What's Next For N.H.'s 10-Year Mental Health Plan?

Jan 24, 2019

N.H. Department of Health and Human Services in Concord, N.H.
Credit NHPR Photo

The New Hampshire Department of Health and Human Services released the final version of the state's 10-year mental health plan. It outlines several steps, including action on the practice of boarding mental patients in emergency rooms when there is no immediate room at New Hampshire Hospital.

NHPR's Jason Moon discussed the report with All Things Considered Host Peter Biello.

So we've been hearing about this report fro a long time now. What problems is this report designed to address?

Well a lot but at the root of them all is a sort of general lack of mental health services in this state. And if you cast your mind back, you know, four or five years to 2013-2014 there was a big mental health class action lawsuit against the state of New Hampshire which was about this very issue that folks were getting unnecessarily institutionalized because there weren't community mental health resources in the state and this 10-year mental health plan is one effort, one piece of the effort to sort of address those concerns and a long-term holistic way. 

OK, so a variety of things in this report, and the cost over the next biennium totals more than $21 million, so what's this money going to be spent on?

Well, a lot of things to address a lot of different sort of layers of the system, if you will. But one of the key areas that it's focusing on is trying to increase the capacity for inpatient mental health treatment so one of the main issues that the state is facing is a shortage of beds for inpatient mental health treatment. Like any New Hampshire hospital. And that's why people are being boarded in emergency rooms waiting for a bed to open up one of the things that the plan recommends is to spend some money to try to incentivize more private providers to become what's known as a designated receiving facility, which is basically what New Hampshire Hospital is--a place where they could get that inpatient treatment. So they're trying to spend a little money to increase the amount of beds available but also spending money further upstream, as mental health professionals would say, to provide lower level services before people get to a point where they need that intensive inpatient treatment facility and so some of that is done through raising the Medicaid reimbursement rates for different types of mental health services and just a variety of other kind of community based mental health services around the state.

And what's the legislative component to this? Are lawmakers in Concord going to have to pass bills to make these recommendations a reality?

Yes, a big yes. And that's the thing to remember. The 10-year mental health plan is not a binding document by any means. It's sort of like, you can imagine it as like a master plan for your town. It's sort of a roadmap for where people think the system should go in the long term and that they sort of gamed it out over the number of years. But none of it actually happens unless the legislature and the governor make it happen, you know, each session. So this is already starting in this session. A lot of these recommendations are already in bills that are being debated right now. And you know we'll see how much of it gets followed 

The 10-year mental health plan is not a binding document by any means. It's sort of like, you can imagine it as like a master plan for your town.

through on. One good reason that it might is that lawsuit we mentioned earlier -- that's still in force and that settlement is reviewed I think twice a year by an external review to see how well the state's been doing on its end of the bargain. And if they don't increase the amount of mental health services that that lawsuit could kick back into effect and the state could find itself back in court. So there are some real incentives here for the state to follow through on these recommendations 

But also uncertainty because a lawsuit can't force lawmakers to vote any particular way.

That is true. We've learned that yes.

But as you continue to report on this what will you be looking for from some lawmakers. What action do you think they'll be taking that you'll be watching for.

Well, I think there's there's by and large broad agreement that a lot of these things need to happen. But I think the question going forward is going to be how much and how soon. And you know it's worth pointing out that there's a lot of other public health related priorities that are on legislators plate this year that aren't even in the 10-year mental health plan. All the issues at DCFY, for instance, and the staffing concerns over there or the issue about closing the state's secure psychiatric facility at the state prison. Those are separate issues that are also front burner for a lot of folks that aren't even in there. So there's a lot to there's a lot to deal with this session.