State’s mental health system faces crisis

A new University of New Hampshire Institute on Disability report suggests ways to improve the state’s fractured mental health system, but the state’s top behavioral health official says they’ll be hard to implement considering recent cuts.The cuts have come in the form of two rate reductions to the state’s 10 community mental health centers — one for monthly case management, the other for functional support services. In addition, a 2-1/2 hour daily limit was set for life-skills and symptom-management services that were previously offered without a cap.
What’s more, “additional cost-containment measures” may be on the way, said Erik Riera, who runs the bureau of behavioral health at the Department of Health and Human Services.At Community Partners in Dover, a nearly $500,000 funding cut came amid an 11 percent surge in clients, and Executive Director Brian Collins said the agency can’t adequately meet the needs of patients.“We have to ration care,” he said. “If you end up with a broken arm you’re going to go to the emergency room and be treated appropriately. If you have a mental illness we’re not going to be able to see you right away. We don’t have the capacity. There’s been staffing cuts. The caseload of the docs is incredible and there are just not enough hours in the week.”For Riera, the problem is funding: after spending about $92.8 million last fiscal year, the bureau was provided with $90.8 million this year — and that was before the bureau experienced a 10.5 percent spike in the number of Medicaid clients needing help. Medicaid beneficiaries make up the majority of the 18,000 residents who rely on the centers.Unlike past years, the bureau can’t seek funds elsewhere because of HHS’ projected $36 million shortfall for the current fiscal year, Riera said.“We are likely to see some local-level closures of specific types of services that are offered because the community mental health centers can’t afford to provide those services any more,” Riera said.At the Seacoast Mental Health Center in Portsmouth, Executive Director Jay Couture said $300,000 in cuts forced the departure of an emergency therapist and an end to its transportation program. Another round of cuts “would make it harder for people to access services,” she said.In Derry, a life-management center home to eight people had to close along with other group homes.“Unfortunately these are all things that are supposed to be expanded in the 10-year plan” crafted by the state to strengthen community safety nets, Riera said. “We’re calling for additional community beds, and now we’re going backward.”

Shifting system

Many of the issues highlighted in IOD researcher Peter Antal’s report, “New Hampshire’s Prescription for Mental Health Care,” have been broached before, but he says the report ties together elements challenging those with mental illness.“We seem to be shifting to a more treatment-care system rather than one that focuses on prevention and support, and why that’s bad for the state is we end up with a situation where people end up more and more likely to be hospitalized,” and that carries long-term costs for taxpayers, he said.Among the roadblocks are higher medical costs for those with mental illness, scarce community resources, lack of coordinated care and limited expertise in emotional and mental health care among primary care providers, the report says.“We know that there are primary care physicians out there that may have a certain level of understanding of mental health issues, but a potential issue arises when they come across an individual with more severe mental health illness,” Antal said.A 2008 N.H. Association for Infant Mental Health survey of 72 health-care providers, including 42 pediatricians or family practice physicians, found less than one in three providers reported having expertise in emotional and mental health, according to the report.The data is especially concerning given that pediatricians prescribe 85 percent of all psychotropic medications taken by youths and the drugs “have many damaging side effects that can be mistaken for a newly emerging mental illness,” the report says.On the cost front, the New Hampshire Center for Public Policy Studies found out-of-pocket expenses reach 17 percent of total expenses for those seeking mental health services versus 8.4 percent for those seeking traditional medical services, the report says.In addition, state and federal parity laws that mandate insurance and managed-care companies cover mental health services at the same level as other conditions do not go far enough, Antal said. One reason is because the laws don’t cover businesses with fewer than 25 employees, the report says.The report offered several recommendations: establish better outreach for the mentally ill, especially the uninsured; allow for electronic health record data sharing to enhance coordination; require additional training in integrated care for providers; create payment plans that are fiscally sustainable; and address the “widespread social stigma” attached to the illness.The report, the result of a joint project between the bureau and IOD, can be found at:– ADAM KRAUSS/FOSTER’S DAILY DEMOCRAT