Making Mental Health Care a Priority
September 16, 2009
| Published Wednesday, September 16, 2009 7:00 am |
by JOSHUA A. BOYNTON
New Hampshire's approach to mental health services has changed radically in the past 35 years. Then, the NH Hospital alone housed 3,000 residents. Today, there are fewer than 200 acute psychiatric care beds statewide, and the average stay is just six days. That shift from institutionalization to community-based mental health requires the support of the business community as community-based mental health care benefits both those with mental illness and the economy.
A report issued last year by the NH Commission to Study Mental Health, called Fulfilling the Promise: Transforming New Hampshire's Mental Health System, found that about 254,000 adults and 55,756 children in NH-or more than 20 percent of the population-would experience mental health issues in a given year.
With so many people in our workforce needing mental health services at some point, businesses may want to rethink mental health and view it as we do physical health, education, child care and other support functions that maximize worker productivity.
Early Treatment, Lifelong Success
The payback from a strong mental health system is huge given that early treatment success rates for mental illnesses are 60 to 80 percent. That vastly exceeds success rates for heart disease, which range from 40 to 60 percent, according to a study by the National Mental Health Advisory Council. Yet in annual per capita state spending, mental health receives $126.71 compared to education spending of $2,386.
Many people are treated by one of the state's 10 private, nonprofit Community Mental Health Centers (CMHC), which provide counseling, case management and emergency intervention services for about 41,000 NH residents, and work closely with other mental health providers. Care takes place in the community and often involves one-on-one and group counseling.
New Hampshire is a known leader in community-based mental health services because providers here focus on building a culture of recovery, so that those who need care do not bounce in and out of treatment.
And treatment practices, like those developed by the Psychiatric Research Center at Dartmouth College in Hanover, are transforming mental health care nationwide. According to Substance Abuse and Mental Health Services Administrations data, only 27 percent of those who seek emergency services nationally returned within 180 days in 2007. That is down from 31 percent who were readmitted in 2004, showing that reintegrating individuals with mental illness back into society, the workforce and our communities reduces incidences of readmittance.
Physical and Mental Health Parity
Despite improvements in care, many employers are reducing mental health coverage as part of their employee health plans. While the state has a mental health parity law, it applies only to serious mental illness, and requires minimal treatment of conditions like depression. The state Mental Health Commission reports expanding insurance coverage to cover a range of mental illnesses is critical to improving mental health in NH.
Just as we would expect an employee with a broken leg or the flu to seek medical attention, a worker with mental health issues also needs care. In fact, the effect of someone with mental health trouble in the workplace can be more damaging than physical health to both the employee and his or her co-workers. One solution would be to expand the mental health parity law to cover diagnoses such as depression and anger management.
Most mental health issues are short term, resolved quickly and result in more productive employees. With treatment, even chronic mental illnesses can be remedied, provided the bias in health insurance against treating certain mental illnesses is resolved.
Reforming Corrections
Another challenge is stopping the revolving door in our correctional system. While deinstitutionalization resulted in increased freedom and better care, there are many, particularly those with substance abuse issues, whose struggles often put them in contact with the legal system.
The cost of prosecuting and incarcerating those individuals is staggering. If the state were to redirect those resources to give the CMHCs and the judicial system the tools to identify and provide treatment, recidivism and crime could be reduced.
In 2006, the Department of Health and Human Services proposed the creation of a centralized location for diagnosis and treatment of those with mental illness who entered the state and county corrections system. The plan included rapid intervention and diversion, and could have avoided prosecutions and incarcerations. Ultimately, the Legislature opposed these ideas, citing the initial upfront costs, despite the substantial long-term cost savings. It remains an idea worth exploring.
For NH to remain a leader in effective community-based mental health care, we must accept that mental health treatment works and be willing to commit the resources necessary for success. If we do so, others states will keep turning to us for leadership.
Joshua P. Boynton is the President and CEO of LifeShare Management Group, Inc., a Manchester-based community support provider for individuals of all abilities with offices in NH, Maine, Massachusetts and Florida. He can be reached at j.boynton@lifeshareinc.org or at 603-625-8825.
