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Two N.H. mental health programs prepare to reopen after staffing shortages caused a temporary closure.

 A bright room inside the Manchester Step Up Step Down Program includes a couch and a tapestry.
Samantha Captain
A room inside the Manchester Step Up Step Down building. The program houses three residents at a time, who can stay for up to 90 days.

Next week, residential mental health programs in Northwood and Manchester will reopen, after staffing shortages left them unable to keep running this winter.

“In a short window of time, we lost almost half our staff…[we lost] four people,” said Samantha Captain, the residential program co-director at On the Road to Wellness in Manchester.

Step Up Step Down, the program Captain helps oversee, offers three Granite Staters a 90-day stay with daily mental health support. Like the name, residents can “step up” into the program while managing mental health challenges, or “step down” from an intensive care setting like a psychiatric hospital. It’s a part of the state’s push to improve mental health care, and reduce the acuity of the crisis in emergency rooms across New Hampshire.

Instead of a clinical program, Step Up Step Down is staffed 24/7 by people with lived experience navigating mental health challenges. The Manchester and Northwood programs are two of four in New Hampshire, and each opened in the last 13 months.

A tight budget has been one challenge for recruiting and retaining staff, said program manager Kali Moulton of the Northwood Step Up Step Down.

She said for many staff, herself included, working at a non-profit mental health agency is more than just a paycheck. But that doesn’t override financial realities. “We still need to be able to pay our bills,” Moulton said. “How do I find someone who can exist on $15 an hour?”

The program is currently state-funded, but Moulton hopes to access more funding through outside grants in the future, which could help raise wages.

The Northwood and Manchester Step Up Step Down programs are one of many New Hampshire health care sectors struggling to recruit and retain health care staff. From nursing to mobile crisis response, the pandemic has exacerbated the state’s long-standing health care staffing shortage.

Moulton and Captain said the program was providing the support for residents they had envisioned, so the temporary closure has been especially hard.

“Residents told us they really could focus on what they needed to focus on to help get their balance back,” Moulton said.

The two also know the need for this type of transitional mental health program is significant. In Keene, the Step Up Step Down currently has a waitlist of 11 people. The program is receiving referrals not only from hospitals but local drug courts and jails, said Christine Allen, executive director of Monadnock Peer Support, the agency that runs the Keene program.

Now, with a reopening date fast approaching, Moulton and Captain are getting ready to receive new residents. The two have hired sufficient staff to help run the program. But both say they’d like to hire more to offer more flexibility for their current teams.

“I'm still looking for an on-call per diem type of a person,” Moulton said, “to help if anybody's out sick or on vacation or whatever it is that we need to do.”

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