(Opinion) Protecting children’s mental health through collaborative care

HEALTH CARE

In 2016, the New Hampshire Legislature enacted a system of care model for children’s behavioral health services, recognizing a critical gap: Children exposed to adverse childhood experiences and those with severe emotional disturbances were falling through the cracks of fragmented services.

Educational, developmental and health care systems were operating in silos, leaving families to navigate complex needs alone.

This system of care framework was built on a fundamental principle: collaboration. No single entity — not schools alone, not health care providers alone, not families in isolation — can address the complex mental health needs of children.

One key component of this framework is the Multi-Tiered System of Support for Behavioral Health and Wellness (MTSS-B), which exemplifies this collaborative approach by creating structured partnerships between schools and mental health providers to ensure children receive coordinated support where they spend most of their time: in their schools and communities.

The MTSS-B policy emerged from a multiyear effort by the Children’s Behavioral Health Collaborative, bringing together state agencies, providers, school districts and child advocates. With bipartisan support and no testimony in opposition, the Legislature passed SB 534 in 2016, establishing MTSS-B in statute to provide the organizational framework necessary for early identification and coordinated mental health care.

Both the Department of Education and the Department of Health and Human Services supported the legislation, as did hospitals, community mental health centers, teachers, special educators, nurses, social workers and other advocates.

In 2020, Gov. Chris Sununu signed and applauded subsequent legislation directing the Department of Education to support MTSS-B development in school districts across the state.

Yet, as the 2026 legislative session approaches, a bill has been proposed to repeal MTSS-B altogether.

For almost a decade, MTSS-B has successfully helped identify children early and connect them to appropriate supports. Community Mental Health Centers (CMHCs) serve as anchors in this system of care, providing clinical expertise and therapeutic services that schools cannot offer alone.

These school-CMHC partnerships operate in districts across New Hampshire demonstrating the statewide reach of this collaborative model. As Jodie Lubarsky, vice president of youth and family services at Seacoast Mental Health Center, notes, “Schools in our region have seen the overwhelming benefit of MTSS-B. We have worked collaboratively to support the development and facilitation of tier 1, 2 and 3 supports in academic communities to have a meaningful impact on the social, emotional and behavioral needs of students. This has allowed educators to focus on educating their students and offering instruction that creates a positive environment for students and staff. Creating an increased understanding of student needs through professional development, consultation and on-site supports while offering a facilitated referral process to services outside of the academic setting has improved student outcomes in our community.”

Early intervention through MTSS-B changes developmental trajectories. When children receive timely support, they build resilience, develop coping skills and maintain connection to their education — preventing the downstream consequences of untreated mental health challenges.

The MTSS-B framework recognizes what research consistently demonstrates: Children have remarkable capacity for growth when provided appropriate support within their natural environments. Without this coordinated approach, children face longer waits for services, more severe symptoms requiring crisis intervention and disrupted education that compounds their struggles.

The bipartisan bill that established MTSS-B in 2016 included a compelling finding that remains urgent today: “Mental health disorders are the most expensive health conditions in childhood, straining public and private resources.”

Repealing MTSS-B would dismantle the collaborative infrastructure that prevents costly crises and emergency interventions. The short-sighted savings from eliminating this program will be dwarfed by the long-term costs: increased hospitalizations, involvement with juvenile justice and child welfare systems, interrupted education, costly out-of-district school placements, stress on overwhelmed systems, and most importantly, preventable suffering for children and families.

At a time when the prevalence and severity of children’s mental health needs have only increased in our state, we cannot afford to go backward. We cannot return to fragmented services where families navigate complex systems alone and children wait until crisis point to receive help. We have a collective responsibility to invest in the well-being of children, and we need to reassert the simple truth that children’s mental health is a public health priority.

The Legislature acted wisely in 2016 to create a system of care with MTSS-B as one of its cornerstones. Now is the time to strengthen this foundation, not tear it down.

I urge legislators to reject efforts to repeal MTSS-B and instead recommit to the collaborative, evidence-based approach that has served New Hampshire’s children and families for nearly a decade.

Dr. Cynthia Whitaker is president and CEO of Greater Nashua Mental Health Center. She lives in Weare.