Mental Health

Citizens Count Editor

The New Hampshire government subsidizes mental health care by funding some outpatient and inpatient mental health services.

The state recently increased that funding thanks to a 2014 lawsuit, which found that New Hampshire needed to do more to keep mental health patients out of hospitals, instead treating them within a community care setting.

If you are looking for mental health treatment in New Hampshire, click here and contact the community mental health center closest to you.

Outpatient Care in NH

Community mental health centers

New Hampshire provides funding for ten not-for-profit community mental health centers. This funding allows the centers to take on any patient in their area who needs help, regardless of his or her ability to pay.

The centers will bill patients who have insurance coverage, whether through a private insurer, Medicaid, or Medicare, but can use a sliding fee scale for uninsured or underinsured patients.

Even when these centers can bill an insurer, the rates at which they’re reimbursed for these services don’t completely cover costs. The funding the state provides—using a combination of state money and federal grants—is what enables them to keep their doors open.

Legal troubles and impact on funding

A large part of New Hampshire’s outpatient mental health funding is dictated by the terms of a 2014 settlement agreement.  That lawsuit argued that New Hampshire violated federal laws – particularly the Americans with Disabilities Act –  by failing to provide adequate mental health services in a community setting and instead relying too much on housing citizens with mental illness in hospitals.

Under the terms of the 2014 lawsuit settlement, New Hampshire had to provide funding to expand community mental health treatment as follows:

  • Develop Assertive Community Treatment (ACT) – teams that can provide regular services out in the community – to serve up to 1,500 individuals with mental illness
  • Develop mobile crisis services – teams that can visit a patient in crisis and provide services – in Concord, Manchester, and Nashua
  • Expand supported employment opportunities, which help individuals with mental illness find and keep employment
  • Expand supported housing, such as group homes and rental subsidies
  • Develop transition plans for residents of Glencliff Home and New Hampshire Hospital to move to community settings

As of the end of the 2017 fiscal year, an independent evaluator concluded that New Hampshire was meeting most of these requirements.  However, the evaluator noted that ACT teams were understaffed according to the terms of the agreement.  The state Department of Health and Human Services disagrees with that claim. 

The 2018-2019 state budget also provides funding for an additional mobile crisis team.

Inpatient Services

In addition to outpatient, community-based mental health treatment, the state provides inpatient treatment for individuals with severe mental illness at New Hampshire Hospital.  There are also some patients living long-term at Glencliff Home, although the state is working to move those individuals back into the community.

Long waitlists

A long waitlist at New Hampshire Hospital was one reason for the 2014 lawsuit against New Hampshire – but so far increasing community-based treatment has not decreased demand for inpatient services. 

At the time of the lawsuit settlement in 2014, on any given day an average of 24 adults were waiting in hospital hallways and emergency rooms for a bed at New Hampshire Hospital.  In 2016 the average was over 30.  On August 21, 2017 there were a record 72 people waiting for beds at the state hospital.

Some of this increase is due to private hospitals around the state closing their inpatient mental health facilities.  The opioid addiction crisis has also placed more strain on the health care system overall.

The 2018-2019 state budget attempts to address the waitlist for New Hampshire Hospital by funding 60 beds at private hospitals around the state that are equipped to house patients with severe mental illness.

Patients in prison?

New Hampshire Hospital has also faced criticism for its lack of a secure psychiatric unit.  In New Hampshire, an individual with mental illness who “present[s] a serious likelihood of danger to himself or to others” may be committed to the Secure Psychiatric Unit in the state prison without committing a crime. 

Some stakeholders argue that federal court rulings require states to keep patients in the least restrictive setting possible, so New Hampshire’s use of the state prison might violate federal law.

A commission of legislators and other officials is evaluating the use of the secure psychiatric unit in the state prison and will report its findings before the end of 2018.

Insurance coverage for mental health treatment

A state law passed in 1994 requires insurers in New Hampshire to cover mental health treatment.  The federal Affordable Care Act also requires any insurer offering a plan on the health insurance exchange to cover mental health services. 

Furthermore, state and federal laws require any insurer that covers mental health services to cover those services and other physical health services in about the same way.  For example, insurers cannot require a much higher copay for a visit to a psychologist than for a visit to a primary care physician.

However, New Hampshire has not increased its Medicaid reimbursement rate for mental health services since 2006.  Many insurers also offer mental health providers low reimbursement rates.  These low reimbursement rates are a financial challenge for mental health professionals, and contribute to a shortage of mental health professionals in the Granite State.  According to the U.S. Department of Health and Human Services, there are shortages of mental health care professionals in every New Hampshire county except Cheshire. 

Related Issues

Medicaid Expansion
Heroin Addiction: Treatment Funding
 

PROS & CONS

"For" Position

By Citizens Count Editor

“New Hampshire should increase funding for mental health.”

  • According to the Treatment Advocacy Center, states should provide a minimum of 50 hospital beds per 100,000 people for patients with severe mental illness.  New Hampshire only provides 12 beds per 100,000 people. The state needs to dramatically increase the number of inpatient beds to meet minimum standards for Granite Staters in crisis.
  • The number of individuals waiting for a bed at New Hampshire Hospital has more than doubled in just a few years.  This rapid increase indicates a failure to meet the needs of citizens with mental illness before they reach a crisis point. 
  • According to the latest data from Mental Health America, roughly 1 out of 5 adults with mental illness in New Hampshire report they are not able to get the treatment they need.  This lack of treatment is due to high costs for treatment as well as a lack of available treatment providers.  While other states have even worse access to mental health treatment, it is still unacceptable to leave one-fifth of residents without treatment. 
  • According to the Centers for Disease Control and Prevention, New Hampshire has the highest suicide rate in New England, and the 18th highest rate in the United States.
  • New Hampshire’s practice of housing some patients in the Secure Psychiatric Unit of the state prison is unethical and potentially violates federal laws. New Hampshire needs to fund a Secure Psychiatric Unit at the state hospital or contract with an appropriate mental health facility out-of-state.

"Against" Position

By Citizens Count Editor

 “New Hampshire should not increase funding for mental health.”

  • New Hampshire is on track to meet every requirement of the 2014 lawsuit settlement, and the 2018-2019 state budget actually adds mental health treatment services above and beyond what the settlement requires.
  • While Mental Health America reports that roughly 1 out of 5 adults with mental illness in New Hampshire are not able to get the treatment they need, this statistic may not be as bad as it seems.  According to the same report, in 2014 New Hampshire ranked sixth in the nation for access to mental health treatment.  That ranking included nine measures of access, from the percentage of adults with mental illness receiving treatment to the size of the mental health workforce. 
  • According to the Henry J. Kaiser Foundation, in fiscal year 2013 – before the lawsuit required New Hampshire to increase spending on community mental health treatment – New Hampshire ranked 16th among states for per capita spending on mental health services, well above average.  Since then New Hampshire has more than doubled state funding for community mental health services.
  • Additional state spending on mental health services will not address the shortage of mental health professionals in the state.  If the state wants to strengthen its mental health care workforce, it should instead invest in programs that encourage university students to prepare for careers in mental health.  

LEGISLATIVE HISTORY

Signed by Governor

Allows the Department of Health and Human Services to waive the work requirement in the child care scholarship program for applicants or recipients participating in a mental health or substance use treatment program. The child care scholarship program gives working parents under 250% of the federal poverty level financial assistance for child care.

Killed in the Senate

Prohibits the use of electroconvulsive therapy on any person 16 years of age and younger.

Killed in the Senate

Prohibits the use of electroconvulsive therapy on persons under 16 years of age and individuals who are involuntary patients but who have not yet had a competency hearing. This bill also requires adults and guardians to sign a detailed written consent form before electroconvulsive therapy is administered.

Signed by Governor

Creates a new account, funded by a surplus from the Children's Health Insurance Program, to fund the state the state loan repayment program and the developmental disabilities wait list. The state loan repayment program helps repay student loans for primary care providers working in places with a shortage of health professionals.  In particular, this bill authorizes $410,000 for the state loan repayment program and $5.4 million for the developmental disabilities wait list. This bill also authorizes the Department of Health and Human Services to use $3.4 million of state and federal funds to establish an additional behavioral health crisis treatment center or mobile crisis team. Lastly, this bill clarifies some of the law around involuntary emergency admissions for mental health, for example to accommodate new transitional housing program services.

Signed by Governor

Requires the Department of Corrections to pursue accreditation of the secure psychiatric unit of the state prison as a psychiatric hospital. The Senate amended the bill to instead require accreditation as a behavioral health facility by the National Commission on Correctional Health Care. This bill also requires the department to submit a biennial report on provisions, standards, or practices that should be revised to improve treatment.

Signed by Governor

Establishes the position of state demographer, establishes a commission on demographic trends, requires state agencies to prepare 10-year cost projections, and requires the legislative budget assistant to include demographic impact notes on legislation. A conference committee amended the bill to add many new provisions. First, the amendment raises some state employee salaries. The amended bill also appropriates $20 million for red list bridge repair and $10.4 million municipally-owned high traffic volume bridge projects, and sends $10 million to the Rainy Day Fund. Another $2.5 million is appropriated for transitional housing for those leaving mental health and substance use disorder treatment facilities. $300,000 is sent to the state loan repayment program, which helps employees in certain critical fields pay back student loans. The amended bill also appropriates $1 million to support "recovery friendly workplace programs" offered by nonprofits, such as programs that train employers how to reduce substance misuse in the workplace. Lastly, the conference committee revised the formula for "disproportionate share hospital payments," which go to hospitals for providing uncompensated care to low income patients.

Interim Study

Repeals the state definition of "mental illness" and replaces it with "mental disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders fifth edition." This bill also allows involuntary commitment for opioid addiction.

Signed by Governor

Establishes a commission to study current mental health procedures for involuntary commitment.

Killed in the House

Requires the Department of Health and Human Services to make an annual report on suicide deaths among individuals receiving services through the department.

Signed by Governor

Establishes a task force to determine the level of service to be provided to clients of community mental health centers. The bill was amended to make several changes to the child protection and mental health systems. For example, the bill adds a new category for reports of child abuse, "unfounded but with reasonable concern." The bill also requires the Department of Health and Human Services to develop a ten-year plan for the state’s mental health system.

Signed by Governor

Allows a law enforcement officer in another jurisdiction to hold an arrested person in need of medical treatment in temporary custody until that person is medically cleared to enter a correctional facility or jail. The Senate amended the bill to also allow police to distribute accident reports to the public.

Signed by Governor

Allows persons licensed as mental health practitioners in other states to practice in this state 60 days after application to the board of mental health practice, pending final approval.

Killed in the House

Extends the suspension of prior authorization requirements that relate to the ability of community mental health programs to prescribe medication that treats severe mental illness.

Interim Study

Permits a person who has been involuntarily committed to a mental health treatment facility to request a review hearing every two years.

Killed in the House

Prohibits the state from placing a person with mental illness in the secure psychiatric unit of the state prison unless that person has been charged with a crime in the past. This would require the state to establish a secure therapeutic psychiatric hospital, as the current state hospital is not equipped to house some patients who present a serious likelihood of danger to themselves or others.

Signed by Governor

Makes various changes to the regulation of psychology practitioners, including disciplinary proceedings, the disclosure of patient records, and educational requirements.

Killed in the House

Authorizes the commissioner of the Department of Corrections to establish a procedure for the involuntary administration of medication to inmates with a mental illness.

Tabled in the Senate

Requires the Department of Health and Human Services to develop a centralized system for transporting persons subject to involuntary emergency admission to New Hampshire Hospital and other designated facilities. At the time of this bill's submission, county sheriff departments handle transportation for persons subject to involuntary admission.

Signed by Governor

Establishes a committee to study mental health and social service business process alignment and information system interoperability.

Killed in the Senate

Establishes a procedure for the annulment of a mental health record.

Signed by Governor

Clarifies that the appropriations for developmental services contained in the 2016-2017 operating budget do not lapse until June 30, 2017. This bill was originally written to require the Department of Health and Human Services to make an annual report on the effectiveness of mental health treatment programs.

Interim Study

Prohibits any person committed to the state mental health system who has never been charged with or convicted of a crime from being admitted to the Secure Psychiatric Unit (SPU).

Signed by Governor

Extends the suspension of prior authorization requirements for community mental health programs to prescribe medication used to treat severe mental illness.

Signed by Governor

Establishes a committee to study the use of restraints when transporting a person subject to involuntary admission proceedings.

Interim Study

Authorizes the Department of Health and Human Services to establish a psychiatric residential treatment facility at the Sununu Youth Services Center.

Killed in the House

Requires community mental health program personnel receive training related to suicide. This bill also establishes a committee to study increasing suicide prevention training.

Killed in the House

Declares that if a patient admitted to a facility is not of sound mind as determined by a physician or a court, the wishes of the patient’s immediate family or guardian shall take precedence over the provisions of the patients’ bill of rights.

Killed in the House

Establishes a procedure to annul a mental health record.

Signed by Governor

Declares that a managed care health benefit plan offering prescription drug benefits to Medicaid recipients shall not require prior authorization for certain drugs used to treat mental illnesses.

Killed in the House

Establishes funding for mental health first aid training programs.

Killed in the Senate

Appropriates money for the Valley Regional Hospital in Claremont to convert unused space to an involuntary commitment mental health facility.

Signed by Governor

Allows advanced practice registered nurses to authorize voluntary and involuntary commitment to state mental health institutions.

Signed by Governor

Requires continuing education on suicide prevention for a license renewal from the Board of Mental Health Practice.

Should NH increase funding for mental health?

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Issue Status

Gov. Sununu signed a bill requiring the Department of Corrections to have the secure psychiatric unit of the state prison accredited as a behavioral health facility by the National Commission on Correctional Health Care. Lawyers for a patient who was transferred to the unit have also filed a federal court petition contesting the use of the facility for non-incarcerated persons. 

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