Report reveals gaps in outpatient services
Lack of community-based assistance clogs mental health system
Portsmouth Herald - 1/7/2018
PORTSMOUTH - A report released last week by Gov. Chris Sununu and the New Hampshire Department of Health and Human Services reveals continuing gaps in the state's mental health services.
The report was an evaluation of the capacity of New Hampshire's health system to address behavioral health needs and points to a shortage in community-based services. The evaluation was conducted by Human Services Research Institute as called for in legislation passed by the state Legislature and signed by Gov. Sununu. It includes mental health and substance abuse disorders in the study as comparable conditions.
HSRI evaluators reviewed more than 50 reports, presentations and data sets, and interviewed 55 stakeholders to identify gaps in the health system's ability to respond to the number of individuals in need of behavioral health services who are waiting in hospital emergency departments. The report recommends that increasing access to community-based services, such as peer support, crisis and urgent care, and to services and housing for individuals transitioning from inpatient care to the community as critical to alleviating the burden on hospital emergency rooms.
"The perception is that extended wait times for behavioral health services in hospital emergency departments are due to there being too few inpatient beds at New Hampshire Hospital," Gov. Sununu said. "Importantly, this report shows that we can take steps to increase availability of these inpatient services by expanding community interventions for those ready to leave New Hampshire Hospital. In doing so, we can better meet the behavioral health needs of patients who need inpatient services as well as those who are ready to transition back into the community."
Because of the study, Gov. Sununu and DHHS Commissioner Jeffrey A. Meyers, with support from Legislature leadership, are redirecting funds set aside for designated receiving facility beds for involuntary admissions to housing services.
"The evaluation confirms what the Department has suspected - that a lack of community-based services is prohibiting the timely discharge of patients from New Hampshire Hospital," Meyers said. "While the Department has and will continue to focus efforts on transitioning those waiting for mental health beds, the wait list cannot be fully addressed until there is greater capacity in the mental health system to increase patient access to community-based services."
Dr. Matt Davis, medical director of behavioral health at Portsmouth Regional Hospital, serves on the Executive Council of the New Hampshire Mental Health Society.
"What we need to do is find solutions now, not in five to 10 years," said Davis. "We need to look at the gaps identified. I think with the amount of attention this is getting now because of the crisis, it's the perfect time to act."
Davis said the report contained few surprises and highlighted the need for better community-based resources, but didn't really address the need for more beds.
"There wasn't anything surprising in the report," Jay Couture, executive director of Seacoast Mental Health Services, said. "It calls for the development of a 10-year plan. We had a 10-year plan in 2008 which was not funded as it was the time we went into the worst recession we had seen so we backslid."
The recommendations in 2008 were not too different. Couture said that plan also addressed the needs for transitional housing and included detailed community-based options.
"So, this report affirms the needs," Couture said. "Now we need to create plans to implement the recommendations. Our systems are complex and interconnected. No one fix will take care of this."
One problem is the wait list for beds. The number of beds increased from 430 in 2016 to 458 in 2017. The report indicates that increased outpatient services for crisis prevention could be a way to reduce the demand for inpatient beds.
Because New Hampshire Hospital was in such a crunch because of the increased influx of mental health and substance abuse patients, Portsmouth Regional Hospital and Parkland Hospital made efforts to supplement with additional beds and two new programs.
Justin Looser, director of behavioral health at PRH, said that adding new beds and programs was needed, but it still has not mitigated the problem.
"We are all busting at the seams," said Looser. "We are not changing the global New Hampshire picture. Outpatient services are needed to avoid the need for hospitalization. We need a mixture of inpatient and outpatient services, and that costs money. Hospitals can work to expand beds, can build it, but if they can't staff it, there is no progress."
Looser said the state's mental health service providers need to work together to establish a clear line of care for patients.
"There is a global lack of resources in the state dedicated to mental health," said Davis. "We lack staff from the bottom right up to psychiatrists. There is a national shortage of psychiatrists in this field. We want to be part of the solution. New Hampshire used to be a role model in this area. We can be again with the right resources."
Couture said she would like to see better collaboration among the state's 10 mental health centers. She would like to see more transitional housing, particularly when it can allow people to remain in their own communities.
"The biggest challenge is housing," said Couture. "When people are released from a center or even jail, there is no way for them to ease back into society. They end up back where they started. We have one group home in Greenland, with eight beds. It's always full and there are always people waiting."
The report suggested a bridge subsidy program to address the need for housing, which Couture supports. The problem, she said, will be finding landlords willing to work with the people involved.
Another problem identified is the lack of sufficient workforce in the mental and behavioral health fields.
"We are competing with hospitals for employees," Couture said. "We can't afford to pay the salaries they can offer. So, staff in this field is often inadequate."
The report details a series of recommendations, which will serve as a foundation for the development of the 10-Year Plan for Mental Health, which was also part of a comprehensive package of initiatives passed in the 2017 Legislative Session. It was funded with a contribution from the New Hampshire Hospital Association and federal resources.
The full report can be seen at https://www.dhhs.nh.gov/dcbcs/bbh/documents/nh-final-report-12222017.pdf.