We can’t wait to fix mental health system

What will it take for New Hampshire to wake up to the urgent need to improve the quality, breadth and choice of mental heath services?

Recent events have drawn attention to the need for improved mental health services, but it appears the will to meet the critical needs of children and adults with mental illness has been in a virtual free fall for 10 or more years.

New Hampshire’s performance has plummeted according to the National Alliance for the Mentally Ill (NAMI). NAMI rated the state as a national leader in 1990. NAMI now scores the state at an overall rating of “D,” and an appalling “F” in having the basic foundation supports in place to deliver quality services and supports needed for recovery.

Funding for community mental health services continues to be inadequate, and has actually declined when inflation and an increased number of eligible citizens are taken into account. Funding is also disproportionately directed toward institutions and service models which artificially control rather than enable individuals to recover and lead independent, fulfilling and safer lives. Additionally, New Hampshire’s mental health insurance parity law has holes big enough to drive a truck through — and health insurance companies regularly do so.

On the national level, the president’s New Freedom Commission on Mental Health issued comprehensive recommendations for action in June 2003. As we approach the five-year mark, the recommendations have not been implemented in New Hampshire. Lack of will and commitment, know-how and vested interests in maintaining the status quo, combined with these funding issues have created an absolute obstacle to change.

New Hampshire’s leaders continue to substitute commission studies for real action.

The first study committee appointed after the president’s call for action met a few times in the fall of 2003, issued a few one-line recommendations, then dissolved. The second commission was convened in 2005 and was to issue a final report in December 2006 and is now requesting an extension until December 2009.

The former commissioner of the New Hampshire Department of Health and Human Services sat on an enlightened 2004 report prepared by his staff for 18 months. That study concluded that more than half the residents at the state psychiatric hospital in Concord could be living in the community if more housing and/or clinical supports were available in the community, options which are far less expensive than the nearly $700 per day costs at the state hospital.

Nothing has been done to implement any of the recommendations.

The tragedies in Whitefield, N.H., and Virginia Tech last spring and Dover, N.H., and in states around the country more recently, again dramatically demonstrate the consequences that can follow in the wake of a failure to provide comprehensive services to evaluate and treat children and adults with mental illness. Far, far more typically, persons with mental illness and their families become victims of the crisis in mental health.

The toll includes extreme emotional suffering, suicide, family discord, unemployment, homelessness, physical illness, financial ruin and unnecessary incarceration. Taxpayers also pay the price through increased health costs created by the over utilization of regular and specialized hospital inpatient acute care.

Funding directed toward high-quality and true community-based, recovery-oriented supports and services and true mental health insurance parity are needed, but it will never happen unless our Legislature, governor and Department of Health and Human Services find the will and commitment to act. The time is now, not in 2009.

Richard Cohen is executive director of the Concord-based Disability Rights Center.