The Interview: Former HHS Commissioner Don Shumway says drug abuse, mental illness link not new

By Garry Rayno, State House Bureau, Union Leader

Published Sunday November 14, 2015

CONCORD — In the 1980s, the state radically changed how it treated the mentally ill and developmentally disabled, moving them out of large “warehouse” facilities into community settings.

Driven by lawsuits, the changes closed the Laconia State School and significantly downsized New Hampshire Hospital, moving patients to cities and towns where they received services through regional centers.
New Hampshire was the first state to close all its institutional services for the developmentally disabled. Through its partnership with Dartmouth Medical School, it ran a much smaller state hospital for the mentally ill that was innovative for the time.
Overseeing the transformation of these essential state programs was a young division director who convinced then-Gov. John Sununu that he could make the new systems work well for the patients and financially for the state.
Donald L. Shumway spent more than 20 years working for the Department of Health and Human Services, leaving as the agency’s commissioner in 2002 to become president and CEO of the Crotched Mountain Foundation, where he helped transform that institution into a multi-faceted facility providing services to the disabled.
Push back

In the 1980s there was resistance to decentralizing services for the mentally ill and developmentally disabled. Shumway said eventually through hard work, people opened their minds, and in time developed empathy for these neighbors within their communities.
New Hampshire looked at things differently then, Shumway notes, adding that the homeless were viewed as families with economic problems, not people with mental illness and substance misuse problems. 

In 1989, a statewide system of emergency homeless shelters was established.
Shumway said when the division established the community-based services for the mentally ill, a division employee would ride with Manchester police on patrol each Saturday night to help.

“The jails were not filled,” Shumway said in a recent interview. “Everybody owned it.”
After the mental health system was decentralized, the state was ranked near the top nationally for service and was rated a “best buy,” delivering value. The system held that ranking for about a decade.
Since then, the system has fallen in the rankings. Several years ago, a federal report found multiple issues with the system and the federal government joined a lawsuit forcing the state to make changes.
“The state has a very difficult time sticking with its priorities for the length of time required,” Shumway said. “You can see the mental health system has slipped over the last decade or more, and jails are filled with individuals with these problems.”
The state has to find a way to stay engaged, that is the hardest thing to watch, Shumway noted — seeing the loss of support and the surge of problems, including the level of substance abuse today.

Old problem
He said the connection between mental illness and substance misuse is not new.

Shumway was standing at a podium before 200 people on Sept. 11, 2001, saying the Medicaid program should have a substance abuse benefit.
When it was announced that the first plane hit the World Trade Center, half the people left.

“It’s hard to do, but you do your best work when you take on an issue and stick with it over time,” Shumway said. “We are now at that point with substance misuse.”
He noted the drug epidemic has touched almost every community, family and law enforcement agency in the state — to the point where all are mobilizing.

“I see political will,” Shumway said, “and when you have political will things happen.”
But he is the first to say it takes time to build that political will and piece together various segments of the community to speak in one voice so the problems can be dealt with.

He noted Crotched Mountain treats patients who have overdosed on heroin and were given Narcan to stop the effects but not soon enough to prevent brain damage.
Such families, Shumway said, have experienced the worst imaginable situation. They often have no idea how much trouble their child is in.

Crotched Mountain works with families and patients to develop a new relationship. “They learn to talk to each other in ways they have never done before.”
He said moving the developmentally disabled from the Laconia State School into the state’s communities helped everyone to redefine what it is to be human. “It helped us understand who we are,” Shumway said.
He said the judicial action never ordered a particular solution, just that a plan was needed to correct the conditions at Laconia.

Shumway said the plan was centered on the families and how to prevent them from being impoverished so they could lead aspirational lives, keeping the American dream alive.
“Everyone comes to this with a gift and an opportunity as individuals they need to have,” Shumway said. “We got it right, and I hope developmental services continue changing and getting it right.”

He said resources are stretched so much today, it forces creative thinking in order to provide services people require.
Shumway called his work at Crotched Mountain “a labor of love. All the roads in my life led me there.”

He said the foundation is a place that stands up for families with children with the most challenging disabilities and illnesses.
But now, Shumway said, he wants to focus on his own family. He expects to step down at Crotched Mountain in January.

The arc of his career has moved from Health and Human Services commissioner, overseeing the health of the state’s 1 million-plus citizens, to Crotched Mountain and its 1,000 residents, to his son, who suffered a brain injury during surgery.
“Moving forward I want to see how he and I can carve out a life so he and I can find new meaning together,” Shumway said. “I yearn for that opportunity.”