By Rick Jurgens, Valley News Staff Writer
Tuesday, May 12, 2015
(Published in print: Tuesday, May 12, 2015)
Concord — People with mental illness in New Hampshire sometimes face long waits for treatment from a too-bureaucratic system where low pay and other factors result in shortages of professional and other caregivers.
That was the gloomy view Monday morning from the vantage of a self-styled Congressional “summit” of about 75 advocates, health care providers and others convened by the state’s two representatives in the lower house of Congress — Annie Kuster, a Hopkinton Democrat, and Frank Guinta, a Manchester Republican.
Some patients, such as those with addiction or substance abuse issues or developmental disabilities, are said to have dual or multiple diagnoses. It sometimes seems that care for such patients remains “in the dark ages,” said Ken Norton, executive director of the New Hampshire affiliate of the National Alliance on Mental Illness.
Their care may involve various state agencies and entail complex payment and reimbursement limits, said Peter Evers, executive director of Riverbend Community Mental Health Center in Concord: “We have been forced into silos to provide services that are dictated by (billing) codes.”
That can leave a patient in limbo. At Elliott Hospital in Manchester, one older patient with both developmental disability and substance abuse issues waited four months in the emergency room for space in an appropriate treatment program to become available, said James Woodward, the hospital’s chief executive.
Maggie Pritchard, executive director of Genesis Behavioral Health in Laconia, N.H., described some of the bureaucratic hurdles in the paths of caregivers. The federal Center for Medicare and Medicaid Services will only reimburse clinics for therapy done while a physician is in the building. Nurse practitioners can prescribe drugs but aren’t empowered to sign off on treatment plans. The Settlement Agreement in a class action lawsuit that sought more resources for community treatment didn’t align completely to a 10-year plan with similar objectives that was written by the state in 2008.
“Sometimes I feel like we’re putting out a fire and there’s another fire behind us,” Pritchard said.
Several speakers warned that the future of the New Hampshire Health Protection Plan, which has used federal funds to pay providers for mental health care for some previously uninsured patients, remains in doubt. The current program, which took advantage of a provision in the federal Affordable Care Act that encouraged states to expand the current Medicaid program of insurance for low-income families, is due to expire at the end of 2016. Its fate could depend on current budget deliberations in the state Legislature.
Kuster said that she and Guinta, who frequently travel on the same airplane between Manchester and Washington, D.C., discovered during an airport conversation that they each had close family members with serious mental illness. That conversation led to plans for Monday’s summit, and prompted the pair to begin working together to write a bill that would expand federal support for mental illness care, research and treatment. Kuster said in an interview that Monday’s summit had pointed out the importance of trying to add to the legislation measures to address workforce shortages and low pay.
Low pay and staff shortages were recurring themes sounded by panelists and audience members Monday. “It comes down to dollars,” said Robert MacLeod, chief executive of the New Hampshire Hospital, a 158-bed state-operated facility in Concord for the mentally ill. “It’s a highly competitive field today in health care.”
Pritchard said that her agency recently hired two doctors after an 18-month search that considered 184 candidates. One of the positions, specializing in psychiatric care for children, took five years to fill, she said.
“People need to get paid,” said Becky Ewing, a physician and advocate for better health care for mothers and children. “We’re not going to change the system (unless) we pay people adequately to do the job.”
Nick Toumpas, the commissioner of the state Department of Health and Human Services, noted that in mental health care there was a tendency to focus on short-term solutions, often with an unfortunate result: “Today’s problems come from yesterday’s solutions.”
Looking to the future, he said that the state would need to develop “a constellation of services around the individual.”
And Michele Grennon, president of the board of NAMI New Hampshire, urged the summit participants to come down off the mountain to design a better mental health care system which would, she said, develop from “treatment from the person up, not from the system down.”
Rick Jurgens can be reached at firstname.lastname@example.org or 603-727-3229.