Expert reviewer issues first report on fixes to N.H. mental health system


Monitor staff

(Published in print by Concord Monitor: Wednesday, December 31, 2014)

Data and dialogue. That’s what Stephen Day, the man tasked with evaluating New Hampshire’s progress in fixing its community mental health system, is keeping his eye on as the state works to implement reforms stemming from a class-action lawsuit it settled last year.

In the first installment of what are slated to be at least biannual progress reports, the expert reviewer cautions that it is “very early” in the implementation of the state’s mental health agreement and would be “premature to reach any conclusions about meeting the performance and quality requirements” ordered under the settlement. The report was issued Friday and can be found under the “Community Mental Health Agreement” section on the Department of Health and Human Services website.

Still, Day points to several priorities for gauging New Hampshire’s mental health improvements in the months ahead. First, there’s the task of figuring out what New Hampshire should measure and how to measure it. Identifying important data sources and developing ways to track that data over time should – as with other aspects of addressing the state’s mental health challenges – be a collaborative process, Day writes in the report.

In the next six months, according to his report, Day plans to pay careful attention to discharge planning at New Hampshire Hospital and Glencliff Home; the initial rollout of mobile crisis services in the Concord area; efforts to connect people living in supportive housing with necessary services; and the continued development of Assertive Community Treatment teams, among others. Emergency department “boarding” will also be closely watched, Day notes in the report, because issues in that area are “likely to be symptomatic of issues in the overall mental health system” that would affect the settlement’s goals.

The class-action lawsuit, filed in February 2012 by the Disability Rights Center and the U.S. Department of Justice on behalf of six plaintiffs, alleged that New Hampshire unnecessarily institutionalized people with mental illnesses and possessed inadequate community resources for helping people avoid emergency situations. In December 2013, the state agreed to a settlement – estimated to cost $6 million in this biennium and $23 million in 2016-17 – that called for an expansion of community treatment, housing, supported employment and mobile crisis teams.

As part of that settlement, the parties selected Day – a former top official with the Massachusetts Department of Mental Health and a co-founder of the Boston-based Technical Assistance Collaborative – to monitor and evaluate New Hampshire’s work to improve its mental health system. The organization Day co-founded has worked with agencies across the country to develop “proven solutions to the housing and community support services needs of low-income people with disabilities and people who are homeless,” according to its website.

Day started his work as expert reviewer in July. Since then, much of his time has been spent familiarizing himself with the institutions and individuals who play a role in New Hampshire’s mental health system. His first report outlines these efforts: meetings with state health officials, the attorney general, members of the state’s Mental Health Coordination Team and others; visits to the state’s community mental health centers, support groups, and Concord Hospital’s “Yellow Pod” behavioral health emergency department; reviews of “voluminous data and documents relative to the (community mental health) agreement,” among others.

Though unavailable to speak about the initial report yesterday, Day said in an August interview that his role as reviewer consists of three main responsibilities: providing technical assistance in implementing the reforms from the mental health settlement; reviewing and reporting on the state’s progress in that implementation; and, if needed, mediating disputes between the parties involved. The settlement, he said in August, provided “a good roadmap for making appropriate improvements in the mental health system.”

Amy Messer, legal director for the Disability Rights Center, said the firm is pleased with Day’s work so far and looks forward to working with others to improve the system in the years ahead. Messer said she was glad to see Day’s notes on the importance of trying to alleviate the pressure placed on New Hampshire’s emergency departments because of mental health issues.

Ken Norton, executive director for the New Hampshire chapter National Alliance on Mental Illness, said this initial report seems to set up a solid foundation for evaluating the state’s progress. Norton, too, was glad to see the emphasis on emergency department boarding, as well as Day’s appreciation for the “strong collaboration” already in place between the community mental health centers and the state.

But to Norton, reading this initial summary felt kind of like starting a good book – but not being able to read past the first chapter, at least not until there’s more action on the benchmarks outlined so far. Now, Norton said, “It really makes me want to see that next report.”

(Casey McDermott can be reached at 369-3306 or or on Twitter @caseymcdermott.)