Op Ed June 8, 2019 – by Suellen Griffin
For far too long, there has been discouraging news about New Hampshire’s mental health system and the obstacles that people in a psychiatric crisis encounter when trying to access care. Hospital emergency department boarding is a daily occurrence; high staff turnover at community mental health centers makes timely access to care difficult; and stagnant Medicaid reimbursement rates have created a serious workforce problem. On top of this, children in need of services have often fallen through the cracks of a siloed behavioral health system.
The good news is that there are significant strides being taken this year by the Governor and the Legislature to support and fund the new 10-year Mental Health Plan, which, unlike earlier plans, includes children and youth as a targeted population. The plan promotes early identification and intervention; expands early childhood/family strengthening programs; includes access to home visiting services, screening and additional assessment of infants and caregivers; and recommends new children’s mobile crisis units. Further, the plan builds on proven state and community-based programs, such as the FAST Forward model; the Multi-Tiered Systems of Support for Behavior and Wellness (MTSS-B); and last year’s SB 534, which directed state agencies to “collaboratively develop systems of care to better meet the behavioral health needs of NH’s children and youth.”
In almost all respects, the success of the new 10-Year Mental Health Plan depends on the ten community mental health centers (CMHCs). Right now, the CMHCs have psychiatrists, clinicians, and case managers – many of whom are working for far less pay than they might receive elsewhere – serving more than 10,000 children, youth and families across the state. They are in hospital emergency rooms holding the hands of traumatized youth waiting for an inpatient bed. They are in our schools, helping teachers and students de-escalate potential crises. And they are serving children and families daily in clinics statewide, providing high-quality, evidence-based treatment and community-based supports that are proven to work.
This CMHC system of care reaches into every corner of New Hampshire communities, often unseen and unheralded. CMHC staff are embedded in schools, hospitals, and the juvenile justice system. They are integrating primary and behavioral health care for children; introducing new methods for treating children coping with trauma and PTSD; and providing suicide prevention programs in the community and in schools. They are the first ones called on when there is an emergency in the community and are on the front lines providing crisis intervention services for which they are not reimbursed. All of this underscores the fact that our community mental health system is not a “failed” one, as some have called it in recent years. It is a successful one, with dedicated professionals who have made it work despite the fact that it has been underfunded.
Investments in the new 10-Year Mental Health Plan are important, but to seriously invest in care for children with behavioral health needs and fully implement the Plan, CMHCs need the ability to attract and retain psychiatrists, child psychiatrists and other clinicians. The Medicaid reimbursement rate for health care providers translates directly to salaries and benefits at the CMHCs. The ten community mental health centers currently have over 200 positions vacant because they can’t afford to pay what their competitors can. The state budget, now in the Senate, includes a 3.1% increase for Medicaid providers across the board, for each year of the next biennium. This is part of the larger workforce proposal which the CMHCs and 50 other health care organizations have advocated for and fully endorse; it is not a cure-all, but it will make a world of difference.
We applaud the work of the Governor and the Legislature in coming together to move the new 10-Year Mental Health Plan forward. We hope they will similarly agree on the Medicaid reimbursement rate increase proposed in the Senate budget. Our children are our state’s biggest asset and we must ensure they receive critical mental health services when and where they need them.
Suellen Griffin is President and CEO of West Central Behavioral Health and serves as an officer of the NH Community Behavioral Health Association.