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New Peer-Run Mental Health Program Aims to Reduce 'Vicious Cycle' of Recurring Hospitalizations

Greg Burdwood, executive director of Connections Peer Support in Portsmouth, in June, inside the soon to be Step Up Step Down in Northwood.
Alli Fam
Over the summer, Greg Burdwood, executive director of Connections Peer Support, has been repairing this Northwood barn, which will house a new three-bed mental health program, called Step Up Step Down.

Leon Amaya normally gets up early to plan. Over the summer, he usually wrote in his journal in a restored mill in Nashua. The space is part of Step Up, Step Down, a new program for people in a mental health crisis.

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The program has three furnished bedrooms, brightly colored walls and communal couches. But it feels more like an apartment than a sterile, cold facility.

 One of the bedrooms in the Nashua Step Up Step Down Program, with blue walls and purple curtains.
Alli Fam
One of the bedrooms in the Nashua Step Up Step Down program, where Leon Amaya stayed over the summer.

Amaya came to the program at the end of May, after he left a psychiatric unit in Brattleboro, Vermont. It wasn’t the first time he’d been hospitalized.

“I kept going in and out of psychiatric units over and over and over, and my life almost came to an end a few times,” Amaya said. “This place has really opened my mind and I'm the healthiest I've been, both physically and mentally in a long long time.”

The state has pledged up to $100 million dollars to alleviate a mental crisis that routinely leaves dozens of people in hospitalemergency rooms awaiting psychiatric care. But building the infrastructure takes time and persistence. Step Up, Step Down became part of the state’s mental health plan in 2019 and just is launching now.

For Amaya, the program is a step down from those more restrictive settings in psychiatric units.

And that's where the program gets its name. It’s a step up from a situation without enough support, and a step down from hospitalization.

“This is an alternative resource to keep folks in the community,” said Ken Lewis, the executive director of H.E.A.R.T.S. Peer Support Center in Nashua, which runs the program. 

Lewis hopes the program can help break what he calls the “vicious cycle” of mental health treatment, from going back to the hospital, to losing housing, to losing community support. Patients may need to rebuild their support network every time they need treatment.

Instead of a clinical program, Lewis said Step Up Step Down is staffed by people with lived experience of mental health challenges. During the day, residents can go to work, or search for it, and access more mental health support at H.E.A.R.T. S’ day center.

Lewis is clear that the program is not a homeless overflow shelter. But he also said the demand for the service is intertwined with the state’s housing crisis, caused by a vacancy rate of around one percent. He said the program could give participants more time to be in a safe place to transition to their next step, instead of trying to plan for their future while experiencing homelessness, staying in a shelter or couch surfing.

Amaya stayed in the program for 90 days, the maximum allowed. While he has a housing voucher for $1,075 to help him move into his own place, it's been challenging to find one.

It’s legal in New Hampshire for landlords to deny renting to someone on housing assistance, and it’s something Amaya experienced firsthand. He said he couldn’t identify many apartments accepting housing vouchers.

Right now, Amaya is staying with a friend in Nashua. He’s just applied for a rental apartment downtown, and he’s feeling optimistic about it. He said the skills he learned in Step Up Step Down have already proved useful.

“I tend to be a little bit impulsive,” he admitted. “My biggest takeaway is money management and budgeting.”

Mental health providers have been pushing for more programs like Step Up Step Down for years. Last summer, the state awarded contracts to four peer support agencies.

The contracts include start-up costs and two years of operation, totaling $2.4 million. In addition to Nashua, the program has opened in Keene and Manchester, with one slated to launch in Northwood on Thursday. Each one has three beds and 24/7 staffing.

After a lengthy hunt for the right spot, Greg Burdwood found this sunny barn in Northwood. The Step Up Step Down in Northwood is opening this week.
Alli Fam
After a lengthy hunt for the right spot, Greg Burdwood found this sunny barn in Northwood. The Step Up Step Down in Northwood is opening this week.

Greg Burdwood runs the Northwood program and is the executive director of Connections Peer Support Center in Portsmouth. After a long search for a location, he landed on a sunny barn at the intersection of Route 4 and Route 202.

The barn had been uninhabited for years and needed significant repairs, which pushed back Burdwood’s original opening date. While the setback was only a few months, Burdwood experienced a sense of urgency because he feels the program is badly needed.

Before the program could open in Northwood, Greg Burdwood and his team had to repair the building.
Alli Fam
Before the program could open in Northwood, Greg Burdwood and his team had to repair the building.

Burdwood has worked in mental health care for decades, and watched as many transitional housing programs closed their doors in the 80s. He says that's left a gap in care that needs to be addressed. Step Up Step Down, he said, “is one of those really important steps in that process.”

Over in Rochester, Melissa Silvey, the executive director of Infinity Peer Support is trying to open a fifth Step Up Step Down, but she’s facing lots of obstacles.

Unlike Ken Lewis or Greg Burdwood, her agency did not secure funding for the program last summer. The agency’s board unanimously voted the project down. They felt like Infinity Peer Support was too in flux to take on such a massive project, and needed to focus on other priorities.

“We're a day late, dollar short because of the way the board voted the last time,” Silvey said. When it comes to the board though, she’s hopeful. The board has a lot of new members and seems more amenable to the project now.

Still, even with space in their current building, Silvey has to jump through some big hoops.

The first is zoning. To have a program like Step Up Step Down, which is residential, the agency needs a zoning variance.

But there’s a history of NIMBYism in the city that has played out in zoning and planning fights. The city denied an application for a proposed methadone clinic in 2018 and a costlylegal battle dragged out for over a year against a substance misuse treatment program operating in a church, SOS Recovery Community Organization.

Funding is also a question. Despite promises of mental health investment, right now, there’s no more money specifically allocated for another Step Up Step Down. While Silvey has tried to find other sources, so far nothing has panned out.

She also foresees staffing will be tricky. The program requires overnight staff, a shift that can be hard to fill.

“I anticipate the market just for employment is going to be challenging,” she said.

But back in Nashua, the Step Up Step Down program has already inspired at least one potential staffer.

It’s Leon Amaya, who has now applied to work there.

“I could learn and grow as a person and end up going from being a student of the program to being a teacher of the program someday.”

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