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 7th to Kristen Welch at kwelch@genesisbh.org or 603-524-1100 x445.

  • Mar 26- N.H. Medicaid expansion bill passes House, goes to governor

    By NORMA LOVE Associated Press

    Tuesday, March 25, 2014          
        

    New Hampshire’s House voted yesterday to expand Medicaid programs to cover an estimated 50,000 poor adults eligible for federal subsidies under the federal health care overhaul law.


    The House voted 202-132 to send a bipartisan Senate plan to the governor that uses federal Medicaid funds to buy private health coverage for adults making less than 138 percent of the federal poverty limit, about $15,856 a year for a single adult.

     

    Democratic Gov. Maggie Hassan said she looks forward to signing the bill, which could be as soon as this week.


    “This bipartisan plan is a uniquely New Hampshire solution and it exemplifies New Hampshire’s tradition of collective problem-solving, demonstrating what is possible when we remain focused on solutions and reach across the aisle to achieve progress for our people,” Hassan said in a statement.


    New Hampshire is one of six states that had not decided whether to expand Medicaid under the federal law.


    The bill passed the Senate on a bipartisan vote, but most House Republicans voted against it. The Democratic-led House rejected nine Republican amendments, including ones to cap the program and block its implementation until federal permission is received to spend Medicaid money on private health coverage.


    The program is projected to cost $340 million a year when fully implemented and would use 100 percent federal aid through 2017 to expand the health care coverage. Adults up to age 65 could qualify, and supporters said the bill would improve the health of uninsured residents by providing access to affordable preventive and primary care. They said that would reduce the amount of uncompensated care provided by hospitals, which could help drive down premium costs and help struggling businesses.


    Rep. Robert Elliott, one of the few Republicans to support the bill, said providing health coverage to the poor was the right thing to do and chided Republicans who opposed it.


    “The public will perceive that we Republicans are opposed to the poor,” said Elliott, of Salem.


    Opponents argued the state’s financial liability should be capped to protect taxpayers.


    “The numbers we have are guesstimates at best. We have no idea how many working-age adults will apply for this,” said Rep. Laurie Sanborn, a Bedford Republican.


    House Republicans tried unsuccessfully to get the House to amend the Senate bill to cap the program at 60,000 people, or $400 million in annual spending.


    The state estimates that 12,000 adults could begin receiving coverage in as little as a month under an existing program to subsidize employer-based coverage, while 38,000 others would receive coverage through the state’s Medicaid managed care program starting July 1 or as soon as possible after that.


    Under the proposal, the state would seek a federal waiver by March 31, 2015. While waiting for the government to act, about 38,000 adults could start enrolling around May 1 for coverage that would begin July 1 in the state’s Medicaid managed care program. If the waiver is denied, their coverage would be phased out over three months.


    With a waiver, New Hampshire could begin using federal Medicaid money to buy private insurance in 2016 through the federal marketplace for the 38,000 people on managed care.


    The federal government would pick up the full cost until 2017. The expansion would end when federal funding drops below 100 percent unless the Legislature voted to continue it. The entire program also would end at the end of 2016 if the Legislature failed to reauthorize it.


    The plan also would provide coverage to an additional 12,000 people eligible through an existing state program that subsidizes employer-based coverage. The Medicaid funding would pay for their coverage until 2017. Their coverage also would end if federal support dropped below 100 percent.


    Source URL:http://www.concordmonitor.com/news/nation/world/11309066-95/nh-medicaid-expansion-bill-passes-house-goes-to-governor
  • Feb 20- Senate Committee Approves Medicaid Expansion
    BY TODD BOOKMAN, NHPR

    New Hampshire lawmakers moved a step closer to expanding Medicaid under the Affordable Care Act.

    The Senate Health, Education and Human Services Committee voted 4-1 on Wednesday to approve a plan that includes a “premium assistance program” which would require newly eligibly Medicaid recipients to select private health insurance starting in 2016.

    Republican Senator Andy Sanborn of Bedford was the lone dissenting vote.

    “We all want to help everyone that is in need, but this bill does nothing except spend a tremendous amount of money with no promise of outcome on the other end,” says Sanborn.

    He cited a decision by Arkansas lawmakers to discontinue a similar “private option” as proof that New Hampshire should be pursuing a different course.

    Members of the Arkansas House of Representatives voted 70-27 in favor of the plan on Tuesday, five votes short of the supermajority necessary for spending bills.

    Under New Hampshire’s plan, an estimated 50,000 newly eligible recipients would gain coverage on July 1st through one of three managed care organizations (MCOs), which effectively manage administration for Medicaid recipients in the state.

    Those companies would be able to include their policies in the federal exchange in 2016, giving recipients the option of continuing their plans.

    Senator Peggy Gilmour, a Democrat from Hollis and co-sponsor of the New Hampshire legislation, says that’s “significantly different” than the Arkansas model.

    The entire package hinges on approval from the federal government, and on the state receiving full funding from Washington. Under the bill, expansion sunsets at the end of 2016, meaning a future legislature would have to renew or revise the program.

    The full Senate will vote on the bill following its February recess.

  • Feb 17- A year of change, momentum for mental health in New Hampshire
    By SARAH PALERMO
    Monitor staff
    Sunday, February 16, 2014 

    One year ago last week, Gov. Maggie Hassan implored legislators to help fix a mental health system that was leaving dozens of patients languishing for days in hospitals unable to treat them.

    She proposed a biennial budget with $28 million to address “one of our most pressing public health challenges,” the lack of space for treating patients in crisis, exacerbated by a lack of ongoing community support. Legislators from both parties and both chambers disagreed with the governor on other issues, but that funding survived the budget process unscathed.

    In the year since, more than $6.3 million has been spent or allocated for improving mental health services statewide.

    A handful of new beds for crisis treatment opened, and dozens more people are now able to afford a stable home.

    Still, last week, 16 adults and 10 children waited in emergency rooms for unavailable psychiatric treatment.

    “There are good things that have happened,” said Jay Couture, executive director of Seacoast Mental Health Center in Portsmouth and president of the state Community Behavioral Health Association. “But there’s been nothing so far that has put a big dent in or ended the wait list. That, to me, is one of the absolute worst indignities, that we are warehousing people who need care when they are at their most ill, rather than being able to treat them effectively. It’s stressful for the clients, it’s stressful for their families, and it’s stressful for the providers, who have no good answer as to why it’s happening.”

    Yet Couture and other mental health care officials in the state are optimistic, one year after the governor directed the state’s attention to mental health, that the funding and attention for their clients has started positive momentum for the system.

    The first year

    Most of the funding that has been spent this year was focused on building supports for people within their communities.

    The state’s 10 community mental health centers used about $3.3 million to create or expand assertive community treatment teams. The teams work with people with mental illness who live independently, checking in frequently, going beyond the traditional definition of outpatient services.

    Every center has funding for a team now, and next year, all will receive funding for an additional team dedicated to children.

    Smaller amounts were set aside for residential facilities, where people with mental illness can live semi-independently but with support available around the clock. About $625,000 went toward renovating and staffing a home in Bethlehem that should open this month with capacity for eight residents, according to Geoff Souther, interim administrator for the state Bureau of Behavioral Health.

    Souther plans to convene a group in March to define what services should be available at another, larger new residential facility, slated to receive $3 million in the 2015 fiscal year. Once the scope of services is determined, the project will go out to bid, and the location will be determined.

    Because the scope of services hasn’t been determined yet, and more complex services cost more per client, Souther couldn’t say last week how many people that facility might serve. Initial estimates envisioned up to 60 or 70 people.
    The budget also included help for people with less complex needs to find housing in their community.

    Using $720,000 available for the current fiscal year, by June, 100 additional people will have received money to help pay rent until they were able to get space in government-subsidized Section 8 housing, according to program administrator Michele Harlan.

    “We’ve been able to assist in ending some of the revolving door for people” who are discharged from New Hampshire Hospital with nowhere to go, Harlan said. “We’ve been able to get people on our program, get them stable and get them connected to services they need.”

    Next year, the program is slated to receive another $1 million.

    Next steps

    More than $1.7 million was allocated this year for inpatient services that could alleviate pressure on local emergency rooms.

    Souther estimated the request for proposals for that project will be published by the end of March, and will likely call for a 16-bed facility. He couldn’t say when the facility would open.

    More change and more treatment options are expected to come in the next few years, in the aftermath of a settlement among the state, the federal Department of Justice and a handful of patients.

    Approved by a judge last Wednesday, the settlement’s terms could cost an additional $6 million in funding in this biennium and $23 million more in 2016-17, state officials have said.

    Legislators began discussing Thursday how to meet the terms, which largely call for more community treatment team coverage and supported housing, as well as supported employment and mobile crisis teams.

    Outside of the budget process and the state Health and Human Services Department, advocates are trying to improve other parts of the system.

    Legislators heard testimony last week on a bill encouraging and providing guidance for circuit and superior courts interested in starting dedicated programs for people charged with crimes related to a mental illness.

    The courts help nonviolent offenders access treatment for the underlying mental illness that caused the illegal behavior – often shoplifting, disorderly conduct, criminal threatening or simple assault – instead of sending the person to jail, where they’re unlikely to get treatment.

    Since the state doesn’t pay for the courts, some counties have started them using federal grants for the first three years and then absorbing the costs into their operating budgets. Merrimack County’s delegation will vote next month on a budget including about $100,000 to continue the program after its grants run out in April.

    The proposed bill doesn’t include any state funding, the main concern of the only speaker opposed to the idea at a hearing.

    “It’s a wonderful advancement in the arc of justice to want more individualized attention, for these cases especially,” said Christopher Keating, executive director of the state Judicial Council. “If this bill passes, it’s the expressed policy of the state of New Hampshire that we want more individualized treatment. That’s a good thing, but it costs me more money to provide adequate representation . . . if we are going to have more meetings and more appointments.”
    At that same hearing, Ken Norton spoke about the experience he saw a family member with a mental illness endure through the court system. She would be arrested and released on bail, but being homeless, she would be unable to maintain her treatment and would be quickly re-arrested for a bail violation.

    “Justice is supposed to be blind, but people who live in areas that don’t have mental health courts simply don’t have access to these services,” he said. “Without them, the justice system is long on punishment and short on protection, deterrence and rehabilitation.”

    Looking ahead

    Despite that, Norton, who is the executive director of the state chapter of the National Alliance on Mental Illness, said in a later interview he joins Couture and other mental health leaders who are optimistic.

    “We have momentum,” he said. “We still have significant challenges that we face, but there is a coming together of people. . . . Everybody recognizes there’s a lot of hard work in front of us, but everyone feels positive about the leadership from Gov. Hassan and the bipartisan support from the Legislature.

    “The settlement really capped the positive news of the year. . . . The reaction from so many corners of this world was, ‘Yes, we really can work together. There’s a lot to be done, but we’re moving forward.’ ”

    (Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

  • Feb 17- Community support teams for mentally ill strengthened
    By SARAH PALERMO
    Monitor staff
    Sunday, February 16, 2014 

    When the New Hampshire mental health system was called a model for the nation, the robust community-based support system for people was a large part of the reason for that praise.

    But community-based supports can be expensive, and were the victim of round after round of budget cuts in the 1990s and 2000s.

    More than $3 million in the current budget was directed specifically to help community mental health centers create, expand or restart the assertive community treatment (ACT) teams that once made the state a national leader in mental health care.

    Like supported residential facilities, ACT teams are designed to help people with mental illnesses maintain a healthy life and prevent crises that might land someone in the local emergency room or state psychiatric hospital.

    That means team leaders such as Kate May, the new leader of the ACT team for West Central Behavioral Health in Lebanon, spend their days far from their desks.

    That’s exactly why May took the new job in July, to spend her time driving around Claremont and Newport checking in on her team’s eight clients.

    She’ll first go to their home, and if they aren’t there, to their usual hang-out spots. She checks in, gets a sense of their status for the day and if needed, helps them get to appointments, run errands or arranges for them to meet with other members of the team: a psychiatrist, a substance abuse counselor and a nurse.

    All of the members of West Central’s ACT team spend part of their work week with other programs, too. When it’s fully staffed – hopefully by July, said program director Regina Mix – the team will ideally work with 15 patients at a time.

    May took the job after several years as a social worker in Massachusetts. During an internship at McLean Hospital in Belmont, she led a therapy group for parents and families of someone with a thought disorder such as schizophrenia or bipolar disorder.

    “It was a really touching group to work with, because I saw how much this affects the lives of a family. The first psychotic break creates chaos, and they have to go through something very much like mourning the person they knew,” she said. “The nature of persistent mental illness is it’s severe and it’s persistent. There is no cure-all.”

    Instead, ACT teams are designed for management of a disease that clients will live with for the rest of their lives.

    ACT teams were first developed in Wisconsin in the 1960s, according to the Assertive Community Treatment Association. Staff at the state hospital there were discouraged by an apparent revolving door. Though they worked to prepare patients for life at home after discharge, the same patients would be readmitted over and over again.
    One social worker was having success, though, according to the association. She spent hours with her clients, even after they were discharged. She showed them how to navigate public transportation to their appointments; she helped them do laundry at the laundromat.

    Once it was put in place more broadly, that kind of support lowered the number of admissions and readmissions to the state hospital.

    “It was developed for people who are very symptomatic and hard to engage, who don’t do well in a traditional treatment setup where they are supposed to come to an office every week for an appointment,” Mix said.

    The official guidelines for ACT teams call for 24/7 coverage.

    “It’s an expensive model to maintain, and that’s a big reason a lot of us weren’t able to do it all,” Mix said.

    As they ramp up services again, the West Central team is working on being flexible.

    The psychiatrist, for example, technically works for the ACT team for four hours on Mondays.

    But if something came up during the week, May said, she could always stop by the doctor’s office and get advice about how best to proceed.

    She had one client, she said, who was struggling to manage his manic symptoms. Once he was placed on the ACT team’s client list, he was able to see the psychiatrist more regularly, and manage his medications better.

    “He can report now, ‘My head is slower, my thoughts aren’t going so fast,’ so his quality of life is better,” May said.
    “That one client who says, ‘I feel so much better,’ that, to me, is success. . . . It’s a roller coaster, but at least for right now, he’s feeling better.”

    (Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

  • Feb 13- Federal Judge Gives Final Approval To Mental Health Settlement
    BY TODD BOOKMAN, NHPR

    Calling the deal a “responsible resolution,” Judge Steven McAuliffe approved a major settlement agreement on Wednesday that will bring more resources to people in crisis.

    Plaintiffs had brought a class action suit against the state, alleging that a lack of services resulted in unnecessary institutionalization of people with mental illness. The U.S. Department of Justice joined the case, saying the state was violating the Americans With Disabilities Act.

    “It has been a long process, but I think the process was a good one," says Amy Messer with the Disabilities Rights Center. "The parties came together and were able to come to a resolution that I think is good for the state of New Hampshire.”

    The state will spend $30 million over the next four years expanding community-based services and programs that provide supportive housing and employment. 

    Lawmakers still need to appropriate the funds. A House Committee begins that task Thursday morning.

  • Jan 29- After ER attacks, a call for more care
    By MARK HAYWARD 
    NH Union Leader – January 29, 2014

    All New Hampshire hospitals should consider adding acute-care beds for psychiatric patients, according to the recommendations of a trio of experts who reviewed the state’s mental health system following two violent attacks last year at Elliot Hospital.

    The recommendation is the first among nearly three dozen spelled out in a 25-page report. (See related story, Page A8.) Gov. Maggie Hassan released the report Tuesday. It was compiled by a judge who chairs the state’s Board of Mental Health Practice, a psychiatrist who is associate medical director of the New Hampshire State Hospital, and an assistant attorney general. 

    The Mental Health Sentinel Event Review Report adds another set of recommendations for the state’s beleaguered mental health system, which has come under scrutiny following complaints about days-long waits at hospital emergency rooms. 

    That chokepoint was highlighted last year by two separate incidents between Elliot Hospital emergency room workers and psychiatric patients. Alleged patient attacks and response resulted in serious, life-altering assaults. 

    The report said 228 sentinel events — described as unexpected occurrences such as death, abuse, rape, serious injury or neglect — occurred at acute care facilities in New Hampshire last year, up from 196 the previous year. 

    Previous recommendations have called for a renewed focus on community- based care, such as placing teams of mental health workers on call to help someone going through a crisis. The review released Tuesday makes note of earlier recommendations, but it reports that in-patient psychiatric beds in the state dropped from 526 in 2005 to 384 last year. 

    “There must be additional capacity, whether arrived at by adding beds or increasing efficiency, or creating satellite campuses of New Hampshire Hospital to treat patients closer to the communities to which they are connected,” the review reads, quoting one person who responded to a survey. The review involved surveys and interviews with unnamed hospital chiefs, clinicians and emergency room workers. 

     The report said hospitals find mental health care is not economically viable because most patients are poor and lack insurance. “Hospitals have tended to lose money treating these patients,” said Steve Ahnen, president of the New Hampshire Hospital Association. 

     But he said some hospitals have taken steps to add psychiatric beds. Franklin Regional Hospital is opening 10 beds for involuntary patients; Elliot Hospital in Manchester is the only other hospital in the state with such beds. 

    At least two other hospitals are in discussion with the state about adding such beds, Ahnen said. Meanwhile, Parkland Medical Center in Derry and Portsmouth Regional Hospital have applied with the state to add voluntary psychiatric beds, he said. 

    He said the state remains in a crisis; 26 people were in hospital emergency rooms Tuesday waiting for admission to the New Hampshire State Hospital. 

    In releasing the report, Hassan noted that Medicaid expansion would provide mental health services for many uninsured people.  The review was led by former Supreme Court Justice Joseph Nadeau, who was joined by Dr. Alexander P. de Nesnera and Senior Assistant Attorney General Michael Brown.

    Here’s what report recommends
    Here are some recommendations from the Mental Health Sentinel Event Review Report: 
    • Each hospital should develop a plan to expand the number of beds.
     • Hospitals should establish a network to assign critical patients to available beds.
     • Provide additional affordable community housing and consider restructuring of group homes.
     • Better training of hospital workers, including all emergency room workers.
     • Better assessment and treatment of mentally ill people who have drug and alcohol problems.
     • “Weigh the benefit to the delivery of mental health care that would occur with an expansion of Medicaid.” 
    • Obtain a waiver of Medicaid rules that require a psychiatrist to approve all psychiatric care rather than a nurse practitioner.
     • Create a tax-exempt Mental Health Trust, which would be supported by both taxpayer funds and private donations. It’s unclear exactly what the trust would do, but a non-partisan, independent board would control how the money is spent.
     • Consider data-sharing between the New Hampshire Hospital and community mental health centers.
     • Encourage more physicians to enter psychiatry.

  • Jan 29- Report Underscores Need for Increased Understanding of Mental Illness, Enhanced Training of Health Care Personnel, Continued Investment in Community-Based Care
    CONCORD - Governor Maggie Hassan today released the report of the Sentinel Event Review that she requested in November to address concerns raised by recent incidents involving patients with acute mental illness, as well as to evaluate the ongoing strains caused by mental health patients awaiting care in emergency rooms.

    The review was led by former Supreme Court Justice Joseph Nadeau, who currently chairs the state’s Board of Mental Health Practice, with the support of Dr. Alexander P. de Nesnera from the Geisel School of Medicine and the Associate Medical Director of the New Hampshire Hospital, and Senior Assistant Attorney General Michael Brown.

    The team’s report emphasizes that a variety of factors – the economic downturn, increased substance abuse, reductions in state hospital beds, reductions in psychiatric beds at New Hampshire hospitals, and reductions in community-based services - have all contributed to New Hampshire’s strained mental health system and that changes are needed at all levels to provide more appropriate and more effective mental health care to those in need.

    "This report underscores the significant challenges faced by those with mental illness in New Hampshire as well as health care providers, and we must continue working together to strengthen community-based mental health services that will help prevent individuals from reaching the point of crisis," Governor Hassan said. "Most importantly, we must recognize that individuals who experience mental health challenges deserve the same level of compassionate care and treatment that we would expect for any other health care need, care that allows them to be fully included in our communities and economy." 

    "I look forward to working with the Governor and the community to address the state of our mental health system," Commissioner Nicholas Toumpas of the Department of Health and Human Services said. "This review contributes greatly to a dialogue that must happen in each community and at the state level." 

    The report calls for a continued commitment to implementing the enhanced community mental health services in the current state budget, including expanded access to acute care beds, adding a new designated receiving facility (DRF), adding community residence beds, providing subsidies for housing and support services, adding 10 Assertive Community Treatment Teams to assist people in crisis, and increasing other community support services.

    In addition, the review team found that additional investment in an integrated range of mental health services, especially to address housing, is needed, along with enhanced training of hospital personnel to address mental health crises, more appropriate treatment of cases of mental illness co-occurring with acute substance abuse, and expanded access to health insurance that provides coverage for mental health. The report calls for continued dialogue and meaningful action by the leaders of our public sector and private health care facilities.

    The recent budget, combined with pending legislation to implement the settlement of a lawsuit about the state of New Hampshire’s mental health system, will make it possible to make significant improvements in the community-based care system.

    And expanding Medicaid, Governor Hassan said, would provide funding for mental health care for many currently uninsured patients.

    Those dollars do not address the report’s recommendations for increased training for hospital and other health care personnel who treat mentally ill patients.

    "I look forward to working with our hospitals, community health centers and other community providers to collaboratively address the recommendations in this report and to help ensure that individuals with mental illness are treated compassionately and appropriately, just as we would expect for any patient in our health care system," Governor Hassan said. "I thank Justice Nadeau, Dr. de Nesera and Assistant Attorney General Brown for their work on this important review, as well as all who cooperated with the team. I will continue working with all of our partners to strengthen mental health services throughout New Hampshire.”

  • Jan 27- Older Addicts Face Limited Treatment Options

    NH Public Radio – January 24, 2014
    By Sheryl Rich-Kern
     
    The latest census numbers project that more than a quarter of New Hampshire’s population will turn 60 or older by the year 2030, up almost 40 percent from 2012. And in that same year, the number of older adults with mental health problems could meet or exceed the number of younger adults with mental health issues.  

    Among the most common mental health issues: depression and alcoholism.This silent epidemic is creating an array of challenges for the health care workforce in New Hampshire.

    Dick Lievens of Tilton sits at a coffee shop in Manchester. At 59, he sports a scraggly white beard and wears a faded denim shirt. It’s a look that’s laid back, but does nothing to describe his state of affairs three years ago: Life was just chaos. Lievens started drinking heavily in his 50s. It didn’t take long before I was totally out of control. I couldn’t go to work anymore. A couple of car crashes. Looking back at it now – it’s like, how could you think that was normal. 

    Lievens is now in recovery. Like many of his generation, his narrative reflects a growing trend of substance and alcohol abuse. According to the Institute of Medicine,  at least 5.6 to eight million older Americans — or one out of five —have one or more mental health and substance use conditions.

    For those struggling with addiction like Lievens, their downfall often begins with prescriptions. I’ve always had anxiety problems. Over the years, you get used to the medications. And you have to keep boosting them up. And it’s not working. And you start drinking to try and squash the pain. And both alcohol and benzodiazepines  – the combination of both is super-dangerous. 

    After hitting bottom, Lievens recovered at Webster Place, a private residence in Franklin. When I walked in the door and one of the guys came out to greet me – he was a resident – he put his hand on my shoulder and said you’re doing the right thing; it’s going to get better from here. That meant the world. I wanted to be that guy. 

    Two and a half years later, Lievens is one of those guys. He’s a mentor running support groups. Webster Place uses lay people like Lievens to help others on the road to recovery. Adults in New Hampshire who need short-term residential centers  like Webster Place but with trained clinicians find only a handful of options.

    And only one facility in the state has a medical staff — outside of a hospital —  to monitor withdrawal symptoms. Cheryl Wilkie directs the Farnum Center in Manchester says the building’s newest wing features a medical detox center. Wilkie emphasizes that alcoholism or drug addiction is not a rite of passage reserved for the young.

    And she says the Center doesn’t treat its older patients any differently. But Wilkie does say that, older adults who become alcoholic may have had other addictions in the past: Whether it’s food or it’s cigarettes. Whether it’s thought addictions, where we think too much. Whether there was some other thing they were consistently doing until they found alcohol and that may have been the thing that soothed them. 

    But whatever the age, Wilkie says roadblocks prevent many from seeking help. Money is always an issue to getting treatment. Fees for medical detox run around three thousand dollars. And one month of residential care? Twelve thousand dollars.  Insurance may cover some of the costs. Medicare does cover some substance abuse treatments, but with limits. And most of the time, the insurance companies say we’ll pay for outpatient, not residential. 

    The Farnum Center reserves 16 beds for low-income patients. But those who qualify for the state subsidy can expect to wait six to eight weeks. Jennifer Kinsey coordinates an state-run program for those over 60 who need brief counseling for alcohol and substance abuse. The program is called the Referral Education Assistance and Prevention program, otherwise known as REAP. Kinsey says:
    There are very limited options for older adults if they have an alcohol problem. There aren’t easily accessible treatments or options for paying for treatment. 

    REAP gets funding from several state-run organizations: the Housing Finance Authority; the Bureau of Drug and Alcohol Services; the Bureau of Elderly and Adult Services; and the Bureau of Behavioral Health and New Hampshire’s Ten Community Mental Health Centers.

    Kinsey explains: If we have somebody with an alcohol problem who is an older adult, we’re the most likely resource for them to address their drinking problem. And it can be effective. 

    Kinsey says the service is free, and isn’t isolated in a facility that counsels addicts.  Instead, clinicians visit seniors at their homes, or sometimes at a senior center. She says the program is designed to make them feel more at ease.

    Older adults come from a period of time when there’s more stigma involved. And they have issues with transportation. And even if they were to go to a treatment program, they probably would feel less comfortable around people a lot younger than them. 

    REAP has been around for more than 20 years and is now expanding. The program is currently training 40 mental health counselors across the state in new methods of addiction counseling. But as New Hampshire’s population ages, Kinsey says the state will need even more resources to address not only addiction, but mental health symptoms — like depression and anxiety — that put elders at risk for alcohol and drug abuse in the first place.

    And geriatric psychiatrist Stephen Bartels agrees. He directs the Dartmouth Center for Health and Aging.   He says:So if we don’t train our entire health workforce around how to assess older adults on a myriad of problems, not just substance abuse, we’re in big trouble in the state of New Hampshire.

    And as more seniors like Dick Lievens share their battles with alcoholism, the voices behind the challenge may become harder for the state to ignore.

  • Jan 21- NH gets dismal D-plus ratings in psychiatric care
    By DAVE SOLOMON 
    A psychiatric care crisis is affecting emergency rooms throughout New Hampshire, according to the American College of Emergency Physicians, which gave New Hampshire a D-plus overall grade and ranked it 28th in the nation in a state-by-state report card on America’s emergency care environment.

     The state slipped from a C-plus and 15th ranking in the last survey in 2009, having improved in only one of five categories — disaster preparedness.

     In the other four categories — access to emergency care, quality and patient safety, medical liability and public health — the state lost ground, according to the national medical society representing emergency medicine, headquartered in Dallas, Texas.

    “New Hampshire has long wait times in emergency departments and one of the worse medical liability environments in the nation,” said Beth Daniels, M.D., president of the New Hampshire Chapter of ACEP, which represents more than 125 emergency physicians, residents and medical students in the state. “We must increase the hospital and mental health resources in our state and enact laws to improve traffic safety,” said Daniels, an emergency medicine doctor in Manchester and Newburyport, Mass.

     The state received a Dminus in the category of “Access to Emergency Care” and ranks 30th in the nation, dropping from a B-minus and 11th place in 2009. According to the study, released last Thursday, the state has a relatively high proportion of adults needing but not receiving substance abuse treatment.

     New Hampshire also received a D-minus for its “Medical Liability Environment” because of laws that favor plaintiffs in medical malpractice cases. For example, the state does not have expert witness rules requiring medical witnesses to be of the same specialty as the defendant and licensed to practice medicine in the state.

     The state dropped from a C-plus to a D-plus in the area of “Public Health and Injury Prevention.” The authors cited the fact that New Hampshire does not require helmets for motorcycle riders, does not mandate seat belts for adults, and does not prohibit cell phone use while driving. New Hampshire has the third lowest rate of front seatbelt use in the nation.

     On the positive side, New Hampshire has a good overall “Quality and Patient Safety Environment,” with triage and destination policies in place for certain patients, such as stroke victims. In that category, the state earned a B and is ranked 10th in the country, although in 2009 it received a B-plus in the same category.

     The state’s grade for disaster preparedness went from C to C-plus after the state implemented a patient tracking system, established mutual aid agreements and enhanced training and communication systems. 

    A call for action 
     At the heart of the report is the failure of the state to provide sufficient beds for NH’s emergency care for psychiatric patients, who end up in emergency rooms.“New Hampshire must act immediately to address its under-resourced mental health system, work with hospitals to increase the number of psychiatric inpatient beds and reduce the boarding and crowding in Emergency Departments,” wrote the report’s authors.

     Boarding of mental health patients in the emergency department has likely contributed to New Hampshire’s higher than average median time from emergency room arrival to emergency room departure of nearly five hours, according to the report.

     The focus on mental health care comes as no surprise to medical professionals in the state, who’ve been sounding the alarm for years on the decline of psychiatric services in New Hampshire. The state has lost 27 percent of its in-patient psychiatric beds in the past eight years.

     Commissioner of Health and Human Services Nick Toumpas told the Executive Council last year that as many as 30 mental health patients a day are being held in emergency room beds across the state, sometimes for days.

     Toumpas got emergency approval for renovations at the state hospital to accommodate an additional 12 beds for acute mental health patients. 

    Sounding the alarm 
     John Clayton, a spokesman for the New Hampshire Hospital Association, said the report affirms the position of his organization. “Our focus for months has been to bring attention to the state’s mental health crisis,” he said, “a crisis that is driving psychiatric patients to hospital emergency departments because of the lack of capacity at the New Hampshire State Hospital and cuts to local, community-based mental health centers.”

    He said at one point last fall, there were 52 patients on the state’s waiting list for in-patient, psychiatric beds.

    “These patients have experienced emergency departments waits of up to five to seven days at times, with no proper psychiatric care available to them,” he said. “This represents a danger to the patients, but also to emergency caregivers. The two headline-making assaults at the Elliot Hospital emergency department are illustrative of a problem that is far more wide-ranging.” A Manchester man was arrested after police said he assaulted two employees at the Elliot Hospital Emergency Department in July. The Manchester  

  • Jan 21- Photographer donates print sales to Genesis Behavioral Health program
    LACONIA — Genesis Behavioral Health's Plymouth Children & Family Program was the recent recipient of a donation to provide winter clothing for children in need.

    Local photographer Jon Secord of J Secord Photography donated 25 percent of his print sales throughout the month of December to the program.

    “It's a great feeling to have an idea and see it grow into reality,” said Secord, “I was able to sell enough prints so the team at Genesis Behavioral Health can purchase winter clothing for local families who may have otherwise gone without this winter. The final total of $225 was way beyond what I had initially hoped to raise, and I am so grateful to everybody who helped this cause and purchased my artwork.”

    “Every year, the needs of the children and families we serve seem to exceed the resources we have available,” said Kristen Welch, director of development & communications at Genesis Behavioral Health, “Mr. Secord's generosity will make a difference for many of the children and families in our Plymouth program. We are once again humbled by the support of our community, and are so grateful for their efforts on our behalf.”

    J Secord Photography recently launched a new website at www.jsecordphoto.com and can be found on Facebook at www.facebook.com/jsecordphoto.

    Genesis Behavioral Health is designated by the State of New Hampshire as the community mental health center serving Belknap and southern Grafton Counties.

    For more information, call 524-1100 or visit www.genesisbh.org.

  • Jan 21- NHPR News Primer: Fixing New Hampshire’s Mental Health System

    By Brian Wallstin  
    Attacks by two psychiatric patients awaiting treatment at Manchester’s Elliot Hospital last year underscored the well-documented problems with New Hampshire’s mental health system.

    In December, the state agreed to settle a federal lawsuit filed in 2012 on behalf of six plaintiffs who had cycled in and out of emergency rooms and the state mental hospital. The state has agreed to spend $30 million over the next three years to re-build its community-based system of care, once considered a national model.

    WHAT BROUGHT ON THIS LAWSUIT?
    In April 2011, the Department of Justice released the results of an investigation that found the state had failed to provide services to people with serious mental illness that would have prevented their “needless and prolonged institutionalization.”

    When negotiations failed to resolve the situation, the DOJ joined the Disabilities Right Center in filing a class-action lawsuit, alleging violations of the Americans with Disabilities Act.

    WHAT DID THE CASE REVEAL ABOUT THE STATE’S MENTAL HEALTH SYSTEM?
    In 2010, for example, more than 17 percent of adults discharged from New Hampshire Hospital were readmitted within 30 days – an admission/readmission rate that was twice as high as in 1990. Of the 1,800 adult admissions, 800 were re-admissions within 180 days.

    In 2011, 45 percent of patients at the state hospital been there for more than a month, and 16 percent had been there more than a year.

    According to the lawsuit, “For most of these individuals, NHH provides little more than custodial care. They suffer a loss of autonomy and choice. They have no contact with their non-disabled peers, except for paid staff, and lack privacy in their living and sleeping arrangements. Their most basic rights are curtailed.”

    WHAT MUST THE STATE DO NOW?
    The settlement requires the state to provide “robust community services,” including:
    • around-the-clock mobile crisis teams in Manchester, Concord and Nashua to prevent unnecessary hospitalizations;
    • Assertive Community Treatment services to at least 1,500 people;
    •240 scattered-site, permanent housing units this year, and another 360 by June 2017;
    •employment services to an additional 1,000 people.

    THIS IS A DONE DEAL, RIGHT? 
    Not quite. The settlement has to be approved by a judge. A hearing has been scheduled February 17 before U.S. District Court Judge Steven McAuliffe.

    Meanwhile, state health officials are currently discussing how to implement the changes they agreed to in the settlement agreement. They say they need about $32 million, including an additional $6 million this year from the state’s General Fund and another $23.7 million for the 2016-2017 biennium.

    The state is also on the hook for $2.4 million to cover the plaintiff’s legal fees.

  • Dec 17- Preventing another Newtown
    As the country faces the one year anniversary of the unthinkable tragedy that occurred in Newtown, Connecticut, which took the lives of 20 children and eight adults, the anger, disbelief and utter loss we feel remains. We still ask why, and what can be done to prevent a tragedy like the one at Sandy Hook from happening again. In the past year, mental illness has been debated and discussed as never before — in the White House, in the halls of Congress, across the state of New Hampshire and in the Governor’s office. 

    We may never have all the answers but we do know that Sandy Hook — and the horror of Tucson, the pain of Aurora, and other incidents — must be addressed as a society. We must shatter the silence — and the myths — that condemn too many people with mental illness, and their families, to isolation and despair. At Community Partners, the Community Mental Health Center for Strafford County, we believe we can start to make a difference in our society, with these steps.

    By educating ourselves about mental illness; and by recognizing that a mental illness is not unlike a physical illness. Those diagnosed with chronic obstructive pulmonary disease (COPD) did not choose to contract a chronic illness. The same is true for someone diagnosed with bipolar disorder; they too contract a chronic illness. Both of these illnesses can be effectively managed with proper diagnosis and treatment. Yet our societal beliefs regarding bipolar disorder (and other “mental illnesses”) often prevent people from getting diagnosed and lead to a life of isolation and despair. 

    By everyone making a personal commitment to help those who have a mental illness, similarly to how we people commit to help someone with a physical illness. Basic first aid and CPR certification courses have allowed many to step in and save a life of another in distress. A similar program, Mental Health First Aid, trains people to become more aware of mental illness and provides basic first aid techniques, allowing them to assist anyone in emotional distress.

    By infusing our mental health system with the resources necessary to treat people in need; a healthy mental health system includes a resourced, comprehensive treatment continuum of prevention, early intervention, and regular intervention and crisis response. Years ago, when New Hampshire was seen as having a model mental health system, Strafford County had a comprehensive continuum of mental health care services available to its residents. As a result of continued devaluation of mental health services and devaluation of those with mental illnesses we witnessed the loss of our inpatient unit, our day treatment program, our intensive outpatient program, and our community-based residential program. 

    Tragedies like Sandy Hook may not be entirely preventable, but the wealth of opportunity to reduce their future likelihood is immense. Becoming aware of the facts versus fiction of mental illness and understanding that people are ill — not physically ill and/or mentally ill — will help us better respond to the needs of our community. In doing so, we will create an environment that once again places value on our people and reduces the likelihood of another Sandy Hook tragedy.

    Chris Kozak, COO
    Community Partners
    Dover 

  • Dec 12- Franklin mental health facility slowly adding capacity
    By SARAH PALERMO

    Two months after opening, a new psychiatric services unit at Franklin Regional Hospital is operating at about half capacity, with plans to be fully operational by the end of the year, officials there said.

    The unit, called a designated receiving facility, will have 10 beds and about 24 full-time staff when it’s completely up. So far, it’s made just a little dent in the overall availability of mental health care in the state, but “any addition of beds is helpful,” said Jay Couture, executive director of Seacoast Mental Health Center in Portsmouth and president of the New Hampshire Community Behavioral Health Association.

    Designated receiving facilities are the only options other than the New Hampshire Hospital in Concord for providing care to patients regardless of their ability to pay. 

    The Franklin facility has staff to serve five patients at a time; more staff are being trained and will be ready by January, said Ellen Wolff, chief nursing officer and senior vice president for patient care services at LRGHealthcare, which oversees the Franklin hospital and Lakes Regional General Hospital in Laconia.

    A 10-year plan written in 2008 by mental health advocates advised increasing the number of these beds statewide to at least 48; at full capacity, the Franklin unit will bring the total to 34. “We knew there was a big need, and while we don’t see this as the solution to the entire problem, we really wanted to be a model for other hospitals who might want to do something like this,” Wolff said.

    The unit includes two single rooms and four doubles, a seclusion room for patients in acute distress, and areas for group therapy sessions and secure medication storage. It also includes a courtroom, because patients committed involuntarily are guaranteed a hearing in front of a judge within 72 hours of admission. 

    Wolff had tried in 2007 and 2009 to open a psychiatric unit at the hospital but low Medicaid reimbursement rates made it unfeasible, she said. The state budget increased funding for mental health services by $28 million over the next two years. During the unit’s first two months, it has received patients from all regions of the state, and one from Vermont, admitted from hospital emergency rooms, Wolff said. Exact numbers of admissions so far weren’t available this week. 

    The most common patient diagnoses have been personality disorders and schizophrenia, she said. 

    Visitors have also come from other hospitals in the state, looking to see if they might be able to replicate the unit, which was fitted into a closed obstetrics wing with minor renovations over the summer.

    Wolff said she was also working with state officials to expand access to emergency mental health care for children.

    The unit only serves adults, and the turnover of beds for children at New Hampshire Hospital is much slower than it is for adults, she said. If that project moves forward, it would most likely be five or six beds at the Laconia hospital, Wolff said.

    The lack of beds for children leaves some young patients waiting days in emergency rooms. One 10-year-old girl in the Laconia emergency room last week had been waiting for an appropriate placement for mental health care for 12 days, Wolff said.

    On Thursday morning, 21 adults and four children waited in emergency rooms across the state for mental health services they could only get at the state hospital in Concord, or in a designated receiving facility such as the one in Franklin. 

    Earlier in the week, the waiting list had fallen to 13, Couture said. “I feel awful for those families. It’s still horrible for every person waiting for care in an inappropriate place, so I don’t want to lose sight of that, but for a system that has had as many as 50 people, it’s improvement,” she said. “I want to celebrate the day we have zero people waiting. I’m sure everybody does.”

  • Nov 25- No deal on Medicaid expansion

    By SARAH PALERMO

    A special session of the Legislature closed yesterday with no deal for expanding Medicaid to an additional 50,000 low-income adults, despite leaders on both sides of the political aisle saying they remain willing and eager to reach a compromise. The Republican-controlled Senate voted on three amendments to its original bill, ultimately approving one, 13-11 along party lines, before tabling the bill in the early afternoon.

    “People of goodwill need to keep working together,” said Senate Majority Leader Jeb Bradley of Wolfeboro. “We’ve seen in the last week that instead of people being serious, it’s been politicized,” he said, pointing to rallies Gov. Maggie Hassan, a Democrat who supports a different form of expansion, has held in the home districts of several senators.

    In a statement released at the end of the day, however, Hassan indicated there was little good will left between the parties on the issue. “We offered Senate Republican leadership nearly everything they asked for; all we wanted was a plan that would actually work from day one and for the long term. But Senate Republicans refused to budge, putting ideology first and the people of New Hampshire second,” she said. “Our providers are ready for expanded health coverage, our businesses are ready, our people are ready, and I am ready. . . . I hope that at some point, a few Senate Republicans will set ideology aside and step forward to do what is right,” Hassan continued. “Until then, it is the people who are hurt, and it is the people whom senators must answer to.”

    The proposal left on the Senate’s table at the end of the day would not give any of the newly eligible people access to the same coverage received by people already in the state’s Medicaid program. Instead, it would give them federal funds to purchase insurance on the federal insurance marketplace, but only once the federal government approves all necessary waivers.

    Those waivers could take anywhere from one to two years to write, submit and be approved, and approval may hinge on whether multiple insurance companies offer plans on the marketplace for sale. Currently, only Anthem Blue Cross Blue Shield offers plans for sale there.

    “It may not be perfect. That doesn’t mean it won’t work,” said Sen. Bob Odell of Lempster, a Republican who had been targeted by Democrats as a potential swing vote. Democrats sought a plan that would give people coverage through the state’s managed Medicaid program until the waivers are approved, then move them onto the marketplace with federal funds for buying plans.

    Sen. Peggy Gilmour, a Democrat from Hollis, proposed an amendment with a two-year deadline to move people onto the marketplace, with automatic sunset provisions if several interim deadlines for writing and submitting the waiver applications weren’t met. It would have postponed the starting date until after the federal government approved the most widely supported provision – that eligible people with access to health care through their employer should be given federal dollars to help pay for the premium.

    It also would have changed the membership of the commission that would have overseen the writing of the waiver applications, and it would have given the state Department of Health and Human Services oversight of the trust for federal funds for premium assistance. That amendment was defeated, 13-11, along party lines. In the House, Republicans lacked the votes to block the Democratic Medicaid expansion plan. But they deployed a variety of procedural maneuvers as delaying tactics during yesterday’s debate, and unsuccessfully offered five floor amendments to the bill itself.

    “I suggest that we have the time, in the next session, to try to come to a reasonable compromise that does it right, both for the people who need the help and for the people who have to pay for it,” said Rep. Neal Kurk, a Weare Republican. “This bill doesn’t do it, but we can get it right.” 

    In all, the House took 21 preliminary votes over 4½ hours of debate before finally voting, 198-146, to pass its plan to expand Medicaid. “The New Hampshire Access to Health Coverage program is the product of extensive study, thoughtful consideration, great innovations and significant compromise,” said Rep. Cindy Rosenwald, a Nashua Democrat. “After four public hearings, the bipartisan recommendations of the Medicaid expansion commission and the testimony of experts throughout the process, it became clear that the people of New Hampshire need and want this opportunity for expanded access to health care, and that this plan is the best way for us to achieve that expanded access,” Rosenwald added. 

    That final vote fell largely along party lines: four Republicans joined 194 Democrats to support the bill, while one Democrat and 145 Republicans voted against it. “For me, this is strictly a conscience vote. I just cannot bring myself to go back to my constituents who make $32,000 a year or less and say to them, ‘I’m sorry, but you’re not going to get insurance,’ ” said Rep. Bob Elliott of Salem, one of the four Republicans who voted for the bill. “I just can’t do that.”

    The Senate quickly killed the House bill on a 13-11 party-line vote. If the issue were to come up during the new session in January, any bills proposed would go before the public in committee hearings before votes by either chamber. As the Senate voted to adjourn the special session, again on a party-line 13-11 vote, Senate President Chuck Morse said he expected to be considering the issue again.“I agree there’s more to do, and I agree there’s a way to get there,” he said. “It’s not over.”

  • Nov 19- Long road to substance abuse treatment for New Hampshire Medicaid patients will soon be over
    By SARAH PALERMO
    Monitor staff
    Tuesday, November 19, 2013 

    Regardless of whether state lawmakers decide this week to make more people eligible for Medicaid, officials have committed to making substance abuse treatment available for the first time to people already in the program.

    The change means that for the first time in the state’s decades-old Medicaid program, participants will have access to treatment for addiction to alcohol and other drugs, which treatment officials say will save money overall by addressing the root cause of many problems.

    “The potential impact on health care from an outcome standpoint and an economic standpoint is huge,” said Ken Norton, executive director of the National Alliance on Mental Illness, New Hampshire chapter.

    “How many people end up in emergency rooms when there’s alcohol behind the situation, whether it causes a mental health incident or an accident or some other medical problem?” he asked.

    “The impact (of substance abuse) on individuals and families and communities is terrible, and providing treatment for those folks is really key.”

    The new addiction treatment coverage isn’t expected to start before December 2014, when the state enters the second year of its phased adoption of managed care, where the state pays a fee per person covered by Medicaid and the companies coordinate the individuals’ care and assume the risk that the care might cost more than the fees collected.

    Earlier this month, Health and Human Services Commissioner Nick Toumpas confirmed at a meeting of the Medicaid Care Management Commission that the department will move forward with substance abuse treatment benefits for existing enrollees.

    Gov. Maggie Hassan promised in her budget address in March to expand Medicaid participants’ access to substance abuse treatment and “continues to believe (it) . . . is the right thing to do for the health and well-being of our families, the productivity of our workforce, and the strength of our communities,” said spokesman Marc Goldberg yesterday.

    Hassan and Toumpas’s commitment to moving forward is the culmination of a years-long roller coaster for substance abuse treatment advocates in the state.

    The federal Medicaid program requires states to cover medically necessary inpatient detox treatment. All states except New Hampshire, Arkansas, Louisiana and Mississippi cover additional addiction treatments.

    Since 2008, federal law has required increasing levels of insurance coverage for substance use disorders, including mandating coverage for people made newly eligible for Medicaid under the Affordable Care Act.

    But a series of loopholes and exceptions left coverage for New Hampshire’s current Medicaid population to the discretion of the state.

    Approximately 58,000 people in the state are eligible for expanded Medicaid under the Affordable Care Act. About 170,000 people are currently enrolled in any given year.

    Adding the benefit to the program won’t require legislative action, only amendments to the contracts with the managed care companies, said Katie Dunn, associate commissioner of the Department of Health and Human Services.

    Officials from HHS said they aren’t able to determine yet exactly how much the new benefit for existing Medicaid enrollees will cost, because they have not yet defined exactly what will be covered.

    Substance abuse treatment contains a continuum of services from outpatient counseling to inpatient residential care.
    Work to define the substance use disorder benefit package will be done between now and the end of the state fiscal year in June, Dunn said.

    A budget estimate for Medicaid expansion included roughly $2,100 per person per year for substance abuse treatment.

    States have experienced anywhere from $1.45 to $7 return on each dollar invested in substance abuse treatment through reductions in other health care costs, criminal activity and increased productivity, according to a report by the Lewin Group released in September.

    “From a human perspective, people that have co-occurring mental health and substance use disorders are the people that have the poorer outcomes, and they’re the ones that are more likely to be hospitalized, more likely to be incarcerated, more likely to be homeless and more likely to die by suicide,” Norton said.

    More than 64 percent of people admitted to New Hampshire Hospital for mental health treatment had a history of substance use, and 55 percent of them were actively using at the time of admission, according to a study of admissions in six months of 2012.

    Forty-four percent of people released from prison in New Hampshire return to the corrections system, at least a third of them because of issues connected to substance use, according to the department’s 2012 annual report.

    Exact predictions of how many people would use a substance abuse benefit if it were granted are hard to come by.
    “What we know is that about 12 percent of the adult population of the state (about 125,000 people) experience problematic alcohol and drug use that would require some intervention,” said Amy Pepin, policy director of New Futures, a nonprofit agency dedicated to addressing alcohol and other drug problems in the state.

    “What we also know to be true is that not everyone needs professional treatment to change from harmful drinking or drug use, and not all who need it would use it,” she said.

    Whatever the increased demand is, it is likely more than the system can handle right now, said Tym Rourke, chairman of the Governor’s Commission on Alcohol and Other Drugs.

    The state’s network of providers is able to treat between 4 and 6 percent of the people who need addiction treatment, he said.

    “The existing provider community (has) been working really diligently, knowing and hoping this is coming, working to prepare, and they are nearing a place to be as ready as they can be,” he said.

    “In most states where they’ve turned on a substance use disorder benefit, it’s not been a wave, not been a crush of people running to the door. It’s been a slow increase over time, so we think providers have time to continue the adjustments to their business model, at the same time these benefits can begin rolling out.”

    “This is a disease, the nature of which is such that not everyone who has it seeks treatment, for many reasons, one of which is stigma,” Rourke said.

    “Part of the hope is that treating it as a disease just like any other chronic health crisis will over time reduce stigma and drive people into treatment.”

    (Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

  • Nov 18- Story of patient without available bed all too common in mental health field

    PORTSMOUTH — The story of Elaine Ronco, a Riverside Rest Home resident diagnosed with manic depressive bipolar disorder who waited at Frisbie Memorial Hospital nine days before she could be transferred to New Hampshire Hospital for full psychiatric care because of a long waiting list, is not that unusual, according to those in attendance of “All Walks of Life: A Statewide Conversation on Mental Health and Substance Abuse.”

    That conversation took place in Berlin, Concord, Keene, Nashua, Plymouth and Portsmouth Thursday night. Portsmouth Listens hosted the local event where mental health professionals, family members of people who struggle with mental illness and/or substance abuse and citizens interested in the topics discussed the ongoing problems within the mental health system. Approximately 60 people were in attendance.

    “My son is 22 years old and he has had 11 jobs since the age of 18 because of substance abuse and mental illness. He has been going to the doctor since the age of 4. We literally had to fight the system for eight months to help him get assistance,” one member of the F Group said during a break-out session facilitated by a person with Portsmouth Listens. “In April he went to the state hospital. It was very difficult for me. I can't imagine a person with mental illness getting through the system.” 

     Foster's Daily Democrat was invited to report on what was being said at the event on condition that group members remain anonymous. “We brought him to the local hospital for years. They would give him an IV and an ativan and send him home,” the same member explained. They said their son was diagnosed with oppositional defiant disorder at 4, but it took until he was 21 to get help.

    ODD is described as an ongoing pattern of anger-guided disobedience, hostility, and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior by the Diagnostic and Statistical Manual of Mental Disorders. 

    “The beds issue is such a shame. It is such a profound failure,” another group member said after the facilitator had the group read a section of data compiled by NH Listens. A chart provided by New Hampshire Hospital showed that in fiscal year 2012 there were 15.6 admissions per hospital bed. There were 6.4 admissions per hospital bed in 2002.

    The data said in an average year there are approximately 2,351 admissions to New Hampshire Hospital. 
     “An increase in the number of admissions paired with a decrease in the number of available beds has resulted in a steep increase in the rate of admissions per bed over the past decade,” the literature said. 

    Bob MacLeod, CEO of New Hampshire Hospital, said there are 30 people on the waiting list during an interview for Foster's earlier this week. Before a new patient can be admitted at the hospital, another patient has to be ready for discharge and have a suitable place to live, MacLeod explained. The hospital was forced to cut $2.1 million in 2011 and 2012, MacLeod said.

    Another group member identified with the parent whose child could not get the services they needed Thursday night. “My husband checked himself into Portsmouth (Regional) Hospital a year ago. He said he was suicidal and addicted. In five days they were going to send him home. I ended up sending him to California. Nobody at Portsmouth's hospital could guide me as to what to do,” they said.

    “New Hampshire's mental health system is in crisis, with people often waiting days or weeks for a bed,” Linda Saunders Paquette, executive director of New Futures, said in a press release for the conversation. 
     New Futures was one of the sponsors of the event Thursday night.

    According to the compiled data, one in five American adults will experience mental health problems this year. In New Hampshire, the public mental health system provides services to only 21 percent of adults who live with serious mental illness. Serious mental illness costs the United States an estimated $193.2 billion in lost earnings per year and an estimated $247 billion in annual costs overall, the data said.

    The New Hampshire Department of Corrections estimates that between 30 percent and 40 percent of adults currently incarcerated in state prisons have a mental illness. An estimated 71 percent of women incarcerated are living with mental illness, the data said.

    Jim Noucas, co-chair of Portsmouth Listens, said the event was part of a national initiative. The information collected from the groups will be processed and sent to the White House, as President Barack Obama has requested it as part of his initiative on behavioral health in coordination with the U.S. Department of Health and Human Services and the U.S. Department of Education. 

    The information collected will also be sent to state representatives, local decision makers, the media and the organizations who sponsored the event. Noucas said Portsmouth Listens puts on these break-out sessions on a variety of different topics to “strengthen the civic infrastructure.”

    “Thirty-five years ago you couldn't say the word 'cancer.' It was a dirty word. It meant you were going to die. Now you can't go a day without seeing a fundraiser or a run for cancer,” Noucas told all of the participants at the beginning of the session. “It is time to take mental health out of the shadows and that is why we are here today.”

  • Nov 14- Mental health leaders hope study will highlight problems
    NH Union Leader – November 11, 2013
    Mental health leaders hope study will highlight problems
    Waiting for beds: Governor ordered review after violent altercations in Elliot emergency room. 
    By BILL SMITH 

    State mental health system leaders say they hope the state investigation into violent outbursts by patients forced to wait days for a bed in the state psychiatric hospital will focus attention on problems with the way mental health services are delivered in the state.

    Gov. Maggie Hassan last week ordered a review of the circumstances that led to violent altercations with staff by patients at Elliot Hospital who were being held in the hospital’s emergency department for transfer to New Hampshire State hospital.

    A retired Supreme Court justice, a senior assistant attorney general and the associate medical director at New Hampshire State were named to conduct the sentinel review, a term used to describe an investigation into a negative outcome in the health care system.

    The study will focus on two episodes at Elliot Hospital in Manchester over the past several month. In July, a Manchester man who had been at Elliot waiting for a bed at New Hampshire State allegedly assaulted two nursing staff members. In October, a man was involved in an altercation with guards, also while awaiting transfer to the psychiatric facility.

    “We see it as a problem, to make people have to wait to get into the hospital,” said Ken Snow, vice president of community relations at the Mental Health Center of Manchester, which provides community-based mental health services.  Snow, and some others involved in the mental health system say there are two components to the problem. A lack of available beds in psychiatric facilities means that patients under a court order for involuntary commitment must often wait in community or acute care hospitals for a bed in a psychiatric unit.

    But he said community based centers, such as the Manchester facility, are limited in the help they provide when a patient comes under severe stress, and the situation becomes worse, building to the point of crisis. “If we could intervene earlier, there would be fewer people reaching the critical point,” Snow said.

    Mental health workers told the New Hampshire Union Leader there have been other violent episodes around the state that have not received the attention of the Elliot incidents. While the review ordered by Hassan is centered on the specific altercations at Elliot, mental health agency executives say they expect the panel to consider the broader issues that are blamed for those incidents.

    “This will give us an opportunity to look at it from a system-wide approach and maybe understand what we can do system-wide given that viewpoint,” said Robert McLeod, chief executive officer of New Hampshire State Hospital.

    The need to keep mental patients who are under state commitment orders waiting for a psychiatric bed is called a crisis by mental health treatment advocates. “(Recently,) we had 30 people who were involuntarily committed waiting for mental health services at the state hospital; seven of them were children,” said Shawn LaFrance, executive director of the Foundation for Healthy Communities, a Concord-based organization that works to improve health care in the state.

    The group published a report earlier this year documenting a reduction of about 140 beds in New Hampshire for psychiatric patients since 2005.  When all the available beds are full, the wait for admission begins when the commitment order is signed. The person ordered committed must wait in the emergency department of a hospital such as Elliot.

    Sometimes, the wait continues for days. “We would never tolerate that if these were cardiac patients who came in, or orthopedic patients,” Snow said. “If you came in with a compound leg fracture and someone said we don’t have any operating rooms or beds so we have to put you in a room and in two or three days we’ll operate, there would be a huge public outcry.”

    Some involved in the system say there is a need for a balanced approach to treatment, to help patients before their problems build and they need emergency or court-ordered inpatient care. “Whenever things get to the point where you have to do more emergency care, which is more resource-intensive, that draws energy and dollars away from more preventative care that focuses on rehabilitation and recovery,” said William Rider, executive vice president of the Manchester Mental Health Center.

    Others say the problem is also seen at the other end of commitment, when patients remain hospitalized because there are few alternatives. “There are those who are not discharged because there is not enough space in other places for them to go to,” said LaFrance. “People who work with these folks and their families realize that it’s not all just adding new beds, although there is clearly a need for that.”

    More hospital beds for inpatient psychiatric care are being added, and funding for state mental health programs was increased in the current state budget. New Hampshire State added 10 beds earlier this year, and is working to create a holding area in its admissions area to take some of the patients who might otherwise wait in emergency departments at hospitals that don’t have the resources of the state psychiatric hospital to deal with patients experiencing a mental health crisis.

    In addition, Franklin Hospital has added 10 beds for mental health patients and McLeod says other community hospitals have considered adding psychiatric beds. But, he agrees that the state needs to balance creation of more inpatient space with restoring community treatment to levels that existed several years ago so that fewer hospital admissions are needed. “The real effort should be to keep them out of an inpatient setting to begin with,” McLeod said.

    He expects the sentinel study team created by Hassan will see its mission as finding the underlying cause for the incidents at Elliot. “There are greater factors than what went on in those incidents,” he said. “I know, in attending the kick-off meeting, that these individuals will be looking at anything that could be relevant.” 

  • Oct 18- Psychiatric patient accused of attack
    Elliot Hospital: Hospital security officer Lawrence Bolduc was able to defend himself against Fernando Ornelas’ repeated punches, police said. 

    By KATHRYN MARCHOCKI 

    MANCHESTER — A psychiatric patient held at Elliot Hospital’s emergency department while awaiting admission to the state’s psychiatric hospital is accused of attacking a security officer Wednesday, repeatedly punching the guard in the face until the officer subdued him with pepper spray and after exchanging blows.

     Both the patient and security guard — a retired, decorated New Hampshire state trooper — suffered “significant” facial injuries during the assault that police say bears strong similarities to the July 8 attack on two Elliot Hospital nursing assistants by a mentally ill patient also waiting for a bed to open at New Hampshire Hospital, the state’s acute psychiatric hospital in Concord. One of the employees in the earlier attack suffered critical injuries that required lengthy hospitalization.

     Hospital security officer Lawrence Bolduc, 49, was able to defend himself against Fernando Ornelas’ repeated punches Wednesday night and pinned Ornelas to the floor until other security officers and a Manchester police officer hired by the hospital to provide extra security came to his aid, police said. 

    “My understanding is it was a very sudden, unprovoked, violent attack,” Manchester police Lt. Maureen Tessier said. 

     Ornelas, 54, of 54 Lancaster Ave., was to be arraigned Friday in 9th Circuit District Court on one misdemeanor charge of simple assault. 

     Ornelas remains a patient at Elliot Hospital; his condition is serious, hospital spokeswoman Susanna Whitcher said. 

    “Although there was an altercation with this patient last evening in the emergency department, for the safety of staff and the patient, the Manchester Police Department took custody of him,” Whitcher added in a three-sentence statement. 

     The hospital’s media staff would not say how long Ornelas had been in the emergency department waiting to be transferred to New Hampshire Hospital. They referred all other media inquiries to law enforcement authorities. There were 25 adults and three children waiting to be admitted to the state-run psychiatric hospital Wednesday morning, the hospital’s acting chief executive officer Richard C. Willgoose said. That number grew to 27 adults and two children on Thursday morning, he said. 

     New Hampshire Hospital has been at 100 percent capacity with a waiting list for several years, Willgoose said. The hospital has 158 beds. 

     The hospital’s waiting list reached its highest number ever on Sept. 3 with 49 adults and three children logged, Willgoose said. The lack of available beds at New Hampshire Hospital has emerged as one of the most critical issues facing the mental health system in New Hampshire, as mentally ill people suffering dangerous episodes can wait for days in local emergency rooms until a bed opens at the state-run facility. 

     The severity of the issue and the dangers it poses to hospital staff gained widespread attention July 8 when Ansel Kinglocke, 34, of Manchester allegedly attacked Elliot Hospital licensed nursing assistants Donald Wyman and Melissa Clermont while waiting to be involuntarily committed to the state-run hospital. 

     Kinglocke had been held at Elliot three days waiting for a bed to open up at New Hampshire Hospital when he allegedly attacked Wyman, stole his employee key card, then attacked Clermont while trying to escape. Wyman suffered critical head injuries in the attack. Clermont suffered a broken cheek bone. Kinglocke faces several assault charges and is undergoing hearings to determine if he is competent to stand trial. 

     Ornelas was being held in Elliot Hospital’s secured psychiatric evaluation unit, which is part of the emergency department, awaiting transfer to New Hampshire Hospital, police said. He allegedly “became increasingly agitated during his stay,” disturbing other patients. Bolduc asked him to return to his room and, while walking him back, Ornelas allegedly attacked him. Other security officers and Manchester Police Office Paul Rondeau came to Bolduc’s aide, handcuffed and arrested him. 

     Rondeau happened to be working a security detail in the emergency department when the incident occurred about 7:25 p.m. Wednesday. 

     Elliot Hospital recently began hiring Manchester police officers to occasionally supplement its security staff in the emergency room, Tessier said. 

     Both Bolduc and Ornelas were treated for facial injuries. 

     Bolduc retired from the New Hampshire State Police as a sergeant in 2011. He received an award in 2010 for saving a girl’s life in Weare. kmarchocki@unionleader.com

  • Oct 11- Fundraiser at Tilt’n Diner to Benefit Genesis Behavioral Health

    Join us on Tuesday, October 15th from 5 PM to 8 PM at the Tilt’n Diner, 61 Laconia Road, Tilton for a Spaghetti Dinner to benefit Genesis Behavioral Health.  The Common Man Family of Restaurants will generously donate $5 from each spaghetti dinner sold that evening to Genesis to support programs and services for children, families, and adults living with and recovering from mental illness.  

    “The Tilt’n Diner has been so gracious to host us for the past 3 years, and we look forward to another successful event on the 15th,” said Kristen Welch, Director of Devleopment & Communications at Genesis Behavioral Health, “It’s a great way to meet our community and share information about our organization and how we contribute to the health of the region.”

    “We are also in the midst of our 3rd annual fundraising and awareness auction,” continued Ms. Welch, “We will have mobile bidding set up at the diner, and staff will be available to provide information about Genesis Behavioral Health.  We hope to see our community there for good food and good company!”

    For more information about the auction, visit the website at www.biddingforgood.com/genesisbh or contact Kristen Welch at 524-1100 x445 or 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.  Find Genesis Behavioral Health on Facebook and follow us on Twitter for updates and information.  

  • Oct 11- Genesis Behavioral Health Holds 47th Annual Meeting & Fundraising Auction
    The Board of Directors of Genesis Behavioral Health will hold their 47th Annual Meeting, “Health Homes: Innovative Solutions for a Healthy Community,” on Tuesday, October 22, 2013 at 5:30 pm at The Common Man Inn & Spa in Plymouth.  The keynote address will be provided by Nancy Gilbert, MS, APRN, Director of Clinical Practice at Greater Nashua Mental Health Center.  Ms. Gilbert will speak about her organization’s experiences implementing a Health Home for people with mental illness.

    “Our vision is to move from co-location and collaboration to fully integrated health care for people with mental illness.  In order for this to happen, we understand we must change our culture, strengthen our relationships, and heighten our attentiveness to health outcomes,” said Maggie Pritchard, Executive Director of Genesis Behavioral Health, “We look forward to working with our partners to develop innovative solutions that lead to wellness throughout our communities for people in the  Lakes Region.”

    As is its tradition, Genesis Behavioral Health will present the 2013 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.  

    For the third year, Genesis Behavioral Health will showcase its annual fundraising and awareness auction at the Annual Meeting.  “Our 3rd annual auction is off to a great start, with a goal of raising $10,000 to support mental health programs and services for over 3,000 Lakes Region residents,” said Kristen Welch, Director of Development & Communications, “Auction items will be on display at the annual meeting and mobile bidding will be available for on-site bids.  We are grateful for the incredible support and generosity of our many donors.  In particular, we want to thank our Gold Sponsors, which include Bank of New Hampshire, 98.3 LNH, WEMJ, and 104.9 The Hawk, and our Silver Sponsors, Northway Bank and The Standard, for supporting this event.”

    The auction runs online 24/7 from October 1 to October 23 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 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.  Find Genesis Behavioral Health on Facebook and follow us on Twitter for updates and information.  

  • Sep 9- Emergency mental health situations at hospital
    By Elizabeth Dinan
    edinan@seacoastonline.com
    September 08, 2013 2:00 AM

    Portsmouth police were called to the local hospital to help with unruly, violent or walkaway hospital patients 200 times during the first eight months of 2013, said Deputy Police Chief Corey MacDonald.

    Simple math shows the numbers mean police were asked to assist at the hospital about 25 times a month this year, or an average of six times a week. During the same period last year, there were 173, or fewer calls for police help at the hospital, he said.

    "It is a good amount of calls for service," said the deputy chief. "The hospital provides security, but we supplement because of our ability to have that intermediate level of force."

    MacDonald explained that means the ability of local police officers to deploy Tasers, if needed, during potentially dangerous situations involving people "acting out violently."

    Police logs and officers' radio communications show calls for police service at Portsmouth Regional Hospital range from requests for help restraining violent patients to finding patients who walked away after being involuntarily admitted for psychiatric reasons. The latter are known in shorthand as "IEAs" and, according to MacDonald, those calls comprise the "majority" of requests for police help at the hospital.

    Hospital spokeswoman Nancy Notis said, "We take the safety of our patients, employees, physicians and visitors very seriously."

    And, she said, the PRH security team "works very closely with the Portsmouth Police Department and area law enforcement personnel."

    Notis also pointed to a recent study by the Foundation for Healthy Communities regarding an effort "to restore more psychiatric beds at the New Hampshire State Hospital" and bolster community mental health services "for patients who cannot find access to the psychiatric treatment they require."

    A three-month study of 575 patients, with information from 15 New Hampshire hospitals, concluded with a finding that psychiatric patients waited an average of 2.5 days in New Hampshire emergency rooms before a bed was available in the state psychiatric hospital. Three of four of those patients who waited in an emergency room for placement "required constant observation," and almost half "required special security," the study found.
    One incident cited was a single psychiatric patient who waited more than five days for a bed in the Concord psychiatric hospital at a cost of $26,310. The cost was for observation by a physician, a nurse and an emergency room technician, as well as a security team that was called to assist 14 times "when the patient became agitated and escalated," the report notes.

    "Dating back to last summer, we were hearing more stories than ever about the influx of mental health patients at emergency rooms, and it was happening all over the state," said Shawn LaFrance, executive director of the Foundation for Healthy Communities, who authored the report. "In summary, our report indicates a failure to fulfill the promise for many people seeking help for mental health problems in New Hampshire."
    MacDonald said, "The state system for people considered a danger to themselves or others is broken."
    "We, and Portsmouth Regional Hospital, are doing what we have to do to get people stable," he added. "The impact for us is we have to respond."
    And that means Portsmouth's responding officers aren't available for other calls.

    During an incident when a suicidal person walked away from the hospital in late August, MacDonald said, four officers were dispatched to find that person. Also in August, a record was set in New Hampshire on a single day when 47 people were waiting in hospital emergency rooms to be transferred for treatment at the state psychiatric hospital.

    The record was set two months after Gov. Maggie Hassan announced the reopening of a 12-bed unit at the state hospital, while saying it "will help address, but not eliminate, the waiting list in hospital emergency rooms for people seeking inpatient psychiatric care."

    Meanwhile, a federal lawsuit alleges the state does not provide adequate mental health services to citizens with mental illnesses.

    Jay Couture, director of Seacoast Mental Health Center, said a new record was set this past Tuesday when there were 49 adults and three children waiting in emergency rooms to get into the state hospital for psychiatric care. She said the need for mental health services has grown the past several years when people lost their jobs and their affiliated health insurance.

    "We're a provider who sees anyone," she said.

    Also president of the N.H. Community Behavioral Health Association, Couture has joined other mental health professionals in signing a letter to the governor asking for a meeting to plan short-term solutions. The short-term "bridge," she said, should be designed to address immediate needs while $28 million in the state's two-year budget is allocated.

    "Things are happening, but we need to come up with a short-term solution," she said. "We wouldn't tell someone having a heart attack to wait."

  • Sep 3- Editorial: Slowly improving the mental health system
    In recent days we have seen, again, the cruel reality of New Hampshire’s crippled mental health care system and a small, new glimmer of hope.

    As Monitor reporter Sarah Palermo described, New Hampshire recently set yet another grim record: the highest number yet of psychiatric patients warehoused in emergency rooms across the state, waiting for a bed at the state hospital in Concord. The previous record, set back in February was 44. But on a recent Monday in August, the number hit 47. That’s 47 people too ill, too suicidal, too dangerous to be let go but getting little if any of the help they so desperately needed – which, no doubt, made their crises even worse. Such emergencies are hard on hospitals too: Their emergency rooms are crowded with patients they’re not equipped to care for, making their regular work that much more challenging.

    More troubling still: Local experts worry that the demand for psychiatric care will likely spike in the coming weeks as children with mental health trouble react to the start of the school year. In other words, last month’s record might ultimately be eclipsed, and soon.

    To their substantial credit, Gov. Maggie Hassan and the Legislature went a long ways toward improving this dysfunctional situation this year. New Hampshire Hospital recently expanded its beds by 12, increasing its capacity to 142 (still down from 250 beds available just three years ago). And the new state budget increased support for mental health services by $28 million over the next two years. Some of that money is being used to create a new 10-bed mental health unit in Franklin, expected to open next month; it will provide an alternative to the state hospital for patients in the throes of a crisis. The money will also increase the availability of special treatment teams that can respond to crises and, with luck, prevent hospitalizations. Trouble is, much of the money won’t become available until the second year of the budget, which starts next July.

    What the terrible new ER record makes clear is that fixing the system will take time. That’s why we were encouraged to hear about a promising new program under way in Keene.

    As part of a $4 million federal grant, a group from Antioch University New England’s Center for Research on Psychological Practice will test the effectiveness of new mental health care models in reducing the number of children with severe emotional disturbances who are placed in hospitals or residential programs. In other words, are there betters ways of preventing some of the crises now clogging the state’s hospitals from occurring in first place? Among the project’s goals: better coordination among the myriad services often at play for mentally ill kids and their families: school counseling, mental health therapist, peer-support services.

    As part of the study, up to 160 New Hampshire children and teens will be served over the next four years.

    Back in 2008, advocates for the state’s mentally ill residents drew up a 10-year plan for restoring what was once a nationally recognized high-quality system of care for New Hampshire’s most vulnerable patients. It recognized that the disintegration of care had happened over time, so improvement would take time too.

    The governor and lawmakers must not take their eye off the ball at this point. Their initial investment of much-needed cash into the system was a critical first step. Now they must carefully monitor the effectiveness of that investment. One simple goal: No more records like the ones being set and then broken at hospitals across the state.

    Source URL:http://www.concordmonitor.com/home/8266442-95/editorial-slowly-improving-the-mental-health-system
  • Aug 26- Trying to help others help themselves
    By RAY DUCKLER
    Monitor staff
    Sunday, August 25, 2013 
    (Published in print: Sunday, August 25, 2013)
    Lance Dixon kissed his wife goodbye on a warm, sunny day.

    He walked a mile, to Franklin’s Ward One bridge, strangely calm after decades of inner turmoil that he never quite understood.

    He had what he needed to commit suicide. He had the rope to hang himself, 40 pounds of weight in a backpack so his body would snap hard before hitting the river, and the idea that killing himself would, finally, unburden his wife and three children.

    “They’d be better off without me,” Dixon remembered thinking. “I was totally worthless and sad.”

    Dixon lived through his suicide attempt that day, earlier this month. Neither he nor officials know if the rope broke or if someone cut it to save his life.


    What’s clear is this: Dixon spent three days in Franklin Regional Hospital, a week at New Hampshire Hospital and then a recent morning with me. He wants his story told, the one about depression and hopelessness eating at his spirit, through grade school and high school and college and work.

    Maybe it’ll help someone avoid what he’s been through. Dixon lived in denial, tried to be tough, tried to beat a serious illness by himself. He did all he could to smile and raise his children and be a good husband, and when his mental illness knocked him flat, he took a walk to that downtown bridge, around noontime, with cars humming past and the water rushing below.

    Now, Dixon finds himself unemployed, deemed too risky to receive the insurance he needed to maintain and repair HVAC equipment. He still has a pink circle around his neck – a label, if you will: suicide try. He knows people will find that troublesome.

    Dixon, 42, fears he won’t be able to find work worth having, a job with responsibility. “I was making a grand a week and looking for houses to buy, and instead of snuggling with my wife at home, I jumped off a bridge, and so I’m branded as crazy.”

    Crazy? By coming forward so others struggling with mental illness might benefit from his story? Crazy? By facing the stigma attached to his recent behavior and wondering aloud why a man with much to give can’t find his niche?

    “I want my story told,” Dixon said. “I think it’s important.”

    Off balance

    It started long ago, with panic attacks as a little kid. Dixon ran the hurdles at Pinkerton Academy, and he never stopped running or trying to clear obstacles through every aspect of high school.

    He felt lonely, isolated, different. He played chess and other board games, loved Dungeons and Dragons, carried a leather briefcase, read Stephen King. His twin sister, Stacey, was outgoing and popular, leaving Dixon with the ID, “Stacey’s brother.”

    “It was difficult socially for both of us, as he was quiet, often picked on and called names,” Stacey, who lives in Melrose, Mass., wrote in an email. “And I would try to stick up for him, but the damage was already done.


    “As early as I can remember, he was physically hurt, from the school bus to every day at school, from third grade to senior in high school,” Stacey continued. “It was just his quiet demeanor and insecurities that these bullies could smell, and (they would) seek out the weakest.”

    He married, had a son and continued his inner fight against sadness, pushing it aside as best he could while working as a sales consultant.

    Then, at age 30, his 3-year-old son was diagnosed with attention deficit hyperactivity disorder. The doctor lowered her glasses and told Dixon and his wife, Christina, that the behavioral disorder was hereditary.

    Had they experienced symptoms?

    “She profiled us and I said yes to all those questions,” Dixon said. “She asked if I’d taken Ritalin. That’s how I found out I suffered from depression and ADHD. I’d been dealing my whole life without taking medicine. It was an epiphany, but a dark one.”

    Armed with prescription medication and the truth, Dixon and Christina had two more children. He felt better more often than he had in the past, but his depression was never far away, never totally pushed aside.

    “A constant fight,” Dixon called it.

    Coping

    He attended a technical institute and acquired his gas-fitting license. He worked his way up, settling in Franklin recently and establishing himself as an HVAC technician. He says he earned $1,000 per week.

    When his illness got the better of him, Dixon would call in sick. Maybe he’d say he had the flu, maybe a headache.

    “I had to fight depression, try to keep a job, fight the side effects and raise a family,” Dixon said. “And I worked in a very macho subculture.”

    Christina tried to persuade her husband to seek treatment. The medication was helping, but something more was needed. With no health insurance at his job, though, and with something as misunderstood as depression, Dixon continued to fight alone.

    “He knew he needed help, but it was a problem of finding the right help and finding how to afford the right help,” said Christina, a part-time pastry chef in Derry. “And once your employer finds out, you’re screwed. If that’s not enough to make you depressed, I don’t know what is.”

    Worse, Dixon stopped taking his medication more than two years ago. He longed to feel normal, on his own, and he thought he could fight the illness, on his own.

    “I thought I was managing my depression without it,” Dixon said. “I found out I am not stronger than my depression.”

    Three weeks ago, on a Saturday night, Dixon and Christina went to a friend’s house for a barbecue. They had fun. “A pretty good time,” Christina said.

    Two days later, Dixon lost the fight, moving into an area he says he’d never felt before. Curling up into the fetal position and crying would no longer work. Within a day or so, he had decided. He was through.

    “This was deeper and darker than anything I had experienced before,” Dixon said, “so I decided to do something about it.”

    The jump

    He packed his work backpack with 40 pounds of tools to add violence to the end of his fall. And he packed the noose he’d made.

    He kissed Christina, dozing in the living room, and left. He told her he was going out, like he had done hundreds of times in the past. His kids were playing downstairs.

    While darkness and sadness engulfed Dixon’s mind, the day was perfect, bright with no humidity.

    “Finally,” Dixon says he thought to himself, “this will be over.”

    He walked halfway across the bridge and wasted no time, measuring the rope so his feet would dangle close to the water, then tying the other end to the bridge, on a bar running horizontal to Route 3, below the top rail.

    Dixon climbed on top, turned his back to the water and pushed away. The rest is fuzzy.

    Dixon says he noticed a white car pull up moments before he jumped, and an unknown man got out and yelled, “Don’t.” Did the guy cut the rope and save Dixon’s life? Did the rope break?

    Whichever, Dixon landed in the water, the noose still around his neck, the other end of the rope still attached to the bridge. He allowed the current to carry him downstream, dazed but largely unhurt.

    “There was an intermediate period of blackness, then I regained consciousness underwater,” Dixon said. “I don’t remember hitting the water. I just bumped and rolled around the rocks for a little bit.”

    He says once he got his footing, near a boat launch, he stood up and removed the noose.

    The police and rescue personnel were on the scene. The Franklin police report says an officer and a firefighter pulled him into a boat, took him to shore and put him in an ambulance for the drive to Franklin Regional Hospital.

    Next, Dixon spent the first of three nights at the hospital, locked in a small room, under observation. Christina didn’t show until the next day, unaware through that first night that her husband had tried to kill himself.

    Didn’t Christina wonder where he was? Wasn’t she concerned when Dixon never came home, after his lunchtime walk?

    Turns out, no. Dixon’s depression meant lots of midday exits. He’d go to a friend’s house and come home the next day, and although this episode seemed different because Dixon left his car behind, Christina never panicked.

    Except, of course, the next day, while working her part-time job delivering the Monitor. A nameless Franklin man had jumped from the local bridge, a story said.

    “I pretty much knew it was him,” Christina said.

    She called the hospital. Soon she was holding his hand and asking what they should tell his boss this time.

    The flu? A virus?

    Dixon had had enough.“I said we don’t have to lie,” Dixon said. “I said I’m done.”

    Facing facts

    Dixon spent three days at Franklin Regional Hospital, on a waiting list for admission to the state’s specialized mental health hospital in Concord. There were nine people ahead of him, despite the nature of his crisis.

    He then spent a week at the state hospital. He said the staff was professional, the accommodations clean, the activities plentiful.

    He checked out on a Wednesday morning, wearing a drab gray sweatsuit, as lifeless as his eyes, and the unmistakable red ring circling his neck. “Good luck,” a patient said in the reception area, before hugging Dixon.

    Then an employee with a raspy voice unlocked the door, and Dixon walked to the parking lot. I took him home to Franklin, a half-hour drive. On the way, Dixon explained why he went to the press.

    “Now that I’ve done something so public and I feel so grateful for being alive, I feel obliged to not hide it,” Dixon said. “If people want to discriminate against me and make it so I can’t work or raise my family, and they take away things that I should have, I guess I have to stand up and say, ‘Yep, I have depression, and I deserve to be able to live my life.’ ”

    At the time, Dixon was unsure whether he’d keep his job as a technician. Initially his boss seemed hopeful and helpful, but later that very day told him the bad news: The company’s liability insurance provider would no longer cover him. With that, he lost his job. His family’s fears instantly deepened.

    “We’re in crisis mode,” Stacey said that day. “It’s too much for him to handle. I worry about his future.”

    There is no storybook ending here. Dixon hasn’t begun looking for work yet, but fears that his illness will scare employers away. He has filed a claim with the state, saying he was wrongfully terminated.

    “Involuntary commitment is not a crime,” Dixon said, referring to his time in the hospital. “There’s no reason I can’t get insured, and there’s no reason I can’t get a job.”

    He’s collecting unemployment and disability. He’s waiting for his medication to start working. He plans on seeing a psychiatrist.

    Meanwhile, he’s not hiding from his past. It’s embarrassing, sure. As Dixon said, “When this article is published, dozens of people I worked with will know.”

    They’ll know that their former colleague suffered from depression for decades. And that’s the way Lance Dixon wants it. He wants you to know he jumped off a bridge on a warm, sunny day.

    “I think I’m a good spokesperson for this,” Dixon said. “There are people in your community who suffer from depression. They should not have to lie about it.”

    (Ray Duckler can be reached at 369-3304 or rduckler@cmonitor.com or on Twitter 
    @rayduckler.)

  • Aug 26- Record number of people waited last week in NH emergency departments for mental health services
    By SARAH PALERMO
    Monitor staff
    Sunday, August 25, 2013 
    (Published in print: Sunday, August 25, 2013)

    Despite a renewed commitment to funding mental health services in the state budget, passed two months ago, a record number of people suffering a mental health crisis waited overnight for a bed at New Hampshire Hospital.

    Last Monday, 47 people waited in local emergency rooms for a bed to become available at the state hospital.

    The previous record was set in February, when 44 people, 18 of them children, lingered in emergency rooms.

    Waiting in an emergency room often exacerbates the mental health crisis that drove a patient there in the first place. An overload of such patients also causes ripples of tension in emergency rooms, as beds and personnel, including security, are occupied by their needs.

    Late last week, after the waiting list had fallen to 31, one adult and one child waited at Concord Hospital to be transferred to the state facility. But last weekend, there were 11 psychiatric patients waiting – in an emergency department designed to support six, said Camille Kennedy, director of behavioral health services.

    The surge in need is especially concerning for mental health experts in the state because of the timing. Providers expect the wait list to grow in October, particularly among children with mental illnesses as they adapt to the first few months of school.

    “That’s something that has been historic, something we know is a trend that has existed and the mental health centers have tried to address,” said Roland Lamy, executive director of the New Hampshire Behavioral Health Association. “The fact that we have this spike now and we’re just approaching what we think is the real spike is very troubling.”

    Members of the association met Wednesday to discuss the situation, and decided they need more data before they can establish a plan, Lamy said.

    The group plans to connect with members of the state hospital association to assess demographic and diagnostic information about people who are seeking or being committed to care, and look at potential regional trends and solutions.

    “We’re looking for, are there specific diagnoses or trends that are happening that we’re not used to, or is it just a sheer spike in the number?” Lamy said. “Are more people coming from a particular region because of the community services aspect, and do we need to work more collaboratively among ourselves to help with community services?”

    Lamy said while the number was saddening, it was not surprising.

    “This is, I hate to keep saying the same thing over and over, but this is part of what we saw coming when we developed the 10-year plan in 2008,” he said. “When we said in 2008 this was a matter of life and death, we were not being provocative. We were telling what we expected to happen.”

    The 2008 plan called for 12 assertive community treatment (ACT) teams to respond to patients in crisis and prevent hospitalizations. Most of those teams were never established or never funded for 24-hour coverage. The plan also called for 132 new residential treatment beds, which haven’t been established, either.

    The state budget increased funding for mental health services by $28 million over the next two years. Part of that funding is responsible for a new 10-bed unit expected to open in Franklin in October and increased ACT team availability in most of the state. However, most of the funding increases become effective in the second year of the biennium.

    “We thought about asking to move some of those dollars to the first year,” Lamy said, “but the unfortunate reality is the state is in a tough economic situation. Maybe that’s the solution, maybe that’s something we need to ask for, but we wanted to be careful in the ask, so that those people who make the decisions have all the data that they need, and that’s something we don’t yet have.

    “We really appreciate the support the governor’s given us this year but . . . we knew this was coming. We did everything we could to educate people about what was needed, and we are still working because this is not a one-year effort, and it’s not a two-year effort. It was a 10-year plan for a reason.”

    (Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

  • Aug 15- Push continues to get help, better access for mentally ill in NH

    By GARRY RAYNO 
    NH Union Leader – August 15, 2013

    PLYMOUTH — Although New Hampshire Hospital has added 12 new beds, on any given day 25 to 30 people continue to wait in local emergency rooms without treatment, the Executive Council was told Wednesday.

    Health and Human Services Commissioner Nicholas Toumpas said 12 new beds were opened in June but those beds are filled so there is a waiting list of people with mental illness who need to be admitted.

    He noted the new capital budget includes money to reconfigure a section of New Hampshire hospital into a new 10-bed crisis center for short term emergency admissions.

    People in crisis can be brought in and stabilized Toumpas said, “but it is not long-term. The long-term solution is to keep people in their communities and treat them there.”

    The new biennial budget includes about $24 million to start rebuilding the state’s mental health system, Toumpas said, but that will take time.

    He said local crisis teams will be established and the state is working with Franklin hospital to establish a designated 10-bed psychiatric unit to treat those from the North County similar to the designated center at Elliot Hospital in Manchester.

    Last month, two workers at the Elliot were allegedly attacked by an acutely mentally ill patient on his third day in the emergency room.

    The city recently held a meeting with state and local officials to discuss what could be done to alleviate the situation.

    At the Executive Council meeting Wednesday, District 1 Executive Councilor Raymond Burton, R-Bath, said police chiefs from his district say their top priority is getting mentally ill into the New Hampshire Hospital for treatment.

    Earlier this year, HHS officials reopened a wing that had been closed in New Hampshire Hospital due to budgetary constraints after law enforcement, health care providers and advocates complained that people were languishing in hospital emergency rooms for days who were suicidal, depressed or manic.

    The state was sued by the federal government and others over its mental health system. That suit is pending in federal court.

    grayno@unionleader.com   

  • Aug 13- Potential Doctor Shortage Could Impact Medicaid Expansion Decision

    BY TODD BOOKMAN, NHPR

    If you’ve got health insurance, you know it can be hard to get a routine doctor’s appointment.
    Representative Neal Kurk (R-Weare), who sits on the commission studying a possible Medicaid expansion, worries it could get harder.

    “As a public official, will I start getting calls from my constituents saying, I had to wait another seven weeks for my doctor’s appointment? My operation took much longer on the left hip that it did on the right hip,” says Kurk.

    Dr. Gergory Soghikian is well positioned to field that question. He’s an orthopedic surgeon and past president of the New Hampshire Orthopedic Society.

    “Typically, total hips and total knees, usually getting done in a two month period,” says Soghikian.

    He says even with an expansion of Medicaid, that wait-time likely won’t change because his specialty isn’t short on physicians.

    Broaden the lens, though, and the picture gets different.

    Nationally, an aging Baby Boomer population and the influx of newly insured through so-called Obamacare will leave the country short by about 90,000 physicians by the end of the decade.

    Clese Erikson with the Association of American Medical Colleges says New Hampshire, at least on a per-capita basis, would seem prepared.

    “In terms of total active doctors, New Hampshire is above the national average. It actually ranks 9th in the physician-to-population ratio,” says Erikson.

    She says the state ranks 5th in the ratio of primary care doctors. But not all of them take patients covered by Medicaid, meaning those that do will be further stretched. The Affordable Care Act saw this problem coming and put extra money aside.

    This year and next, primary care docs will get reimbursed for treating Medicaid patients at higher Medicare rates.
    Tess Kuenning says that could help increase services at community health clinics. She’s President of the Bi-State Primary Care Association.

    “As you get more resources into the health centers, then you can use those resources to continue to build primary care capacity,” says Kuenning.

    It may not be just doctors that fill that capacity. Physician assistants and nurse practitioners are also gearing up for a possible expansion.

    “Nurse practitioners will have more opportunity to work within organizations that are expanding their primary care programs,” says Gene Harkless, President of the New Hampshire Nurse Practitioner Association. “Nurse practitioners will have more opportunity to consider whether they want to start their own business.”

    Along with primary care needs, there’s concern that the state’s already strained mental health system won’t be able to handle an influx of new patients.

    “Having more people with Medicaid does not put more psychiatrists in New Hampshire ,” says Jeffrey Fetter, President of the NH Psychiatric Society.

    Wait times at community mental health centers vary, but most facilities currently can see new patients within 10 business days. And like other health clinics, Medicaid expansion means these non-profits could get paid for the patients they currently see for free.

    Nancy Frank with the North Country Health Consortium says the reimbursement issue is especially important in Coos County, where doctors are already in short supply.

    “It is a challenge to recruit doctors to the area, because they really have to want to be in our rural communities, and they have to be able to find what is necessary for them and their partners and their families,” says Frank.

    The Commission, meanwhile, will continue to debate the necessity of Medicaid expansion. A potential doctor shortage is just one of the issues involved.  

  • Jul 25- New psychiatric unit slated for Franklin Regional Hospital

    By SARAH PALERMO
    Monitor staff
    Wednesday, July 24, 2013 

    After several attempts over the past few years, Franklin Regional Hospital plans to begin serving patients in need of acute psychiatric care in October. State officials hope the hospital’s 10-bed unit will shorten the list of patients spending days at a time in emergency rooms waiting for mental health services.

    Officials developing the project will appear this morning before the state’s Health Services Planning and Review Board, where they’ll make the case that the relatively small construction investment by Franklin Regional Hospital makes the project exempt from the board’s normal lengthy review process.

    The proposed 10-bed “designated receiving facility” would occupy the former obstetrics unit in the Franklin hospital. If all goes according to plan, it could be open Oct. 1. It will be the second such facility in the state; Elliot Hospital in Manchester has an 8-bed unit.

    In the continuum of care, this type of facility is considered one step less restrictive than New Hampshire Hospital, because hospital-based programs often allow patients to stay closer to their community. A designated receiving facility is the only type of unit, other than the state hospital, that can accept patients who are being committed against their will.

    Officials at LRGH, which operates the Franklin hospital and Lakes Region General Hospital in Laconia, have been trying for several years to bring inpatient care to the region, said Ellen Wolff, the chief nursing officer.

    In both 2007 and 2010, plans were abandoned because it would have been too costly to the hospital, she said.
    Converting the former obstetrics wing for its new use is expected to cost about $780,000, mostly for security features, accessible bathrooms and specially designed furniture, Wolff said. 

    When it’s open, the wing will employ the equivalent of 24 full-time hospital staff members; physician support will be provided by Genesis Behavioral Health, she said.

    Nearly $5 million is in the state budget for the facility for the next two years, part of the $28 million Gov. Maggie Hassan allotted for improving the state’s mental health system, which was deemed as “in crisis” by federal officials in 2011.

    In 1998, there were 101 beds for involuntary admissions at community hospitals; the opening of the Franklin unit will bring the current total to 18. A 10-year plan written in 2008 by mental health advocates advised bringing the number of these beds up to at least 48.

    Since 1990, the number of state hospital beds for adults and children has dropped from 316 to 130. In that same time period, 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. 

    On Monday, 22 adults and two children were waiting for beds at the state hospital, said Jay Couture, president of the state Community Behavioral Health Association. Those numbers are down significantly from February, when a record 44 people, 18 of them children, waited in local emergency rooms for psychiatric care.

    The state also plans to open a second acute psychiatric residential treatment program, like Manchester’s Cypress Center, this winter. That facility could have as many as 16 beds at a location to be determined through a request-for-proposal process this fall, said Erik Riera, administrator of the state Bureau of Behavioral Health. 

    “The goal is to get it down so nobody has to wait if they need inpatient care,” he said.

    (Sarah Palermo can be reached at 369-3322 or 
    spalermo@cmonitor.com or on Twitter @SPalermoNews.)

  • Jul 23- Hospital attack prompts local security review
    By JOHN KOZIOL
    jkoziol@citizen.com

    LACONIA — In the wake of the recent attack upon employees at Elliot Hospital, in Manchester officials at Speare Memorial, Lakes Region General and Franklin Regional hospitals are reviewing their security plans for accommodating mentally-ill patients in their emergency rooms.

    In addition to looking at making their facilities safer, representatives of Speare, Lakes Region and Franklin as well as of Genesis Behavioral Health, also said they’re all cautiously optimistic that the additional $24 million in the state’s mental health budget will mean more beds available for psychiatric patients at the New Hampshire Hospital in Concord and also for local, early-intervention programs.

    On July 8, a 33-year-old Manchester man, who at that point had spent three days in the Elliot emergency room while awaiting admission to New Hampshire Hospital, attacked two employees, serious injuring one of them.

    The incident highlighted the shortcomings of the current mental-health system where there is often too much demand and not enough supply, specifically of treatment beds at the state hospital in Concord. Until beds open up at the NHH, patients who need psychiatric treatment are now taken to their local medical hospital where they are placed under observation. At Lakes Region General, one such patient spent 15 days in the Emergency Department until a vacancy opened up for him at the NHH.

    Michele Barney Hutchins, who is the community relations director at Speare Memorial, said the attack at Elliot Hospital could have happened at her hospital or at any hospital in the Granite State.

    The potential problems and costs to hospitals posed by temporarily housing psychiatric patients in emergency rooms is not new, she said on Wednesday, adding that, while expanding the NHH is a good thing, the expansion will help, but won’t entirely correct a situation wherein there will probably still an unfulfilled need for residential mentalhealth care.

    “Like everyone else, we do have [psychiatric patients] in the emergency room,” said Barney Hutchins, and their presence there will be reconsidered in light of what happened two weeks ago at Elliot.

    Bud Salmon, who is the head of security for LRGHealthcare, which is the non-profit parent of both Lakes Region General and Franklin Regional hospitals, said all safety protocols at both facilities are currently being reviewed. He added that the reviews began in the wake of the Dec. 14, 2012 massacre of 26 people at the Sandy Hook Elementary School in Newtown, Conn. and include the construction of a special area within the hospitals’ emergency departments for housing mental-health patients.

    The reviews took on an increased urgency, however, because of events at Elliot, said Salmon.

    Like Barney Hutchins, Salmon thinks more beds at NHH will help LRGHealthcare.

    “I think it’s a step in the right direction,” he said. “Any time we can open more beds in Concord it will alleviate the backlog in our emergency departments across the state and if we can shorten the amount of time in the ED’s then you have less potential for a problem.”

    Kristen Welch of Genesis Behavioral Health, which serves Belknap County and parts of Grafton County, said more money for mental health services in the state budget is a very good thing.

    Apart from enhancing the capacity at the NHH, some of the money will be used to construct a 16-bed psychiatric treatment program somewhere in the state as well as to pay for the implementation of Assertive Community Treatment Teams in each of New Hampshire’s ten counties.

    Welch on Friday said Genesis is already hiring staff for its Belknap County ACT team, which, along with the 16-bed facility is intended to relieve pressure on the NHH and by extension, hospitals like Lakes Region, Franklin and Speare.

  • Jul 11- ER attack puts focus on mental health system

    CONCORD, N.H. —Concerns are being raised about the state's mental health system after two workers were attacked in a Manchester hospital earlier this week.

    Police said Ansel Kingslock spent nearly four days in a psychiatric evaluation room at the Elliot Hospital emergency room before attacking two workers on Monday.

    At Concord Hospital, Dr. Travis Harker said there have been times in the emergency room that have gotten his attention.

    "Certainly, it does frighten me at times," he said. "But I feel like I have a safe system where I work to make sure that we can kind of control the system."

    Harker said most people suffering from a mental illness aren't predisposed to violence, but there are concerns when manic, suicidal or homicidal patients turn up at emergency rooms in increasing numbers.

    "And the longer that those people stay and not get the treatment they need, the more likely that that type of person would potentially become more violent," Harker said.

    Health officials said the attack at Elliot Hospital isn't an isolated case.

    "There have been other people here in our state who are health care workers who have been injured in these situations, and also, in some instances, the security people have been injured," said Shawn LaFrance of the New Hampshire Hospital Association.

    LaFrance said he recently wrapped up a three-month study of 15 hospitals in New Hampshire focusing on this issue. Among the findings is that one in three people seeking mental health care in the state spend an average of two-and-a-half days in an emergency room.

    More than half who were involuntarily admitted on an emergency basis had to wait more than 24 hours before being placed at a specialized facility. At least half required constant observation and special security.

    LaFrance called it a standard of care that would otherwise draw outrage.

    "I don't think anybody would tolerate this if it were cancer or heart disease," LaFrance said. "I mean, nobody would think, 'Just wait here for a few days, and we'll find a cardiologist and a place to send you.'"

    Harker, who is also the president of the New Hampshire Medical Society, said the issue is so critical that his group will be devoting its annual meeting to furthering education on mental health for New Hampshire doctors.

    Read more: http://www.wmur.com/news/nh-news/er-attack-puts-focus-on-mental-health-system/-/9857858/20926596/-/22vi6q/-/index.html#ixzz2Yk4HQDvT

  • Jun 5- N.H. Medicaid Called Lifeline: Health Service Urges Program’s Expansion
    By Ben Conarck
    Claremont — The head of a top Upper Valley mental health organization has come out strongly in support of expanding Medicaid, arguing that the senate’s unwillingness to include funds to help pay for the expansion in its upcoming budget vote would be felt by many of the state’s most vulnerable.
     
    Suellen Griffin, president and CEO of West Central Behavioral Health, said earlier this week that low-income families have too much hanging in the balance for the state to not take advantage of available federal funds. Her comments come as lawmakers continue to butt heads over whether to expand Medicaid coverage for up to 58,000 additional New Hampshire residents.
     
    “Anything from a sudden death, to a divorce, to problems with children ... It impacts the entire family and they end up not being functional,” Griffin said. “They call us to get services and we treat them, regardless of their ability to pay, and we treat them for as long as we need to.”
     
    But Griffin said the mental health outfit hasn’t received any help from the state in about a decade for treating patients who are uninsured or under-insured. She added that expanding Medicaid under the Affordable Care Act would supplement coverage for roughly 30,000 New Hampshire residents who use the mental health system and fall into one of those two categories.
     
    West Central Behavioral Health is based in Lebanon and covers lower Grafton County along with all of Sullivan County, including Claremont and Newport.

    A Senate finance panel voted last month to strip Medicaid expansion, which is a component of the Affordable Care Act supported by both Democratic Gov. Maggie Hassan and the Democratic-controlled House, from the budget. Two Upper Valley Republican Senators voted against the expansion, opting instead to establish a study committee for the expansion and revisit the issue in a year.
     
    At a Statehouse news conference yesterday, Hassan sidestepped a question about whether she would expand the program without legislative approval, or veto a state budget proposal that did not include the expanded program.
     
    “We are working with the senators of both political parties asking people to rise above political ideology to move forward with this. We need collaboration across the aisle in both chambers and in all branches of government,” she said.
     
    The expansion is estimated to cost the state $85 million but would also bring as much as $2.5 billion in federal dollars to the state over the next seven years, but Senate Republicans have questioned whether those guarantees are reliable.
     
    State Sen. Jeanie Forrester — a Meredith Republican whose district includes the towns of Haverhill, Dorchester, Piermont, Orford, and Orange — said that while she recognizes the need to improve access to health care — she also has plenty of reservations about the proposal to expand Medicaid.
     
    Forrester said that she is still waiting for an answer on whether New Hampshire could pull out from the program if the federal government stopped covering its share.“Even if we could, I’m not sure once we got into it that we would want to get out if it,” said Forrester. “Because how can you pull out an entitlement once its set in place?”
     
    Forrester added that lawmakers should consider the worst-case scenario of the federal government leaving the entire tab to the state, and the question of how it would pay for the expansion under those circumstances. “Are we prepared as a state to either cut services or raise taxes to pay for it?” asked Forrester. “That’s a big question for me.”
     
    The expansion would allow anyone under the age of 65 who earns up to 138 percent of federal poverty guidelines — about $15,000 for a single adult — to enroll in Medicaid. The federal government would reimburse the state at full cost of the program for the first three years, and at 90 percent of the cost after that. 

    State Senate Majority Leader Jeb Bradley, R-Wolfeboro, issued a statement yesterday emphasizing that Medicaid is New Hampshire’s “largest and most expensive state program, costing $1.4 billion a year and accounting for 27 percent of the state’s general fund spending.
     
    “Before New Hampshire rushes into a fundamental overhaul and expansion of this entitlement, practicality dictates that we study it carefully and consider our options,” Bradley said. State Sen. Bob Odell, a Lempster Republican who represents the Newport area, also voted against the expansion. Odell did not immediately return calls for comment yesterday.
     
    State Rep. Laurie Harding, a Lebanon Democrat and vice chairwoman of the Health, Human Services and Elderly Affairs Committee, described the Senate’s position as “misguided,” contending that the federal government has never failed to make Medicaid payments, even in times of fiscal stress. “The other thing is that in order for the federal government to bail on this particular bill, it would take an act of Congress,” Harding said. “They can’t just decide not to continue the program.”
     
    Harding acknowledged questions about how New Hampshire could implement a program that critics argue could be short-lived and underfunded, but she responded with a question of her own. “If you were somebody who never had insurance, never had the ability to get treatment for your condition ... If you were offered one year of coverage, would you take that one year?” Harding asked. “My response is, of course they would take that one year ... To not give them the chance is not acceptable to me.”
     
    Griffin said there was no way of telling how many more people West Central Behavioral Health would be able to serve under Medicaid expansion, due to uncertainty about how many more people would elect to receive help if they were eligible for Medicaid coverage. She added that the expansion would allow for the treatment of substance abuse under Medicaid coverage, which New Hampshire does not currently allow but which is commonplace in other states, according to Griffin.
     
    Despite the outcome of the Medicaid expansion, Griffin said she is cautiously optimistic about the future of the mental health system in New Hampshire, especially now that the Senate has indicated it would not cut any of the $28 million for mental health services included in Hassan’s budget for the next two years. “I’m optimistic, I would use that word,” Griffin said. “I would not use ‘confident.’ ”
     
    Given that the Senate majority has asked the Department of Health and Human Services to find $40 million in cuts, Griffin said it was hard to emit confidence.But when asked if the Senate might shave funding from the $28 million designated for mental health in the upcoming budget negotiations, Forrester replied flatly, “No.
     
    “We’ve been fully supportive of that in (the Senate Finance Committee) and I doubt that the Democrats would have a problem with that issue,” she said.
     
    The New Hampshire-based nonprofit substance abuse prevention group New Futures will be holding a news conference on the topic of Medicaid expansion at 10 a.m. today at the Claremont Opera House, where Griffin will be an invited guest. 

    The issue of Medicaid expansion represents one of the last stumbling blocks that the House and Senate must overcome to solidify a budget before July. The Senate will vote on the state budget tomorrow.

  • Jun 4- Hassan makes pitch to expand Medicaid in NH
    CONCORD, N.H. —Democratic Gov. Maggie Hassan urged the Senate on Tuesday to reverse course and expand Medicaid to an estimated 58,000 poor New Hampshire adults.

    The Senate votes Thursday on its version of the state budget for the two years beginning July 1. The Senate budget would study Medicaid expansion under the federal Affordable Care Act unlike the House's spending plan, which would expand Medicaid.

    Hassan and the House included funding to implement the expansion so New Hampshire health care providers would share an estimated $2.5 billion over seven years at an estimated $85 million state cost.

    Democrats control the House, while Republicans control the Senate. The issue is the biggest hurdle to reaching compromise on a budget by the end of the month. House Republican leaders held a news conference Tuesday to support their Senate colleagues' budget.

    Hassan said it appears she needs legislative approval to expand Medicaid. She declined to say if she would veto the state budget if it blocks expansion.

    New Hampshire's Medicaid program now covers low-income children, parents with children, pregnant women, elders and people with disabilities. The expansion would add anyone under age 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,000 for a single adult.

    New Hampshire could refuse or postpone a decision, but there are benefits for states that choose to expand Medicaid now. The U.S. government will pick up the entire cost in the first three years and 90 percent over the long haul. Hassan said delaying expansion could cost New Hampshire up to $340 million next year.

    "The federal government has historically fulfilled its commitment to the Medicaid program," Hassan said at a Statehouse news conference.

    Republican leaders are wary of federal promises to keep up the commitment.

    The state's decision on expanding Medicaid is affecting efforts to implement a managed care system for existing Medicaid clients. That has been stalled because hospitals, mental health clinics and other providers refused to participate because of low state reimbursement levels for treating those patients.

    The federal government assumes hospitals and other medical providers will face less charity care for the uninsured once the overhaul is fully in place and is reducing states' ability to tap funding used to help offset those costs.

    The current budget, written by Republicans, cut state hospital aid to help pay for charity care for all but a handful of critical access hospitals. The 10 largest hospitals then sued over Medicaid rates, which complicated efforts to negotiate over managed care.

    Hassan's budget would restore some of the aid but only if the hospitals pay taxes on their revenues at much higher amounts than the Senate believes is realistic. The state parcels out the hospital tax revenue to pay medical providers, for general state spending and to aid hospitals.

    The Senate budget also would restore some aid to the hospitals and use some non-hospital tax revenues to boost the amount. In return, hospitals would have to agree to participate in managed care by July 1 to benefit. The Department of Health and Human Services also has adjusted key rates to entice hospitals to participate.

    The three companies attempting to establish managed care networks signed contracts with the state believing Medicaid would be expanded under the federal law and increase their client base by thousands of people.

    On Tuesday, Hospital Association President Steve Ahnen said hospitals probably will participate in the Medicaid managed care network even if the state doesn't expand Medicaid to cover uninsured adults. Ahnen mentioned the Senate's budget as one reason for the decision.

  • Jun 3- Health groups urge Medicaid expansion in NH
    CONCORD, N.H. —Organizations that provide free or low-cost health care and mental health services across New Hampshire again urged the Legislature on Thursday to approve expanding Medicaid coverage to the state's poorest adults.

    New Hampshire's current Medicaid program covers low-income children, pregnant women, parents with children, elders and people with disabilities, but the state is deciding whether to expand it to include anyone under age 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,000 for a single adult.

    The Democrat-controlled House and Gov. Maggie Hassan back expansion under the federal Affordable Care Act, but the state Senate's budget panel recently recommended establishing a commission to study the idea instead.

    At a news conference Thursday, officials representing community health and mental health centers argued that expanding Medicaid would help thousands of hard-working, low-income adults access primary and preventive care. The Bi-State Primary Care Association and the New Hampshire Behavioral Health Association also emphasized that federal money promised to the state if it expands Medicaid could pay for new jobs in the health care industry.

    "We have the chance to bring the greatest statewide economic impact in terms of job creation, income growth and revenue growth than any initiative ever considered by our elected officials, impacting residents of New Hampshire in every county, in every town, in every House and Senate district," said Tess Kuenning, director of Bi-State Primary Care Association. "New Hampshire has arrived at a health care crossroads. We can choose a path to healthier, more productive population with insurance coverage and access to services, or we can stay on a path to the status quo."

    Bi-State Primary Care represents 17 community health centers that serve 122,000 residents each year. The behavioral health association represents 10 community mental health centers that serve more than 50,000 individuals. Officials from both organizations said expanding Medicaid would help support what they described as financially fragile operations that serve the state's most vulnerable populations.

    A report commissioned by the state Department of Health and Human Services estimates that expanding Medicaid would boost enrollment by about 58,000 people by 2020, and together with other provisions of President Barack Obama's health care overhaul law, would reduce the number of uninsured residents from roughly 170,000 to 71,000. The report estimates that expansion could cost the state $85 million during that time period, but the state would get $2.5 billion in federal funding.

    Expansion opponents, however, don't trust the federal government's promise. Appearing on New Hampshire Public Radio on Thursday morning, state Rep. William O'Brien, R-Mont Vernon, argued that expanding Medicaid would be unaffordable and wouldn't necessarily improve health care outcomes for those who currently lack insurance.

    "It's expanding a broken system," he said. "Why don't we just put money out in barrels on Elm Street in Manchester?"

    Read more: http://www.wmur.com/news/politics/health-groups-urge-medicaid-expansion-in-nh/-/9857748/20361130/-/11p6io6/-/index.html#ixzz2V9utzQWi
  • Jun 3- Mental health advocates cautiously optimistic about state budget
    Even without casino money or a jump in the gas or cigarette taxes, the $28 million Gov. Maggie Hassan wants for improved mental health care remains in the state budget headed to the full Senate this week. Advocates are cautiously optimistic it will stay there despite a looming $40 million hole in the state Department of Health and Human Services budget.

    If it does, the state could see additional mental health services by fall: new space at Franklin Regional Hospital for people in crisis and waiting for a state hospital bed; more community housing for people who need mental health assistance; and additional treatment teams across the state.

    Jay Couture, president of the state Community Behavioral Health Association, believes public awareness has changed the priority level lawmakers have begun giving mental health care. Hassan’s two-year spending plan is the first real increase advocates have seen since before they wrote a 10-year improvement plan in 2008, Couture said.
    “I think that with the (mental health) budget cuts that have happened over the last decade and particularly over the last budget cycle, it has become apparent, not to just those who work within the system, but to the general community, just how far you can cross the line before you erode the system and it’s no longer sustainable,” Couture said. “And we are there.”

    Lawmakers have not disagreed as they’ve put together the next two-year budget. “We understood that we need to fund mental health,” said Sen. Chuck Morse, a Salem Republican and chairman of the Senate Finance Committee.

    Both the House and the Senate Finance Committee have passed budgets that leave Hassan’s proposed $28 million mental health care spending intact.

    They have differed over expanded Medicaid, which the state’s 10 community mental health centers say is critical to helping them recover the cost of serving uninsured or under-insured patients. The House included expanded Medicaid in its budget, the Senate Finance Committee didn’t. But even without expanded Medicaid, the state Department of Health and Human Services said it can move ahead on its proposed two-year spending plan for mental health services.

    Later this month, the state hospital plans to open 10 additional beds so fewer people in crisis are lingering in emergency rooms awaiting a space. Over the long Memorial Day weekend, there was an average of 23 adults and 14 children waiting in emergency rooms for bed space, according to state hospital counts.
    By July, the department plans to add 12 community residence beds to the existing for people who don’t need a hospital bed but do need intensive treatment. In July 2014, the state would add 62 more, bringing the statewide total to about 200.
    By July, there would be five additional Assertive Community Treatment Teams, which offer support to people in crisis that can lead to decreased need for hospitalization. By the following July, there would be five more, and half of the 10 would be just for children. They’d also expand coverage from five days a week to seven.
    In September, the state plans to open a 10-bed unit at Franklin Regional Hospital for people waiting in emergency rooms for a state hospital bed.
    In July 2014, the state wants to open a 16-bed inpatient unit as an alternative to the state hospital or as a transition space for people leaving the state hospital.
    The threat to these additional services is not specific budget cuts by lawmakers but a more complicated combination of budget reductions and shortfalls that, for now, total about $40 million. Here’s how that figure breaks down:
    The Senate Finance Committee, as lawmakers do every year, wants the state Department of Health and Human Services to find $7 million in budget savings over the next two years.
    The Senate Finance Committee also wants Hassan to cut $20 million in general fund spending for personnel across all agencies. Sheri Rockburn, director of finance for the department’s community-based and mental health care, said that could amount to an $8.8 million cut for all of health and human services.
    Neither the House nor the Senate finance budget includes $9 million Commissioner Nicholas Toumpas said his department owes in a federal Medicaid settlement. Toumpas has said he’ll need to find that money somewhere in his budget.
    Toumpas has also warned lawmakers that the delay in implementing managed care will prevent the state from saving $10 million he has counted on. That loss of savings will become an expense, he has said.
    Finally, Toumpas has said he expects his department to spend nearly $4 million more on aid to the disabled and on children emergency services than House and Senate finance members estimated.

    As for the $7 million in savings the Senate Finance Committee is requiring Toumpas to find over the next two years, Morse said he and other committee members would have preferred to identify the cuts themselves. Morse said the department did not present a budget that made it easy to specify cuts. “I have confidence the commissioner can find a way to find $3.5 million (in savings) each year,” Morse said.

    Rockburn said her department has discussed possible cuts or delays in new programs to make up for the possible $40 million hole. She said Friday that none of the recommendations include cutting mental health services. The one possibility discussed was delaying the addition of some community housing for people who need intense support. But it remains only a possibility, not a certainty, Rockburn said.

    Annmarie Timmins can be reached at 369-3323, atimmins@cmonitor.com or on Twitter @annmarietimmins.

  • 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- 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 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 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- 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 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 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.



  • 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!


  • 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 46th 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 2nd 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

    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

    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

  • 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
  • Mar 28- Council puts off managed care decision
    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?
  • Mar 21- State mental health system is broken
  • Mar 20- State hospital wait list hits historic high
  • 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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