News & Events

Feb 23- Advertising Opportunities Available!

Promote your business and support a healthy community!

In recognition of National Mental Health Month in May, Genesis Behavioral Health will print an educational insert in 5 of the Salmon Press Newspapers (Meredith News, Gilford Steamer, Plymouth Record Enterprise, Alton Baysider and Winnisquam Echo). The insert will be distributed to over 27,000 area households. All proceeds will be used to support direct mental health care to over 3,000 children, families and adults in the Lakes Region.

Advertising opportunities start at just $100! For more information about ad pricing, please contact Kristen Welch at 524-1100 x445 or email kwelch@genesisbh.org. We thank you for your support!
Apr 30- 2012 Community Forums--"Opening Minds with Listening Ears"

Hear what has happened over the past year.

Understand the challenges ahead.

Meet the service providers and recipients.

Know what can be done to help.

Tell us what you think.

Monday, May 14, 2012 from 4:00 pm to 6:00 pm

Plymouth State University, Ice Arena Welcome Center, Plymouth

Keynote Address by The Honorable Jeanie Forrester

New Hampshire State Senator, District 2

or

Tuesday, May 15, 2012 from 5:30 pm to 7:30 pm

Taylor Community, Woodside Building, Laconia

Keynote Address by The Honorable Edward D. Philpot, Jr., PLLC

Belknap County Commissioner

Light refreshments will be served at both forums.

Kindly respond by May 7^th to Kristen Welch at kwelch@genesisbh.org or 603-524-1100 x445.

Apr 29- Report: NH needs new approach to children’s mental health, substance abuse problems

By Telegraph Staff

The difficult, delicate task of handling the issues of mental health and substance abuse in
children will be the topic of a hearing in Litchfield next month, one of a half-dozen around the
state to discuss a new project to improve the “fragmented” treatment options.

The problem is serious, the report says, noting that:
• One in five children in the state has an emotional disorder that affects their daily functioning.
• Of children receiving mental health services, 43 percent also have an alcohol or drug use
disorder.
• On any given day, 250 children are living and receiving care in an in-state residential
treatment facility outside of their home community.

The Children’s Behavioral Health Collaborative, representing more than 50 groups involved in
family services, released a “Plan For Improving the Behavioral Health of New Hampshire’s
Children” last Monday ; the group called it the first such plan in state history.

The plan was being rolled out at a series of six regional presentations statewide, beginning last
Tuesday in Manchester. The closest presentation to Nashua will be at Campbell High School in
Litchfield on May 16.

The plan describes the current children’s behavioral health system, which includes substance
abuse in addition to mental health, as underfunded, under-resourced and fragmented.

While adult mental health issues have attracted public attention, children’s needs have largely
not made it onto the public radar, the plan said. The solution, said Ken Norton, executive
director of the National Alliance on Mental Health-New Hampshire, “is a comprehensive,
integrated system of care. What we have now is a maze of multiple systems: siloed,
fragmented, broken.”

“We know there’s a challenge, but we now have a powerful solution to make it better,” said
Kim Firth, program director of the Endowment for Health, which along with the New
Hampshire Charitable Foundation provided financial support for the project. “We can
transform children’s behavioral health care in this state. This plan outlines how to do it.”

The plan provides a step-by-step template for changing the way children’s behavioral health
services are delivered by addressing workforce, finance and service array strategies.

The plan recommends a series of steps to improve the children’s behavioral health system,
including “redesigning a new system of service,” creating teams to support families, and
investing in treatment.

Future regional presentations will be held at these places and dates:
Penacook at Merrimack Valley High School on May 3, from 8:30-10:30 a.m.
Somersworth at Goodwin Community Health, May 14, from 8-10 a.m.
Campbell High School in Litchfield, May 16, from 3:30-5:30 p.m.
Berlin at Enriched Learning Center, May 29, from 3-5 p.m.
Mar 18- I'm one of the 26 percent with mental illness

By ANNMARIE TIMMINS
Monitor staff
Sunday, March 17, 2013

After the Monitor’s mental health series, “In Crisis,” was published last week, I got one reaction more than any other: Readers were surprised, some unconvinced, that 26 percent of New Hampshire’s residents have a mental health disorder.

The statistic appeared in the second story of the series and came from a 2010 study by the Concord-based New Hampshire Center for Public Policy Studies. The percentage includes a range of diagnoses, from major depression to anxiety problems to bipolar disorder.

“Didn’t 26 percent seem high?” a caller asked me last week.

Not to me. But I’m one of the 26 percent.

I have been hospitalized twice for “suicidal ideation,” most recently for eight days in 2009 with a diagnosis of “major depressive order and anxiety disorder,” according to my records. I take four medications a day and have my counselor’s name and number in my emergency contacts on my cell phone.

This will be news to most of the people who know me, family members included. That’s because with lots of help from my husband, a lot of exercise (one of my therapies) and medication, I’m able to keep my depression and breakdowns private.

So, I understand the reaction to the 26 percent.

Most people with a mental health disorder are able to manage their illness, many so well that our disorders are invisible outside our homes. With the help of counselors, medication, even hospitalizations, we work, raise families, volunteer in our communities, run companies, hold elected office and go to school with little indication of what’s at work inside us.

Readers of our series met some of the 26 percent.

But there are tens of thousands of others with mental illness whom readers didn’t meet, people whose struggles aren’t as evident.

They – I – manage only because we have access to the right combination of resources. Through my husband’s job I have state health insurance, not Medicaid, so I had more options when I needed emergency hospitalization. Still, I waited 13 hours in the Concord Hospital emergency room for a treatment bed.

I am also a “highly-functioning depressive,” as my husband likes to say, because I have a job and a family that accommodate me when I fall into crisis. And I’ve finally found the right mix of medications. I’m one of those people you don’t see as “in crisis” – but you might if I lost my health insurance, lost my job or didn’t get “case management” from my husband.

That’s one of our jokes, only it’s true.

My colleague Sarah Palermo and I had hoped to introduce you to some of these people because even though they aren’t visible, they and their families are also affected by state budget cuts that have diminished community mental health care. Long waits in emergency rooms show the state hospital doesn’t have enough beds to accommodate the patients who need them. Cuts to Medicaid have prompted several community hospitals to shut their own mental-health wings and left case workers with more clients than they can adequately care for.

But many of the people we talked with declined to go public, for fear of stigma.

I asked Michael Cohen, the former executive director of the state chapter of the National Alliance on Mental Illness, what it would take for the prevalence of mental illness to be better understood. Awareness, Cohen said.
“Personal stories . . . are powerful tools for changing minds,” he said.

Okay. Deep breath. Here’s my story.

Mysterious beginning

I can’t tell you why I have such significant depression and anxiety because I don’t know. I had no trauma as a kid growing up in Loudon. My family ate breakfast and supper together every day. My mom stayed home until my brother and I had finished fourth grade.

Television was off limits, except on Sundays during the Walt Disney hour. I liked doing chores. We went camping every summer. I was allowed every pet I wanted, except for a horse.

My only consistent gripe was that my mother made me wear dresses and itchy tights to Sunday school. To this day, I’m out of my church clothes Sunday mornings and into sweats before my husband can get his coat off.
But something changed in me by the fifth grade.

I was afraid to be anywhere but home, and frequently the school nurse had to call my mother because I was crying or throwing up for reasons I couldn’t identify. I liked school. I just didn’t like being at school.

My teachers diagnosed me as being shy.

This “shyness” continued through high school, with long crying jags at the breakfast table until my mother made me leave for the bus. They continued in college except I stayed in bed, missing classes, because I had no one forcing me to face the day.

I didn’t know how to ask for help because I didn’t know how to explain what was wrong.

I’m certain I survived college only because I found the journalism program junior year. (Until then, my grade point average was 2.5.) To my surprise, I discovered that a reporter’s notebook could be my shield against a world that distressed me. After many many (many) counseling sessions, I think the notebook allows me to be a version of myself that I like better.

That’s why despite my mental illness, I’ve been able to take on difficult, challenging and stressful stories at the Monitor, from the Catholic Church abuse scandal to a death penalty trial, to reporting during the reign of former House speaker Bill O’Brien, who didn’t hide his disdain for my reporting or my paper.

I’ve cracked publicly just once. In 2006, I had to fly to Columbus, Ohio, to cover the Episcopal Church’s general convention because the church was in an uproar over New Hampshire’s decision to choose openly gay Gene Robinson for its leader. I was terrified of flying and did not relish being outside my safe zone.

I got so worked up and distressed, I developed shingles and spent long spells in my hotel room crying, not because of the pain, but because I was so afraid to be in an unfamiliar place. I will be forever grateful for the priest from New Hampshire who recognized my state and helped me survive Ohio.

Hospitalization

Maybe this (mostly) professional success was why I never sought help until I was hospitalized at Catholic Medical Center in Manchester in the late 1990s.

In the months before that hospitalization, I’d become less able to hide this still-undiagnosed depression and anxiety. Working long hours was my therapy, and if I wasn’t working, I was sleeping, often with the help of NyQuil.

I was 27 and had already struggled more than half my life with too-frequent feelings of hopelessness. I didn’t understand why I was so deeply sad, and I was angry that I couldn’t end the sadness.

I began hurting myself, I think out of anger. I destroyed possessions that had sentimental value. I viewed others’ acts of kindness with deep suspicion. I began quietly planning my suicide.

When my then-boyfriend realized how bad my situation had become, he took me to the Catholic Medical Center in Manchester, which, like many hospitals in the state, has since closed its psychiatric wing. Back then, there were 236 beds for people like me in community hospitals. Today there are 150.

I agreed to be admitted to CMC, but I wouldn’t call it a voluntary admission. I didn’t consider myself the kind of person who ends up in a “mental hospital.”

Some parts of those five days remain very clear. My dental floss was confiscated for fear I’d hang myself with it. My concerned parents visited, and we didn’t know what to say to one another. My friend and boss, Felice Belman, brought me chocolate frosted cupcakes.

During one group therapy session, several other patients said they’d been hospitalized two, three, seven times before. I recall knowing that this would be my one and only hospitalization. I considered myself simply weak, not ill.

I had begun taking Prozac in the hospital, and I continued that after I was released. I also continued meeting with counselors, but it took several tries before I found one who worked for me. The one I liked best urged me to use humor to turn around a dark mood.

When he stopped practicing, I started a panicked search for another counselor. In our series, people complained about going through several counselors within a year because turnover is high in such a stressful and underpaid profession.

Exhausting search

That is a genuine weakness in our state’s mental health system. Like the people in our stories, I found the search for a new counselor exhausting and, at times, hopeless. Like them, I gave up my search a couple of times, unable to summon the energy to explain myself to yet another person who might not work out.

I finally found a new counselor I liked in Plymouth, and for a long time drove there from Concord once a week. We worked together for a few years. I liked that she gave me homework in between sessions that helped me reflect more on my thinking process. We tried different medications in search of one that would bring me some relief.

We had some success. But at that point, I still viewed my depression and anxiety as something I could shed through hard work. To me, it was like staying in shape. With discipline and determination, I believed I could get over depression, get off medication and stop attending counseling.

I’m not surprised I failed. I’m surprised how long I thought that plan was possible.

I went on and off medication with predictable results. I always had a bottle of NyQuil in my refrigerator. By my early 30s, I wondered how much longer I’d have the energy to talk myself into just getting out of bed for work.
That was the only goal I considered viable.

I ruled out having children because I doubted my ability to remain stable under such responsibility and stress. I ruled out having a lasting personal relationship. As Monitor colleagues left for bigger newspapers, I stayed at the paper, afraid – unable, really – to consider a new venture.

At least I really loved my job.

I thought about suicide, a lot.

I wondered then – and still do today – whether life is a stretch of happiness interrupted by moments of depression or the other way around. I went back and forth. I still go back and forth.

In 2003, I met my now husband. We married a year later. He knew this story, although we both realized later he didn’t really understand the full power of depression.

I continued with my counseling and medications, although not without setbacks and missteps. I was still often unable to handle disappointment and stress. I had stopped seeing my counselor in Plymouth. I didn’t have a psychiatrist monitoring my medication because even with insurance, I couldn’t find a psychiatrist willing to provide that service.

The last mental health doctor I used to monitor my medication asked me how many times I had been in jail or prison on my first visit. When I said zero, he said, “Zero. Really?” Later, when my pharmacy accidentally shorted my prescription, I called him for three days, panicked about running out of pills. He suggested I had done something improper with my medication and declined to remedy the problem with my pharmacy.

I now rely on my nurse practitioner for prescription refills. After our series was published in the newspaper last week, I heard from a primary care doctor who said this has become a troubling trend for doctors and nurses whose specialty isn’t mental health.

Hidden struggles

These struggles have been largely private to everyone except my husband. I’m so expert at hiding the giveaways, I’m sure friends didn’t even know I have such deep depression.

In early 2009, I found myself unable to cope with a series of challenges in my personal life. I needed to return to therapy but couldn’t find the strength to call counseling practices in search of an opening. And I was embarrassed to return to my last counselor. So, my husband did that search for me.

I don’t know where I’d be if he hadn’t.

I began meeting regularly with the Concord counselor he found, and I liked her very much. But as my personal problems grew more complicated, I began giving up my fight for happiness. My husband describes me as despondent during those days. I returned to fantasies of suicide.

I went to a counseling appointment on the afternoon of May 3, 2009, after spending the early afternoon deciding what I’d put in a suicide note. I felt close to needing one. I thought about the contract I had made with my counselor to be safe and decided I could probably write a note that would make her see I had given recovery all I had.

When I appeared for my appointment, my counselor recognized quickly that I required emergency help. She arranged for me to go Concord Hospital’s emergency room, where staff from Riverbend Community Mental Health would find me a hospital bed. My husband says I called him with the news before I headed to the hospital, but I don’t remember.

He and I spent the next 13 hours in the emergency room’s Yellow Pod, the same one described in our series. It took Riverbend staff that long to find a psychiatric bed in a New Hampshire hospital. I was lucky. Because I had private insurance and not Medicaid, I was able to go to Hampstead Hospital, which had a bed and accepted only private insurance.

Those 13 hours, I believe, worsened my condition. And Yellow Pod is considered a model when compared with the waiting space in other emergency rooms across the state.

There was no bed, only a hard rubber chair. The door was locked. I couldn’t see the nurse’s station. The noise of the TV, which was behind Plexiglas was so distressing, my husband asked it be turned off. I don’t think there was a bathroom. There was no food or water easily available.

I tried to convince my husband and the Riverbend staff that I felt better so that I could go home. They disagreed.

At 1 a.m., an ambulance arrived to take me to Hampstead. My husband was told he couldn’t drive me. And he couldn’t come in the ambulance. Nor should he follow the ambulance, hospital staff said, because Hampstead would not let him in.

Scared, alone, embarrassed

I laid on the back bench of the ambulance for the 40-minute ride to Hampstead, sobbing and regretting I had asked for help. I was scared. I was alone. I was embarrassed.

Like some of the people in our series, had I known what that experience would feel like, I don’t think I would have gone willingly. I understand why some people in our series said they are reluctant to ask for help. I understand why getting help often requires an involuntary admission, even an escort by the police.

For eight days, I shared a locked psychiatric ward with about 20 other patients, some suffering from depression, some struggling with alcohol and drug addiction. I attended group therapy and individual therapy most of the day. I remember feeling distraught and trapped. No one could say when I’d be released.

When my husband visited the first few days, we weren’t allowed to leave the floor.

Eventually, we were allowed outside, to walk the hospital grounds, but only for a short time. My parents joined us one evening for a meeting with a social worker. I was 40, and that was the first time I had been able to talk with my parents about my life long struggles with depression.

As my mental health improved, I was allowed an afternoon furlough. At my request, my husband took me to a nearby gym so I could exercise. Again, I was lucky. I heard other patients arguing over the phone with bosses or spouses who wanted them back on the job or back at home, immediately.

My husband visited me every day. I asked him to tell a few friends about my situation. I would need their help when I got out. Those friends reached out even if they didn’t know exactly what to say. My editor Hans Schulz wrote me a note.

“I don’t know why you’ve been dealt such a bad hand, but I do know how loved and respected and admired you are,” it says. “The world is a better place with you in it. I’m very much looking forward to the day when you’re back at your desk. I miss you a lot.”

I am one of the 26 percent. Until now, most people just didn’t know.

(Annmarie Timmins can be reached at 369-3323,
atimmins@cmonitor.com or on Twitter @annmarietimmins.)
Mar 14- In crisis: Future uncertain for mental health care in NH

Concord Monitor – March 13, 2013
In crisis: Future uncertain for mental health care in N.H.
By SARAH PALERMO, Monitor staff

Twelve years ago, Pam Brown was working as a banker and looking to open her own consulting business when her son, then 18, suddenly dropped out of high school, withdrew and stopped eating. His family eventually was able to commit him to a psychiatric hospital, where he was diagnosed with psychosis.

Brown and her family did whatever they could to learn about mental illness, help him get treatment and advocate for improvements to the state mental health system. They supported his re-entry to high school, helping him finish his last semester. But after that, they saw he had no other support for creating a full life.

“After you figure out how to get your family member help, you find out it’s a long haul,” Brown said. “It’s a chronic illness, and it isn’t enough just to deal with the immediate acute symptoms, but how do you get someone their life back that was so interrupted?”

Her son could secure a job – four times, in fact – but if things got stressful, he would stop going. “And if you’re not working, or you’re not going to school, you have no life,” his mother said. “It is totally isolating and it just exacerbates the illness because you have a feeling of despair and hopelessness, and it is self-perpetuating. It’s a cycle of failure that doesn’t have to be that way.”

Four years ago, she stopped waiting for the system to help her address his needs of social engagement, education and employment. So she and the families of five other people with mental illness formed New Hampshire’s first certified clubhouse, a peer support organization.

Brown and others in the mental health community say they are happy that the new governor, Maggie Hassan, has included more money for community-based care in her budget proposal and that she wants to move forward on a 10-year plan to rebuild the mental health system in New Hampshire, a plan that has lain dormant for more than four years. They are glad the state hospital is adding more beds for people in mental health crises.

But the most meaningful reforms in care, if they materialize at all, may be years away from improving the lives of people with mental illness.

For one thing, no one knows yet whether the Legislature will go along with Hassan’s proposal to add $28 million in mental health care funding. Hassan’s own plan to fund her priorities counts on $80 million from legalizing and licensing a casino, far from a sure thing.

Uncertainty surrounding the state budget isn’t the only factor that makes it difficult to predict how changes at the state level will reach the mentally ill and their families. Some of those decisions will be made in the courts and in hospital board rooms.

One lawsuit filed against the state by patients and their families alleges that inadequate community resources have led to unnecessary hospitalizations. The case isn’t scheduled to move to trial until June 2014. It could result in court-ordered reforms, if the state doesn’t implement changes before then.

And no one knows what will happen when the state Medicaid program is taken over by managed care organizations, or when that transition could start. Because of another lawsuit filed by hospitals over Medicaid reimbursements, that process is already well behind schedule.

“I’d like to be more optimistic,” said Louis Josephson, CEO of Riverbend Community Mental Health. “If what the governor proposed happens, there will definitely be some relief. . . . On paper it seems like there’s some good plans, but I’ve been in this business in this state for too long to be too hopeful.”

What Hassan would do
On paper, what the governor has proposed is this: $28 million in additional funds over the next two years for community mental health care, broken into several pots. Hassan’s office and the state Department of Health and Human Services couldn’t say exactly how much is to be allocated to each project, but the funds are aimed at:

??A new 10-bed inpatient facility in an existing hospital for patients in a mental health crisis. Only Elliot Hospital in Manchester has this type of facility, with eight beds available.

??16 beds for patients in need of short-term inpatient care for acute psychiatric treatment, doubling that resource.

??74 new community treatment beds. As of January 2012, there were 159 of these placements available.

??Funding to give housing subsidies and residential support services to 100 more people with mental illness.

??10 new Assertive Community Treatment teams, a support for people in crisis that can lead to less need for hospitalization. Nine of these types of teams are already in place, serving people in four regions of the state. However, none of the existing teams serves children; six of the new ones would.

??Funding to bring assistance and treatment to 350 more older adults who are at high risk for hospitalization.

??An additional 36 percent in funding for peer support programs.

Separate from Hassan’s proposal for the next biennium, New Hampshire Hospital is adding 12 beds for patients who require emergency admissions but do not need extended inpatient services.

By the end of the year, the hospital will also reorganize programming for children and young adults, including substance abuse education. It will also begin video conferences to consult with local emergency rooms, where patients awaiting involuntary admissions to the state hospital often languish because of a shortage of beds. That could potentially decrease admissions to the state hospital and improve coordination with community mental health centers when patients are released.

In an interview with the Monitor last month, Hassan wouldn’t rank these proposals or project how she would adjust them should the Legislature cut her funding request, except to say “our top priority should always be the physical safety and health of both patients and the public.
. . . We’re really trying to do this so the various pieces complement each other.”

Almost all of her proposals are priorities outlined in the 10-year plan state officials and mental health care providers drafted – but never funded – in 2008.

Most are also the services identified in the federal lawsuit against the state as ways to avoid or end hospitalizations for people with mental illness. The Disabilities Rights Center filed the suit a year ago on behalf of several families, and the U.S. Department of Justice has since signed on. The center says Hassan’s plan doesn’t address all the flaws in the spectrum of care the state provides.

“We’re very pleased that the governor has recognized the problem and wants to address it. We are concerned that much of what has been proposed includes a lot of additional inpatient beds and still not enough of the kinds of evidenced-based community practices that we know can keep people out the hospitals and promote recovery and meaningful lives for people,” said Amy Messer, the Disabilities Rights Center’s legal director.

While more inpatient beds might lessen the time a patient waits in an emergency room, the gains a patient makes during hospitalization can erode quickly without adequate support in his or her community, Messer said.

“I think and I hope we’re moving forward, but my concern about the proposals is we don’t want to see some short-term measures that are costly but don’t really fix the problem.”

Managing Medicaid
The state’s 10 community mental health centers say it would take a two-year investment of $37.6 million to bring the state in line with the 10-year plan. The funding gap between what the centers say they need and what the governor has proposed could mean that establishing more community resources like supported group homes isn’t feasible, Josephson said.

Supported housing is one of the least expensive treatment options for people with mental illness, at a cost of about $200 per day compared with $1,000 per day at the state hospital. The community centers are currently reimbursed at about two-thirds the cost of operating the 159 beds in group homes, he said.

“There is no way Riverbend or any other center is going to invest in more treatment beds if we can’t get paid,” Josephson said.

Hassan didn’t specify what rate the state would offer to pay the community health centers for operating those services, but she said that health care providers will likely see fewer uninsured patients if the state expands Medicaid under the federal Affordable Care Act. Medicaid expansion, however, depends on the will of the Legislature.

If Medicaid in the state is expanded, the Affordable Care Act requires states to provide mental health and substance abuse coverage at a rate equivalent to traditional health care coverage. Hassan said her budget would extend that parity of coverage to all Medicaid recipients in the state.

Medicaid recipients and mental health care providers are also awaiting as-yet unknown changes when the state moves forward with a plan to use private managed care organizations to administer the program.

Mental health care providers say they don’t understand how their services are supposed to fit under the managed care model. For example, under managed care, once a diagnosis such as a broken bone is made, the company authorizes services – X-rays, a cast and check-ups – for a limited time, after which a provider will need to seek reauthorization to continue treatment.

“The people we are serving and treating have chronic conditions,” said Dennis MacKay, executive director of Northern Human Services, a mental health center in Conway. “It can be managed, but there is not a cure.

“The last thing I want to do is add administrative staff to keep filing and applying for prior authorization and renewals, or take clinical staff time away from patients.”

MacKay and other leaders of the community health centers are working with the managed care companies to create models for the new system.

But a big roadblock is the lawsuit 10 community hospitals have filed against the state, claiming they’ve not been adequately reimbursed for Medicaid patients. They have refused to join the managed care companies’ network of providers.

Peer group on its own
One item in Hassan’s budget proposal is key to helping people succeed in their home communities, advocates for the mentally ill say.

Peer support services bring people together who have varying levels of experience with the mental health care system to support each other, encourage each other and fill in the gaps left by clinical services.

That’s why when Pam Brown couldn’t find anyone to help her son restart his life after his diagnosis, she worked with other families to create Granite Pathways in Manchester, New Hampshire’s first clubhouse for people with mental illness. Clubhouses are a type of peer support agency, a place they can go as often and for as long as they need, to support each other, form social safety nets and work toward recovery and independence.

Most other clubhouses in the country receive some public funding. Granite Pathways, now in its third year of operation, isn’t included in the state’s peer support budget, but 17 other groups are.

What the other peer support agencies do may work for some people, but Brown said she believes the clubhouse model is uniquely beneficial because it focuses on work, either on behalf of the clubhouse or at local businesses or nonprofits.

Charlie Perkins of Manchester has struggled with mental illness his entire adult life. After moving from Maine last year, he spent almost every day for several months inside his apartment. He’d leave for his appointments at Manchester Mental Health, but those were only hourlong interludes in a life lived alone.

Then he found Granite Pathways. He’s there every day now, practically from open to close.

Like similar clubhouses around the world, Granite Pathways is organized around work units that tackle tasks such as membership, housing, employment or education. Perkins most enjoys the employment unit, where every morning he checks job listings and posts them on a bulletin board, looking to see if any opportunities match the skills of his fellow members.

“We take care of each other,” he said. “The friendships are the best part. We know each other.”

Other members write grants, give tours and help Brown raise more money to keep the lights on and support her hopes for a larger space. About 60 people use the clubhouse regularly, and there is a waiting list of people interested in joining.

Brown’s son was her inspiration in creating a clubhouse, but he told her over and over that he wasn’t interested.

After it opened, when he would lament his loneliness or wish he had help going back to school, Brown would gently remind him that Granite Pathways offered a solution.

“Now he comes all the time,” she said.

Though the clubhouse is in a cozy corner of Brookside Congregational Church, with big windows lighting one office and a few tables tucked into a kitchen area for the daily lunch service, Brown said she dreams of a bigger space. With public funding, the group could move somewhere with a real kitchen, real offices, room to grow. They could begin partnerships with employers and fulfill the clubhouse’s mission.

But Brown couldn’t wait around for the state to help her son, and she’s not waiting for it to help with the clubhouse, either.
Mar 14- Mental health court gives offenders treatment, not time

Concord Monitor – March 12, 2013
Mental health court gives offenders treatment, not time
By ANNMARIE TIMMINS
Leaning on her cane, a 56-year-old woman made her way to the front of a Concord courtroom to resolve charges of simple assault and disturbing the peace. Her schizophrenia and delusions had, once again, required a call to the police.

But this time, instead of being hospitalized against her will, she’d been arrested and given a choice: Face criminal charges and maybe jail, or agree to counseling and intense monitoring through a new mental health court. With close to half of the state’s inmates believed to be suffering some form of mental illness, counties have embraced mental health court and treatment as a way to reduce recidivism and save money on incarceration costs.

The woman chose the latter and attended her first session Feb. 20.

“We are going to move forward,” Judge Gerard Boyle told her as she began to renew complaints about her arrest.

From the bench, Boyle made clear that she needed to stay on her medication and out of trouble with the police. She had to attend all her counseling appointments and come back to court weekly.

The rules and the robe are a big part of mental health court because they remind participants that a new arrest or poor participation can land them back in regular court, even jail. Recently, when a female participant became uncooperative and combative, Boyle put her on notice.

“I’ve not had anybody in this program . . . who has shown such disrespect or caused so much chaos,” Boyle told the woman. “I’m not sure (you) should be in this program. I think the only thing that is going to catch (your) attention is being up in Boscawen” at the county jail. She’ll learn this week if she remains in the program.

But just as important, Boyle said, is the personal attention each person who comes before him receives. It might be a reminder to a woman that she can call for help. Or high praise to a young man for two weeks of good progress. Even a friendly disagreement with a woman over which dog should have won the Westminster Kennel Club show.

Boyle finds that connection with everyone, even on their first day.

“You look good today,” Boyle told the woman with the cane. “Nice jacket, by the way.” It was black with an American flag patch and the words, “Proud to be an American.” The woman smiled, looked at her jacket and back to Boyle.

“Thank you,” she said. “I got it at a thrift shop.”

What jail can’t provide
Concord’s mental health court began about 18 months ago and is one of the newest of nearly a dozen in the state. The goal is the same at each: Treat rather than incarcerate nonviolent offenders who break the law because of mental illness.

“You need a place to address issues that these people have because the standard criminal justice system doesn’t,” said Merrimack County Attorney Scott Murray, a 30-year prosecutor who helped create the program. “The judges have a limited number of tools or alternatives that they can bring to bear to get at what is causing these people to get into trouble.”

Without an alternative, the state’s jails and prisons have become an extension of the state hospital, minus the treatment, said Ron White, the Merrimack County jail superintendent. He cited a 2005 study by the New Hampshire Association of Counties that found that as much as 46 percent of New Hampshire’s jail population has some form of mental illness. Experts say a decline in community mental health services – counseling, case management and crisis intervention – has increased the number of people whose illnesses land them in court and behind bars.

Most of the 28 people who have participated in Concord’s mental health court have attempted suicide at least once and have been hospitalized several times, said Robert Dumond, the court’s program manager and only paid employee.

Most are on medications for their mental illness but also struggle with substance abuse or developmental disabilities, Dumond said. They’ve been charged with misdemeanor-level offenses, often involving shoplifting, disorderly conduct, criminal threatening, theft or simple assault.

To graduate from mental health court, which takes six months or longer, participants must attend weekly meetings with therapists, take their medications consistently and stay out of trouble as they resume their daily lives in the community. They are also connected with vocational therapists and substance abuse treatment when necessary. And they have to come to court, weekly at first, and less often as they stick with their treatment plans and improve.

When participants graduate, their charges are dismissed or considered resolved without a sentence, depending on the seriousness of the offense. Mental health court provides such a vital alternative that Concord’s police chief, John Duval, said he didn’t hesitate to sign on.

“I think there is an ethical obligation to look at any opportunity to separate out folks that shouldn’t be (in a criminal court),” Duval said. The justice system “should hold them accountable but get them the help and services they need so the behaviors that got them where they are hopefully aren’t repeated, and folks can get back on track with their lives.”

Duval and Murray believe the program is helping, but they worry that it won’t survive.

The state does not pay for the mental health courts. Counties that have them started their programs with three-year federal grants and absorbed the cost when the grant money ended. Concord’s court will deplete its grant money this year, and the court’s architects said they’ll have to ask the county to foot the $100,000 annual bill if they can’t secure another grant.

It’s impossible to know how much money Merrimack County has saved by not prosecuting and jailing the people in mental health court because the program is new and some participants may have avoided jail anyway.

Keene opened the first mental health court in 2003. Its director, Michael Potter, said it costs $21.30 a day to put someone through the program. A day in jail costs more than $100, depending on an inmate’s medication and security needs. In 2011, 76 people went through Keene’s mental health court, Potter said.

There is an additional savings to keeping people with mental illness out of jail. Once someone on Medicaid is incarcerated, their benefits stop, leaving the county to pick up the cost of treatment and medications, White said. Susan Stearns, director of development for the Greater Nashua Mental Health Center, works closely with the mental health courts in Hillsborough County. She said her county saved $65,000 on medication expenses in 2010 and $141,106 in 2011. The court served 235 people the first year and 309 the second.

“But it’s not just about the numbers,” said White, the Merrimack County jail superintendent. “It’s also about what it provides the individuals.”

Treating mental illness in jail is a challenge, he said, and not just because he has too few counselors and doctors to assist prisoners. Defendants can be reluctant to accept treatment while incarcerated, especially if they are in crisis. And a jail isn’t a therapeutic setting.

When mentally ill prisoners are released after receiving little to no treatment, they are far more likely to re-offend and go back to jail, White said.

“By treating them in the community, we can help them connect with a counselor and learn the process of getting help,” White said. “It’s better for the community. It’s better for the county. And it’s better for the individual.”

Bigger demand than anticipated
Since Concord’s mental health court began meeting weekly in September 2011, 43 people have been referred by defense attorneys, prosecutors, the police or parents.

Of those, about 15 chose not to enroll or were ineligible, either because their crimes were violent or sexual in nature or because they were deemed incompetent.

The people who have enrolled have ranged in age from 17 to 66. In each case, the city or county prosecutor involved has agreed to resolve it through mental health court with the consent of the victim.

The nearly 30 participants so far is more than twice what Dumond had planned for, but he’s never considered turning away anyone who was eligible and interested.

Instead, Dumond has given everyone in the program his cell phone number and permission to call at any hour. He’s the program’s only paid employee and relies heavily on the help of five college interns. Boyle said Dumond works 80-hour weeks.

The court’s first graduate was a 58-year-old retired Marine whose past trauma and ongoing mental health issues led to an involuntary admission to the state hospital. During her admission, she became combative with the police and was charged with simple assault.

Boyle, also a retired Marine, lights up when he tells her story.

“She used the same skills she had learned in the Marines to focus on getting the job done,” Boyle said. “She did extremely well and became a mentor to others. This was clearly not somebody who belonged up at the county jail.”

Success is not defined by graduation alone.

Dumond said one current participant who is in her mid-20s had been arrested 14 times in a year before coming to mental health court. Since enrolling, she has had no arrests, although she has admitted herself to the hospital several times, Dumond said.

“The mental illness continues to exist,” he said. “But in my mind, that is a success.”

The night before each Wednesday court session, Dumond gives Boyle and the attorneys on both sides a detailed report on how well each participant has met challenges that week and whether he or she has progressed in therapy.

Not everyone has made it through. Two men were removed from the program, one because of a new arrest and the other because he absconded, Dumond said.

But they have been the exceptions.

An example to others
A 20-year-old man from Salisbury learned last week that he will graduate next month, a year after enrolling. That means his theft and drug charges will be dismissed.

The man said he didn’t graduate sooner because he had some setbacks. He said that included an addiction to spice, a synthetic marijuana.

“They helped me through my ups and downs,” the man said, crediting Dumond, his public defender Brooke Belanger and the court staff. “I would imagine that if I was in the normal court system, I would have ended up in jail. It would have been, ‘You screwed up again.’ These people have helped me in the ways that I needed.”

When asked how he’d been most helped, the man said, “I can talk to anyone here about anything.”

Another participant, a 50-year-old Concord man, could have graduated four months ago, but he has been unwilling to say goodbye to the people involved with the program. He came into the program charged with operating after suspension, and the city prosecutor’s office saw the court as a way to get him mental health treatment that may have eluded him otherwise.

Belanger doesn’t want to see the man leave the program and has told him she’d like him to stick around as a mentor to newer participants. “One of our clients said, ‘Can you tell me when (the man) graduates because I want to be there,’ ” Belanger said. “He was one of the people he helped the most.”

The man has already proven himself to be a great mentor, Belanger said. He’s told others in the program how they can get a free phone if they can’t afford one. He’s tracked people down at homeless camps and given out job leads. And when he sees court participants on the street in Concord he tells them “to keep their nose clean.”

Belanger said the man was a very different person when he began mental health court. He agrees.

“Here you get the help you actually need,” he said. “And everything isn’t being slammed at you. It’s more relaxed so you don’t feel so tense. It would do more harm by putting (participants) in jail than having them take this program.”
Mar 11- New Hampshire's mental health system: from leader to failure

By ANNMARIE TIMMINS

Monitor staff

Sunday, March 10, 2013
(Published in print: Monday, March 11, 2013)

During his 1971 inaugural address, then-Gov. Walter Peterson identified seven goals for his next term. First on the Republican’s list was improving mental health care.

Peterson wanted to stop warehousing people with mental illness at the state’s psychiatric hospital and begin treating them in local communities. “A state mental institution,” Peterson told lawmakers 42 years ago, “is, more than anything else, a symbol of failure to help people in time.”

Two decades later, the state had become a national leader in mental health care by beginning what Peterson had envisioned. Lawmakers had established 10 community mental health centers and put money into local housing and local treatment. And under the leadership of then-Gov. John H. Sununu, the state had opened a modern 316-bed state hospital in place of the 19th-century-era institution, once called the New Hampshire Asylum for the Insane, that had housed nearly 2,000 people.

At the time, Donald Shumway, then director of the state’s Division of Mental Health, said the national recognition showed “our plan is really heading in the right direction.”

The acclaim would be short-lived.

Today, everyone from mental health advocates to lawmakers to Gov. Maggie Hassan describe the state’s mental health system as broken.

In a scathing 2011 critique, the federal government said mental health care here is “in crisis.” Federal officials accused the state of violating the Americans with Disabilities Act by starving the community care system in favor of unnecessary hospitalization. Last year, several patients made the same allegation in a federal lawsuit against the state that the federal government has joined.

Meanwhile, people in crisis languish in emergency rooms, sometimes for days, waiting for a hospital bed. The state’s jails and prisons have become the new mental health “‘asylum,” with an estimated 65 percent of the state prison population having a mental illness, according to a prison spokesman.

Many community hospitals have closed their own psychiatric wings. And the 10 community health centers that once brought the state honor, have cut, not expanded, services in the 20 years since the National Alliance for the Mentally Ill ranked New Hampshire so highly.

In her budget address last month, Hassan ticked off these failings and asked lawmakers for $28 million over two years to begin resuscitating community mental health services. It’s uncertain how the Legislature will respond, especially given that Hassan proposes to find the money by counting on revenue from a casino.

But like Peterson did 42 years ago, Hassan sounded a moral note in her assessment of mental health services, saying, “We are not that kind of state.”

How, then, did New Hampshire get so off course?

‘Whipping boy’

There are two culprits, according to mental health advocates in the state, and they are inextricably linked: money and awareness.

“I think there have been competing needs” in shrinking state budgets, said Michael Cohen, who until 2011 was the executive director of the state chapter of the National Alliance on Mental Illness. “And the question has been which of the needs is going to be a priority. And I think for too long the mental health system, unfortunately, has been the whipping boy.”

Asked why, Cohen responded, “I think it’s a value issue . . . and a lack of knowledge, to some extent, of an understanding of what the impact of serious mental illness is on families and the communities.”

Yet Cohen is likely correct when he says everyone knows someone with a mental illness.

According to a 2010 study by the New Hampshire Center for Public Policy Studies, 26 percent of the state’s adults, more than 253,500 people, have a mental illness. A study that same year by the National Alliance on Mental Illness estimated that 43,000 of those adults suffer serious mental illness. The majority of those adults seek treatment at a mental health clinic or from community services, according to the report.

Hassan is not the first to ring the alarm.

Even as the national advocacy group ranked New Hampshire tops in mental health care in its 1990 report, it expressed concern about the state’s future. Then-Gov. Judd Gregg had ordered 9 percent budget cuts for state personnel to balance the state budget.

“The question facing the mental health system in New Hampshire,” the report’s authors wrote, “is whether it will be able to maintain existing levels of service and continue to improve and expand in the face of what is likely to be continuing pressure to cut budgets.”

The answer to that question is undisputed.

Steady erosion of services

Dennis MacKay is the chief executive officer of Northern Human Services, one of the state’s 10 mental health centers. It provides mental health and development care in the state’s three most northern counties, and like the other centers, contracts with the state. The centers rely on Medicaid money for 60 percent of their budgets, with the state covering about 20 percent and the rest paid by Medicare or private insurance.

“What has happened in the North Country is similar to what has happened elsewhere in the state,” MacKay said. “There has been a gradual shrinking of resources. There just seems to be a constant drip out of resources.”

In December, Nick Toumpas, commissioner of the state Department of Health and Human Services, announced he would ask for an additional $10 million in his budget to expand community mental health care. And for the first time in years, the state hospital would add 12 beds to shorten long waits in emergency rooms, Toumpas said.

“It is unacceptable,” Toumpas said then, “for someone experiencing a psychiatric crisis to have to wait this long for critical inpatient care – for both the individual as well as their concerned family members.”

If the community mental health system has such boosters, why hasn’t it been nourished?

MacKay and state officials point to two national recessions, the first in the 1990s and the most recent one that began in 2008. In response to both downturns, the state cut its own agency budgets, including Toumpas’s department, which lost millions.

And elected officials also cut the amount of Medicaid given to community mental health centers. Medicaid covers the bulk of the centers’ budgets and pays for treatment, day programs, crisis management and in-home care.

Mental health advocates measure the “shrinking of resources” a number of ways:

??Since 1990, the number of state hospital beds for adults and children has dropped from 316 to 130. Meanwhile, the number of yearly admissions has climbed, from 1,358 in 2002 to 2,305 last year.

??The state’s community hospitals provide far less psychiatric care today, largely because the amount they receive in Medicaid reimbursement falls short of what it costs to admit and treat a psychiatric patient. Since 1990, the number of mental health beds in community hospitals has gone from 236 to 150, and six hospitals have closed their psychiatric wings altogether, according to the New Hampshire Hospital Association.

??The state hospital has also become nearly the only hospital in the state accepting people who require hospitalization against their will. Since 1998, the number of beds for these involuntary admissions at community hospitals has gone from 101 to eight, all of which are at the Elliot Hospital in Manchester.

??There remains too little affordable housing in the community for people with mental illness. Between 2010 and last year, 134 people discharged from the state hospital relocated to a homeless shelter, jail or motel, according to records filed in the federal lawsuit.

??The beds in group homes for people with mental illness have become even fewer. There were 178 in 1998, according to the community mental health centers. Today, despite an increase in the state’s population, there are 159.

Riverbend Community Mental Health in Concord has had to combine day programs and close peer support centers that were a relatively inexpensive way to provide the mentally ill with day-to-day support close to home. Case managers are taking on more patients because of budget cuts.

“When you take away those things – community hospital beds, mental health center care and the state hospital, it’s a pretty crippling situation,” said Louis Josephson, chief executive officer of Riverbend in Concord. “They are now saying that 30 percent of all people who get into New Hampshire Hospital are being discharged within 24 hours. And in two days, they are back in the hospital.”

A blow to the 10-year plan

In 2008, just as the state was recovering from the recession of the 1990s, mental health advocates and state officials stood together to unveil a 10-year plan for rescuing the community mental health system.

Over the coming decade, the state would add 132 group home beds; increase financial aid for rent in community apartments; increase the number of involuntary-commitment beds outside the state hospital from eight to at least 48; and create a crisis response team in each area of the state to assist people without hospitalizing them.

MacKay helped write it and was optimistic.

“We had the community support and certainly had the support from a number of consumer groups,” MacKay said. “We had a nod from hospitals that it would be helpful. I was feeling we might be able to accomplish some things.”

MacKay recalls Toumpas, who also worked on the plan, telling reporters at a press conference the state was spending its mental health dollars in the wrong place. MacKay said Toumpas agreed with mental health advocates that community mental health care was cheaper and more effective than hospitalizations.

Jay Couture, executive director of the Seacoast Mental Health Center, was on the team too and shared MacKay’s hope – briefly.

“Just weeks after it was released, the entire nation was in recession,” Couture said.

Little of the plan was realized. It’s now the basis of Hassan’s community mental health budget request. That’s been welcome news to leaders of the community mental health centers, although they’d like to see the state invest $38 million - $10 million more than Hassan – in the next two years.

They’ve met with Hassan and described her as empathetic. They’ve said the same about lawmakers who will decide the state’s budget.

But they also know empathy doesn’t pay the bills.

(Annmarie Timmins can be reached at 369-3323,
atimmins@cmonitor.com or on Twitter @annmarietimmins.)
Feb 22- Mental health math doesn't add up for hospitals

NHPR--In the 1950s, the state psychiatric hospital in Concord was home to about 2,500 adults. The manicured campus had it all, including a golf course, barber shop, skating rink.

“For some folks, they talk about those days like some of us talk about going to college," says Ken Norton, Director of National Alliance on Mental Illness in New Hampshire (NAMI-NH).

“There was bowling and movie theaters and different events at night. They had their friends there and they were very used to the way that the hospital functioned.”

This was the era before psychiatric medicine, before the idea that mentally ill people shouldn’t be warehoused.
That soon changed.

In the 1960s and 70s, the often terrible living conditions inside of psychiatric hospitals became public, and the movement to deinstitutionalize began. By the 1990s, only a few hundred of the sickest people remained locked in the state hospital.

Everyone else was receiving treatment at local hospitals, or community mental health centers like Riverbend in Concord.

That’s where Louis Josephson is the Executive Director.

“Twenty years ago, New Hampshire was considered to have the best mental health system in the country.”
But in the past two decades, the system has crumbled. And its crumbled for one reason.

“Well, I think it is money,” says Josephson.

Specifically, a decline in payments from insurance companies and the government. The community hospitals that used to help treat the mentally ill just can’t afford to do it anymore.

Josephson says a patient in a hospital psych ward can cost $1,500 a day. Medicare, Medicaid: they’ll reimburse nowhere near that amount. The math just doesn’t add up for the hospitals.

“They look around and look at their Boards of Directors and say, ‘something’s got to go,’ and they often pick psychiatry.”

Back in 1990, there were more than 230 psychiatric beds at local hospitals. Today, there are fewer than 150, and none left in the North Country.

And there have been cuts to the state psychiatric hospital, the safety net to the system. That facility has half the beds it did 20 years ago.

Patients, with nowhere else to go, now wait in emergency rooms for days on end for a bed to open up.

“These people are suffering,” says Shawn LaFrance with the New Hampshire Foundation for Healthy Communities. “I believe that people wouldn’t tolerate this if they had a stroke or a heart attack or broken bones, that they would spend a day, two, three days waiting for somebody to help them.”

The waitlist for a bed, sometimes 30 or even 40 deep around the state, means emergency departments must adapt.
At Concord Hospital, they’ve blocked off four rooms and made them safe for people in crisis.

Louis Josephson says the area is called the Yellow Pod.

“It is de-sensitized, everything is secure. There is a television behind Plexiglas, there are blinds also behind glass. There’s soft furniture here that cannot be thrown. This is all costs we’ve absorbed.”

He estimates the hospital is spending $1 million dollars a year temporarily housing people in the ER. That may not be sustainable.

A fix, though, could be coming: Governor Hassan has set aside $28 million in her budget to try to shore up the state’s mental health system. Some of that money could go towards more beds; community-based services and counseling would also see a boost.

Advocates like Ken Norton of NAMI-NH say the funds are a positive step.

But he wants something bigger.

He wants to see an end to the stigma surrounding mental health in America.

“If you look back 30, 40, 50 years ago, no one said the word ‘cancer’. They would whisper it, there was a lot of fear associated with it. We still have these fears and attitudes around mental illness that allow us to think that it is okay to not provide medical care, and to not provide comprehensive insurance.”

Norton says that until the shame surrounding mental illness fades, the resources to treat it won’t arrive.
Feb 21- $4,140 Donated to Genesis Behavioral Health

We are pleased to announce a $4,140 donation to Genesis Behavioral Health of Laconia and Plymouth. As part of our commitment to assisting non-profit agencies in the communities that we serve, MVSB matched all 2013 employee contributions to the Lakes Region United Way dollar-for-dollar. The $41,400 in matched funds were distributed evenly to 10 deserving non-profit agencies selected by MVSB employee vote.

“We are always grateful for donations, but this surprise could not have arrived at a better time,” said Maggie Pritchard, Executive Director of Genesis Behavioral Health. “We are in the process of creating a strategic plan for technology at our organization and these funds will aid in the development of this plan. Enhanced technology will allow us to increase efficiency while continuing to provide the highest level of service to our patients and the community.”

The mission of Genesis Behavioral Health is to provide essential services that enhance the emotional and mental health of our communities. They do this by offering comprehensive mental health services to children, adults, elders, and their families throughout the Lakes Region. They work in collaboration with medical and health care professionals, law enforcement personnel and court officials, school administrators and teachers, social workers and public health officials, and businesses throughout Belknap and Southern Grafton Counties. For more information, visit www.genesisbh.org or call (603)524-1100.
Feb 19- Mental health advocates cautiously hopeful about governor’s proposed funding

By PATRICK MEIGHAN
Staff Writer

State and local mental health advocates greeted news of the governor’s proposal to partially restore funding for mental health services with cautious optimism last week.

“I can be very happy about it, but not content,” said Eileen Brady, homeless outreach
advocate for the Nashua Soup Kitchen & Shelter.

Brady said she frequently works with people who are homeless because of mental illness. Brady also follows proposed legislation for the Greater Nashua Continuum of Care, an association of organizations that shares information about providing services to the homeless.

Untreated mental illness has been cited as a common cause of homeless, and in announcing her $11.1 billion, two-year budget, Gov. Maggie Hassan said too many with mental illness wind up in emergency rooms or homeless because of lack of a bed in the community or services to help them.

Brady curbed her optimism by reflecting that a “long road” lies ahead in the process for the
budget to be approved.

Hassan’s proposal includes what she called a $24 million investment that would dedicate a too-be-determined hospital for a 10-bed emergency unit, a 16-bed psychiatric center for short-term care and 74 more beds in the community for longer stays.

“We’re very thankful the governor is using the 10-year plan for mental health services as a
guideline,” said Susan Stearns, director of development at the Greater Nashua Mental Health
Center at Community Council.

The 10-year plan of action, which recommended increasing inpatient and outpatient services, was developed five years ago by representatives from various agencies, but has largely collected dust since then. Directors of the 10 mental health centers across New Hampshire spoke in a conference call Thursday afternoon to discuss Hassan’s proposed funding, Stearns said.

Also, the New Hampshire Community Behavioral Health Association will analyze the governor’s 1,374-page budget proposal over the weekend and planned to report back to the mental health centers early this week, Stearns said.

“We still have to get through the process of moving the budget forward,” said Ken Norton, executive director of the National Alliance on Mental Illness New Hampshire.

His organization will be working with the Legislature in the coming months to advocate for the mental health funding, Norton said.

“Certainly, it’s a huge step forward,” he said of the governor’s proposal. “We’re clearly at a crisis point right now as a state. We have people unable to get inpatient care or care in general. We have people with intensive medical need, and they’re not getting treatment.”

Last February, six residents with psychiatric disabilities sued New Hampshire in federal court for failing to provide adequate mental health services.

Citing Feb. 4 as a day-in-the-life example, 18 children and 26 adults on that day were in hospital emergency rooms across the state waiting for psychiatric care, Norton said.

“We want people to come forward and get help,” Norton said. “We don’t want people to wait until there’s a crisis.”

While the December shooting in Newtown, Conn., raised public awareness about issues concerning the availability of mental health care, the issues existed long before that, Norton said.

Norton said the mental health alliance will be looking at the governor’s proposed funding in more detail in the coming days.

Brady said she’s worried about the viability of the two funding sources Hassan cited, a highend casino and a 30 cent increase in the tax on a pack of cigarettes.

“Gambling won’t be giving money to some who need mental health services this summer,” Brady said.

Gambling is a slow generator of revenue and an unreliable one because of competition with casinos in other states, Brady said. There’s also no guarantee the $80 million licensing fee Hassan’s budget banks on will ever materialize, since gambling is illegal in New Hampshire and any bill to change that faces a stiff test in the Legislature. Brady also doubts a cigarette tax increase – part of which simply restores taxes recently cut – will generate much revenue.

Stearns said while she isn’t sure if the Greater Nashua Mental Health Center will benefit from the governor’s proposed funding, she’s hopeful the funding will prove a benefit to state residents in need of mental health services.

Patrick Meighan can be reached at 594-6518 or pmeighan@nashua
telegraph.com. Also, follow Meighan on Twitter (@Telegraph_PatM).
Feb 19- Hassan proposes $28 million more funding for mental health care community services

By SARAH PALERMO Monitor staff

For weeks as she prepared her vision for how the state will operate over the next two years, Gov. Maggie Hassan has been receiving daily updates on the growing number of people waiting in local emergency rooms for psychiatric treatment.

The number has grown over that time, to a record high last week of 44 people, 18 of them children.

In her state budget, released yesterday, Hassan proposed adding $28 million over the coming two years to address the problem, which she called “one of our most pressing public health challenges.”

Her proposal does not approach the request community mental health care providers made last month, seeking a $38 million increase over the next two years, funding they said would have brought the state up to date on the 10-year mental health plan adopted – but never funded – in 2008.

Hassan said in her address she is committed to moving forward with the 10-year plan, calling it “critical for the safety of the public and the health and well-being of individual citizens.”

The money is allocated for several priority items:
??A new, 10-bed inpatient facility, in an existing hospital, for patients in a mental health crisis. Only Elliot Hospital in Manchester has this type of facility, with eight beds available.
??16 beds for patients in need of short-term inpatient care for acute psychiatric treatment, doubling that resource.
??74 new community treatment beds. As of January 2012, there were 159 of these placements available.
??Funding to give housing subsidies and residential support services to 100 additional people with mental illness.
??10 new Assertive Community Treatment teams, a support for people in crisis that can lead to decreased needs for hospitalization. Nine of these types of teams are already in place, serving people in four regions of the state. However, none of the existing teams serves children; six of the new ones will.
??Funding to bring assistance and treatment to 350 more older adults who are at high risk for hospitalization.
??An additional 10 percent in funding for peer support programs.

Taken together, the elements of the plan are “a very significant move forward to try to treat people within the community,” said Kathy Sgambati, a former state senator and former deputy commissioner of the state Department of Health and Human Services. Sgambati worked with Hassan as a budget adviser on the mental health system.
She pointed specifically to the services for elders with mental illness, estimated to cost $100,000 each year, and the peer support programs, receiving $150,000 each year, as “cost-effective community-level services that can really help people avoid hospitalization.”

That New Hampshire’s lack of community-based services for the mentally ill create or increase unnecessary hospitalizations is the allegation made in a lawsuit filed last year by several patients and their families. Sgambati said the proposed increases weren’t directed at that complaint specifically.

“The lawsuit is out there, and I think we have clearly met with a number of advocates . . . but our approach was to take the most critical needs and find the capacity to fund them.”

Amy Messer, legal director for the Disabilities Rights Center, is the lead attorney on the case. While she was pleased with the governor’s proposals, particularly the expanded assertive community treatment teams, she would not say whether it could affect the suit.

“The question remains whether we’ll have the right mix and sufficient capacity of services to end the needless institutionalization that currently exists,” she said. “We hope to work with the governor and the state to really craft a positive, meaningful and lasting reform. There’s still a lot more work to be done.”

‘Some things . . . all of us can support’

While some parts of Hassan’s budget won little enthusiasm from state Republicans, funding for increased mental health care seemed to earn bipartisan support.

“I thought her suggestions were very innovative, and I’m looking forward to working with her,” said Sen. Nancy Stiles, a Hampton Republican and chairwoman of the Senate Health, Education and Human Services Committee.

“There’s some things that I think all of us can support: more funding for the (developmental disabilities) wait list, mental health programs, CHINS, the community health center. These are some priorities that Republicans have had for a long time,” said Sen. Jeb Bradley, a Wolfeboro Republican.

But, Bradley added, “we can’t be paying for things with uncertain revenue sources. . . . These are the things that I think Republicans, but certainly Democrats also, will be asking, to make sure that the numbers add up and this is a balanced budget.”

Hassan described the funding increase as “restoring” the budgets for those programs.

In 2011, the Legislature passed a budget that cut funding for the Department of Health and Human Services by $238 million, including a $2.5 million cut that brought the state’s psychiatric care facility down to its current capacity of 152 beds.

Health and Human Services Commissioner Nicholas Toumpas announced in December a plan to reopen 12 beds in July.

As they did after Toumpas’s announcement that there will eventually be more space at the state hospital, mental health care providers said they valued Hassan’s apparent support for the 10-year plan, but noted they are still far from feeling the benefit of any increased funding.

“This is a big step forward,” said Roland Lamy, executive director of the New Hampshire Community Behavioral Health Association. “The fact that the governor seems to support the priorities of the 10-year plan is critically important . . . (But) we’ve been very vocal over the fact that we’re in an immediate crisis. This is a great step, and a strong recognition that there is a problem for the people of New Hampshire.”

(Sarah Palermo can be reached at 369-3322 or
spalermo@cmonitor.com or on Twitter @SPalermoNews.)
Feb 15- In Budget, Hassan Lays Out Priorities

BY JOSH ROGERS, EMILY CORWIN, SAM EVANS-BROWN AND TODD BOOKMAN

The governor’s budget address is the starting point for the months of wrangling and compromises that will eventually determine where the state will spend its money.

In the budget released today Governor Hassan spelled out her priorities in key areas like education, healthcare and infrastructure.

On Education

Restoring cuts to the state’s public universities was a centerpiece of Maggie Hassan’s campaign for governor, and education was at the center of her speech.

Hassan: “Ever-rising tuition rates can force many families to avoid even considering New Hampshire’s public colleges and universities, hurting our competiveness. If we hope to encourage job creation and innovative economic growth, we cannot keep losing our young people or fail to develop our workforce.”

Hassan proposed restoring 90% of the funding for the University System of New Hampshire, and 100% of the cuts to the community colleges.

The governor’s budget even included a $3 million dollar increase in next year’s allotment.

Ross Gittell, the Chancellor of the community colleges, says after two years of belt tightening, this money would allow for some expansion.

Gittell: “We really had to cut down on some programing, we had to rationalize some delivery, and this new budget as put forward by the governor will really let us meet the needs of industry, and help our students and help the state’s economy.”

But education initiatives also saw some cuts as well.

Governor Hassan took aim at the controversial education tax credit plan, which will give out $3.4 million dollars’ worth of scholarships in the next school year.

Hassan: “To help pay for these investments, this budget repeals the voucher tax credit that would have diverted millions of dollars in taxpayer money to private and religious schools with no accountability.”

Supporters of that program disagree.

Baker: “Nationally these programs are shown to save money, and significant amounts of money in the long run.”

Kate Baker with the Network For Education notes that yes, the state loses an average of $2,500 dollars in tax revenue per scholarship, but every student that leaves public schools for private ones is a student that public schools aren’t paying to educate.

The fiscal impacts of the tax credit aren’t yet completely clear: what is is that Republicans will fight this change.
And that won’t be the only fight in this budget.

On Health Care

Education wasn’t the only area where Governor Hassan offers an ambitious agenda: there’s also health care.

The biggest change will be expansion of the state’s Medicaid program, allowing low-income childless adults to enroll in the state/federal program for the poor.

That change will cost the state $80 million over seven years.

But it promises to bring in $2.5 billion in federal money.

Hassan is also calling for a $28 million investment in mental health services.

Hassan: “We can all agree that our mental health system is deeply strained. And though we won’t fix all of our challenges at once, it is time to resume our efforts to repair our mental health system.”

Those repairs start with money for community-based services; an increase in hospital psychiatric beds; and ten new crisis response teams.

Jay Couture with Seacoast Mental Health calls the Governor’s support a positive step.

Couture: “This is something we have been talking about for years. Should this be implemented, I think that it will greatly benefit some of our most vulnerable citizens.”

Other vulnerable citizens helped by Hassan’s budget plan are those waiting for services on the developmentally disabled wait list.

She promises to fund those programs, in full.

On Infrastructure

Transportation infrastructure was another thing Hassan campaigned on.

She says New Hampshire needs to step up to the plate. The state’s highway fund is looking at a shortfall of $740 million dollars over ten years.

Hassan: “Maintaining and repairing our state’s roads and bridges and funding transportation projects are crucial for our economy.”

Years of neglect and underfunding, Hassan says, were at play when the Seacoast’s Sarah Mildred Long Bridge closed suddenly last month.

Bill Boynton at the Department of Transportation echoes the Governor’s concerns. He says New Hampshire’s road and bridges represent an $8 billion dollar investment. Yet, he says, the state will leave more and more roads and bridges to decay, if policymakers don’t increase revenue to the highway fund.

Boynton: “The last time the gas tax was increased in New Hampshire was 1991 and those dollars today are only 60% of what they were worth in 1991, and fuel continues to go up, salt prices, all the things we do continues to go up in costs so the costs are far outpacing revenue at this point.”

Hassan did not offer a specific solution to the state’s infrastructure woes.

She did, however, point to proposals from both Republican Senator Chuck Morse and Democratic Representative David Campbell. Morse would like to allocate income from a casino to fund highways, roads and bridges. Campbell is proposing an increase in the gas tax and auto registration fees.

On Paying For It All

While Governor Hassan didn’t leave lawmakers room to dicker on transportation issues, she was loud and clear on some things.

Hassan: “My budget includes $80 million from licensing one high-end, highly regulated casino.”

Hassan acknowledged that gambling has been a “difficult debate” in Concord for years, but she said with casinos on the horizon in Massachusetts, New Hampshire needs to act.

Hassan: “Will we let Massachusetts take revenue from New Hampshire’s residents to fund its needs, or will we develop our own plan that will allow us to address social costs and invest in our priorities?”

Another major revenue source for Hassan is a more time-tested one: higher cigarette taxes.

Hassan: “My budget proposes reversing the cigarette tax cut and increasing the tax by an additional 20 cents.”

Hassan anticipates $40 million from the increase; she expects another $22 million to come from fatter insurance premium tax collections under the expansion of Medicaid.

She also wants to suspend several tax changes recently enacted by Republicans. With a divided legislature, good relations with Republicans, at least in the GOP-held Senate, are crucial for Hassan.

But GOP leaders say 30 cents is way too much to add to the tobacco tax.

They also say if Hassan ends up supporting the higher gas taxes, which she did not rule out, this budget will be very pricey. Jeb Bradley is State Senate Majority Leader.

Bradley: “Senator Morse, Chairman of the Finance Committee, thinks on first blush it’s a billion dollars of new spending. That’s a lot of new spending.”

Bradley added, though, that it will take a little time to properly evaluate the full effect of Hassan’s proposals. As Hassan herself noted at the end of her speech, a final product demands cooperation, but she concluded,
“Let me be clear, we must end this process with a balanced budget, and I will veto anything else.”
Feb 8- Scorecard with no winners: 44 wait for mental health care

By Jay Couture

We live in an era where records, particularly when they are shattered or just barely missed, are in the news on adaily basis. We hear of high-scoring basketball stars, record-tying golfers and quarterbacks, and death-defying feats of athleticism. We hear which movies grossed the most ticket sales over the past weekend, which actors and actresses are making the most money, and who has won the most awards and gold statues. We are regularly apprised of the most recent political polls and the approval and disapproval ratings for the president, our governors, members of Congress and others in elected office. Everybody loves a winner, as the saying goes.

Here in New Hampshire, we broke another record this week, too, but this is one that won't make headlines and that most people won't hear about. It wasn't in the world of sports, entertainment or politics. It was in the world of treatment, or lack thereof, for people in acute psychiatric crisis. It is one that is nothing to celebrate, or be proud of.

On Monday, Feb. 4, there were 44 people stuck in hospital emergency departments throughout our state awaiting a bed at New Hampshire Hospital. These were 44 adults and children who have been deemed to meet the criteria for an involuntary emergency admission, which must be made to a designated receiving facility (DRF). These individuals are not safe to discharge as they have been determined, according to state statute, to be a danger to themselves or others. This situation generally means that an individual needs to be admitted to the state's one psychiatric inpatient facility — NHH — because there are only eight DRF beds remaining, at Elliot Hospital.

Despite the fact that NHH recently converted four visitation rooms to patient rooms to increase capacity by up to eight beds, our community-based mental health system of care has been eroded so much over the years that we simply cannot keep up. And because there were no DRF beds at Elliot, or elsewhere, on Feb. 4, there were 44 people languishing in hospital emergency rooms, not receiving the care they needed in a timely, humane or costeffective way. In what other segment of health care would we, as a society, accept this? If you had a family member or friend with cardiac disease or kidney failure, would you be complacent when told, "Sorry, there is no care available," or that there is a lengthy waiting list before your loved one can even see a doctor?

It costs far more to get to the point where people in a psychiatric crisis require the acute services of an emergency department and an inpatient bed than it does to provide adequate funding for community-based mental health services. It goes without saying that services provided in a timely manner in the least restrictive environment have the double benefit of being more clinically effective and less costly.

The state's Ten-Year Mental Health Plan, "Addressing the Critical Mental Health Needs of NH's Citizens: A Strategy for Restoration," was released in 2008, but has not been adequately funded. It still provides a valid framework for our state, and there is still time to rebuild our community-based system of care by funding the plan now. We need to do better for the 44 adults and children who sat in hospital emergency rooms on Feb. 4 because the system had no room for them. We need to commit to moving the Ten-Year Plan forward this year.

Jay Couture, MHA, is executive director of Seacoast Mental Health Center in Portsmouth and president of the New Hampshire Community Behavioral Health Association.
Feb 6- Sebelius: Bring mental illness out of the shadows

President Obama following lead of John Kennedy 50 years ago on improving access to care.

Fifty years ago Tuesday, President John Kennedy shattered the national silence when he delivered a message to Congress in which he called for a bold new community-based approach to mental illness that emphasized prevention, treatment, education and recovery.

In the half century since, we've made tremendous progress as a country when it comes to attitudes about mental health. But recent events have reminded us that we still have a long way to go to bring mental health fully out of the shadows.

The vast majority of Americans with a mental health condition are not violent. In fact, just 3% to 5% of violent crimes are committed by individuals who suffer from a serious mental illness.

But we know that some instances of mental illness can develop into crisis situations if left untreated, and those crises can lead to violence. More often than not, those with mental health conditions direct these violent acts at themselves. Tragically, there are more than 38,000 suicides in America each year, more than twice the number of homicides.

This is just one of many ways untreated mental illness takes a toll on our society. Bipolar disorder and major depression are responsible for more than 300 million days per year in lost productivity. As many as three in 10 homeless Americans have a serious mental illness. In total, mental health conditions place a greater burden on our economy than cancer or heart disease; and yet more than 60% of people with mental illness do not receive help.

The Obama administration has already made great strides in improving access to mental health care. Because of the Affordable Care Act and previous legislation making care on a par with other illnesses, 30 million Americans will gain access to health coverage, including up to 10 million who have mental health issues. Mental health care must also be covered in the new Health Insurance Marketplaces, which will open in every state this fall to help citizens find coverage that fits their needs and budget.

The president has proposed additional actions that will make it easier for young people to get mental health care. This is critical since three quarters of adult mental health conditions appear by the age of 24. His plan would train more than 5,000 mental health professionals to serve young people and advance new strategies to make sure young people and their families continue to receive support after they leave home.

But we know that lack of coverage and access to services are not the only reasons people go without the care and treatment they need. The truth is that while America has come a long way, we are still a country that frequently confines conversations about mental health to the far edges of our discourse.

We often fail to recognize the signs of mental illness, especially in young people. And when we do see those signs, our first reaction is often not to reach out, but to turn away. This is a culture we all contribute to. And it's one that all of us -- community leaders, teachers, pastors, health providers, parents, neighbors and friends -- need to help change if we want to reduce the tragic burden of untreated mental health conditions.

That's why President Obama has called for a national dialogue on mental health that will be kicked off in the coming weeks. This dialogue will seek to address the culture of silence and negative perceptions of mental illness that keep so many of our nation's young people from seeking care. It will challenge each of us to do our part to create communities where young people and their families understand how important mental health is to positive development and feel comfortable asking for help when they need it.

The good news is that when people do seek help, we have much more effective treatments and supportive services than we did 50 years ago. The proof is the tens of millions of Americans with mental health conditions who are living healthy lives and contributing to their communities. But people will only take advantage of this progress if they are not afraid to seek help. Now is the time to work together to banish those fears and bring mental health out of the shadows once and for all.

Kathleen Sebelius is secretary of Health and Human Services.
Jan 22- Make mental health a budget priority in NH

If ever there were a time for mental health organizations to pitch the need for more funding to state lawmakers, now would appear to be it.

So it made perfect sense that a Concord-based organization representing 10 community-based mental health centers chose Monday – the one-month anniversary of the tragic Sandy Hook Elementary School shootings in Connecticut – to issue a position paper detailing its budget priorities for the next two years.

That it also came a month before Gov. Maggie Hassan is expected to present her two-year budget for fiscal years 2014-15 didn’t hurt, either.

But whether the nation’s renewed focus on mental health issues in the wake of Sandy Hook will translate into a renewed commitment by cash-strapped state lawmakers to expand mental health services remains an open question.

“The last month has seen a horrific escalation of crises in mental health and the failings of our community-based system,” said Jay Couture, president of the New Hampshire Community Behavioral Health Association, in a prepared statement. “A month ago today, the shootings in Newtown, Conn., shocked our community and also raised the public’s concerns about mental health issues.”

In order to offset the damage done by the state’s inability to invest in mental health services in recent years, Couture put forward an ambitious plan that calls for spending $37.6 million over the next two years to fund 132 new treatment beds, Section 8 rental subsidies and more outpatient caregiver teams, among many other provisions.

Specifically, the plan calls for spending roughly:
- $10 million for 38-48 new beds spread among four regions of the state.
- $1.5 million for 20 new beds to treat individuals facing mental health and substance abuse problems.
- $900,000 for 12 new beds to care for those most in need of treatment and otherwise destined for hospital emergency rooms.
- $11.6 million to double to 12 the number of teams that provide outpatient services with the goal of keeping patients out of hospital emergency rooms and jails or prison.
- $1.8 million to offer a rental subsidy to those individuals on a waiting list for a Section 8 federal housing voucher.

Sadly, even lawmakers sympathetic to the problem may be powerless to do much over the next two years, given the state of the budget.

Speaking at the Greater Nashua Chamber of Commerce’s annual Economic Outlook Luncheon on Thursday, Charles Arlinghaus, president of the Josiah Bartlett Center for Public Policy, told Nashua business leaders that the state could be looking at a $25 million deficit in the two-year budget cycle that ends June 30.

If that weren’t bad enough, he projected it will cost more than $200 million over the next two years just to maintain the current level of services, while state revenues only will increase by about $10 million.

If true, lawmakers will have to be extremely diligent in setting budget priorities for 2014-15. When they do, some additional resources for mental health treatment should be near the top of the list.
Jan 15- Officials discuss mental healthcare system

By JOHN KOZIOL
jkoziol@citizen.com

LACONIA — For decades, the State of New Hampshire has been underfunding mental-healthcare services to the point where the system might now collapse. But there’s a bright spot there, too, says Maggie Pritchard, in that for the first time she can remember, lawmakers seem to care and want to know more about what can be done to stave off that possibility.

Two of those lawmakers — state senators Jeanie Forrester, R-Meredith, and Andres Hosmer, D-Laconia — joined Pritchard, who is the executive director of Genesis Behavioral Health, for a regularly-scheduled meeting of the Joint Advocacy Committee, whose members come from Genesis and from LRGHealthcare, which is the parent of Lakes Region General and Franklin Regional hospitals.

Although planned well in advance and geared to bring the newly-elected senators from the Lakes Region up to speed on the state of mental healthcare here, the meeting comes on less than a month in the shooting massacre of 26 people at Sandy Hook Elementary School in Newtown, Conn. by a young man who may have been suffering from mental illness.

While horrible and terrible, the shooting has focused attention on mental health, which is a good thing in itself, said Pritchard, although more needs to be done. With the State of New Hampshire paying agencies like Genesis less than 50 cents on the dollar for providing mentalhealth services under the current Medicaid program, the overall mental health system is threatened, Pritchard added, although not many people know it.

The “how” of how things ended up where they are now, said Pritchard, is that the Medicaid reimbursement rate is a very fluid thing, dictated by the whims of the NH General Court that often have no connection to what it costs mentalhealthcare providers to administer services.

New Hampshire’s mentalhealth system was created as an elaborate and “very difficult” exercise in balancing costs among people who could pay for all or some of them, while footing the bill for those who couldn’t. Somewhere down the line, however, the costs were reshifted to “You, the taxpayers,” said Pritchard, because the state’s own response is lacking.

On Thursday, seven people with mental illnesses - two of whom who waited more than 24 hours - were stuck in emergency rooms at LRGH, Franklin Regional and Speare Memorial hospital in Plymouth - because there was no room for them at the State Hospital in Concord.

Those persons had to be guarded and monitored, which costs the hospitals money, but their conditions were only being “managed,” not treated, said Pritchard, and the delay in getting them care in a timely manner was only going to lead them to ultimately receive “more expensive care,” the cost of which also gets picked up by taxpayers and healthcare consumers.

Shifting resources to the most seriously ill people will only bankrupt the larger mental-health system, said Pritchard, who added that of the 3,300 patients that Genesis sees at its facilities in Laconia and Plymouth, the largest percentage are those with “severe and persistent” illnesses such as schizophrenia and bipolar disease. Those patients must be treated, she said, but not at the risk of eliminating services to people who need less-intensive care.

Following yesterday’s meeting with Hosmer and Forrester, Pritchard said she was “cautiously optimistic because people are listening and paying attention” to mental-health issues.

“I can’t tell you in my 30 years in this business how many senators have asked me for more information,” said Pritchard, but two did and more may.

During Friday’s meeting, Forrester told attendees that she and Hosmer were “not the experts, you are,” adding, “We need specific direction, specific things. What’s your No. 1 thing we can do in the next year?”

The shooting in Newtown, Forrester continued, is an opportunity to “educate lawmakers” about New Hampshire’s mental-health system.

Hosmer said there still seems to be a “stigma” around mental illness, as if it implied a conscious “weakness” in the sufferer.

“If we treated our cardiac patients the way we treat our mental- health patients,” he added, “there’d be an outcry.”

Pritchard promised Hosmer and Forrester that Genesis and similar agencies would renew their education outreach efforts to members of the New Hampshire House and Senate.

“We are invested in educating whoever will listen,” said Pritchard.
Jan 15- Mental health advocates call for $38 million in state budget

By ANNMARIE TIMMINS Monitor staff
Tuesday, January 15, 2013

New Hampshire’s 10 community mental health centers called on state lawmakers yesterday to put an additional $37.6 million in their next two-year budget to improve care for the mentally ill.

It’s a steep request that legislative leaders doubt can be wholly fulfilled, given the competing demands on the budget, including a new women’s prison and more money for the state’s universities. But mental health experts said yesterday the amount – $18.8 million for each of the next two years – is necessary to rescue a mental health care system “in crisis.”

Jay Couture, president of the New Hampshire Behavioral Health Association, said the budget request would bring the state up to date on the 10-year mental health plan adopted – but never funded – in 2008. This budget request would pay for the additional residential beds, community treatment services and in-patient beds that were called for in that 2008 plan, Couture said.

“I certainly understand that times continue to be challenging,” she said yesterday when asked how she expected lawmakers to receive this request. “But I’m cautiously optimistic. I think lawmakers and the general public are certainly recognizing that the needs of those with mental illness need to be addressed. We cannot continue to put off such critical services.”

The mental health centers are asking for money to build new community group homes and for the money for staff to care for patients. They also want 12 additional “crisis” beds in the state and up to 48 additional beds for mental health patients in area hospitals. The centers also want money to increase the number of “Assertive Community Treatment” teams across the state to respond quickly to a person in crisis with hopes they can remain in their communities.

Some of the requests overlap with those Commissioner Nick Toumpas recently said he will make to the Legislature when he delivers his budget for the Department of Health and Human Services. In late December, Toumpas, who could not be reached by deadline yesterday, said he will ask lawmakers for $10 million to improve mental health care in the state.

Yesterday’s challenge from the community mental health centers came a month after the school shootings in Newtown, Conn., where the shooter’s mental health is being questioned. And they came a week after the state chapter of the National Alliance on Mental Illness held a press conference in Concord to highlight the shortage of available beds at New Hampshire Hospital.

Ken Norton, executive director of the state chapter of NAMI, said then that it’s not uncommon for people suffering a mental health crisis to spend several days in hospital emergency rooms waiting for a state hospital bed.

The budget request also coincides with a tour interested lawmakers will take tomorrow of Riverbend Community Mental Health Center in Concord.

The challenge for Couture and her colleagues won’t be convincing state lawmakers that mental health care falls short of the demands on it. It will be persuading them to find the money to rectify that.

The governor’s office received an advance copy of yesterday’s release from the state’s mental health centers.
Gov. Maggie Hassan’s spokesman responded to a request for comment:

“Gov. Hassan believes that the state of our mental health system is a pressing challenge and thanks those seeking to help our citizens who are in need of care,” Marc Goldberg said in a press release. “The governor is currently working to bring people together to make the difficult decisions needed to balance the budget while protecting New Hampshire’s priorities, including providing access to mental health and health care services. She thanks the New Hampshire Community Behavioral Health Association for their advocacy and looks forward to working with them and other stakeholders to continue improving the health of all Granite Staters.”

Sen. Chuck Morse, a Salem Republican who chairs the Senate Finance Committee, could not be reached for comment yesterday. But Sen. Lou D’Allesandro, a Manchester Democrat who serves on the committee, wasn’t optimistic that the next budget will have all that Couture has asked.

“The gravity of the mental health situation has been brought to my attention by my mental health center in Manchester,” D’Allesandro said. “But there’s no way that kind of money (can be found) over that period of time without some serious revenue enhancements.”

D’Allesandro said the competition for limited state money is fierce. He cited the request to restore money for the Children in Need of Services program and the need to build a new women’s prison, given that the state is being sued over the conditions of the existing one. The Legislature has not decided whether to expand Medicaid services, and lawmakers are waiting to see if the state wins or loses a federal lawsuit brought by the state’s hospitals.
“Add mental health care to that mix, and you’ve got an enormous amount of activity that’s going to make demands on the fiscal integrity of the state,” D’Allesandro said.

Rep. Mary Jane Wallner, a Concord Democrat and chairwoman of the House Finance Committee, agreed. She said yesterday the Newtown shootings and previous tragedies linked to mental illness have “heightened all our awareness.”

“But it’s a tight budget,” she said. Wallner said it’s premature for her to make any predictions about what budget resources will be available to any state agency or community. All she knows now is that mental health care will be part of the conversation.

“From the people I talk to, I think people are very much wanting to look at mental health and what we are doing for New Hampshire citizens,” she said. “I know from my own experience, there is really a lack of services available and families need help.”

(Annmarie Timmins can be reached at 369-3323, at
atimmins@cmonitor.com? or on Twitter @annmarietimmins.)
Jan 7- Video of the NAMI NH Press Conference

January 7, 2013--NAMI NH and other organizations held a press conference today regarding the current mental health crisis in NH. Watch coverage of the event on YouTube.

http://www.youtube.com/watch?v=Fxx1_pTwuzM
Jan 4- Genesis stresses importance of mental health services in wake of Newtown

BY ERIN PLUMMER

LACONIA — The tragedy in Newtown, Conn. has created increased awareness in the importance of mental health services. One local mental health provider says such services are available in the community, but continued advocacy is vital.

The deaths of 27 people, including 20 children, at Sandy Hook Elementary School have turned national attention to the need for mental health services that could possibly prevent further tragedies. In the Lakes Region, mental health professionals are working with local emergency responders in spreading the importance of recognizing and working with a mental health crisis. Kristen Welch, Director of Development and Communication at Genesis Behavioral Health, says the organization works closely with local police departments and emergency rooms.

“We work very closely together with first responders to ensure that people are aware of our services,” Welch said.

Welch said “very few”people with any form of mental illness will commit a violent crime. However, the incident has made people more aware of the importance of mental health services.

“We agree with the fact there needs to be better access to mental healthcare for everyone, and the increased need to raise awareness and reduce the stigma,” Welch said, hoping people in need would “utilize their community mental health center as a resource. I think its unfortunate that it takes tragedy like this to highlight the importance of mental heath.”

Welch said many people will see mental illness as something that cannot happen to them, but one in fivepeople will be diagnosed with some kind of mental illness. She said it is essential that someone with a mental health issue, whether mild or severe, seek help.

Genesis Behavioral Health is one such resource, and has services for people of all ages. Services must be paid for, but the center takes all private insurances plus Medicare and Medicaid. Emergency services are available 24 hours a day, seven days a week regardless if someone can pay up front. People without insurance and in need of emergency services will not be denied service.

“We are able to treat people who are severely mentally ill, and someone who is going through a rough time,” Welch said.

There is also a great need for advocates for mental health services.

“We need people to speak out and say it’s unacceptable that funding has been cut so much from these critical services,”Welch said. After last Friday’s tragedy, Welch said Genesis has seen an increase in phone calls from people concerned about mental health issues in the community. “We have seen a sort of heightened awareness and an increase in concern and phone calls,”Welch said.
Dec 20- Holiday Wishes from Genesis Behavioral Health

As we come to the end of 2012, we gratefully pause to acknowledge the support we have received from the communities we serve. Check out our latest newsletter to find out what's happening at Genesis Behavioral Health!

http://myemail.constantcontact.com/Holiday-Wishes-from-Genesis-Behavioral-Health.html?soid=1110322445324&aid=Oi-jzSSu72w
Dec 18- We Can't Tolerate Less Than High Quality Services for Mental Health

Do you hear what I hear?

This week we heard Commissioner Nick Toumpas and the N.H. Department of Health and Human Services announce they were making an effort to improve the bed crunch at New Hampshire Hospital by re-opening 12 additional beds.

This and other action steps are being taken to reduce the wait list for people in crisis, many of whom are waiting for several days in hospital emergency rooms for a bed to become available. Much as a child does at this time of year, I am listening carefully to what I hear and patiently waiting to see "what will appear" in our communities.

More than five years ago, the State of New Hampshire heard clearly from the National Alliance on Mental Illness (NAMI) that mental health care in our state had gone from an A/B rating to a C/D rating. As a parent, I know that such a significant loss in performance means we have to pay closer attention. The school counselors, the teachers, the parents, and the student's peers all need to rally around that person and support them as they return to stronger performance. We have not been able to rally the support for people with mental illness who need the services, due in part to the persistent and pervasive stigma that continues to surround this disease. The services have been cut away over the years by lowered reimbursement rates and service limitations. In the Lakes Region, we no longer have 24-hour residential care. We no longer have crisis beds to help keep people from deteriorating to the point of needing hospitalization or to assist them in transitioning back to their community. Now, the effects are acutely felt, as our patients are experiencing multi-day waits in emergency rooms, our staff have increased administrative responsibilities as a result of these waits, and our hospitals and police departments are managing psychiatric patients for longer lengths of time, which ultimately affects our entire community.

This holiday season, I hope to be pleasantly surprised by strong support from the public, from leadership , from the staff, and from those affected by mental illness directly and indirectly. The support should be the resounding sound of voices in unison noting we cannot tolerate anything less than a rebuild and reconfiguration of high quality comprehensive services to those suffering from an illness that has gone unheard for too long.

Best wishes to all for a healthier and happier 2013. We look forward to hearing from all of you.

Maggie M. Pritchard, Executive Director
Genesis Behavioral Health
Laconia
Dec 12- DHHS' Immediate Plan of Action on Mental Health Released Today

Concord, NH – The New Hampshire Department of Health and Human Services (DHHS) is announcing the release of its plan to help reduce the wait time for patients in local hospital emergency rooms for inpatient psychiatric care. Budget reductions, the closure of local hospital inpatient psychiatric units and since 2009 the loss of 60 beds at New Hampshire Hospital (NHH) has led to a waiting list for patients seeking inpatient psychiatric care. Many patients are now waiting several days in a hospital emergency room for a bed to become available at New Hampshire Hospital.

“This is of critical concern to me personally, and DHHS as an organization,” said Commissioner Nicholas Toumpas. “It is unacceptable for someone experiencing a Psychiatric crisis to have to wait this long for critical inpatient care - for both the individual as well as their concerned family members. As we develop our budget request for the next two years, we will be seeking additional funding to continue to accelerate progress on our 10-year Olmstead Plan, but also fund new and innovative programs that are designed to support individuals so that they can live in their communities with the supports that they need. In the meantime we have some immediate steps we are taking to reduce the waitlist.”

DHHS’ immediate plan of action includes:

NHH tracking all individuals awaiting a bed at NHH on a daily basis. These are reviewed and triaged by the Physician in Charge at NHH.

Finalize a plan to utilize psychiatry staff at NHH to provide additional consultative services to local ER physicians on the management of behavioral health crises.

Finalize a plan for Commissioner approval to temporarily reopen 12 beds at NHH that currently are closed.

Within the next 10 days, finalize implementation of Project RED (Re-engineered Discharges) to provide better community follow-up after discharge in order to reduce readmissions, which will also increase the availability of beds at NHH.

Expand peer-run crisis respite beds.

DHHS’s budget submission contains requests for additional funding to continue building community capacity, including:

Establishing additional inpatient capacity available on a statewide basis to allow individuals to receive care on a local basis.

Expanding peer run services, including peer crisis beds in the community, to serve an additional 400 adults with severe mental illness annually, through a peer run model.

Continuing to expand the number of Assertive Community Treatment Teams by adding an additional 7 teams, bringing the total to 17 teams for the State of NH.

Expanding residential options for consumers, including a doubling of the size of the Housing Bridge Subsidy program from 110 to 210 by the end of FY 15, and adding an additional 48 supervised residential beds in the community.

“Let me be clear, we cannot do this on our own,” stated Toumpas. “This is a very complex subject and involves the coordination of many partners. We will continue to reach out to our Community Mental Health Centers, consumer and family members, the NH state Planning Council, NAMI-NH, the law-enforcement community and local hospitals to develop and most importantly advocate for the supports and services that are needed today and in the future here in New Hampshire.”
Nov 6- Happy Birthday, N.H. Hospital

November 04, 2012 - 2:00 AM
Monday afternoon, as Hurricane Sandy blew into the region, a small celebration took place for a big birthday.
New Hampshire Hospital, our state psychiatric facility, celebrated its 170th birthday, having begun operations Oct. 29, 1842. While much at NHH has changed over those years, one constant that has remained is the staff's commitment to treat people with dignity, compassion and respect.
Over the years, NHH became a community within a community — it had a movie theater, ball fields, a golf course, skating rink, as well as medical/surgical facilities, dentist's office, hairdresser, nursing home and many other amenities. The treatment process for patients involved working: helping to cook or clean or do chores on the farm that grew most of the food the hospital used. At its peak during the late 1950s the hospital census was about 2,700 adults. Today, the hospital has a maximum census of 150 adult beds with an average length of stay of about 10 days. Since its inception, NHH has treated more than 80,000 individuals.
As deinstitutionalization swept across the country, New Hampshire's 1983 Nardi-Wheelock report resulted in the development of more community-based mental health services in our state. NHH was an important part of that transformation process with our governor and legislature deciding to close the overcrowded and run-down Brown building and build a much smaller state-of-the-art in-patient hospital, which opened in 1990. They also contracted with Dartmouth Medical School to provide highly trained psychiatrists to lead the treatment teams at NHH. During the early 1990s, New Hampshire was recognized nationally for having the best mental health services system in the country.
The success for building a smaller hospital facility was dependent on a statewide system of community supports including the development of regional Designated Receiving Facilities at local hospitals, which could provide voluntary or involuntary short-term crisis stabilization and care closer to people's homes, families and community supports. Unfortunately, this vision was never fully realized and most of the DRFs that did open have since closed due to funding reductions, which have also negatively impacted other important community supports for people with mental illness. This — combined with admission rates that have more than doubled since the new hospital was built and cuts that have forced NHH to reduce beds — has resulted in our present situation where people in crisis spend days and sometimes weeks in emergency departments awaiting a bed at NHH. These have been contributing factors in legal advocates and the federal Department of Justice filing suit against the state for alleged violations of the Americans with Disabilities Act.
Despite these challenges, there is still much to celebrate on New Hampshire Hospital's birthday. NHH has a competent and dedicated staff who are passionate about providing high-quality services. These staffers are led and supervised by compassionate and talented psychiatrists from Geisel (Dartmouth) Medical School. NHH was recently reaccredited by the Joint Commission of Hospital Accreditation — the gold standard for hospitals. NHH's commitment to quality and improving services is also evidenced by an innovative partnership with NAMI NH — the National Alliance on Mental Illness, in which family members are trained as quality control monitors and can go into the hospital at any time and check on treatment programs, facilities, food and talk with staff and patients to hear concerns they have. The monitors meet regularly with NHH administrators to provide feedback and offer recommendations.
This fall, NHH has begun an innovative discharge planning process to improve continuity of care between NHH and community treatment providers and, hopefully, reduce readmissions. NHH also continues to be a teaching facility and in addition to training Dartmouth psychiatric and medical residents, also trains art therapists, nurses, psychologists, occupational therapists and social workers from New Hampshire's colleges, universities and community and technical colleges.
Perhaps the best indicator of the quality of care provided at NHH comes from the families of those who have been treated there. While not everyone has a positive experience, over the 30 years I have worked in the mental health field I have heard on numerous occasions and as recently as last week that the care their loved one received at NHH was of a higher quality than they received at a private psychiatric hospital.
As we celebrate and reflect on 170 years of our state's care and treatment of people with mental illness we face many challenges in the future. The success of New Hampshire Hospital is dependent on the success of our 10 regional community mental health centers as well as our local hospitals and other private providers in being funded at a level that can provide effective treatment and supports for people with mental illness. It will be incumbent on our new governor to work with the Legislature to prioritize and immediately resolve the current situation of people in crisis who are waiting days and sometimes weeks for an in-patient bed and to ensure community supports are in place to protect our most vulnerable citizens and promote recovery from mental illness.

Kenneth Norton, LICSW, is executive director of the National Alliance on Mental Illness New Hampshire.
Oct 16- Genesis Behavioral Health Holds Annual Meeting & Fundraising Auction

The Board of Directors of Genesis Behavioral Health will hold their 46^th Annual Meeting, “The Many Pathways to Recovery,” on Tuesday, October 23, 2012 at 5:30 pm at Steele Hill Resorts in Sanbornton. The keynote address will be provided by Marshall B. Hatch, III, who recently spent several months in New Zealand learning about their mental health system. He will share photos and lessons learned about programming that focuses on wellness and leads to recovery from mental illness.

“We have focused much of our efforts this year on creating a culture of total wellness—mind and body—for our patients as well as our staff,” said Maggie Pritchard, Executive Director of Genesis Behavioral Health, “With programs such as Healthy Choices, Healthy Changes, which provides people with mental illness with health mentors and incentive programs for smoking cessation, we hope to see an improvement in health outcomes for a population that dies, on average, 25 years younger than other Americans.”

As is its tradition, Genesis Behavioral Health will present the 2012 Helen Holbrook Leadership and Service Award and the Dr. George “Pete” Harris Community Service Award at the Annual Meeting. The Holbrook Award is given to an individual who leads by example and gives of themselves to strengthen the cause of mental health in the Lakes Region, while the Harris Award is presented to an individual who promotes increased awareness, sensitivity, understanding and acceptance of mental health issues in the Lakes Region through educating the public.

“Our 2^nd annual fundraising auction is underway with a goal of raising $15,000,” said Kristen Welch, Director of Development & Communications, “Auction items will be on display at the annual meeting and technology will be available for on-site bids. We are grateful for the incredible support we have received from the community, and for the commitment of our auction sponsors, Northway Bank and Nassau Broadcasting. There are some great items this year, and all support mental health care for over 3,000 of our Lakes Region residents.”

The auction runs online 24/7 from October 1 to October 24 at 8:00 pm. To view the items, make a bid, sign up for email updates or refer a friend to the auction, visit www.biddingforgood.com/genesisbh.

Members of the community who wish to attend the Annual Meeting should RSVP to Kristen Welch, Director of Development & Communications, at 524-1100, ext. 445 or email kwelch@genesisbh.org.

Genesis Behavioral Health is designated by the State of New Hampshire as the community mental health center serving Belknap and southern Grafton Counties. A private, non-profit corporation, Genesis serves over 3,000 children, families, adults and older adults each year. For more information or to schedule an appointment, call 603-524-1100 or visit the website at www.genesisbh.org.
Sep 18- Battle Over Mental Health: Lawsuit Seeks to Force NH to Improve Care Services

By Karen Dandurant

news@seacoastonline.com

September 16, 2012 2:00 AM

A class-action lawsuit, filed in U.S District Court in Concord, alleges the state does not provide adequate mental health services to citizens with mental illnesses.

It was filed on behalf of six residents who say their lives have been disrupted or destroyed by prolonged and needless stays at state institutions. The six claim that if adequate community services were available, institutionalization would have been unnecessary and the quality of life for themselves and their families improved.

The suit charges Gov. John H. Lynch and other state officials with violating the Americans with Disabilities Act, the Rehabilitation Act, and the Nursing Home Reform Act for their failure to provide clinically necessary and cost-effective community services to avoid needless institutionalization.

The named plaintiffs are or have been institutionalized at New Hampshire Hospital, a state-operated psychiatric institution in Concord, or at the Glencliff Home in Benton, a state-operated nursing facility primarily for individuals with mental illness.

The plaintiffs' allegations include those of a 22-year-old Newport woman whose 20 psychiatric hospitalizations at NHH over the past 10 years robbed her of the normal educational and social experiences of adolescence; a 65-year-old man who went to Glencliff as a "temporary resident" in 2005 and remains there seven years later; a 30-year-old Manchester woman who lost custody of her daughter while she cycled in and out of NHH; a 55-year-old woman from Dover who has spent much of the last five years at NHH or Glencliff, where she is so isolated that she rarely sees her mother, children, grandchildren or siblings; a 45-year-old Rochester man whose wife was forced to sell their home while he languished at NHH; and a 54-year-old wife and mother from Danville who wants to be with her family and return to work, but without assertive community treatment and supported employment services, has remained at NHH since April of last year.

Plaintiffs call upon the state to fix what they say is a broken system and expand community services, as required by federal law.

"For many individuals, these prolonged institutional admissions and hospitalizations result from the inability of New Hampshire's existing community programs to meet their basic treatment needs and to prevent their unnecessary institutionalization," said Amy Messer of the Disabilities Rights Center, which is representing the plaintiffs along with Devine Millimet & Branch, the Judge David L. Bazelon Center for Mental Health Law, and the Center for Public Representation.

The lawsuit, Lynn E. v. Lynch, echoes the findings issued last April by the U.S. Department of Justice following its investigation of New Hampshire's mental health system.

The suit claims that without community services, hundreds end up back at NHH or other state-supported psychiatric units across New Hampshire, where they get little more than custodial care in an environment that violates their privacy and dignity and robs them of their independence.

"Community-based services are far better for people, and they are far less costly than institutional care," Messer said. "On average, community services cost a fraction of institutional services."

On the front lines of mental health care

Joann Muldoon is director of behavioral health services at Portsmouth Regional Hospital. The facility offers crisis stabilization in a 22-bed unit. The average length of stay is three to five days for some adolescents over age 15 and adults over 18.

"We do psychiatric assessments, medical management, one-on-one therapy, family meetings, discharge planning and arrange follow-up appointments, mostly through the emergency department," Muldoon said. "Our primary referrals are through Seacoast Mental Health and Community Partners, but also through Chestnut Hill, a private facility."

Muldoon agrees that current follow-up services in New Hampshire are inadequate. She said the system needs to be re-evaluated and changed because it does not meet the needs of the current populations.

"Services are available to those with health insurance, but for those without, the wait for evaluation and follow-up are much longer. Hospitals are using emergency room beds in waiting and there is a long backup to be seen. For those with dual diagnoses of mental health issues and substance abuse, many will not be seen because some facilities will not accept them."

The goal, said Muldoon, is to see funding available for those who can live in the mainstream community with supportive services. Without those services, she said the patients end up hospitalized repeatedly, or in jail.

The no-brainer, said Jay Couture, executive director of Seacoast Mental Health Center, is that services are cost effective. "It is ultimately much less costly to provide these services than it is to commit a person to a hospital, a long-term care facility or jail," she said.

Messer said it costs $450,000 a year for a hospital bed, money that she also argues hat can be better used.

One reason for the lack of funding may be the stigma and misunderstanding surrounding mental illness.

"The parity is not there," Muldoon said. "There is a limit to psych days. But by law, we are supposed to be treating these patients in the same way we would treat a person with chronic diabetes. Other states like Massachusetts do this well and until New Hampshire recognizes the disease processes involved in mental health, legislative funding efforts will not be successful.

"Depression, as one example, is a clinical diagnosis, yet here we are raised with the mentality that we need to be self-reliant, that we need to change our own situation, to suck it up. We need to realize treatment is needed, services are needed and that they are successful."

Police, fire, jobs and infrastructure are traditionally high on the priority list for funding in New Hampshire. Muldoon said mental health is low on the totem pole.

"Substance abuse is skyrocketing among teens," she said. "People are turning a blind eye to mental health issues that are becoming epidemic. We need to educate the public, to overcome the stigma and then maybe this attitude can change. This is just as important as critical care needs."

It is said that everyone is touched by, or knows someone affected by cancer. Couture said the same applies to mental health and it should be treated and not ignored.

"One in three people, at some point in their life, will get a diagnosis of some type of mental health issue," Muldoon said. "We need to recognize this is a disease that can be treated with the proper resources. Treatment can
improve lifespan, heart disease, chronic pain, headache and fatigue. It is so important to maintain mental health."

Couture heads the New Hampshire Community Behavioral Health Association, charged with creating a 10-year plan to address the critical needs of this population. She said the state sees about 52,000 cases a year, but lacks the proper funding to do it right.

"We are not a part of it on either side, but obviously our needs are connected," she said. "It is ironic that New Hampshire was once at the forefront of this issue. But services have eroded and many resources that were once available no longer exist. We need to return to our commitment to address mental health."

Couture said she was part of creating the 10-year plan in 2008. "Four years later," she said, "services in many areas have eroded even further. Beds and housing have been lost. We have to go to the individual towns to ask for help to maintain the little funding we now have available. This is people's lives, our neighbors and family members. It is really sad to me. It someone has a heart attack, we don't make them wait to be treated. How long will we force this very vulnerable group to wait for change?"

Messer said, "People are asking for help," but "they are not getting it."
Aug 22- Genesis Behavioral Health Receives Grants to Improve Services to Schools

LACONIA — Genesis Behavioral Health was the recent recipient of grants from the Samuel P. Pardoe Foundation and the 3M Foundation to improve school-based mental health services for children and their families.

These awards, $5,000 from the Pardoe Foundatiom and $2,500 from 3M will allow Genesis Behavioral Health to support mental health clinician time at schools in need of additional mental health resources.

"Our clinicians are already located in several school districts in the region," said Maggie Pritchard, Executive Director of Genesis Behavioral Health, "This improves access to care for the student and family, who often face challenges with transportation and taking time from work for appointments. It also allows us to partner more effectively with the schools, providing them with support and producing the best outcomes for the child."

The two grants will provide funding for services that clinicians are not currently able to provide, such as attendance at meetings, crisis intervention and consultation with school staff, as well as providing information regarding mental health treatment.

Ray Barrett, Director of Children & Family Services at Genesis Behavioral Health said, "We look forward to enhancing our current partnerships with area schools with these additional resources while integrating mental health services in school settings."

Founded in 1989, the Samuel P. Pardoe Foundation supports education, land resource management and social service programs in the Lakes Region of New Hampshire. The Samuel P. Pardoe Foundation has a particular interest in programs that provide educational and economic opportunities for underprivileged persons, especially children.

3M is a diversified technology company serving customers and communities with innovative products and services. Each of their six businesses has earned leading global market positions and they have multiple locations worldwide, including Tilton. Their Health and Human Services Community Giving Program helps enrich the lives of youth and strengthens families.

Genesis Behavioral Health is the Lakes Region's community mental health center, serving Belknap and Southern Grafton Counties. A non-profit organization, Genesis provides services and programs to the community's children, adults and elderly and serves over 3,000 individuals each year. For more information or to schedule an appointment, call 524-1100 or visit the website at www.genesisbh.org.
Jul 12- Living United in the Lakes Region-National Mental Health Awareness Month

Living United in the Lakes Region - National Mental Health Awareness Month

by Lakes Region United Way

May is National Mental Health Awareness Month. This month Living United speaks with Genesis Behavioral Health Executive Director, Maggie Pritchard and Kristen Welch, Director of Development and Communications, local mental health services and impacts of state and federal changes such as Medicaid Managed Care and the Affordable Care Act. Tune in and hear from our local mental health experts.

http://vimeo.com/42615695
Jun 11- Medicaid Program Information Meetings to Be Held Statewide
Publish Date:
June 4, 2012

Concord, NH - The NH Department of Health and Human Services (DHHS) is holding 11 information sessions in June and July on the new Medicaid Care Management program.

The meetings are for those who use Medicaid services as well as family members and caregivers and for human service agency case managers or service coordinators who work with them. Others are welcome to attend if they are interested.

Information covered will be on the first step of the new Medicaid Care Management program scheduled to launch later this year. The first step encompasses those Medicaid services that address medical needs, such as doctor visits, inpatient and outpatient hospital visits, prescriptions, mental health services, home health services, speech therapy and audiology services. Enrollment for the new program is projected to begin in October and services in December.

Meeting topics will include basic information about:
- When the new program will start
- What people will have to do when signing up for the program
- How people can pick a Care Management health plan
- How the new program will work
All of the 11 sessions will cover the same information, so people need to attend only one.

This is an information meeting only. It is not for signing people up for the new Care Management program. That will happen later in the year.

Registration is not required, but is appreciated. To register go to http://www.surveymonkey.com/s/CareMgt

Meeting Schedule:
- Dover, Tuesday, June 12, Dover Middle School, 16 Daley Drive, 5:30-7 pm
- Manchester, Wednesday, June 13, Manchester Health Department,1528 Elm St., 5:30-7 pm
- Conway, Thursday, June 14, Kennett Middle School, 176 Main St., 5:30-7 pm
- Littleton, Monday, June 18, Littleton High, 159, Oak Hill Ave, 5:30-7 pm
- Keene, Tuesday, June 19, Keene Public Library, 60 Winter St., 5:30-7 pm
- Laconia, Monday, June 25, Laconia Middle School, 150 McGrath St., 5:30-7 pm
- Derry, Tuesday, June 26, Municipal Center, 14 Manning St., 5:30-7 pm
- Concord, Wednesday, June 27, International Brotherhood of Electrical Workers Hall, 48 Airport Road, 5:30-7 pm
- Nashua, Thursday, June 28, Nashua High South, 36 Riverside Dr., 5:30-7 pm
- Claremont, Monday, July 9, River Valley Community College, 1 College Dr., 5:30-7 pm
- Portsmouth, Tuesday, July 10, Portsmouth Public Library, 175 Parrott Ave., 5:30-7 pm
May 16- A voice for those with mental illness

Fulfilling a need
By Harrison Haas

LACONIA — Community leaders were asked to raise awareness of mental health disorders in our society after hearing the crucial role mental health services provide at the local level during the second of Genesis Behaviorial Health’s annual community forums on Tuesday evening.

The first forum was held in Plymouth Monday night.

The forums are held each May to coincide with Mental Health Awareness month as a way to educate the public about mental health services and to get valuable feedback from the community.

With 1 in 4 Americans being diagnosed with a mental health disorder each year, Margaret Pritchard, Genesis Behavioral Health’s executive director, said it was critical that these people receive the proper care.

“The message this year, which is more important than ever, is about how loud we have to speak because the people we serve don’t have a voice,” said Pritchard. “It’s our intent for their voice to be heard.”

Pritchard said it is paramount to educate people about the importance of mental health facilities in communities, especially with funding constantly being cut at the state level, a funding source that has been a primary revenue source for years.

“People don’t understand some of the risks of not providing mental health services,” she said. “We hope to educate everyone, because if you don’t support this system, you, as a community citizen, have a consequence likely.”

Local service providers and others in leadership positions throughout the Lakes Region attended the forum. Addressing the crowd as the keynote speaker for the evening was Belknap County Commissioner Ed Philpot, who touched on the value of the services provided by Genesis.

“We’ve seen significant changes in the way organizations, such as Genesis, are funded and the way state funding activities influence what we’re able to do and what services we’re able to provide at a local level,” Philpot said.
“Genesis is a prime example of an agency that has really stepped up in very difficult times to continue to provide much needed services with diminishing resources.”

According to Philpot, the state legislature eliminated close to $1 billion from the state budget last year. He noted that much of the money that used to go to social services and local services providers has since been eliminated, leaving organizations scrambling to find alternative sources of revenue.

Instead of preventing tax increases, Philpot said that legislatures managed to increase the burden on communities and community organizations, like Genesis, for providing services that are absolutely necessary.

“People with developmental disabilities did not go away,” he said. “People who are ill and are in need of treatment are still here. They still live with us. The problem is now that we down shifted the costs of taking care of those folks right down to the community level.”

By having mental health service providers in communities, Philpot said it helps identify those who are in need of those services, which ultimately helps the community as a whole.

“It gets harder and harder each day to differentiate what each agency does,” he said. “The more agencies that are out there, the more difficult it comes to secure adequate, correct, appropriate, and meaningful funding for different agencies.”

Philpot said there are several agencies that do good service in the community and they must continue to do well to continue to strengthen society. One of the biggest challenges, said Philpot, was to trying to present the information to people and get across the central message of how a community effectively utilizes these services.

At the end of the forum, Helen Holbrook was recognized for her work with Genesis Behavior Health as she will be officially retiring from her duties with the organization. Holbrook was the first staff member of Genesis, beginning back in 1966, and is finally stepping down from one of the committees she to recently served on.

Holbrook, who is in her 90s, was unable to attend.

Accepting a gift from Genesis was Holbrook’s daughter, Elaine Morrison, who shared a story about her mother. During a recent phone conversation, Morrison told her mother that she had been planting flowers near the old police station in Laconia.

“I told her we were planting with the homeless, and she asked where,” said Morrison. “I said it happens to be in front of the old police station.”

Morrison said her mother got very excited when she heard that.

“She said ‘did you know that was the first mental health center and that’s where I worked with Dr. Pete Harris at the very beginning’,” Morrison said.

Holbrook told her daughter to take a yellow rose bush from her house and plant it in front of the building so it would be a part of the community garden.

“The ironic part is that there is a yellow rose in front of the building which housed her first mental health job,” said Morrison. “So she is still giving back to the community through the rose.”

The Genesis Behavior Health annual forum was held in the Taylor Community’s Woodside building in Laconia.

For more information about Genesis, visit www.genesisbh.org.
May 10- Council okays managed care

Council okays managed care

3 private firms to be paid $2.2 billion

By Ben Leubsdorf / Monitor staff

May 10, 2012

The Executive Council yesterday approved contracts worth a combined $2.2 billion to have three private companies implement managed care for New Hampshire's Medicaid program.

The all-Republican council voted 3-2 to approve the trio of three-year contracts, which had been tabled twice previously, in March and April.

Councilors Ray Wieczorek of Manchester and David Wheeler of Milford voted against the contracts. Ray Burton of Bath, Dan St. Hilaire of Concord and Chris Sununu of Newfields voted to approve them.

St. Hilaire said the council had delayed the vote to study the contracts in more detail, get input from interested parties and address some concerns.

By yesterday, he said, "We got all the answers that we needed."

The vote means the state can begin the process of implementing Medicaid managed care, including seeking a green light for the program from the federal Centers for Medicare and Medicaid Services.

The plan is to begin enrolling patients for medical, pharmacy and mental health services Oct. 1 and have the program start in early December, said Health and Human Services Commissioner Nick Toumpas. A second stage, covering specialty services for patients requiring long-term care, will be implemented a year later.

"We need to go about this in a very deliberate, measured way," Toumpas said after yesterday's vote. "Our overall approach on this is not looking at the savings side of this, but driving efficiencies in our Medicaid program so we have a sustainable program going forward."

State officials have said managed care will save the state millions, and Republican legislative leaders yesterday praised the council's vote.

"Managed care will not only bring greater efficiency to the Medicaid program, but it will result in higher quality care for the over 100,000 Medicaid patients across New Hampshire," Speaker Bill O'Brien said in a statement. "This will mean that our Medicaid program will keep people healthy instead of paying for people who get sick. At the same time, it will save state taxpayers millions as we focus on prevention and reducing the high overhead of our Medicaid program."

But advocacy groups and care providers said they still have concerns about the program, especially with next year's planned implementation of managed care for long-term care services.

"I think there's a lot of work to be done on the implementation side. That's really where the rubber hits the road," said Kelly Clark, state director of AARP New Hampshire. "And we certainly feel that the provider associations and the advocacy groups and the patients should have a seat at the table."

Moving forward

New Hampshire is one of just three states without a comprehensive managed care program for Medicaid, according to the Kaiser Commission on Medicaid and the Uninsured. Alaska and Wyoming are the others.

Under managed care, Medicaid program participants enroll with a private provider paid by the state for each covered patient and are provided with primary care physicians or "medical homes." The system is designed to save money by encouraging regular preventative care over expensive emergency-room visits.

Gov. John Lynch last year said managed care would save the state $32 million in a biennium, and the Legislature voted to implement the program. Federal law requires patients to have a choice, and the Department of Health and Human Services this year selected three companies to administer the program. The contracts involve the state paying the companies a combined $2.2 billion over three years to manage care for all Medicaid patients.

The companies are Granite State Health Plan, run by Centene Corp. of St. Louis; Granite Care-Meridian Health Plan of New Hampshire, run by Detroit-based Meridian Health Plan; and Boston Medical Center HealthNet Plan.

With yesterday's vote to approve the contracts, Toumpas said his department will begin "three key sets of activities that all need to happen in parallel." One is to make sure the systems of the state and the three contracted companies can share data; a second is for the managed care providers to begin assembling networks of service providers around the state.

The third and crucial step, he said, is to get approval for the contracts from the federal government. He said the Center for Medicare and Medicaid Services would be formally notified yesterday and would have 90 days to review and sign off on the program, though he cautioned that it could take longer if federal officials have questions.

"We can do nothing from the implementation standpoint without their approval," Toumpas said.

The system had been planned for a July 1 start, but with the delayed approval from the Executive Council, Toumpas said the state now plans to begin enrolling patients Oct. 1. The program will go live 60 days later, covering medical, pharmacy and behavioral care.

Long-term care services are set to come under managed care a year later. Many specifics of that program are still up in the air, Toumpas said.

"We will be working with the managed care organizations, and have already started the outreach to the various providers, advocacy (groups), clients and so forth in order to be able to give them meaningful input into the design of what Step 2 is going to look like," he said.

However, Toumpas said, with the program's late start, the department will likely have to find $6 million or $7 million in spending reductions from other programs in the coming fiscal year to compensate for the $16 million in savings that had been expected under the managed care program.

Questions remain

Advocacy and other groups that have expressed concern with the program greeted yesterday's vote cautiously, and urged the state to include their input as managed care is implemented.

Last month, the New Hampshire Fiscal Policy Institute issued a paper raising "critical questions" about the contracts, including issues that the group said could create geographic and other obstacles to accessing services.

"The questions that the Policy Institute raised have not been answered, is the short version," said Deb Fournier, a policy analyst with the group.

Clark, the AARP state director, said her group is particularly interested in the plans for managed care for long-term care services.

"One of our No. 1 priorities is to find out how we can help people stay in their communities in the long term," she said, "and Medicaid dollars come out to be a large percentage of their costs in the long term."

St. Hilaire said councilors heard concerns about that second stage of managed-care implementation. In an April 30 letter to Lynch and the Executive Council, Toumpas promised to hold a series of forums and set up an advisory council for that process.

"The commissioner has spoken of establishing some type of an advisory group to have feedback into the process," Clark said. "It's unclear to us exactly who would be part of that process. We hope, of course, that he will look broadly and make sure there is diversity and that providers and advocates are included in that mix."

Jeff Dickinson, the advocacy director for Granite State Independent Living, said much work remains to be done.

"I think it's great that the council slowed things down, so that everybody could take a more deliberate look at the contracts," he said.

But, he added, "I don't feel like an awful lot of the concerns that folks raised have been substantively addressed at this point. There's an awful lot that's not in the contracts, with the thinking that it'll be filled in later. And for a lot of us, I think that's disconcerting."

(Ben Leubsdorf can be reached at 369-3307 or bleubsdorf@cmonitor.com or on Twitter @BenLeubsdorf.)

Source URL: http://www.concordmonitor.com/article/328655/council-okays-managed-care
Apr 19- Council again delays vote on Medicaid contracts

CONCORD – The Executive Council has again put off voting on the largest set of contracts in state history – for three companies to administer New Hampshire's Medicaid program.
By TED SIEFER
State House Bureau

CONCORD – The Executive Council has again put off voting on the largest set of contracts in state history – for three companies to administer the state's Medicaid program.

The council voted at its meeting Wednesday to table the contracts, totaling up to $2.2 billion through 2015, with three managed-care organizations.

“This item is absolutely monstrous, not only in dollar value, but in it affecting at least 10 percent of our state,” said District 3 Councilor Christopher Sununu, comparing the contracts to other items on the council's agenda. “There is a large part of this contract that is still very unknown.”

Citing its complexity, the council voted to table the contract at its last meeting on March 28. Last week, councilors met with the vendors and state officials to go over details of the plan to shift the existing state-run Medicaid system to managed care, which would affect health care coverage for tens of thousands of poor and disabled residents.

“We're getting concerned calls and letters from constituents,” said District 4 Councilor Ray Wieczorek. “I've been assured by the vendors that their service would remain the same, that they would be able to keep their doctors.”

He posed the question to Health and Human Services Commissioner Nick Toumpas whether there was more his office could do to reassure people in the Medicaid program.

“I'm not outsourcing the thing and saying have at it,” Toumpas said. “They'll be doing this with our aggressive oversight … I think if we can do this in an appropriate way, some of the fears you raise will be addressed.”

The state anticipates saving tens of millions of dollars over the course of the contract; however, because of its complexity and other factors, the shift to managed care won't likely happen until Jan. 1 at the earliest. Officials had hoped the program would be ready for the start of the new fiscal year on July 1.

Wieczorek said it was appropriate for the council to exercise caution. “They obviously want to get this done as soon as they can, but I think our deliberations are necessary. We're talking about the largest contract in the history of the state. We can't afford to make a mistake. We have to make sure we do our due diligence.”

The managed care contracts could next come up for a vote at the executive council's meeting Wednesday, May 9.

The proposed contracts are with managed care organizations established by Centene Corp., based in St. Louis; Boston Medical Center; and Meridian Health Plan, based in Detroit.
Apr 11- Medicaid contracts raise questions

What about those without coverage?

By Maggie Pritchard / For the Monitor

The Medicaid managed care contracts were made public last week. They span more than 500 pages and propose significant changes to the health care of tens of thousands of New Hampshire residents. What concerns me, however, is what is not included.

As the administrator of a community mental health center, I need to raise a question or two to better understand how this proposal will affect the care of the patients we serve and the sustainability of Genesis Behavioral Health and the other centers throughout the state.

Under the new plan, managed care organizations would be responsible for Medicaid recipients. They are not responsible for the uninsured. According to current state law, it is the state that is responsible for the poor and uninsured. For years, community mental health centers have been designated to serve those who cannot pay and do not qualify for Medicaid. Community mental health centers also serve those with Medicaid spend-downs (deductibles) who cannot and do not pay, and offer emergency care to all 24/7, 365 days a year. The impact of providing these services has created fiscal instability within the organizations, which has not been recognized by the state.

These issues will not be addressed within the context of managed care. Though managed care is being touted as savings to the state, care for those who cannot pay and do not qualify for Medicaid are the largest contributors to the fiscal instability of the community mental health system, which continues to carry the state's burden for care. So, who will be responsible?

Last year, the Legislature voted to allow community mental health centers to establish a wait list and prioritize services based on need and the level of funding available. As a mental health professional, this is more than troubling to me. People need treatment to get better and recover from their illness. We don't tell someone with a gushing wound to simply slap a band-aid on it and come back when they can afford a few stitches. Untreated mental illness is a health-care crisis. Allowing a delay in treatment for those with serious mental illness is to the detriment of the patient, the community and other resources, such as the emergency departments and the police.

As the person responsible for ensuring the sustainability of our services, I will have to take measures that will be unpopular and misunderstood by our patients and our community. The message is that community mental health centers are not expected to serve the uninsured beyond their emergent needs and a screening appointment. Neither of these equate to treatment, but rather crisis intervention and assessment of need. There is no cure for severe and persistent mental illness. People can and do recover, but they can't do so without treatment.

What is the plan going forward? Are the consequences of not having a plan for our most vulnerable citizens worth the risk or the cost? Will we be forced to post signs on our buildings turning away the uninsured mentally ill, beyond the intake or emergency care we are mandated to provide? When the person whose thoughts are impacted by their mental illness harms him/herself or others, will we all turn a blind eye and say we never saw it coming?

These are the questions we must ask going forward. I hope we are able to answer them while remaining responsible to our patients and the communities we serve.

(Maggie Pritchard of Laconia is executive director of Genesis Behavioral Health and has more than 30 years of experience in the mental health field.)
Mar 28- Council puts off managed care decision

By Matthew Spolar / Monitor staff

March 27, 2012

Time is money as New Hampshire races toward implementing a Medicaid managed care system, but the state's executive councilors indicated yesterday they are likely to put off a vote until next month on whether to contract out the program to private organizations.

"This is way too big a contract" not to take more time to review it, Councilor David Wheeler of Milford said after about 100 people filled a room inside the Legislative Office Building in Concord to hear Health and Human Services Commissioner Nick Toumpas and state Medicaid director Katie Dunn explain the proposed system and take questions from the five-member, all-Republican council.

"It would be wise to have some more time . . . to assess where the possible savings could be, where the possible pitfalls could be," said Councilor Dan St. Hilaire of Concord.

"If the motion isn't made, I plan to make it" to delay the vote, said Councilor Ray Burton of Bath.

Democratic Gov. John Lynch recommended managed care to save an estimated $32 million in the two-year budget ending June 30, 2013, and the Republican-controlled Legislature passed a bill, signed by Lynch, setting a target date of implementation by July 1. After putting the program out to bid, state health officials selected three out of six total applicants to receive a combined $2.2 billion to operate Medicaid in New Hampshire as the system is rolled out in phases over the next three years. Federal law requires Medicaid recipients have a choice between managed care vendors, Toumpas said.

New Hampshire has previously experimented with aspects of managed care, but this marks the first time it will contract with private organizations to manage care for all of its Medicaid populations, and the contracts would be among the largest in the state's history. Under managed care, a contractor sets up Medicaid recipients with primary care physicians or "medical homes" where they receive regular preventative treatment. The companies must control costs to stay under the budget allotted them by the state, and the system is designed to save money in the long run by discouraging patients from making unnecessarily expensive emergency room visits.

"We've heard a lot about how, in this type of environment, the managed care organization is going to achieve some kind of profit," Toumpas said, noting that two of the three proposed vendors are for-profit companies and one is nonprofit. "There is not one organization with which the department works where that organization is not looking to achieve some surplus. . . . I see nothing wrong with that, because what we're doing is we're getting value for what it is that they are bringing to the table."

A dozen organizations - including AARP New Hampshire, the Children's Alliance, the New Hampshire Hospital Association and Granite State Independent Living - sent a letter to the executive council last week requesting more time for public review of the proposed contracts.

"Many of our children, our frail elders and people with complex medical needs rely on Medicaid and need to know the new system will support the care they need to maintain their health and safety," Kelly Clark, state director of AARP New Hampshire, said in a statement.

Councilors worried yesterday that the private organizations would save money by cutting services for Medicaid recipients.

"I don't think they've made their case that the savings are coming all from efficiencies," Wheeler said.

Toumpas sought to allay those concerns. Though the organizations - headquartered in St. Louis, Detroit and Boston - would bring in new techniques and perspectives to achieve savings, they must meet requirements and performance standards, he said. Some money is withheld unless those standards are met, and the organizations are subject to satisfaction surveys, he said.

"There are specific standards of access that are very, very measurable," Toumpas said. "Clearly there are a lot of accountabilities that we have on the managed care organizations."

Toumpas said the department is facing technological challenges in setting up a computer system to implement managed care, and noted that an enrollment period for Medicaid recipients would have to be open 60 days before the system goes live. Hearing this, the governor questioned whether it's feasible to meet a target deadline in three months. (next page »)
Mar 26- Can managed care plan possibly improve things?

By Louis Josephson / For the Monitor

March 24, 2012

What happens when you take a mental health system that the federal Department of Justice has found to be out of compliance with two federal laws and throw it into the hands of a for-profit managed care company? Well, New Hampshire is about to find out.

On Monday, the Executive Council will vote on accepting the largest contracts in state history; managed care contracts worth hundreds of millions of dollars. I hope the councilors will decide to delay their vote so that patients, consumers, family members and providers can digest the 1,000-page contracts and raise thoughtful questions.

Beyond a small delay to ensure the managed Medicaid companies are proposing plans for successful oversight of the system, New Hampshire citizens need to question whether the switch to managed care for our most vulnerable persons with mental illness is the right thing to do.

Last spring, the Department of Justice found that New Hampshire's mental health system was a mess. People with mental illness are stuck in expensive state hospital beds or in the Glencliff Home or are cycled through the state hospital so quickly that no effective treatment is provided. The reason behind this situation is years of rate cuts to community mental health centers (the state's safety net for people with mental illness) have starved the system of resources need to serve people successfully in their communities.

The managed care companies are charged with squeezing $30 million in savings from our Medicaid program even after these out-of-state companies take their administrative fees and profit margins. This can only mean less service for Medicaid patients or less revenue for medical and mental health providers. It doesn't take an expert to figure out that further rationing of services for people trying to get help from a system in crisis won't work.

More people will be stuck in emergency rooms or expensive hospital beds. A day at New Hampshire Hospital cost $950 versus a day of supported residential care in the community at $200. More people will roll from crisis to crisis because they won't have the consistent support of a community case manager or therapist. Mental health centers are at serious risk of closing and being lost as a resource for their communities. Police and jails will continue to be the default mental health system for our state.

Have other states turned to managed care to Medicaid to bring costs down? Yes, although Connecticut recently got rid of its Medicaid managed care program because it found it wasn't savings dollars and care got worse. But other states have "carved out," or not changed, services for adults with serious and persistent mental illness or children with serious emotional disturbances, allowing them to get the cost-effective support that keeps them out of expensive alternatives. New Hampshire is the only state that is folding all people with mental illness into standard managed care with no exceptions.

I am worried about how the people we serve will live under managed care. Our system is already so degraded that any reductions or restrictions in care will significantly affect our most vulnerable consumers. But what is so frustrating to me is that if we took the administrative cost and profit dollars that the three managed care companies will consume and invested them in community care, we could make a real impact on reducing expensive hospital costs and save the state money.

It is time for consumers, family members and supporters of people with mental illness speak out on the impact of managed care Medicaid. Let your representative and the governor know that you want New Hampshire to spend its money wisely on effective, less expensive community care instead of short-sighted cost-cutting that will result in worse outcomes and cost us all more in the long run.

(Louis Josephson is the CEO of Riverbend Community Mental Health Inc. in Concord.)
Mar 21- State mental health system is broken

By Monitor staff

March 21, 2012

'State hospital wait list hits historic high" read the headline over Monitor reporter Annmarie Timmins's Saturday story about a mental health system that's collapsing for want of resources. That record should be viewed with a deep sense of shame because not too many years ago New Hampshire had arguably the best system in the nation to treat people with mental illness speedily and give them the help they need to return to life in the community.

Last Friday, 21 people in the throes of a mental health crisis were forced to wait, in some cases more than a day, for admission to the state psychiatric hospital in Concord. The average wait for a bed was six hours just a few years ago. It can now be a day or more. During January and February, Concord Hospital had 52 adults and 16 children spend at least one night awaiting a bed in the state hospital. They stay on a mattress on the floor in rooms that have been retrofitted to be as safe and secure as possible.

The waiting list is just one of the reasons the state was hit by one lawsuit over inadequate care of the mentally ill by the Disabilities Rights Center of New Hampshire and could face another by the U.S. Justice Department. Because the system has broken down, people cycle in and out of the state hospital. Its admission rate is 40 percent higher than average, its readmission rate nearly twice the national average.

The problem needs both long-term solutions and a short-term fix: more beds, whether at the state hospital or in one of the residential facilities Riverbend and the other community mental health centers have mothballed for want of funds. The state hospital, which a few years ago had 210 beds, now has just 130.

Bob MacLeod, chief executive officer of the state hospital, seems to be taking a cross-your-fingers and hope it goes away approach to the problem. He speaks of increasing the hospital's efficiency, but it already releases patients after so little treatment that they are almost guaranteed readmission.

"I don't use the word crisis," MacLeod told Timmins. "I think crisis is overstating it. I think we do have challenges." All it will take to turn MacLeod's "challenges" into a crisis is for one distraught person on that waiting list to take someone's life. Long term, the state needs to provide its 10 community mental health centers with the resources they need to help the mentally ill avoid hospitalization.

The state's care of the mentally ill is grossly inefficient, needlessly expensive and sorely inadequate.

A room in a residential facility run by a community mental health center costs $200 per day. A stay in the state hospital is $950 per day, and a night in the emergency room is more than twice that. And then there's the cost of incarcerating a large number of the mentally ill who need treatment, not jail.

The state is not saving money by starving the mental health system. But it is creating an extraordinary expense for property owners, who must foot the bill for jails, and for employers and the insured, who must pay higher health insurance premiums to make up for the losses hospitals suffer when they serve as way-stations for the mentally ill.

The lawsuit, or suits, will likely take years to play out. But November offers a way for New Hampshire to rebuild its once great mental health care system. Voters should check the track record of their representative and senator, make mental health care an issue in the election, and support candidates who will fight for cost-effective quality care for the mentally ill.
Mar 20- State hospital wait list hits historic high

Mentally ill stay in emergency rooms
By Annmarie Timmins / Monitor staff

March 17, 2012

The number of mentally ill people waiting in local emergency rooms for a bed at the state hospital has reached a historic high, sources said yesterday.

Yesterday morning, a North Country mental health center alerted the state's other centers that 21 people were awaiting a state hospital bed as they headed into the weekend, the busiest time for admissions. The waiting list is typically four to six people, said Bob MacLeod, chief executive officer at New Hampshire Hospital.

"The waiting list and times are certainly trending upward," said MacLeod, who said the wait was down to about 15 by yesterday evening. "I don't use the word crisis. I think crisis is overstating it. I think we do have challenges."

MacLeod said March tends to be a busier time for mental health admissions, even outside the state. Louis Josephson, chief executive officer of Riverbend Community Mental Health Center in Concord, said that confirms what he's seen. Three weeks ago, the waiting list had 19 people on it, he said.

The state hospital is down 24 beds from last year because of budget cuts in July. And those cuts followed years of bed reductions, according to Josephson.

Three years ago, he said, the state hospital had 202 psychiatric beds for adults and children in a psychiatric crisis. Now there are 130.

"Three years ago, a long wait was six hours, and eight hours was a really long wait," Josephson said. Now it's not unusual for people to be in an emergency room a day or longer waiting for a bed.

"It is definitely a huge burden on hospitals and on mental health centers," he said.

Concord Hospital's emergency room, for example, has only four rooms for psychiatric patients waiting for a state hospital bed, Josephson said. There are two other rooms Riverbend can use for waiting patients, but because there is hospital equipment in those rooms, they are not appropriate for every patient
.

The rooms do not have beds because they were not designed for long waits. When there are five or six people waiting one or two days in the emergency room, security becomes a concern, Josephson said.

Recently, Riverbend had an 8-year-old in need of help, a 17-year-old who had made a serious suicide attempt and an older man suffering from untreated schizophrenia, Josephson said. And there were no beds available at the state hospital.

"By day two, the (8-year-old) starts banging his head on the wall and cries out," Josephson said. "That agitates the man, who kicks a hole in the wall, and that scares the 17-year-old."

MacLeod said he has not discussed the increased waiting list with staff at the state's mental health hospitals or emergency rooms. He's not convinced the response should be asking the Legislature for more money.

"I'm not sure that is an option at this point, and I'm not sure that's the only answer," he said.

MacLeod said this uptick is recent and may reverse direction after March. He also said the state hospital is seeing more people from the criminal justice system, who can be harder to relocate in the community. That can delay freeing up bed space, he said.

"I think we have to look at how we can do things better, more efficiently," he said. "And doing it in a fashion that doesn't build unnecessary infrastructure but better infrastructure. I see this as a challenge that we all need to put our heads together on and come up with ideas that heretofore haven't quite developed."

Meanwhile, community mental health centers are also adjusting their approach to care - and not for the better, Josephson said. He said staff are spending more time with fewer patients at the emergency room, waiting for bed space. In addition, Josephson said, the state hospital is discharging people quickly, sometimes too quickly.

"Twenty-five to 30 percent of patients are out within 24 hours," Josephson said. "That is a historic high. They are not even starting them on new meds. They are looking at them and saying, 'You look safe to me. Goodbye.' "

Josephson continued: "The state saves money, but we are all paying for it, and it's not good care."

(Annmarie Timmins can be reached at 369-3323 or at atimmins@cmonitor.com.)
Mar 8- Statewide mental health forum gives NH failing grade for lack of progress

CONCORD – Community mental health leaders gave New Hampshire a failing grade for improving care for adults and children with mental illness.

The Community Behavioral Health Association of New Hampshire sponsored a forum Monday that looked at how state government has responded to the goals of a 10-year plan crafted in 2008.

“There is not a single one where I can confidently say we have made significant progress,” said Jay Couture, executive director of the Seacoast Mental Health Center.

Speakers blamed state budget cuts and a lack of coordination for the state failing to meet the top priority of keeping the mentally ill in the community and out of emergency rooms or state institutions.

Ken Norton, executive director of the National Alliance for the Mental Illness, said society would not tolerate the lack of care if these residents had medical problems rather than psychiatric disorders.

“It is just very painful to read this status report; it confirms anecdotally what NAMI is experiencing from family members,” Norton said. “Why do we continue to discriminate against people with mental illness?”

Rochester Police Chief David Dubois said his team, with specialized training in mental health, saw a 27 percent increase in people served last year; more than a third of them were potentially suicidal.

The forum surely provided ammunition for the Disabilities Rights Center that last month filed a class-action suit against the state for failing to provide appropriate care for the mentally ill. The suit charges that the state’s treatment of adults at the New Hampshire Hospital and the Glencliff Home are in violation of the Americans with Disabilities Act, the Rehabilitation Act of 1973 and the Nursing Home Reform Act. New Hampshire Hospital has an admission rate 40 percent higher than the national average. Its readmission rate is nearly double the national average.

In 2010, more than 15 percent of the patients discharged by the hospital were readmitted within 30 days. Nearly one-third were readmitted within 180 days, and some patients are essentially in and out of the hospital all year.

A federal audit last year criticized New Hampshire system, noting that people in psychiatric crisis can wait for hours in a hospital emergency room before they receive help, which is costly and inadequate. The federal report noted that the state could treat these adults in the community for much less than it now spends to treat them.

Here are some of the recommendations in the 2008 plan and the state’s response since then:

Community Residential Support: The plan envisioned an increase in group homes and a housing bridge subsidy. The state served 36 people in the bridge program that was not an increase, community mental health centers have closed 44 beds, and the state’s transitional housing unit was cut from 49 to 35 beds.

Inpatient Psychiatric Care: The plan sought to add 12-16 bed units at hospitals in all four corners of the state. Last July, Southern New Hampshire Medical Center in Nashua cut its psych unit from 30 to 10 beds, and New Hampshire Hospital closed its 15-bed continuing care unit. Over the past decade, admissions to the state hospital have gone up 104 percent.

Assertive Community Treatment Teams: This goal was to create 12 new teams that intervene with the mentally ill who are in crisis. There have been no teams added to the five now in existence.

Better Care of those with Mental Illness and a Developmental Impairment: The priority here was to create residential treatment in the community for this population. The closure of the state’s neuropsychiatric unit forces these individuals to seek out-of-state or private institutions.

Workforce Retention: Invest more training in staff, create electronic medical records and increase the numbers of those who want to enter the field. A state budget cut of 6 percent in the case management rate forced many centers to eliminate positions or cut salaries. Centers have seen turnover rates as high as 23 percent in the past year.
Feb 13- N.H. Mental Health: From Success to Suit

N.H. mental health: from success to suit
Decline attributed to funding, politics
By Maddie Hanna / Monitor staff
February 12, 2012

It's a historical point that makes the present more striking: New Hampshire, now under fire for confining too many mentally ill people in institutions, was once admired for developing a community mental health system.

Attorneys who filed a class-action lawsuit last week on behalf of people with serious mental illness drew attention to that contrast, noting how the National Institute of Mental Health recognized New Hampshire as a model in the late 1980s, after the state downsized its psychiatric hospital and sent patients into the community.

Today, New Hampshire is no longer touted as a success story. Group homes have closed, hospitals have shuttered psychiatric units, and admissions to the state's institutions have soared, from 900 in 1989 to 2,300 last year.

The overburdening of the state hospital prompted the state's health and human services commissioner to declare the system "broken," and federal officials followed by accusing the state of failing to provide community services and needlessly institutionalizing people with mental illness, a claim that also forms the basis of the lawsuit filed by the Disabilities Rights Center last week.

But while the contrast is stark, what drove the deterioration is less obvious. Mental health providers say there was no single factor, instead citing an ongoing lack of rate increases that led to cutbacks at community mental health centers.

And several people involved in the mental health system said they think a lack of political will and a change in governing philosophy have also contributed to its failure.

"You can talk about plans, you can talk about whether they were implemented or changed, but I think the fundamental starting point is an acceptance of responsibility," said Don Shumway, president and CEO of Crotched Mountain, who headed the state Division of Mental Health in the 1980s and oversaw reforms that moved the state toward a community-based mental health system.

In those years, leaders from both political parties believed that providing a quality mental health system was "a public commitment that had to be made and a responsibility borne by the state," Shumway said.

"That is in question at this time."

System in transition

Shumway became director of the Division of Mental Health under former governor John Sununu in 1984, just as a state study commission had produced a report calling for the downsizing of New Hampshire Hospital and the development of community services.

"Experience in New Hampshire has shown that when community services are in place, admissions to the state hospital are greatly reduced," according to an excerpt from the report reprinted in the lawsuit against the state. The state shut down units at New Hampshire Hospital and built a new version off Clinton Street, transitioning from a facility that had once served 2,800 patients in the 1970s to a hospital with capacity for fewer than 200, according to state reports.

It also developed the network of 10 outpatient community mental centers that exists today. While the centers pre-existed those reforms, they had been limited to providing therapy - services that were useful, but not geared toward people with more severe forms of mental illness, Shumway said.

Under his tenure, the centers developed the ability to treat people with illnesses like severe depression and paranoid schizophrenia. Group homes were developed, and specialized treatment teams providing intensive outreach services were set up across the state.

The state also developed new laws, including a conditional discharge policy, which allowed the state hospital to readmit people who didn't take their medication.

"It was very progressive, but it was also conservative," Shumway said of the law.

Read the full article
Feb 7- Community Forum on Health Services in the Lakes Region

Thursday, February 23rd
7:00 - 8:30 pm
Community Room, Busiel Mill
One Mill Plaza, Beacon Street East, Laconia

Health care in the Lakes Region is changing and facing new challenges because of many factors, including new financial pressures and healthcare policies. We all need to be aware what this means to us, our families, our businesses and to NH's way of life. Come and join us at a public event to understand the current state of healthcare in our community and what the future may bring.

Our distinguished panel includes:

Henry Lipman, Chief Financial Officer of LRGHealthcare, and Laconia City Councilman

Margaret Franckhauser, Executive Director of Community Health and Hospice

Chris Santaniello, Executive Director, Lakes Region Community Services

Kristen Welch, Director of Development and Communications, Genesis Behavioral Health

This event, open to all, will be hosted by the Belknap County Democratic Committee. For more information, please contact Ed Allard at 366-2575.
Jan 3- Thank You for Supporting Genesis!

‘Tis the season of giving— and of giving thanks. We have much to be grateful for this year, and you—our community— deserve our heartfelt appreciation.

The past year was one of financial challenges, a shifting political climate and an increase in the numbers of people in need of help from Genesis Behavioral Health and many of our community partners. The community’s response to these challenges was tremendous. You showed your support by giving your time, talents and financial support, despite a tough economy. You acted as advocates for us when we needed a strong voice for mental health, a sector of health care that is so often silenced because of persistent stigma. You supported our mission through in-kind donations. Perhaps the most enthusiastic response came as we embarked upon an online auction, our first major fundraising event in recent history.

Times are tough for everyone, and it was humbling and heartwarming to witness the community’s generosity and support throughout the auction. You donated, you bid, you contributed to a successful event that raised muchneeded funds to support essential behavioral health care services for over 3,000 of our neighbors in the Lakes Region.

Sponsored by Nassau Broadcasting and Northway Bank, the auction reached hundreds of donors throughout the country, and helped educate many on the importance of mental health in our community. The auction closed the day after our Annual Meeting, for which the Inns & Spa at Mill Falls provided the setting with décor generously given by Belknap Landscape Company, Inc. and Appletree Nursery. Their support helped stretch a limited budget and ensure a lovely event for all in attendance. The giving spirit of Belknap Landscape Company, Inc. and Appletree Nursery continues, as they are also providing greenery for our employee holiday appreciation event in December. The support of the business community is key to our work, and we are grateful for all you do to contribute to our mission.

Our sincere thanks and appreciation go to the following businesses and individuals for donating items and services to the auction: All My Life Jewelers, Ann Nichols, Appletree Nursery, Bailey Brown, Beane Conference Center, Berry Delicious Bakery, Blissful Lotus Yoga, Boni Gross, Boston Red Sox, CADY (Communities for Alcohol and Drug-Free Youth), Charles and Nefeesa Peterson, Chuck Plante, Circle K (Union Avenue), Creative Treasures, Cydney Shapleigh- Johnson, Cynthia Reiffen, Dave Garneau, Dawn Lacroix, Doris Duff, Dynamic Ceramics, Donna Davison & Granddaughters, Ed Drury, Forever Bonnie Tattoos, Gilmanton Winery & Vineyard, GourmetGiftBaskets. com,Harris Family Furniture, Hart’s Turkey Farm, Heavenly Confections by Jean Cadrette, Hector’s Fine Food & Spirits, Heritage Farm Pancake House, Holland Hill Studio, Hughes Automotive, Ippolito’s Furniture, Irwin Toyota Scion Ford Lincoln Hyundai, Janice Porell, Jennifer Stevens, John Kealey, John Rogers, Kayleigh Moran, Dr. Kelley White, Kim Beardwood Smith, Kristen Cadwallader, Laconia Athletic & Swim Club, Laconia Village Bakery, Lakes Region Acupuncture, Lakes Region Community College, Linda Hagan, Liz Merry, Lochmere Golf & Country Club, Maggie Pritchard, Magic Foods Restaurant Group, Manchester Monarchs, Maui Tanning Company,Meadowbrook U.S. Cellular Pavilion, Meredith Village Savings Bank—Laconia Branch, Miller Lovett, Music Clinic, New Hampshire Ball Bearing, Oooey Gooey Confections, Patrick’s Pub & Eatery, Paula Clearwater, Petal Pushers Farm, Piano Lessons by Ann Winchester, Plaistow Army & Navy Store, Planet Fitness— Belmont, Plymouth State University Ice Arena, Prescott’s Florist, Rain Water Arts, Rosie Traynor, Shaheen & Gordon, P.A., Shang Hai Restaurant, Shooter’s Tavern & Pizzaria, Simone Maglio of Style of Boston, Staff & Board of Genesis Behavioral Health, Star Nails, Steele Hill Resorts, Susan Stearns, Terry Murphy’s Court Street Auto, Terry Wright, The Boulia- Gorrell Lumber Company, The Children’s Museum of New Hampshire, The Clip Joint, The Galleria Salon & Day Spa, The Home Beautiful, The Inns & Spa at Mill Falls, The Meat House, The Onion, The Wine’ing Butcher, The Winnipesaukee Playhouse, Tiffany’s Beauty & Tanning Salon, Tina Hayes, Trish Weatherbee, U-Frame We Frame, Vickie and Terry Trudelle, Whittemore’s Flower Shop, and Woodie and Susan Laverack.

Anne Frank said, “How wonderful it is that nobody need wait a single moment before starting to improve the world.” So many of you have improved the lives of our patients—and improved the work we do—with your generosity this year and throughout our 45 year history. This holiday season,we thank you and wish you much health and happiness in 2012.

Genesis Behavioral Health is designated by the State of New Hampshire as the community mental health center serving Belknap and southern Grafton Counties. A private, non-profit corporation, Genesis serves over 3,000 individuals each year. For more information or to schedule an appointment, call 524-1100 or visit the Web site at www.genesisbh. org
Oct 27- Effectiveness of mental health courts topic of annual meeting - from Laconia Citizen

MEREDITH — With a mixture of humor, candor and determination, the board of directors of Genesis Behavioral Health held its 45th annual meeting at Church Landing on Tuesday, while learning how mental health courts, as they seem to be doing in Grafton County, could be a way to balance mental health and public safety in the Lakes Region.

Lara Saffo, the Grafton County Attorney, in giving the keynote address, said the effort that Genesis had a role in there was paying off dividends in mental health courts in Littleton and Lebanon by providing mental health services to those offenders who need them, something which is typically less expensive and has a better outcome for the individual and community rather than incarceration.

The criminal justice system and the mental health system have to work together to reduce recidivism, said Saffo, which has a huge financial impact on society, drawing money away from paying for improvements to schools, roads, or, she said, expanded mental health services.

Of the more than two million Americans currently incarcerated, almost 17 percent have a serious mental illness, she said, adding that a recent study has shown that “some of the largest mental health facilities in the United States are jails.”

With 15 years as a prosecutor, Saffo said she quickly learned that “I can’t give victims back what they’ve lost,” be it the overall sense of security or a prized possession, “and I’ve long since learned that the only way I can help victims is to stop crime,” including by working with groups like Genesis.

In Grafton County, the Grafton County Mental Health Group — of which Genesis is a member — helped advocate for the creation of two mental health courts which may soon be joined by a third in Plymouth.

Susan Stearns, who is chair of the Genesis Development Committee, said a mental health court in Hillsboro County that was funded on a temporary basis was so successful that the county decided to formally include it in the coming year’s budget.

Earlier, Stearns took Maggie Pritchard, who is Genesis’ executive director, to task for winning a special raffle, but not rejecting the prize: a pie.

“Maggie, Maggie, Maggie,” Stearns intoned sardonically, “have you no shame?” to which Pritchard shot back “apparently not” and Stearns concluded “I’m not surprised.”

The exchange delighted the attendees and Stearns later went on to present the Helen Holbrook Leadership and Service Award to Ann Nichols, an executive with Laconia Savings Bank, and the Dr. George “Pete” Harris Award to Dr. Jim Pilliod, a pediatrician and long-time State Representative from Belmont.

Pilliod, who worked with Harris soon after Harris founded Genesis Behavioral Health in 1966, said he initially wondered “what on earth do we need it for,” adding, however, that over the past five decades he has found out exactly why it was needed.

As a word, “genesis” means a beginning, said Pilliod, but as for Genesis, the organization, “it should never end.”

© 2011 citizen.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Oct 26- 'Unfair' cuts weigh on mentally ill, over 500 flood budget hearing - from Concord Monitor

Marcille was one of more than 500 people who attended an afternoon budget hearing yesterday, with more expected for an evening hearing that was scheduled to last late into the night. Patients and advocates, people with mental illness and physical illness, homeless advocates and bridge builders, all came to advocate for their causes. The most concern was for the services provided by the state Department of Health and Human Services. Gov. John Lynch proposed a $10.7 billion biennial budget that would give Health and Human Services - the state's largest department - $621 million less than what the agency calculated it would need to maintain current services. The House Finance Committee recently asked Health and Human Services Commissioner Nick Toumpas for a list of an additional $346 million in cuts, which would bring the department back to its 2004 funding levels.

Terry Marcille, 48, lives in Concord and has a master's degree in geography.

- more
Sep 8- $209 million slashed from HHS budget, deep cuts proposed for social services - from Concord Monitor

The House Finance Committee yesterday took a carefully wielded ax to the Department of Health and Human Services budget.

After working through the weekend and going line by line through a series of potential budget cuts, the committee recommended reducing the governor's budget for the Department of Health and Human Services by an additional $209 million.

"We looked at them individually and made some judgments about what would good policy be, what kinds of reductions would cause the least harm to people," said Rep. Neal Kurk, a Weare Republican and chairman of the finance committee division dealing with Health and Human Services.

But Democrats and health care advocates say the additional cuts will cause serious harm to people in need. "I am extremely distressed that we seem to be sending our most vulnerable citizens - the elderly, our children, the mentally ill, the unemployed - a message that we have no sense of community, that we have no sense of responsibility for our fellow citizens, that we don't care if they don't get these services," said House Democratic Leader Terie Norelli.

The 2012-2013 budget proposed by Gov. John Lynch would have given Health and Human Services - the state's largest department - $621 million less than the agency calculated it would need to maintain current services. But Republican leaders who control the House say Lynch's revenue estimates are $300 million too high. They also object to the governor's cuts to local aid. House Finance Committee members have pledged to make up the difference through deeper spending cuts.

Last week, Health and Human Services Commissioner Nick Toumpas presented the House Finance Committee with a list of $346 million in potential cuts. Toumpas made clear that he did not support the cuts, which he believes would shift costs to cities and towns and dismantle the infrastructure the department has set up to maintain services for vulnerable citizens.

After his presentation, more than 500 people turned out for a public budget hearing, many pleading for social services - services for people with disabilities or with mental illness, or for people who are homeless.

In sessions on Sunday and yesterday, the Finance Committee division dealing with Health and Human Services tentatively decided to accept most of the governor's cuts, as well as a large number of the cuts on the list Toumpas provided. The committee did restore potential cuts in some of the most controversial areas, such as services for people with developmental disabilities.

Children's services

One of the most drastic impacts could come from the elimination of the state's system for "Children in Need of Services," or CHINS, a category of children ordered by the courts to get treatment, guidance or counseling before they become delinquent. According to the Department of Health and Human Services, just over 1,000 children fell into this category in fiscal year 2010. Eliminating the system is expected to save more than $7 million over two years.

The Department of Health and Human Services estimated that 18 percent of these children will end up in the juvenile justice system. "Schools, communities, diversion, police would have to find another way to deal with it," Eric Borrin of the Department of Health and Human Services told the Finance Committee.

Democrats objected to the cut. "I don't know what would happen to these children in their communities," said Rep. Sharon Nordgren, a Hanover Democrat and Finance Committee member. "Some are violent. Parents can't deal with them. They're a danger to themselves and their community." (next page »)

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News & Events

November 04, 2012 - 2:00 AM

Monday afternoon, as Hurricane Sandy blew into the region, a small celebration took place for a big birthday.

New Hampshire Hospital, our state psychiatric facility, celebrated its 170th birthday, having begun operations Oct. 29, 1842. While much at NHH has changed over those years, one constant that has remained is the staff's commitment to treat people with dignity, compassion and respect.

Kenneth Norton, LICSW, is executive director of the National Alliance on Mental Illness New Hampshire.

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Council okays managed care

Questions remain

Children's services