‘System Is Broken: Mental Health Centers Seek $30 Million To Add Workers, Bolster Treatment

In the past two years, the state has spent millions of dollars expanding mental health care. But those in need are still waiting. In the trauma center, several days. The mobile crisis team is an hour away. To register for a consultation. For placement after psychiatric treatment.

Mental health advocates say that lack of treatment has consequences. Patients who delayed cancer or heart treatment during the pandemic have seen their conditions deteriorate, as have people who did not receive timely mental health care.

"It's like telling a pregnant woman, 'Cross your legs and wait,'" says Maggie Pritchard, president of the New Hampshire Behavioral Health Association and executive director of the Lake County Center for Mental Health. "If someone is having a psychotic episode and they need help, you can't do that."

The 10 partner community mental health centers, which treated about 60,000 people last fiscal year, most of whom are covered by Medicaid, told Gov. Chris Sunui they need an additional $26 million to $28 million a year to address time Standby. To cover costs, they suggested that states increase reimbursement rates for Medicaid, which funds about 70 percent of the central budget and does not fully cover the cost of providing care.

“With the exception of the last two years (the center has raised rates 3.1% per year), the rates that govern our rates have not changed in 20 years,” said Roland Lamy, executive director of the association. "One quickly sees that inflation is inflation and we are not immune to it."

The budget increase, which increases rates from 21.5% to 23%, will support two key needs, Lammy said: hiring and retention, and housing.

With about 340 clinical openings, the center is asking for a raise of between $26 million and $28 million, which Lamin says is 7 to 43 percent below the national salary reported by the federal Bureau of Labor Statistics. The average annual salary for a downtown psychiatrist is about $68,000 less than the national average. Registered nurses make about $13,000 a year, while psychologists only make $40,000.

The centers are also seeking an additional $1.5 million to add an additional 60 beds for people who do not require hospitalization but cannot live independently. A severe shortage of all housing options prevented New Hampshire hospitals from discharging patients who were ready to be discharged but had nowhere else to go. Jake Leon, a spokesman for the Department of Health and Human Services, said 50 patients, each with one bed, and 44 adults were waiting to be hospitalized.

The center will get Sunuu's response on February 14 when it announces its biennial budget proposal. If that includes his request for nearly $30 million, the funding will still face months of budget negotiations between the House and Senate.

Untreated mental illness is associated with other illnesses, substance abuse, increased risks of homelessness and incarceration, and problems at work and school. If left untreated, it also increases the risk of suicide, which is the second leading cause of death among Granite Staters ages 10 to 14 and 25 to 34, according to the Centers for Disease Control and Prevention.

The pandemic has exacerbated barriers to mental health care and forced more people to seek help when they lose their jobs. The pandemic has also brought significant state funding to address the shortage of medical services.

With Sunuu's approval, the Department of Health and Human Services spent $15 million to purchase Hempstead Hospital to expand inpatient and outpatient care for children and adolescents. A year ago, the province launched Emergency Access Points, 24-hour call centers for people seeking mental health and substance abuse treatment. He can be reached by phone at 833-710-6477, the national hotline at 988 or online at nh988.com. Leon said the call center answered about 22,000 calls, texts and chat messages in the first year.

All 10 community mental health centers now have mobile crisis response teams that respond to a person's location and are an alternative to EMS. During the first six months of 2022, the team flew around 8,400 stabilization missions.

Leon said the department is renovating a 15-bed unit at Hampstead Hospital that will care for children and adolescents. It also expanded its care team to include nurse practitioners, mental health counselors with master's degrees, and counseling assistants to reach more children.

The centers received funding in the last budget to begin expanding vacant housing in their areas. And they have used about $45 million from the federal pandemic in employee bonuses, salary adjustments, benefits and training in the hope that the investment will encourage staff to stay and hire new employees.

At Riverbend Community Mental Health in Concord, staff received gift cards, new desk chairs, and wellness activities. Car maintenance offered to employees who work outside the office and visit customers in the community is very popular.

"It was so successful that we wanted to see if we could do it again," Riverbend CEO Lisa Madden said. "They feel honored and respected for doing their job in their own vehicle."

Susan Stearns, executive director of NAMI NH, which connects families with support and resources but doesn't provide care, said the investment, especially the call center, was an important step forward.

"I understand that there is still a lot of work to be done to build this system," he said. “But it gives me great hope. When you think about how big and complex it is, I think New Hampshire has been able to make this very transformative system change in the middle of a pandemic. So we know we can do hard things. I get real hope from things like this. The need is too great.

Stearns knows that families, providers and advocates get frustrated when investments don't remove barriers to treatment.

“I don't want to say it will take longer than you expect, because systems transformation takes time,” he said. "The problem is that we don't have much time."

Center leadership said this need could not be met without addressing the labor shortage for people with disabilities. They say that it is impossible to do without increasing salaries by 26-28 million dollars a year. In addition, Madden said the student loan forgiveness available to doctors with graduate degrees should be extended to doctors with graduate degrees.

Madden is seeking to fill 40 positions, 37 of which are clinical work working directly with patients. According to him, staff turnover is very high, especially for new employees. 45% of people quit smoking within the first year and 22% within one to two years.

Like Madden, Pritchard says job offers sometimes go unanswered for weeks.

"In the past, if you had more demand, you hired more workers," says Pritchard. - Now no one comes through the door. Instead, he said, medical staff were trying to meet the increased demand by taking on additional clients or extending the time between client appointments.

Lamy said this allowed the center to see more clients despite reduced clinical staff, but also increased the risk of staff burnout.

"I've been doing this for a long time, and the sadness that you see on the faces of suppliers knowing that we can't meet demand is not due to a lack of effort, a lack of desire," Madden said. . "It's real. It completely destroys the essence of your professional existence and it's hard to watch."

This is painful for the client.

"Without a doubt, what we've gotten the most is the difficulty in accessing care, getting to that first appointment," says Stearns. “If you're lucky, you'll talk to someone who tells you we can wait for you. Some places will say, "Call every day until we have space." Some say, "We don't believe there are future revelations that we can predict." "

A Concord mother and her 15-year-old son, who asked not to be named to protect their privacy, have been particularly hard hit by labor shortages.

He has been in the Concord Hospital emergency room since Jan. 6, waiting for one of the 55 beds at Hempstead Hospital, the state's only children's hospital. He is not alone.

On Monday, 11 more children were waiting for beds. The staff shortage is partly attributed to the 55 adults and children waiting to be admitted. Leon said nine beds at Hampstead Hospital were closed due to staff vacancies. New Hampshire Hospital, the largest adult behavioral health hospital in the state, lost 31 beds for the same reason and has about 150 beds available, he said.

The 15-year-old mother said she waited longer than most because she had the only room in the hospital. He was first admitted to Hampstead Hospital last summer after suffering an amphetamine-induced psychosis caused by ADHD medication.

He said he was belligerent and angry, which was also out of character for him. A deep anxiety came. "It's a little scary, really," the woman said. He said he started consulting after waiting a year for the opening in Riverbend.

Her son called 911 on January 6 and said he was afraid of hurting himself. He went to Concord Hospital that same day.

The so-called "yellow pod" holding areas are not designed to hold a person for days, let alone weeks. The boy's mother said that a few days after his arrival, he had not received the medication prescribed and supervised by people without mental illness. “They don't know how to de-escalate,” he said. "The smallest things become the biggest."

However, she said she did not want her son sent home.

“He realized it was a means to an end and that was what he had to do. I knew the system was broken. I think he understands that.

A brain dead teenager can only roll his eyes and write texts