New Hampshire re-evaluates approach in light of budget shortfalls

New Hampshire re-evaluates approach in light of budget shortfalls
(April 2009 Issue)

By Phyllis Hanlon

A freefalling economy is forcing New Hampshire's leadership to re-evaluate its approach to behavioral health care.

Sheila Gardner, Ph.D., executive director of the Mental Health Council (MHC), says that her commission is working with Community Mental Health Centers, private, non-profit agencies located in 10 regions of the state, to establish priorities and implement a 10-year plan created by Health and Human Services. This plan recommends increasing the number of supportive housing units; adding four Designated Receiving Facility units; developing 12 new intensive outpatient Assertive Community Treatment teams; implementing an electronic medical records system and retaining and increasing a community mental health workforce.

Gardner indicates that funding for some of these programs has been requested but is not included in the governor's budget. She says, "MHC will work with various stakeholders to figure out the most important pieces of the budget."

In spite of the monetary shortfall, MHC is focused on four key initiatives that they believe will improve the entire system. These initiatives include better integrated health care, supportive housing, children's mental health and mental health in the criminal justice system, according to Gardner. "There has been a longer term failure to develop programs for folks with mental health in systems where they are not well served," she says, referring to homeless shelters and prisons.

A strong proponent of integrated healthcare, William Gunn, Ph.D., president of the New Hampshire Psychological Association, practitioner at Concord Hospital and faculty member at New Hampshire's Dartmouth Family Medical Program, says, "It's a struggle to achieve clinical productivity when the two [disciplines] are separate. We have no backup case management or psychological services. Other parts of the country have done this with great success."

Gunn also says that recognizing health and behavioral codes will be fiscally and morally responsible. "They are made for an integrated care setting," he says. "It's more efficient and makes more sense to treat the whole person." He admits that restrictions on funding for community mental health centers pose a serious challenge. "We're struggling to figure out how to survive," Gunn says.

New Hampshire has eliminated funding for a national best practices suicide prevention program, according to Michael Cohen, MA, CAGS, executive director of NAMI-NH. "The commissioner had put $107,000 for 2010 and $116,000 for 2011 in his budget, but the governor cut it out," he says. "We're advocating strongly to have it put back. We've served many, but we've only scratched the surface."

James Monahan, vice president of the Dupont Group, which works for the New Hampshire Behavioral Health Association, says that the state will see a three to five percent reduction in Medicaid support. "But Medicaid rates and eligibility will not be changed in large part due to the stimulus package," he says.

Monahan notes that the closure of Miller House, a residential facility staffed by personnel from Riverbend Community Mental Health, as well as staff reductions and the elimination of benefits, are on the horizon. The news is not all bad though. He says that the budget contains a provision for a four percent increase for some psychological treatment services.

Cohen says, "In the budget-making process, the legislature should take a reasonable look at where expenses could be cut, but they should also look at the revenue side. The state legislators have to be courageous and step forward with revenue options."

Gunn sees an upside to the bleak economic picture in the form of "crisis opportunity." He says, "There is the open expectation that this [economy] would force us to think about things in a different way."