Community mental health centers on the precipice of a ‘transformational’ moment

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The state’s 10 community mental health centers would be able to expand services significantly and offer statewide mobile crisis response under a contract going before the Executive Council Wednesday.

“This is really transformational and something I have not experienced in my 20 years,” said Brian Collins, executive director of Community Partners, which serves greater Dover, and president of the New Hampshire Community Behavioral Health Association. “I will tell you that we are on the precipice of something that is positive.” 

The 10 contracts total $52.4 million and would give some centers nearly 50 percent more than what they get now from the state Department of Health and Human Services to serve low-income residents. In addition to a mobile crisis team, each center would add six supported housing beds, an employment counselor, and services for people who are deaf or hard of hearing.

Some centers would also start integrating medical and mental health services for clients 18 to 35; developmental health supports in schools; and one would add a small residential program for people dually diagnosed with severe mental illness and either a developmental disability or acquired brain disorder. 

A few questions remain, however. 

The creation of statewide mobile crisis response teams, planned for in 2019 but never implemented, promises to make the greatest impact by connecting providers with people in the moment, while they are still at home, before they go to an emergency room. DHHS officials have said the statewide mobile crisis response unit is one of their top priorities, but they have not yet been able to hire someone to run the call center, which is expected to resolve 70 percent to 80 percent of calls over the phone. At its last meeting, the Executive Council tabled the department’s proposed $9.3 million contract with Beacon Health Optics of Boston to run the center over concerns that Beacon is seeking payment up front. Councilors have asked the department to revisit the terms with the company.

Second, hiring staff to provide these expanded services will also be a challenge. Many of the state’s 10 centers already have 25 to 40 clinical staff vacancies. William Rider, CEO of the Mental Health Center of Greater Manchester, said staffing shortages led his agency to add the supported housing beds to an existing facility rather than build a new one because doing so would allow the center to use existing staff for at least some of the additional work.

The Mental Health Center of Greater Manchester on Cypress Street. Photo/Carol Robidoux

The increased contacts that will go before the Council Wednesday are part of DHHS’s larger effort to expand treatment to help people manage their illness in their own communities and avoid crisis visits to emergency rooms. In May, DHHS also significantly increased its rates to hospitals and long-term care facilities in exchange for an additional 50 in-patient psychiatric treatment beds. As those beds have become available, the number of adults waiting days in emergency rooms for treatment has dropped, from 42 in mid-May to two on Monday. The number of children, however, has hovered between 20 to 25 since then. 

“Over the last several years, Gov. Chris Sununu and the state Legislature have made significant investments to support the state’s 10-Year Mental Health Plan and Children’s System of Care,” said DHHS spokeswoman Kathy Remillard. “This comprehensive approach to providing essential mental health services and supports across the lifespan is in the process of being implemented to transform how the state addresses the behavioral health needs of individuals, families, and communities.”

Jay Couture, CEO and president of the Seacoast Mental Health Center, said the expanded contract will allow her center to not only add a mobile crisis unit but also expand its supported community housing program to 14 beds, allowing it to help more people who can live and work in the community with the support of a group home setting. 

Couture’s center already integrates primary and mental health care, a practice she said allows both types of practitioners to have a better understanding of their clients’ needs. The contract would allow the center to hire someone to coordinate the in-school counseling program, allowing the center to have a better understanding of students’ needs.

“There’s a lot of good stuff in (the contracts) in terms of providing expanded services,” Couture said.

Rider, whose treatment center in Manchester would receive an additional $3.7 million in the proposed contract, said additional funding is critical to maintaining timely services for clients. The Manchester center is one of three in the state to already have a mobile crisis unit, a crucial service but also one that has cost the agency about $2 million since it started five years ago.

This contract would be a chance for Collins and his team at Community Partners to create a mobile crisis response unit as well as bring on an employment counselor to work with clients who would like to work but need help finding the right job and navigating employment benefits and the Medicaid benefits they rely on for counseling. 

“We are excited about it and daunted by it,” he said. “It will require more clinicians, and there is still a clinician shortage in the state. This is not something that will be like turning on a light, but we are rolling up our sleeves and ready to get to work.”


Republished with permission under Creative Commons licensing.