Pepe, president and chief executive officer with Catholic Medical Center said hospitals need to enter into a cooperative working relationship with state government to deal with the issue.

“We are willing to work closely with the state to make sure we identify the best solutions,” Dr. Pepe said.

Any permanent plan needs to create more infrastructure for housing these patients once they are out of a hospital setting, Conroy added.

“The CEO of New Hampshire Hospital has made it clear to us that this is not just a matter of finding emergency beds but providing for post-discharge sites as well,” Conroy said.

Gov. Chris Sununu said while the state has made “significant strides” to rebuild its mental health system, there’s more work to be done. But he said, “Through this new 10-year mental health plan, we are establishing a road map for the next decade that will make New Hampshire’s mental health system the gold standard for the rest of the nation.”

Other recommendations:

• Funding for suicide prevention;

• A statewide campaign to help the public recognize signs of mental distress and how to access services;

• A commission to address the needs of “justice-involved” individuals;

• An oversight commission to address workforce shortages.

The plan also highlights “bright spots” found in communities across the state. “Anyone who travels NH’s mental health landscape comes away humbled by the wisdom, passion, and commitment of administrators, clinicians, and staff alike to the individuals, families, and communities they serve — despite low salaries and otherwise stressful work conditions,” it states.

“The commitment and ingenuity of our many committed, dedicated mental health professionals will surely play a pivotal role in driving the next iteration of NH’s mental health system.”

The 10-year plan can be viewed here: www.dhhs.nh.gov/dcbcs/bbh/documents/10-year-mh-plan.pdf.

Beyond the Stigma, a series exploring solutions to the state’s addiction and mental health challenges, is sponsored by the New Hampshire Solutions Journalism Lab at the Nackey S. Loeb School of Communications and funded by the New Hampshire Charitable Foundation, Dartmouth-Hitchcock Medical Center, NAMI New Hampshire, and private individuals. Contact reporter Shawne K. Wickham at swickham@unionleader.com. To read previous stories in this series, visit: unionleader.com/stigma.