Op Ed December 8, 2018 – by Craig Amoth
With New Hampshire’s midterm elections behind us, there are major changes in the works in Washington and at the Statehouse in Concord. What has not changed is the critical need for our elected officials to come together in 2019 and address the ongoing mental health crisis.
The crisis includes the boarding of persons with acute mental illness in hospital emergency departments, for lack of psychiatric beds and community-based supports; the need for better solutions for the opioid and addiction epidemic that continues to wrack our state; and the fact that suicide is up 33 percent overall since 1999 nationally and rising at an alarming rate since 2006. None of these issues are new, but years of neglect, the lack of a coherent plan and insufficient funding to support critical programs have all taken their toll.
New Hampshire’s community-based system of mental health care was once considered by many to be among the best in the nation. But since the 1980s, it has been so neglected that it took a 2013 class-action court case and a 2014 settlement to start putting it back on track. Meanwhile, our community mental health centers struggle to provide access to critical services because Medicaid reimbursement rates (the bulk of the funding for mental health) have not seen increases since 2006. The lack of sufficient funding has far reaching consequences, including a serious workforce shortage, as evidenced by clinical staff vacancy rates of about 10 percent across the 10 community mental health centers.
New Hampshire now has a unique opportunity to address these concerns and set an example for others in the nation. Work has been underway this past year by service providers, advocates, state officials and others, to develop a new ten-year mental health plan. A draft of the plan was recently released by the N.H. Department of Health and Human Services and the department is soliciting public comment. The plan was thoughtfully developed and does hold much promise, but lacks specificity and clarity in some areas.
A meaningful first step would be to increase the Medicaid reimbursement rate to assist community mental health centers and other providers of psychiatric services with critical staffing shortages. A simple fix is to include adequate funding for a permanent rate increase in the next budget. The state could and should do more to support the State Loan Repayment Program, which helps medical and behavioral health professionals with their tuition loans if they agree to stay and practice in the state for a certain length of time. The repayment program is a proven way to attract and retain staff and should also be funded in the 2020-2021 state operating budget.
The state needs to take meaningful steps to relieve staff at health care organizations of duplicative and unnecessary administrative burdens. There is a whole litany of reforms like these — some of which will require funding, some of which will just require common sense — on which the governor and Legislature should collaborate if they truly want to increase efficiency and focus this limited workforce resource on more direct care.
Community-based services are necessary and important, but the lack of sufficient psychiatric hospital beds across the state needs to also be addressed. Last but not least, meaningful reforms and funding of services for children, youth and families have to be included in the Plan if we are to be successful.
The recent November election marks the unofficial start of the 2020 New Hampshire presidential primary. With the national spotlight of the primary about to shine on us, we have a unique opportunity to offer examples of compromise, cooperation and civility to the rest of the country, and particularly to our very divided federal government. We have the advantage of being a small state, where people know each other, where we see the concrete impacts of action and inaction by the Legislature in real time, on real people, and where we can get things done.
This is a pivotal moment for mental health in New Hampshire: we need statesmen to help put back together a broken system of care, and we can set an example for the rest of the United States as we do it. New Hampshire should aspire to be first in the nation for best practices in governing, as we pass meaningful policy and budget bills in the 2019 session to bring back a mental health system we can be proud of.
Craig Amoth is CEO of Greater Nashua Mental Health Center and a member of the National Council for Community Behavioral Healthcare.