The shooting death of a Gilford teen by police this month has raised concerns about New Hampshire’s efforts to provide mental health services for young people. Gilford police had been called to 17-year-old Mischa Fay’s house multiple times in the previous year due to mental health concerns. This time, an officer shot and killed Fay.
Dr. Julie Balaban is Section Chief of Child and Adolescent Psychiatry at Dartmouth Health Children’s. She spoke with NHPR’s All Things Considered host Julia Furukawa about what services are available for teens in crisis, and what gaps remain in the state’s mental health system. Below is a transcript of their conversation.
Transcript
Julia Furukawa: It's no secret that New Hampshire has struggled to fund and build out a robust mental health system, especially for young people. Can you give us a sense of what services are available and maybe what gaps still remain?
Dr. Julie Balaban: Sure. There are many services that are available at very different levels of care for kids. I think the problem is that there aren't enough of each of them to meet the needs. So at the, let's say, the mildest level of need would be somebody who might be struggling with something that would benefit from some therapy, either individual therapy or family therapy. And we certainly have a lot of wonderful, well-trained specialists in child and adolescent mental health, as therapists, in the state of New Hampshire. We just don't have enough of them. Then in the more specialized or intensive level, more complicated psychological needs. So, for example, children who need to manage trauma in their life, and we have a lot of those families in New Hampshire, they often need specialized psychological services, psychotherapies. And there are fewer people who are trained in very specific evidence based treatments for some of the more complicated problems. So it's a little bit harder to find people and the waitlists would always be longer for those. And then, of course, the highest level of care is inpatient hospitalization.
We certainly have a lot of wonderful, well-trained specialists in child and adolescent mental health as therapists in the state of New Hampshire. We just don't have enough of them.
Julia Furukawa: Now that you mentioned that, a shortage of inpatient psychiatric beds for children and teens has been a long standing issue here in New Hampshire, and the state has acquired Hampstead Hospital to help. However, there are now even fewer beds available there because of some staffing shortages. What might the consequences of that be?
Dr. Julie Balaban: Well, we already have the consequences of that, which is kids in need of hospitalization are sitting in emergency rooms or at our hospital, sometimes on the inpatient pediatric unit, and keeping those beds from kids who need it for medical reasons. I personally have always felt that one of the problems with the inpatient hospitalization situation was that it has become the place that kids need to go because of the lack of the other services that I already discussed. So kids who are unable to access the right level of care that they need before they get to the point of needing a hospitalization might avoid needing a hospitalization.
Julia Furukawa: So teens who may be in an acute mental health crisis may exhibit aggressive or violent behavior. Are there kinds of interventions available that could hopefully prevent a situation in which law enforcement might be involved?
Dr. Julie Balaban: One of the things that has happened more recently nationally, of course, is the 988 crisis line, which is great because it's something that everybody can remember. But in New Hampshire, they've also rolled out a rapid response program that I think has a lot of potential for being able to intervene in situations before it gets to that level of safety and risk. So if families are noticing that kids are really struggling or starting to escalate and they can get the rapid response team to come out and, either to talk with them on the phone, or by [telehealth] or even to come out to the house and meet with them and help to calm things down, hopefully that would avoid the need for calling the police to keep things safe. And I think that if there's a system in place, and I don't know that there is, but there could be, where when 911 gets the call for something that's identified as being mental health related, it would make sense to also then reach out to the rapid response team for that area. And I think the two together really probably have the best way of managing a situation like that. I know that we have an adult psychiatrist in our program who's actually gone out to some of the local police stations to work with the staff there about de-escalation, and I think that's something that could be done more widely and in an ongoing way to really support the officers who are faced with this situation.
