On mental health, NH can set a national example

With the spotlight about to shine on us, we have an opportunity to offer examples of compromise, cooperation and civility to the rest of the U.S.


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With New Hampshire’s midterm elections behind us, there are major changes in the works in Washington and at the State House in Concord. What has not changed is the critical need for our elected officials to come together in 2019 and address the ongoing mental health crisis.

New Hampshire’s community-based system of mental healthcare was once considered by many to be among the best in the nation. But since the 1980s, it has been so neglected that it took a 2013 class action court case and a 2014 settlement to start putting it back on track. Meanwhile, our community mental health centers struggle to provide access to critical services because Medicaid reimbursement rates (the bulk of the funding for mental health) have not seen increases since 2006. The lack of sufficient funding has far-reaching consequences, including a serious workforce shortage, as evidenced by clinical staff vacancy rates of about 10 percent across the 10 community mental health centers.

Work has been under way by service providers, advocates, state officials and others, to develop a new 10-year mental health plan. A draft of the plan has been released by the NH Department of Health and Human Services and it is currently soliciting public comment. The draft plan was thoughtfully developed and holds much promise but lacks specificity and clarity in some areas.

A meaningful first step would be to increase the Medicaid reimbursement rate to assist community mental health centers and other providers of psychiatric services with critical staffing shortages. A simple fix is to include adequate funding for a permanent rate increase in the next budget.

The state could and should do more to support the State Loan Repayment Program (SLRP), which helps medical and behavioral health professionals with their tuition loans if they agree to stay and practice in the state for a certain length of time. The SLRP is a proven way to attract and retain staff and should also be funded in the 2020-21 state operating budget.

The state needs to take meaningful steps to relieve staff at healthcare organizations of duplicative and unnecessary administrative burdens.

There is a whole litany of reforms like these — some of which will require funding, some of which will just require common sense — on which the governor and legislators should collaborate if they truly want to increase efficiency and focus this limited workforce resource on more direct care.

Community-based services are necessary and important, but the lack of sufficient psychiatric hospital beds across the state needs to also be addressed. Last but not least, meaningful reforms and funding of services for children, youth and families have to be included in the Plan if we are to be successful.

The recent November election marks the unofficial start of the 2020 presidential primary. With the national spotlight about to shine on us, we have a unique opportunity to offer examples of compromise, cooperation and civility to the rest of the country, and particularly to our very divided federal government.

Craig Amoth is CEO of the Greater Nashua Mental Health Center.

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