All Doorways lead to Manchester: Statewide system creates dumping ground

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A group of homeless people camping at Bronstein Park last week head over to the shelter for dinner. Photo/Carol Robidoux

MANCHESTER, NH – Opioid crisis. It’s so familiar a phrase that the word crisis gets lost, somehow. Even as the opioids become less relevant to the equation. What began with highly-addictive pain pills – oxy drugs – became a heroin crisis, a cheaper alternative. It didn’t take long before fentanyl and other synthetic – and deadlier drugs – took over.

Nevermind the countless people struggling with alcohol, cocaine and meth addictions. They are not included in the state’s $48.5 million federal grant, which is specific to the opioid crisis. Addiction, in all its variations, is a contributing factor to what’s happening here, right now. Manchester is struggling harder than ever to keep up with the demands on city services. More than half of those who receive services here are from outside the “Manchester catchment area,” one of nine designated Doorways which were opened in January by the state Department of Health and Human Services, with much fanfare.

Nine months later, we are in full-blown crisis.

The New Horizons shelter is filled to capacity and turning people away, unheard of in the summer months. Yet, the 24 “safe beds” approved by the city board of aldermen in January for those in recovery sit empty. The “gap funding” came from the city, $130,000 from Community Development Block Grant (CDBG) funds, and $70,000 from the city’s Affordable Housing Trust, to allow the shelter to remain open during the day and hire two additional case managers.

“I just inspected the beds the other day,” said Manchester Fire Chief Dan Goonan on Thursday. “Two rooms, 24 beds, sitting vacant. They can’t be occupied because of the governor’s budget veto. They’re supposed to be sober living spaces for people who don’t want to be in a wet shelter.”

The money needed for personnel to supervise the “sober living” section of the shelter is on hold due to the veto, so the beds can’t be filled, Goonan said.

Newly renovated “safe beds” area of New Horizons shelter is unoccupied for lack of funding to hire a supervisor. Photo/Chief Dan Goonan

Meanwhile, the city has seen an unusual influx of people in need of services that range from addiction recovery to the basics, food and shelter. Police Chief Carlo Capano last week said he’s never seen anything like it in his 25 years as a police officer in a story last week on the rise in makeshift campsites popping up around the city, including parks.

There are many moving pieces contributing to the crisis, but in a state flooded with money that’s supposed to stem the crisis, where is Manchester’s lifeline?

Mayor Joyce Craig said the greatest disappointment is that the Doorways are not working. Instead of creating nine doorways leading to “spokes” of statewide services, all doorways currently lead to Manchester.

“We supported the program, given that the goal of it was to keep people in their home communities. It was supposed to help with the volume of people coming into Manchester for services. In 2018 we worked so hard, the whole community came together to work this out. and we did so in a way that we got things working better,” Craig said. “For the first time we saw good numbers. Overdoses were down by 19 percent and deaths from overdoses were down by 23 percent. We knew we were doing something right.”

In the fall of 2018 Sununu asked communities to submit plans for consideration as the state anticipated how to spend the SAMSA grant.

“We submitted a plan and it was completely ignored and then, the Doorway program was launched,” Craig said. “Since then we’re seeing increases in opioid deaths and overdoses. If you look at the data, before Doorways, from January to June, 329 people visited Safe Station from outside the Manchester catchment area. There were 503 over that same time period in 2019. It’s not working,” Craig said.

Another extenuating circumstance is that Manchester hosts the only year-round emergency homeless shelter in the state.

“I spoke with Kathy Kuhn of FIT/New Horizons in trying to figure out where all the homeless people are coming from. We were seeing an influx of people from Nashua and Merrimack, and we did some digging and found out that on July 30 Harbor Homes closed Nashua’s emergency shelter, which is being converted into a transitional shelter. They’re not servicing people on an emergency basis any longer. And nobody informed us of this,” Craig said.

New Horizons has been hiring a police detail due to an increase in “aggressive and brazen” behavior, Craig said.


 

Above: Aug. 19, 2019 letter sent to Gov. Sununu by Mayor Craig


Chief Goonan says he is in touch with all the hubs. “There are no services for people elsewhere. That’s why they’re sending them here,” by taxi, Uber and Lyft. And in places where there are no taxis, Ubers or Lyfts, people are told simply to “head south.”

“These people are desperate and we have no sheltering. The biggest driver of homelessness here is the lack of sheltering around the state, but the state doesn’t acknowledge that. Manchester is doing the bulk of services for opioids and sheltering. If DHHS doesn’t realize what’s happening, they’re completely incompetent,” Goonan says. “I’ve had enough of the politics.”

Craig says with the weather changing, the state must hear what city officials are saying.

“It’s important for the state to understand what’s happening in Manchester,” Craig said. “Winter is around the corner. What is their statewide plan for emergency shelter this winter?”

Craig sent a letter on Aug. 19 to Sununu summarizing the fallout from the Doorways that has landed in Manchester. In the letter she says that she has contacted Department of Health and Human Services Commissioner Jeffrey Meyers “no less than 20 times,” with no meaningful response, except to “be patient.”

Patience turns to frustration

On Thursday a small delegation from Manchester traveled to Concord to finally meet with Meyers. The agenda was simple:  Discuss how to stop the crush of people seeking services in Manchester, who should be getting the help they need at one of the other “Doorways” under the statewide delivery model funded by a $45.8 million two-year federal grant.

The meeting didn’t go as planned.

Originally, Mayor Craig and City Health Department Chief Anna Thomas planned an “incident command structure” meeting, which was to include Police Chief Carlo Capano, Fire Chief Dan Goonan, City Solicitor Emily Rice and point persons from Catholic Medical Center and Elliot Hospital, along with a delegation from Dayton, Ohio, who have made notable stride in battling their own opioid crisis through strategic coordination with Ohio’s state government.’

City Health Department chief Anna Thomas, speaking at a community forum on homelessness in June 2019. File Photo/Carol Robidoux

Thomas said bringing together city officials tasked with handling emergencies is a strategy already in place here. But without cooperation from the state, it’s a futile effort.

“This is a strategy used in emergencies and epidemics, and it makes perfect sense in an instance like this because of the numbers we’re seeing come through Manchester,” said Thomas. “It’s warranted.”

However, days before the scheduled meeting  Meyers pulled the plug on the guest list. He told Thomas he would only meet with city officials – so police and fire, and hospital partners were crossed off the list. Craig and Thomas arrived with Rice and two health department senior officials.

The governor was invited to sit in, unbeknownst to the Manchester delegation.

And within an hour of the meeting, Sununu issued a press release that infuriated and frustrated the Manchester delegation.

“I’m so mad and upset this is happening,” Craig said Thursday night.

The press release was titled, “Governor Chris Sununu Announces New Partnership to Help Manchester Reach Full Potential,” [see the full press release below] and the second paragraph, in particular, is patently false, according to Craig.

It reads:

“Upon learning from Mayor Craig that the City of Manchester does not currently have an opioid response plan, Governor Chris Sununu recommended forming a new coordinating team that will be composed of state and city officials to ensure cooperation between the City of Manchester and the State of New Hampshire on a variety of issues. This new team will be able to assist Manchester in formulating city-wide response plans and identify deployed financial resources to ensure there are no gaps in the system.”

“The governor says we have no plan. That is false. I never said that,” Craig said, citing three plans the city has in place –  the Mayor’s Addiction Response Plan, and a plan initiated by former city health director Tim Soucy, and a plan that Thomas is now working on, subsidized through county funding.

“It’s not a plan on a shelf, its a plan we can work on and implement. Part of that plan involves something called CAST – Calculating Adequate Systems Tools, which looks at whether a community has adequate systems in place for treatment and recovery,” Craig said. “Manchester was the first U.S. city to complete the tool. In fact, it’s a deliverable of the substance use disorder continuum of care plan so the governor should know about that plan.”

Beyond that, the governor’s press release makes it sound like he proposed a partnership plan with the city. It’s quite the opposite, Craig said.

“If anything, during the meeting Anna mentioned Manchester not having a plan, but she was referring to a plan – in coordination with the state,” Craig said. “Our health department has an amazing and incredible relationship with the CDC and other national organizations, and in conversation with these organizations, it’s clear that we need a better ongoing relationship with the state. We’ve been trying to establish that for months, but we’ve made no headway. That was one of our objectives in going there.”

Treating a crisis like a crisis

Manchester City officials met back in July with the group from Dayton at the suggestion of the Centers for Disease Control. The next step was to engage state officials in the process, Thomas said.

She was prepared with a “punch list” of requests to address a problem that is close to being a public health crisis, Thomas said. In fact, they were there to find out at what point a health crisis could be declared. 

“One of the hurdles we have is that we can’t learn from other rural areas. I need urban examples. We know disease occurs differently in urban environments. That’s how we learned about facing it head-on, by standing up an incident command structure. The first part of the meeting was just to bring together our state and local partners, and the second half we were going to bring in the experts from Dayton. We were going to let the Commissioner know how we’ve engaged this opioid rapid response team. Commissioner Meyers didn’t feel it was necessary to have the CDC or folks from Dayton in the room, so we took that off the agenda,” Thomas said.

According to Thomas, Meyers at first said she could bring anyone to the meeting she wanted, so she assembled the city’s incident command team.

“He then told the mayor earlier this week he wasn’t ready to have a meeting like that, and so we uninvited the chiefs and the hospitals,” Thomas said.  “Commissioner Meyers set the parameters.  He would only discuss the opioid crisis. We were not to talk about Doorways or Safe Station, which defeated the whole purpose. For us, it was an opportunity we’ve been waiting for, for a long time, to talk about how the state and city can work together. How do you not talk about Doorways and Safe Station when it comes to opioid response?”

That’s a question Chief Goonan has, as well.

Safe Station began in Manchester and has extended to other community fire stations to increase access to recovery and reduce the number of overdose deaths. File Photo/Carol Robidoux

Safe Station, which has been applauded by everyone from President Trump to those who write personal thank-you notes after receiving a new lease on life, has yet to be implemented as a statewide solution. More than 6,200 people have entered a city fire station seeking help for addiction, says Goonan.

The only time the governor visited was when Trump came through in March of 2018, says Goonan.

“Why hasn’t Safe Station been implemented statewide? It’s not the governor’s idea. I don’t know how else to say it. The doorways and how it was set up, was his idea. Where’s 2.0? Because 1.0 ain’t working – just ask the Doorways, people are coming down from the Doorways because at least they have a shot at treatment in Manchester,” Goonan said.

“What used to take weeks now takes days. We get the majority of people who come to Manchester into the pipeline quickly, and there’s really not much cost involved. We’re the front door to the doorways. Most of the hubs are only open from 9 to 5, which is another problem. The governor says there’s so much money coming into Manchester, but the first stop is Concord and that whole bureaucracy before it trickles down. They want to double-down on something that’s not working. He says they’ve sent $5 million dollars to Manchester’s Doorway. That’s news to me,” Goonan said.

“If the governor said, ‘Hey, city of Manchester, here’s $5 million to invest in things that are needed, like stabilization beds and wrap-around services, maybe we’d get somewhere. But nobody asked us. This is just bureaucracy, and it’s infuriating to me as a fire chief in Manchester. We’re on the front lines of a community on the forefront of this massive opioid crisis – and it’s no longer just an opioid crisis, it’s an ‘all of the above’ crisis,” Goonan said. “People forget about alcohol, but thank god they’re allowing us to send people with alcohol problems to the hub now. For a while, they said we couldn’t use transportation funds for alcohol.”

 

NH Overdose Deaths 1999-2017 Graphic/NH DHHS

Hub-and-spoke

“The Doorways” was initially launched as the “Hub-and-Spoke Model,” but in the months since it was introduced, the concept of Doorways has prevailed.

“Frankly, the hubs have no spokes, no shelters, no treatment beds, no help outside of Manchester. The mayor has even said that she’d rather not accept any more state money if the money can pay for building hubs and spokes systems where they should be, where people around the state can go and access services. People should be able to function and thrive where they live. They need to build these systems up so they adequately meet the needs of the state,” Thomas said.

During the Thursday meeting with the governor, Thomas and Craig asked for a more consistent way of working with the state to address Manchester’s saturation of need.

“The governor said, ‘Why don’t we set up a team?’ That was what we had asked for, and he said it like it was his idea,” Thomas said. “We’ve learned from the CDC that we can’t fix this by ourselves. We’ve saved a lot of lives, but moving forward we need the state to be part of our incident command structure. There’s no state-local plan outside of the Doorways, but that doesn’t get into intervention and prevention, only treatment and recovery. We need a comprehensive plan in all those domains.”

Thomas also would like to see an ombudsman assigned to the state.

Years ago, when dealing with oral health, all communities were getting the same money – even though Manchester had five times the need, said Thomas. When an ombudsman got involved it allowed decision-making to be made based on a formula of where the most need was.

“And that’s why we asked the Commissioner for an ombudsman. He said he’s open to it, although he wouldn’t go as far as declaring it an ombudsman, but he agreed to have someone from DHHS more present in our community. He asked us to give some thought to who we might want to represent us,” Thomas said.

Craig and Thomas both also raised the question of NH’s overdose fatality review committee – established several years ago under Governor Hassan, the committee has become defunct.

“That’s something the CDC asked us, if we had such a committee, and did Manchester have a seat at the table,” Thomas said. “The reason why those are effective is they’re conducted with rigor and methodology for investigating every death and understanding why did that person overdose, what led to that addiction. I think there’s something to be said for all these people tragically losing their lives in vain. We’re not trying to learn to get to prevention, and it is at least a small way of honoring the loss of life.”

Thomas says she left the meeting feeling like differences were aired and the conversation about how to move forward in a collaborative way was finally initiated.

“I left the meeting in good faith that the state wants to work with us. At the end of the day the biggest take-home message is we want the state to help us. They made it sound like ‘Manchester doesn’t have a plan, and we’re going to come in and fix it.’ Right now, what we don’t have is a plan that reflects collaboration with the state. Unless we have a plan that’s tied to a commitment of action for working together, it won’t work. A plan isn’t a solution. The action is the solution,” Thomas said. “I don’t want to get tangled up in the politics of it. We have a moral obligation to get people the help they need, and we can’t continue to do the work of the state here. That’s why we have a state DHHS.”

Thomas also noted that she and Sununu grew up in the same town. “We were afforded opportunities in our lives. We were lucky, but there are many people who have not been afforded the same opportunities and may have been raised in crisis and instability, and that’s all they’ll ever know. Right now, we’re not helping them out of that crisis.”


Below is the statement issued by Gov. Sununu following Thursday’s meeting with city officials.  The governor was not available for an interview as requested by the InkLink for this story.

Governor Chris Sununu Announces New Partnership to Help Manchester Reach Full Potential

Concord, NH – Today, Governor Chris Sununu met with HHS Commissioner Jeff Meyers, Manchester Mayor Joyce Craig, along with city and state officials to discuss ways to help Manchester realize and take advantage of the full array of state resources already available to the city.

Upon learning from Mayor Craig that the City of Manchester does not currently have an opioid response plan, Governor Chris Sununu recommended forming a new coordinating team that will be composed of state and city officials to ensure cooperation between the City of Manchester and the State of New Hampshire on a variety of issues. This new team will be able to assist Manchester in formulating city-wide response plans and identify deployed financial resources to ensure there are no gaps in the system.

“Today I joined Mayor Craig and Commissioner Meyers for a productive conversation regarding the issues surrounding the City of Manchester,” said Governor Chris Sununu. “Manchester is a great city, but we must recognize and address the challenges they face. This new coordinating team will help create a system that will allow for the city to target key areas of need at the local level.”

Under Governor Chris Sununu, the state has heavily invested in Manchester and other localities through a variety of funds, which should allow Manchester City officials to target other key areas of need.

BACKGROUND PROVIDED:
In his first term, Governor Chris Sununu’s Administration delivered:

  • $1.7M to Manchester to improve roads and bridges
  • $1.7M to Manchester for safer schools
  • $1.1M to Manchester in additional kindergarten aid
  • $2.7M to Manchester for the opioid epidemic
  • State funding to cover the cost of Safe Station transportation to HUBs
  • Over $5M in funds to establish the Manchester Doorway at Granite Pathways

In addition, ongoing state support to Manchester in FY19 includes:

  • $102.4M in school adequacy
  • $3.2M in building aid
  • $1.2M in Special Education aid
  • $631K in tuition and transportation aid
  • $12M in federal funds/grants

Contact Carol Robidoux at carolrobidoux@manchesterinklink.com


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About Carol Robidoux 6367 Articles
Longtime NH journalist and publisher of ManchesterInkLink.com. Loves R&B, German beer, and the Queen City!