Suellen Griffin: The path ahead for state mental health system
For the Monitor
This is a brief update on the successes and failures we saw this year, and a beginning of the discussion we need to have about 2019.
Along with many other health care advocates and social service providers, CBHA worked hard this year to ensure passage of Senate Bill 313, reauthorizing Medicaid expansion. More than 50,000 Granite State citizens would have been left without health insurance if the Medicaid expansion program had not been extended. That number includes thousands of individuals with mental illness who are served by the 10 community mental health centers. The leadership and support of Gov. Chris Sununu, Sens. Chuck Morse and Jeb Bradley, and other policymakers and budget writers was key to its passage last month. We sincerely thank the many legislators on both sides of the political aisle who recognized the need to ensure health insurance coverage for their constituents.
We also championed legislation that will add funding for the State Loan Repayment Program, which helps community mental health centers attract and retain staff. A proven and cost-effective way to address workforce shortages is funding SLRP, which helps individuals pay down their school loans and creates an incentive for them to stay in New Hampshire. CBHA has tracked employment trends at the 10 community mental health centers since December 2015. The data show steady increases in vacancies across the 10 centers. At the end of May there was a 9.2 percent vacancy rate with 218 open positions, 194 of which were clinical.
Lack of staff at our centers means that people with mental illness may not be able to access services when and where they need them, at the community level. This is directly linked to the hospital ER backup and the need for more psychiatric beds at N.H. Hospital. There were over 53 pieces of legislation introduced in the 2018 legislative session related to workforce but less than half the bills were approved (and few are as meaningful as the SLRP funding). We suggest that the Legislature identify workforce as its No. 1 priority for 2019, and that proposals for changes to licensing and other bureaucratic barriers be presented as a package.
Filing 53 separate bills on any one topic can amount to duplication and lack of consistency; some of 2018’s workforce bills were referred to the Labor Committee, some to Health and Human Services, others to the Executive Departments and Administration Committee. And in addition to over a dozen ongoing workforce study committees and commissions that the Legislature or state agencies have established, several new ones were created. There needs to be a comprehensive approach to workforce and legislative leadership needs to take a leadership role on this. The current workforce shortage affects much more than the health care field and nonprofit service providers. All New Hampshire businesses and industries would benefit from an all-inclusive and targeted initiative to fix the problem.
We have said before and will say again that, first and foremost, the Medicaid reimbursement rate schedule for community mental health centers needs to be increased; and the entire mental health system of care must be funded fully. House Bill 400, which directs the Department of Health and Human Services to develop a new Ten-Year Mental Health Plan, was enacted a year ago and work is now underway, with a final report and recommendations for legislation due later this year. Therefore, we offer this list of criteria for the Ten-Year Plan authors and the Legislature – both new and returning members – to consider and take to heart.
To improve mental health in New Hampshire, we as a state must:
1) Adequately reimburse the CMHCs for the vital role they play. The Medicaid fee schedule for community mental health providers has seen no increase since 2006.
2) Increase the income limit for Medicaid clients with spend-downs, which has not been adjusted since 1999.
3) Continue to support the State Loan Repayment Program.
4) Improve support for the implementation and sustainability of evidence-based practices.
5) Ensure that licensure reciprocity laws for mental health and substance use treatment professionals are implemented.
6) Improve access to care in a timely manner.
7) Reinstate the moratorium for prior authorizations for medications prescribed by CMHC prescribers.
8) Add and incentivize the use of new technologies to improve care.
9) Create urgent care centers for behavioral health clients.
10) Increase funding for step-down crisis respite services.
11) Increase funding for peer-based recovery support services.
12) Improve opportunities for hospitals and CMHCs to work together.
13) Re-release the RFP for an Acute Psychiatric Residential Treatment Program to create more capacity.
14) Work closely with managed care organizations.
15) And finally, add more voluntary and involuntary inpatient beds and community-based residential services.
(Suellen Griffin is president of the N.H. Community Behavioral Health Association and president and CEO of West Central Behavioral Health in Lebanon.)