5 Things to Know About NH’s New 10 Year Mental Health Plan
Decades of neglect combined with an economic downturn that led to chronic under-funding, have created a situation where New Hampshire has fallen from being a leader in providing community-based mental health care to being a state in crisis.
1. What Is Is
Rolled out with Gov. Sununu’s support in 2018 and refined in 2019 after public comments sessions held by the Department of Health and Human Services, New Hampshire’s 10 Year Mental Health Plan is a roadmap for reversing our state’s mental health care crisis by 1) addressing short-term pain points and long-term needs with staffing, funding, and infrastructure initiatives 2) transforming the state’s mental health service delivery model to better meet the needs of patients, families, and providers 3) focusing more attention on the needs of children with mental health issues (not just adults) and 4) transforming the entire system over the next decade to increase capacity, treat mental illness earlier and more effectively, and better utilize technology.
It starts with a series of fundamental changes in the way mental services are delivered, beginning with the patient’s very first interaction with the system. Instead of leaving people in crisis to find care on their own, one phone call to a new centralized mental health portal refers them to available service providers in their area who are in the best position to help. So instead of trying to guess where to go, bouncing aimlessly through the system, or simply heading to an emergency room, patients and family members will be able to access a one-stop-shop to be directed to the type of care that best fits their situation.
Another key part of the plan are 14 specific policy fixes and funding recommendations for 2020 and 2021. They include:
Increasing the Medicaid reimbursement rate to assist community mental health centers and other providers of psychiatric services with critical staffing shortages.
Providing mobile mental crisis centers that can provide care to children in their community as an alternative to emergency rooms.
Building out the nine regional hubs used to direct opioid users to assessment and treatment to also provide assistance to people with mental health issues.
Mapping out options for increasing the number of psychiatric beds in the state while lowering time spent in emergency rooms waiting for admission.
More funding for suicide prevention efforts, community based services and housing, therapeutic day programs and partial hospital programs proving out-patient treatment, training for emergency room peer navigators.
2. What It’s Not
Legislation. While there are key components of the 10 Year Mental Health Plan that will require legislative action, the 10 Year Plan is not a “bill” that legislators will vote up or down on. Other parts of the plan will be accomplished through executive action by the governor as well as by realigning and redesigning existing resources within the Department of Health and Human Services itself.
Cheap. The plan itself proposes almost $22 million in additional spending in FY2020 and FY2021. But overall spending will likely be higher.
Written in stone. Like all plans, the 10 Year Mental Health Plan is likely to change and evolve over time as some issues are addressed and new issues come to light. Upturns and downturns in the economy can also play a role. Most of the recommendations of the original 10 year plan developed in 2008 were scrapped when the economy—and state revenues—hit the skids.
3. Why We Need It
The current system is inefficient, ineffective, and inhumane. It victimizes patients, providers, and taxpayers alike.
Since the 1980s, state support for mental health services in New Hampshire has declined to a point where advocacy groups were prompted to file a 2013 class action court case. The 2014 settlement started the process of picking up the pieces. But services remain scattered, poorly integrated, and hard to access in a timely matter—especially for people needing psychiatric beds for the most severe problems. At the same time, community mental health centers and other providers struggle to hire and retain staff because Medicaid reimbursement rates haven’t been increased since 2006. This keep salaries artificially low, making New Hampshire an unattractive destination for qualified mental health workers. This has led to high job vacancy rates and a workforce shortage.
More.
4. What’s Been Started
Several key components of the state’s new 10 Year Mental Health plan took a big step forward earlier this month with the passage of several bills in the House that originated in the Senate.
SB14. Among a host of reforms targeted at the care of children, this bill invests $18 million over the next two years to expand mental health services for children, including dedicated mobile mental health crisis units that can help them avoid the need for emergency hospitalization.
SB5. This bill makes a $3 million appropriation to the department of health and human services to increase Medicaid provider rates for mental health and substance abuse disorders.
SB6. The bill funds 77 new positions in the Division for Children, Youth and Families over two years at a cost of $8.6 million, consisting of 57 new child protective service workers (CPSW) and 20 new supervisors.
SB11. Already passed in both bodies and signed by the governor, this bill addresses the emergency room boarding crisis in New Hampshire, funding increased reimbursement rates for facilities designed to meet patients needs, or Designated Receiving Facilities.
SB292. This legislation requires the Commissioner of the Department of Health and Human Services to submit a plan for implementation of the 10-year Mental Health Plan within six months of its finalization and to fully implement the 10-year Mental Health Plan within two years of its finalization. Annual progress reports are also required.
5. What Happens Now
The good news is that after years of neglect, good things are finally starting to happen. Many of the plan’s key recommendations are on track to be addressed in the next two years rather than the next 10. Legislation to fund those recommendations is also receiving wide bipartisan support in the legislature as well as support from the governor.
However, given past history it would be premature to run up any victory flags. The previous 10 Year Plan was the ultimate victim of bad timing, rolled out in 2008 just as a severe downturn in the economy and declining revenues hit the country—and New Hampshire—hard.
But that was then and this is now.
After three decades of decline, we’re finally making progress.