The Mental Health System Adjusts to COVID-19 | New Hampshire Public Radio

The Mental Health System Adjusts to COVID-19

Mar 30, 2020

Mobile crisis team members.
Credit Mental Health Center of Greater Manchester

For Granite Staters struggling with mental illness -- and those caring for them -- fears about COVID-19 have added layers of anxiety. Telemedecine can help but not in all cases, and protective gear needed for in-home visits is scarce.  Community mental health centers, considered essential services, remain open around the state, with as many services as possible being provided remotely. But case managers must still at times drive patients to get their prescribed injections, and mobile crisis team members must respond in person in crisis. We talk with those managing these situations, trying to help while also keeping themselves safe. 

Air date: Monday, March 30, 9 a.m.

 

Mental health professionals urge people suffering from suicidal thoughts to seek help by contacting the National Suicide Prevention Lifeline, which is available 24 hours a day at (800) 273-8255, or by texting the crisis text line at 741741.  

 

FOR MORE RESOURCES, SEE BELOW: 

 

 

GUESTS:

Mental Health Care Resources:

To find a community mental health center near you, visit here.  These centers are open 24 hours a day, seven days a week.  

To find a peer support group near you, as well as "warm lines," phone numbers to call when help is needed during times of mental distress, visit here.  Anyone who is experiencing suicidal thoughts is urged to call the National Suicide Prevention Lifeline at 800-273-8255 or text 741741. 

Visit NAMI-NH, the New Hampshire Chapter of the National Alliance on Mental Illness, for the latest on mental health care in N.H. during the COVID-19 crisis, for help finding support,  and for numerous crisis lines, including  the national Disaster Distress Helpline at 800-985-5990. 

The Harbor Homes mobile crisis response team covers Amherst, Brookline, Hollis, Hudson, Litchfield, Mason, Merrimack, Miford, Mont Vernon, Nashua. Call 603-816-0101 to reach this team.

The Bureau of Behavioral Health at the N.H. Department of Health and Human Services can be contacted here

 

Related Reading:

A psychiatrist writes about mental health during this pandemic: "Just as we are moving rapidly to safeguard our physical health, we must act with equal urgency to preserve our mental health and make psychiatric care accessible."

Health care workers report high rates of depression and anxiety, a new study shows.  

Some, including the WHO, argue that we should be using the term "physical distancing" vs. "social distancing," which emphasizes a sense of social isolation during a time when social connections are essential. 

Transcript

 This transcript is machine-generated and will contain errors.

 

Laura Knoy:
From New Hampshire Public Radio, I'm Laura Knoy and this is The Exchange.

Laura Knoy:
New Hampshire's mental health system already had its problems even before the Corona virus hit. But now in the midst of a pandemic. Granite Staters struggling with mental illness have added anxiety and in some cases added trouble getting the care they need. Mental health professionals are extra challenged these days as well. While telehealth helps, in some cases, it doesn't work for all. And no shortages of protective gear we hear about in other health settings apply to some mental health providers who see patients in group homes, in hospitals and community centers. Today, on The Exchange, how New Hampshire's mental health system is faring amid a pandemic.

Laura Knoy:
And a reminder that mental health groups urge people suffering from suicidal thoughts to seek help by contacting the National Suicide Prevention Lifeline, which is available 24 hours a day at 800 273 8255, or by texting the crisis line at 7 4 1 7 4 1. That information is all on our Web site NHPR dot org slash exchange. Our guest for the hour: Jay Couture, She's CEO of Seacoast Mental Health Center and president of the New Hampshire Community Behavioral Health Association that represents all 10 community mental health centers around the state. Jay Couture, welcome back. Great to have you.

Laura Knoy:
And also with us, Jessica LaChance, director of the Mobile Crisis Response Team for the Mental Health Center of Greater Manchester. Her team covers Manchester, Bedford, Candia, Goffstown, Hooksett, Londonderry, Auburn and New Boston. Jessica, it's a big coverage area. You're busy person. We appreciate your time.

Laura Knoy:
And also with us, Ken Norton, executive director, the New Hampshire chapter of the National Alliance on Mental Illness and Ken Norton. Welcome back and thank you again for helping us out. Good morning. Well, all of you, can you first just tell us how this coronavirus and the way it has affected our entire state from both health concerns to social distancing and its impact? How has this changed life for the people that you work with? Ken?

Ken Norton:
Well, I think that there's kind of three groups of people that we're trying to address. And the first thing that people with serious mental illness that had been involved in the mental health system and has some connection to the mental health system in a previous diagnosis, whatnot. And then the second group is the general population. How is it affected all of us and how will it affect all of us? And then I think the third group that we need to begin to pay attention to is how is it going to affect the providers, the folks that are on the front lines? And, you know, certainly the kind of short answer is that many of the services that had been provided face to face are now being done remotely to the extent that they can be, but that there are still many people that are on the frontline seeing people every day.

Laura Knoy:
Jay, How about you? How has this pandemic affected the way that you do your work and the people that you work with, whether they are patients, as Ken described, or the providers?

Jay Couture:
We are definitely trying to find that balance between meeting client needs and protecting staff safety and client safety as well. So we have had to rapidly transition into that telehealth universe and figure out for those people that we are interacting with face to face, for example, in our group home or in our injection clinic, how we're able to best provide that service even when we can't get adequate personal protective equipment. So it's been a challenge, we're having daily huddle every morning via Zoom for staff and getting out regular communications daily to staff just to try to let everyone feel like they know what are the decisions that are being made today and how is that going to impact the work that I'm doing?

Laura Knoy:
Do you have any sense, Jay, of how much of the work that you do can be done through telehealth and how much has to be done face to face? Because I think a lot of listeners might think, well, mental health that's taking your meds and talking to your therapist, you don't need a face to face for that. But you seem to be saying no. And in some instances there is direct contact. There has to be.

Jay Couture:
That's true. If you are receiving a medication by injection, which we have probably 150 to 170 individuals for whom that's the case, then you need to have a direct interaction with a health care provider who can give you that injection. If you are living in a residential group home that is staffed 24/7, then you're going to have face-to-face interactions with individuals and some of our clients who need to be seen in person on the assertive community treatment team. You know, those individuals are also still getting some. face-to-face interactions. Though it's not as simple as moving everything to telehealth, but everything that we can move, we are moving. And generally it's been pretty well-received.

Laura Knoy:
Jessica, how about you? You're helping people directly, people who are immediately in crisis. How has the pandemic changed the way that you work?

Jessica LaChance:
Sure. Well, just to reflect what Jay has said, I think, you know, we are trying to be as business as usual as possible in this sort of new pandemic world. So it's certainly a challenge. But I think the message that community mental health for certain wants to get out is that we are still here for people and we are doing the things that we can to provide safety for our clients, our staff and families. Things like telehealth and telehealth can be provided for most of our services. As someone from a mobile crisis team, it's not something that we typically do. So it does have an added challenge. And there certainly are people out there who need that face to face assessment. There are people at risk. And so you can't really capture that by telephone. And we need to get out there to do that assessment.

Laura Knoy:
So can you describe that a little more, Jessica, that that, what the meaning of that face-to-face interaction is with someone in crisis that, you know, telehealth just isn't going to capture.

Jessica LaChance:
Sure. So when we go out onto a scene, when we're providing a crisis assessment, we're putting our face out there to make that connection. So we may have somebody who has never had connection with a mental health person before. And so part of it is building that relationship, building that trust. We're also trying to sort of figure out in terms of a risk what the person's environment may be like if they have family who are support system for them. What are their risk factors? Something even like having a weapon in the home, something that might give us an indication that there is somebody at greater risk who may need an evaluation that helps them to stay safe. So those are things that we certainly can't capture over the phone. We also work very closely with our emergency services providers and our emergency response providers in the community, the police departments, the fire departments and so on. And certainly they also are face to face service for a lot of the things that they do. So there's no really way around that. So we're trying to do what's safest for our staff. And what is in the best interest of our clients, the people who we see so that they can remain safe in the community.

Laura Knoy:
Again, that's Jessica La Chance, director of the Mobile Crisis Response Team for the Mental Health Center of Greater Manchester. Also with us, Ken Norton, executive director of the New Hampshire chapter of the National Alliance on Mental Illness. And Jay Couture, CEO of Seacoast Mental Health Center and president of the New Hampshire Community Behavioral Health Association. And this hour on The Exchange, we're talking about how New Hampshire's mental health system is dealing with the coronavirus. We'd love to hear from you both providers or patients suffering from mental illness. How are you coping? Let us know. Let's take a call from Laura in Jaffrey. Hi, Laura. You're on the air. Thanks very much for being with us.

Caller:
Oh, good morning. Thank you. My question is, I was just informed by my psychotherapist and psychiatrist that they, of course, are no longer seeing patients in their office at their hospital. And I know how vital it is for a behavioral health practitioner to watch a patient, bodily language, facial expression, et cetera. And how effective can a telephone appointment with my practitioner really be if they cannot be with me one-on-one in their office, feel my energy, watch my facial expressions. What...how effective is it?

Laura Knoy:
Laura, thank you very much for calling, it's a good question and Jay, I'm going to throw that to you please.

Jay Couture:
So we are using HIPAA-compliant televideo platforms whenever possible, so they act.There actually is visual connection between the provider and the client. So we're using Zoom and for most of our providers and our prescribers are using a platform called Doxy.Me. But it allows you to sit and have a conversation face to face, see the body language, see the facial expressions and the feedback that we are getting from the clients so far is that it has been really positive.

Laura Knoy:
I wonder can about people in areas less well-served by broadband, by high speed Internet, and whether they need to do mental health in a telehealth wa just on old-fashioned telephone, raising some of the concerns that our caller raises. What do you think, Ken?

Ken Norton:
I mean, that's a significant challenge. I mean, there are a lot of people that really don't have Internet access and, you know, and how do we reach them? And, you know, while the while the telephone is not the ideal setting, it certainly can be very effective. And it is a great way of keeping in contact. I mean, one of the things that is kind of amazing about this whole pandemic, while we are spending a lot of time thinking about the future and what what's happening. I've spent some time thinking about the past and saying what if this had happened 20 years ago before we had all this technology that allows us to have this face to face contact with so many people and these different platforms that are secure for working remotely and providing services remotely? So, you know, there are limitations. There are some indications that some people may be more apt to talk openly on the phone than they would be in person. Even so, you know, there are definite upsides and downsides here.

Laura Knoy:
Well, Laura, it's good to hear from you. David's calling in from Laconia. Hi, David. You're on The Exchange. Thanks for being with us.

Caller:
Thank you, Laura. I was hoping that you and the panel would discuss, if you have a chance, this cycle of sort of hope and despair that a lot of people, I think most people, humans go through. And most recently with the extension of our guidelines to stay in for another month. One would think that right now a lot of people who were hoping to see a lessening of our restrictions are feeling a little bit more despair. And that's really all I had to say.

Laura Knoy:
Oh, David, I am so glad you called, because I am guessing there are lots of people listening who are nodding their heads. As you said, the cycle of hope and despair for sure. Ken, why don't you take that one first? But I think only from everybody on that. Go ahead, Ken.

Ken Norton:
Sure. Thank you, David. I mean, I think it's a really important question. And I think the first thing is we we need to acknowledge those feelings and validate them for ourselves and for others. I mean, there's significant loss of of so many things in our lives right now. Contact with loved ones, you know, that we may not be able to see, my dad's in assisted living, for instance, and, you know, like I can't go see him. And, you know, and other people are in similar situations. So that I think the first thing is to acknowledge and sort of grieve those things that have changed in our lives. But I think the other thing that's that's really important is that we need to try to stay in the present. And if we let ourselves get too far down the road, then those feelings of hope, helplessness, turn into hopelessness. And, you know, and that can be really discouraging. So I think to the extent that we can, taking things one day at a time is really important. And thinking about gratitude and the things in your life that you are grateful for can be very helpful.

Laura Knoy:
David, thank you so much for that call. Jay, do you want to jump in on that? I guess I'd like to change a question a little bit for you. We've been talking about people who, you know, struggle with severe mental illness, people who were already in the mental health system. But what about the public at large? Jay, what are you expecting to see from people who don't normally struggle with mental illness, but do find themselves, as David said, in that cycle of hope and despair?

Jay Couture:
I think that this truly is a stressful time for everybody. You know, our routines are up ended. Our liberties are somewhat confined with the new executive order. And we do need, like Ken just mentioned, to stay in the present.Be thankful for the good things that we have and find ways that we can get support even if it's remote. So I've heard of people doing group Facebook gatherings, but through Facebook Live so that they can feel like they're still connected to their friends and family members. And I think that's really important. What is the way in this environment that you can still stay connected to things that are really important to you? And how can you get the support that you need to get through each day as we whether this crisis.

Laura Knoy:
Jessica, I'd like to you from you on this too. I think it's a profound point that David makes.

Jessica LaChance:
It absolutely is, and I'm a little heartened to hear the language changing from social distancing to physical distancing, and I think that's a really important distinction to make, is that we have been told now for weeks about social distance, social distance. And unfortunately what that does, it puts people at risk for disconnecting from people. And so really focusing on the physical distancing, but still staying connected to people. And it is a very challenging time. I feel that we have to get very creative, as Jay said, things like Facebook Live and finding groups and finding that support that does maintain that physical distance that we still need to to hopefully help this pandemic pass through, but also to connect with people. The main thing we talk about when we do any type of counseling in any type of mental health is the connection. And no matter what you're doing in therapy, it's the connection that matters. So keeping that connection, however it happens, is very important during this time.

Laura Knoy:
And Jay, for somebody who is already struggling with a mental illness, how does this cycle of hope and despair, this added anxiety, affect their treatment, affect their ability to do what they need to do to stay mentally well?

Jay Couture:
I think that we need to remember that people, whether without mental illnesses, are individuals and they're going to react in different ways to the same stressful situation. And so really having their providers work with them to identify what are the stressors for this individual and what are the supports that they have in place and available to them or that we can add and make available to them during this time are really being thoughtful on an individual basis. What's going to be most helpful to this person at this time and how can we make sure they get what they need?

Laura Knoy:
Ken the president said yesterday that's been widely reported that the social distancing or physical distancing measures that he'd hoped to lift by used to would be in place until the end of April. But he also said the economic crash caused by this pandemic could cause enormous mental health problems. What do you think?

Ken Norton:
I certainly think that the economic stress that many people are going to feel is going to be very real and will impact on their mental health. And again, I think part of that is that the piece about just staying present and not trying to get too far down the road about the what ifs. But I think that it also offers the opportunity for us. I mean, I think two things. One, that generally as a people, when we're in crisis, there is a tremendous amount of resiliency that emerges that we may not have seen before. And two, it offers the chance to do things differently than we've done before and develop better health and mental health habits and new routines.

Laura Knoy:
Well, and speaking of the economics of this, that's what we'll be talking about tomorrow on The Exchange for now. Coming up, more with those on the frontlines of mental health care during this coronavirus crisis.

Laura Knoy:
This is The Exchange, I'm Laura Knoy. Today, New Hampshire's mental health system adjusts to the coronavirus. We have three guests, Ken Norton, executive director of the New Hampshire chapter of the National Alliance on Mental Illness. Jessica LaChance, director of the Mobile Crisis Response Team for the Mental Health Center of Greater Manchester, and Jay Couture, CEO of Seacoast Mental Health Center and president of the New Hampshire Community Behavioral Health Association. And Jessica, I want to ask you again, since you are out in the field providing direct services, how the shortage of protective gear that we're hearing about in the, if I could put it this way, physical health field, how is that affecting providers in your field, Jessica?

Jessica LaChance:
It is absolutely affecting us. I think, you know, we are asking for donations. There are things that we are in need of. We are at a at a point right now where things are rapidly changing in terms of what the CDC guidelines and our public health guidelines are. So we do want to make sure when we do go out for a face to face that both our staff and the people we are serving are protected. So we are looking for things like rubber gloves, face masks, sanitizer, alcohol wipes, protective gowns, eyewear. These are all things that we are supplying to our staff when they are going out on an outreach, depending we're screening everyone who calls in and we are screening people who walk in. However, we do need to still have that level of protective equipment available to us at all times. So it is certainly a challenge.

Laura Knoy:
What kind of screening are you talking about, Jessica?

Jessica LaChance:
So we have a screening that is following the guidelines of the CDC and our public health, asking people if they have a fever, if they have traveled recently, if they have a cough. So we're we're trying to determine if someone is showing symptoms before we interact physically with the person. We are also doing the same with our employees in terms of making sure that our employees are self-monitoring and that they are following the guidelines as well. So if they are showing any symptoms that they are not at work and are staying home,.

Laura Knoy:
But you don't have actual coronavirus, COVID-19 test kits, Jessica, you're just asking, Do you have a fever? How are you feeling?

Jessica LaChance:
Correct.

Laura Knoy:
Did you ever think you'd be in this state where you're sort of asking for donations?

Jessica LaChance:
Well, you know, we are, Community mental health is a non-profit world, so we certainly do not have a budget for things like this when they happen. And, you know, the mental health system in New Hampshire already is strained financially in terms of making sure that we're providing the services that we can provide and covering the costs. So when something like this happens, it really throws us for a loop. So we certainly are not prepared for a response.

Laura Knoy:
Ken, what is your organization doing to make the state aware of the need for this gear in the mental health field as well? Been in a lot of attention, you know, to hospitals and legitimately so.

Ken Norton:
Well, I think that, you know, again, there are different levels here in terms of because there is a shortage of how it gets prioritized. And certainly likewise for inpatient facilities, mental health facilities, they're not medical per say, but there is need for protective equipment there as well. And there have been shortages among some of our inpatient psychiatric facilities. And then again,as Jessica said, the direct service staff that are having face to face contact with folks. I can certainly say with real assurance that at the highest levels of the Department of Health and Human Services, these folks are working nonstop to try to not only address the immediacy of some of these things, but to look down the road to plan for contingency plans and how things will occur. So folks are working pretty hard to address these issues.

Laura Knoy:
Well, and coming up next hour, we'll be talking with Dr. Ben Chan, the state's epidemiologist. We'll definitely talk about those shortages. I want to ask you, Jay Couture, about anxiety among mental health professionals themselves, about their own health and safety. Given these shortages, given that they're out there giving that they can't socially distance, you know, from everyone.

Jay Couture:
It's a thing. We definitely are trying to work with our staff to help them feel the safest that they can when they have to interact directly face to face. I need to say publicly how amazing the staff have been in moving forward with their work in these really challenging times. I echo Jessica and Ken in both the need for personal protective equipment to help lessen people anxiety and make us all safer, but also that we've been working with the state directly. We have weekly calls now with the Department of Health and Human Services. The governor's office is aware of the needs that we have as well as our congressional delegation. And we we still serve people who are testing positive for COVID-19 if they need an injection. So we had our first community-based injection last week. It's going to be critical that we have what we need so that our staff can do that safely and help those individuals maintain their health in the community by having access to their psychiatric medication.

Laura Knoy:
So, Jay, how are the people who work for you doing then sort of managing that fear and anxiety around the work that they do?

Jay Couture:
So I think that they've been so supportive of each other. We're doing, as I mentioned earlier, a daily Zoom huddle with, you know, anyone that wants to sign on. I think we had about 25 or 30 people on. They started out in the beginning, they were last lasting an hour. Now they're, you know, 20 to 30 minutes where we can just check in and see how people are doing and what what we can do to make each other feel a little less stressed, a little less anxious, and a little less not alone in having to continue to work in what can at times be a really stressful environment right now. And the work is stressful anyway.

Laura Knoy:
Yeah, exactly. And you've had staff shortages and financial shortages already. And we've been talking so many times on The Exchange about the struggles of the community mental health system, even before all of this hit. I want to share an email from Samantha who says, I currently work with individuals with developmental disabilities and mental illness and their processing of the situation is so much different than the average person. Samantha says it has been a big challenge to ensure they are receiving appropriate clinical supports throughout the next few months. Samantha asks, How do you weigh the risk of engaging with them in person in their group homes to ensure that they and those supporting them are safe and staying home to keep yourself healthy? Samantha, thank you so much. And Ken, I would really love to get your response to that. We forget that some people are living in group homes. We forget that, as Samantha says, you know, people process this information differently. So go ahead, Ken, please.

Ken Norton:
Sure. You know, I think that that's really a key question. And that's something that Jay had alluded to earlier in terms of the different levels of the frontline. Those folks that are in community residences need, are dependent on staff. And and those staffs, you know, are taking I know personally are taking pretty serious precautions for themselves about making sure that they are keeping safe so they're not bringing something into that residents home. And I think a couple of things in terms of Samantha's question that are important. One is that, you know, folks with disabilities have always been marginalized populations. And one of the things that we risk in this environment is that those folks that have been marginalized in the past get further marginalized. And so how do we make sure, again, that they're that their staff have the proper protective equipment and other supports and resources? And then how do we find a balance between limiting that outside contact? Should people be coming into those residences or is it important to kind of pare down to a core level of staff that might be involved and how do we limit their interactions with the community? And again, that creates certainly increased stress for many of these people, as she points out, that process information differently when their daily routines and their ability to interact with people in the community or sort of, do their set schedule is disrupted.

Laura Knoy:
Well, Rosie sent us an email on that point. Rosie says, I just want to bring some attention to the fact that providers right now are under a lot of stress. I'm a therapist at a community mental health agency. Not only are we also dealing with all the increasing anxiety and unknown that comes with the coronavirus pandemic, but we're also dealing with the fact that the work we do is already often very hard and can be pretty emotionally taxing. Rosie says, I personally have found that doing teletherapy. And telephonic therapy has been extra draining for me, she says. I know that I personally have to spend a lot more time practicing really good self-care and managing my own emotions around what's going on so I can be present for my clients. Rosie, thank you so much for that e-mail. We really appreciate it. Jessica, any thoughts about what Rosie says? You know, not everybody thinks that, you know, the telephonic or the telemedicine for some people is draining.

Jay Couture:
I agree, and Rosie, I just want to shout out to you that, thank you for calling or e-mailing in. And I think that we don't always give ourselves credit in this direct care field, that we are a resilient bunch. And that comes along with being in this profession. And I think we have to recognize and validate that, yeah, this this is very challenging. Telehealth is not the same as looking at someone and having that, again, that connection. So I think tapping into our own resilience and figuring out, OK, how do I stay grounded? How do I manage these things so that I can be with somebody else, together, really going through the anxiety and the the added stress of this situation. So I know in terms of what the mental health center in Manchester is doing is we have a COVID emergency operations team that is made up of our senior leadership team and is very transparent with all of our staff. And we have a hotline that staff can call into with questions, concerns, thoughts. We are doing the daily huddles, the support of staff, talking about resilience, what helps us to be more grounded and more resilient in a time like this and recognizing that this is not ideal for anyone. And we have work to do and we have people who need us and we need to be there for each other.

Laura Knoy:
Rosie, thank you so much for the e-mail and good luck to you as well as you do this work. And let's take a call. This is Peter in Keene. Go ahead, Peter. You're on the air. Thank you for being with us.

Caller:
Thank you so much. I've worked with all three of these panelists in some ways as the executive director of Monadnock Peer Support. And just want to thank all three of you for everything that you have been doing, but also wanted to call attention...I was really inspired by David's comment about there are a lot of people who haven't been identified before, either by the clinical system or by the peer support system, that are struggling. And I know that the New Hampshire peer support system has had to push all of our publicly accessible group and telephone numbers and all of that so that people have access to that. And I'm wondering if through your programming, if we can give the listeners tools and resources that they can call or they can reach out to if they aren't necessarily someone who's been identified, but this is just throwing them into a crisis.

Laura Knoy:
So sort of people, Peter, who were not part of the regular mental health system. But this is just really thrown them, as you say, and they need they need help. Peter, thank you very much and all of you. Do you want to jump in on that, Ken Norton and any resources that you mentioned, Ken? We'll definitely put up on our Web site, NHPR.org slash exchange. And there's helpful information links, phone numbers. They are ready. But go ahead, Ken. What would you add to that list of sort of important places or resources for people to go?

Ken Norton:
Sure. Well, thank you, Peter, for calling and for the work that you do. The peer support agencies in the state are a great resource. Many of them have warm lines. And I think that that's the thing that I would like to emphasize. And I will forward you a resource sheet that you can post on the Web site with that warm line information. So you talked at the beginning of the show about the National Suicide Prevention Lifeline, which is a very important number, 800 273 8 2 5 5. But that's kind of a crisis line. And a warm line is for somebody that's just needing support in the way that Peter described. And maybe they're isolated. Maybe they have concerns or worries. They don't feel that it rises to the level. They're not having thoughts of suicide, but they just need some support. And so the warm lines are a great resource for that. And the some of the peer support agencies are also opening up some of their online groups to people that have not, as Pete Peer described, not previously been identified and served by them. So those resources are available to folks as well.

Laura Knoy:
So, Ken, is that new? We've heard about hotlines for a long time, obviously, and we have that national suicide prevention lifeline information on our Web site. But is this warm line idea new?

Ken Norton:
No, it's been around for quite some time. It just tends to not get as much prominence or play as as the crisis lines. And it's been more, you know, for people within the mental health system that are aware of it. But it's really been great that the peer support agencies have been opening this up to folks and expanding their hours and making it more available.

Laura Knoy:
Ok. Well, thank you for that call. Peter, and Chris in Epping wrote an e-mail that I want to share with everybody. Chris says, If isolation is challenging for adults, what do we do for our kids who are surrounded by adults all day, every day? I'm getting word that my young daughters are starting to shut down emotionally because they can't play and socialize with other kids. Remote learning, Chris says just doesn't cut it. Are there potential long term developmental concerns here? Wow, Chris, that is such an important point. And I'm not sure who wants to jump in on that one. That's a that's that's a tough one. Jay, do you want to take that?

Jay Couture:
Sure. I think that it is a really challenging time for kids and especially for younger kids, helping them to understand what is happening and why they can't be socializing with their friends. And there are some resources that are out there. There are YouTube videos that have been created already to help explain what physical distancing is for younger kids. There are support groups that are available. We have a page on our Web site that is dedicated to COVID-19 updates with connections to the peer support and the clubhouse online groups that they're offering. Parents of anxious kids, support group, talking to kids about COVID-19. So there are some resources that we have collected and put out there. And I think the other mental health centers have done the same as well, just trying to find ways that in the moment we can provide the best support. I don't think that any of us understand yet what the long term ramifications of this social distancing is going to be, and we're going to have to be mindful of that once this is over, how we help people reconnect.

Laura Knoy:
That's a really interesting point that Chris raises. And Chris, thank you. Ken. I wonder what what you would tell parents, especially teenagers, too. I mean, their social connections are so important. What would you tell parents to just watch out for as our kids enter another month of this?

Ken Norton:
Well, I think one I think it's a great question. And I think that one of the things that I think is important to state is that our children and whatever age they are is kind of feed off of us and they mirror us and our reactions. And so I think it's really important that we maintain our own self-care and acknowledge some of these challenges that are going through. And I think that the other part to that is to allow open conversations and to bring these topics up. Ask us what it's like for them. Ask them how they're feeling, validate their feelings and acknowledge that. And to the extent that means certainly teens are pretty media savvy, much more media savvy than many of us. And so they are using online forms and, you know, and getting together socially that way. But, you know, to the extent that you might be able to do that for younger children and have have them be able to see each other face to face, via a computer that might be helpful in terms of maintaining some of those relationships as well.

Laura Knoy:
Well, Chris, really glad you raised that point. Thank you. Coming up, a lot more of your calls and e-mails as we look at how the coronavirus pandemic is affecting our mental health system here in the Granite State. Stay with us. This is The Exchange on NHPR.

Laura Knoy:
This is The Exchange, I'm Laura Knoy. tomorrow on our show. Another two hour exchange. First, how small businesses are impacted by the coronavirus and all the shutdowns. And then at 10:00, we'll talk with Rich Lavers, deputy commissioner of Employment Security. So that's all tomorrow morning on The Exchange. This hour, the impact of the coronavirus on mental health care. We've been hearing from you provider's parents. People struggling with mental illness. And all of you to that earlier e-mail from Chris, who worried about the mental health impact on her young daughters of all this isolation and social distancing. Lauren sent us an e-mail in response. Lauren says to the earlier e-mail and well-articulated point about connectivity, Lauren says a zoom dance party and celebration of a birthday shouting over from port to port to check on neighbors. A child's art show shown by Facebook live a continuing yoga asana class by phone where Internet is not available. Thank you, Laura. Not everyone has great Internet sending good old cards by snail mail, playing games remotely together and gathering to express ourselves by group texts. Lauren says We can model for our kids and ourselves resilience and commitment to staying in touch. Staying positive and keeping an ever expanding circle of contact with neighbors, friends, family, co-workers and others in your community. Lauren, thank you so much for writing in. And let's take a call. This is Catherine in Hanover. Hi, Catherine. You're on the air. Welcome.

Caller:
Hi. Thank you. I was thinking that, you know, a piece of the mental health world, but not being represented as a private practitioner. I have a private practice in Hanover and our, at least my business has dropped at least 75 percent. Many people are tightening their belts, so people who were paying out of pocket for a session aren't doing so anymore. And I also take Medicaid insurance and those people aren't coming in right now either because I think they're all home dealing with kids, dealing with job loss. And we don't have a paycheck. We don't have you know, I don't have anyone paying me to stay home. So it's been a really challenging time for the private practitioner. And I thought that might be interesting, too.

Laura Knoy:
Yeah. I'm glad I called. So. Have you been able to connect with any of your patients by telehealth?

Caller:
Oh, absolutely. I set up on mine. I have a client set up forums for clients so that they know what to do and how to get prepared. I have a HIPAA-compliant Zoom platform. I do lots of therapy online. I have for many years, but people aren't doing it right now because it costs money and everyone is saving their money or watching their money disappear in the stock market or like Dartmouth College. The students are gone. All the workers are at home. The hospital here, people who were coming into our, hospital workers aren't because they're overtaxed from working at the hospital. So it's been a really odd, very surprising outcome.

Laura Knoy:
Wow. Catherine, I'm sorry to hear about your situation. I can completely understand what you're saying. And Ken, it sounds like some people who might normally have seen a therapist for help, either they can't access the service because they either work at the hospital. So they're incredibly busy doing incredibly important work or they're home with, you know, kids and working at home and they just cannot take time for that, you know, telehealth appointment. What do you think?

Ken Norton:
Yeah, I mean, I think that Catherine presents it really well. I mean, some of the challenges that are faced, particularly by private practitioners. I think that, you know, anecdotally, sometimes when we are in crisis, those usual routines, for all the reasons that she mentioned, become less important. And maybe people are feeling that that that therapy appointment is less important or they just cannot arrange it given the upheaval in their schedule.And, you know, on the other hand, there are probably lots of people that previously didn't consider therapy a priority, might be looking for therapy now. And hopefully they will be able to seek out that and be able to connect with folks like Catherine.

Laura Knoy:
Well, I want to ask all of you about the long goal by the state to get people in a mental health crisis out of the emergency room. And as you all know, this has been, you know, a long problem where people just who are in the midst of a crisis had nowhere to go. So they would go to the E.R. to at least be safe there. And Jessica, right now, especially emergency room leaders are saying, please, please, please do not send people in a mental health crisis here. We don't know what we have going on in terms of people infected with COVID-19. How is how is that effort going, the effort to really get mental health patients out of the emergency room and into a more appropriate setting?

Jessica LaChance:
Well, I think for them, I think I can speak for my area and we are so, so fortunate to have mobile crisis and so, I realize not all areas have that. I think it definitely highlights the need for mobile crisis because the whole goal of it is really to keep people out of the emergency room. So ninety five percent of the people, the mobile crisis team here in Manchester goes out to see, do not end up going to an emergency room. So it matches what our goal is, is to provide the same level of assessment to people in the community that they would get walking in the door. And right now is just not a safe, potentially or feasible option because of what's happening with the pandemic. So we are just redoubling our efforts to try to reach out to people and let them know that there is another option. We are also happy to see that New Hampshire Hospital has been able to receive patients in a more, more quickly over the last several weeks, in fact, on Friday, we had nobody holding in the emergency room for hospitalization, both at the Elliot Hospital and our other local hospital. So that was a very good thing to hear, is that people are moving along quickly. Our Cypress Center has vacancy as well. So we have the ability to take people who need hospitalization more quickly out of the emergency room environment.

Laura Knoy:
Wow. So say that again, Jessica, because this has been a long conversation. Ken Norton and I have talked about this a dozen times, the extreme concern that people were being inappropriately treated for a mental health crisis in the emergency room. So you're saying, Jessica, at least where you work, you don't have that problem anymore?

Jessica LaChance:
It's always, I think it's always a challenge. We certainly have had times when we have had people holding in the emergency room who need hospitalization, who don't have access to beds. So I don't want to I want to be clear that that is still an ongoing challenge. I think right now, though, there've been some creative solutions to move people along a little bit more quickly than before this pandemic hit. So I'm hopeful that that means that there is some solutions down the road, even without COVID-19, that people can move more quickly to the appropriate level of care. And again, I want to stress the importance of being able to see people where they're at without having to walk through the emergency room doors and providing them things like safety plans and risk assessments and connection to treatment that they do not need to walk through an emergency room door to access.

Laura Knoy:
Well, and Jay Couture, and putting on your hat as president of the New Hampshire Community Behavioral Health Association now, most communities do not have mobile crisis units. So what are you hearing about the efforts by emergency rooms to not have people in a mental health crisis come into the emergency room, given the concerns about coronavirus.

Jay Couture:
I do want to respond to that, but I want to reflect for just a few seconds on the private provider listener's comments. Catherine in Hanover. We're all seeing decreases in revenue because of this. And what I think everyone who is in the health care field needs to be aware of is that there are going to be some funds that are made available to help assist with the losses related to this. There are funds through the state of New Hampshire.I think it was Executive Order number nine. And then also the CARES act, the federal legislation also has low interest loans and some grants that are available for providers. So I would suggest that the listener look at the state COVID-19 page and maybe find some resources that would be helpful.

Laura Knoy:
Catherine, hope you're still listening. Yeah.

Jay Couture:
In terms of the emergency room. I think that sometimes out of crisis you get movement on longstanding difficult issues and that you can see has happened in the numbers of people who are waiting for an involuntary admission. So the numbers are lower now, I think, than they've been in the many years that we've been tracking that because kids have been moved now to Hampstead Hospital, which has freed up space to add more adult beds at New Hampshire Hospital. And one of the things that happened in my region and over the past week was we were able to do our very first televideo emergency assessment of of someone in the home who went straight from home to their inpatient psychiatric admission, didn't have to stop at the emergency room on the way. And that is huge. It saves money and it saves time and it gets someone to the level of care they need more quickly.

Laura Knoy:
And sometimes when people are in the emergency room, sometimes their mental state becomes worse because they're there for, you know, a day or two days and it's just not the right place. Since we've been talking a little bit about the state hospital. A mom emailed us. She won't give her name. But this mom says, my son is currently in the state hospital. He's been there for several months. I'm grateful for the help he is getting now, but I am terrified for his release. He will need support through our local mental health center. I'm not confident that he will get the support he needs. With social distancing, I also don't feel like he could handle the day to day conditions of a quarantine. I am currently unable to visit my son due to the quarantine, although I talk to him daily. It's very hard to reconcile what he's going through and what is happening in the world and how this will all end for him and the others in his situation. The stress of all this is too much to bear at times. I cry every day for him and our family. Wow. I really, really appreciate this mom calling in and e-mailing in and there's so much to unpack from there. First of all, it sounds like Ken Norton, she herself could use some help through one of those warm lines that you talked about. But talk, Ken, about this disconnect that she describes between, you know, her son right now at the state hospital, but not really sure how he's going to manage when he gets out.

Ken Norton:
Yeah, I I'm going to focus more on her and maybe let Jay from the Community Behavioral Health Association talk more about the discharge piece. But to just say that, you know, at NAMI New Hampshire, that's a big part of what we do is to provide support to family members. And so if she's not. With us, or if other family members are in similar situations, we have online support groups. We have closed Facebook pages. What she is feeling and what she is experiencing is shared by a lot of other people, even during good times that those concerns and those fears. And so certainly would encourage her to get in touch and get support for herself and her family.

Jessica LaChance:
Does anybody else want to talk about. Maybe. Maybe to you, Jessica. The idea that, you know, it's a different world inside the state hospital than out. And this mom is concerned that her son won't be able to manage it appropriately.

Jessica LaChance:
Yeah, I think and this is a great example of where, you know, maybe knowledge is power. And I think Ken brings up a great point about utilizing the services that are outside of the hospital, such as NAMI, to really know what questions should she be asking, what questions can help her to feel more in control of the situation that she does not feel any control, I'm sure. So having that ability to be supportive then and also to be informed about what does happen upon discharge, what are the expectations from in terms of the community mental health center? If there's a community mental health center involved, what are the things that may happen once he is discharged that can help reassure her that there are services in the community to help?

Laura Knoy:
Wow. Thank you for emailing to that, mom. And our very best wishes for you and your son, Dave at West Central Behavioral Health wrote in. He says There is concern that there's a bubble brewing that will come to the fore after the physical health crisis if COVID-19 passes. Dave says issues like PTSD, agoraphobia and anxiety disorders will crop up en masse that will have to be addressed. He says these will require substantially increased levels of treatment, support and funding for New Hampshire's community mental health centers and the marginalized and vulnerable populations we serve. David also says I'd like to add some thoughts from West Central Behavior Health's medical director, Diane Roston, that social proximity remains important even when we practice good physical distancing tactics. We can't lose sight of how meaningful social interactions are to us, and we should strive to try and stay in touch with others during this crisis, be it by phone or video, social media or getting out for walks to see people from a safe six foot distance. David, thank you very much for that. Dennis in Keene writes, I direct the Monadnock Region System of Care project, and I was hoping Ken could speak to the System of Care work happening statewide and how it's a great resource for children and families struggling with significant emotional challenges. Thanks, both of you, David and Dennis, for those e-mails. And Ken, do you want to quickly address what Dennis in Keene writes about?

Ken Norton:
Sure. I mean, the System of Care is a comprehensive model. That's a national model that's been adopted in New Hampshire and it's been incorporated into the 10 year plan. And it provides wraparound support to children and families who are at risk of out-of-home placement. And one of the reasons that we have seen such a decrease in the hospital waiting list is the progress that we've made with keeping children out of the hospital or out of out-of-home placements and the ability to then move children out of New Hampshire Hospital to Hampstead Hospital and open those beds up for children. So that System of Care model has been very appropriate and very successful for families at risk. And I would just, you know, add to David's concerns. I think that those points are very well-taken about, people tend to hold it together during a crisis. But, you know, the fallout that we may see around some of those anxiety disorders and acute stress disorders, PTSD, whatnot. Again, frontline workers and other people may be yet to come.

Laura Knoy:
Well, and maybe we will gather the three of you again to talk about that in another month or six weeks or so. Check in with just how the state's mental health system and the mental health of Granite Staters in general is doing. For now, though, thank you all very much for giving us your time. We know you've got a lot going on and we really appreciate it. Jessica, Lachance. It was great to have you. Thank you. Thank you very much. That's Jessica Chance, director of the Mobile Crisis Response Team for the Mental Health Center of Greater Manchester. Jay Couture, thanks a lot. We really appreciate it. Thank you very much. That's Jay Couture. She's CEO of Sicko's Mental Health Center, president of the New Hampshire Community Behavioral Health Association. And Ken Norton, a big thank you to you. We really appreciate it. Really important topic. Thank you for having us on today, Ken. Ken Norton is executive director of NAMI, the New Hampshire chapter of the National Alliance on Mental Illness. And again, exchange listeners, there are lots of links and important information on our Web site about hotlines and warm lines. As Ken Norton mentioned, that Web site is NHPR.org/Exchange.