NH’s ‘shameful’ mental health care picture

Seacoast center director points to bed shortages, workforce challenges

When people think about the crisis caused by the lack of mental health beds in the state, many think about adults affected by the shortage. But Jay Couture, executive director of the Seacoast Mental Health Center, said it also impacts children.

“For my center, we have people who get stuck in the Exeter (Hospital) emergency department every day,” while they wait for a bed in a mental health facility, she said. “In the month of March, it usually ran two to four people a day for us. Most often it’s adults, but it’s also kids. The last half of March we had at least one kid every day that was stuck there. We even had an 8-year-old.”

Unlike Portsmouth Regional Hospital, Exeter Hospital has no mental health beds, Couture said. That means people who need emergency inpatient treatment – Seacoast Mental Health is a community mental health center that provides outpatient services – have to wait in one of two locked, windowless rooms in the emergency department, Couture said.

“It’s probably, from my perspective, the most shameful thing that’s happening in our system,” Couture said about how people with mental illness are treated. “It wouldn’t happen for any other illness. If you came in with a heart attack they’re not going to make you wait in a windowless room with a security guard that has to escort you to the bathroom.”

Like many who work with people with mental health issues, Couture bemoans how long people have to sometimes stay in emergency rooms.

“We had an adult in Exeter who was there for 28 days,” she said. “You can’t even begin to think about the impact on the client, but the staff is also impacted too, because they don’t have any good answers.”

Qualified candidates

Efforts to improve treatment at the community level are hindered by staffing challenges. Community mental health centers across the state are struggling to fill vacant positions, Couture said.

She estimated Seacoast Mental Health has 10 unfilled positions funded in its budget. For instance, a clinical team leader position has been open since December, and a nurse position has been open since July 2016. Other centers have even more vacancies.

The NH Community Behavioral Health Association, which nine of the state’s 10 community mental health centers belong to, has studied the problem of filling open positions in New Hampshire. One factor is the shortage of qualified candidates. Another is starting pay.

“Our salaries are significantly lower than other places where a psychiatrist or licensed social worker could work, and there’s a shortage of those professionals out there, period,” she said. “When we are one of the lowest-paying employers it exacerbates it.”

Community health centers also face competition from in-state private hospitals.

“We’re able to hire master’s-level people straight from college and then provide them with training,” Couture said. “I start a master’s-level person out at just over $40,000, but there is a provider in this same city that can hire that same person for $56,000. That’s too big a spread for me to bridge.”

It is particularly difficult to hire child psychiatrists, Couture said, adding the problem is “significant and it’s been in place for years.” Part of the reason, she said, is that “you get trained to be an adult psychiatrist, and then you do extra training for kids. You really have to be committed to do it.”

Seacoast Mental Health’s medical director is a child psychiatrist who has been with the center since 1963.

A child faced with mental illness often affects the whole family, said Couture. “If you’ve got three kids and you’ve got one who’s stuck in an emergency room or needs to be coming in for services, that impacts the entire family,” she said. “For me, making sure whether it’s outpatient services or inpatient services, the goal really has to be to get people what they need, when they need it, where they need it.”

‘Unspoken crisis’

Her comments came after Gov. Chris Sununu recently called the shortage of hospital beds for mental health patients the state’s “next big unspoken crisis.” Sununu addressed the issue at a recent Greater Portsmouth Chamber of Commerce event and said he gets daily reports on “how many folks with mental health issues are sitting in emergency rooms with no bed.”

“Sometimes they’re there for two weeks or more with no place to go because we have no place to put them, we have no availability in our beds,” he said.

The governor held a meeting earlier this month with mental health advocates to try to come up with ways to address the issue both in the short and long term. Couture, who attended the meeting, said there was “a good discussion about some solutions.”

“A number of the solutions that were talked about were things that we used to have that were eliminated and were talked about bringing it back,” Couture said. “Needing to add more beds in the community was one of the biggest issues talked about.”

She is hopeful the meeting will lead to real action. “If there were things we agree on that could get added in (the budget), that would mean there’s hope in getting something up in the next fiscal year,” she said.

Despite the crisis the state is dealing with, Couture stressed “even in this chaotic environment we are able to help people reach their recovery goals. The staff we have here are incredibly dedicated.” – JEFF MCMENEMY/SEACOASTONLINE