By Rick Jurgens

Granite State News Collaborative

WEST LEBANON -- The illness and physical distancing of the COVID-19 pandemic have especially challenged thousands of New Hampshire residents with mental illness and substance use disorders.

Ominously, the pandemic arrived in the early days of New Hampshire's “10-Year Mental Health Plan” aimed at closing gaps in the state’s array of services for people with mental health, substance use and other behavioral issues. 

In a news conference on Thursday, Gov. Chris Sununu described that array of services as “a disaster” when he took office in 2017. 

Coincidentally, that disaster was at least partially a result of the unravelling of a previous 10-year plan that was adopted in 2008 but collapsed in the budget and economic fallout of the Great Recession that also began that year.

Now there is a new plan. Issued in 2019, it called for the state of New Hampshire to spend an additional $24 million on mental health care in its first two years. 

On Thursday, Sununu promised that mental health reform efforts would survive the pandemic that has shredded the state's economy and budget: “We’re really going to keep tackling this issue head-on.”

Sununu said that mental health care, along with the state's efforts to address substance use disorders and improve child and youth services, are all “just off the table, when it comes to potential budget cuts."

One clear benchmark of progress in mental health care reform: a reduction in the number of patients “boarded” in emergency rooms or correctional facilities awaiting treatment for severe mental illnesses. Sununu noted that one night about six weeks ago there was not a single individual reported as boarding and waiting for high-level mental health care. 

But that momentum has been hard to sustain. On June 18, there were five children and 21 adults awaiting high-level mental health care, according to the New Hampshire affiliate of the National Alliance on Mental Illness, which on Tuesdays and Thursdays publishes a boarding tally on its Facebook page. The recent tallies are down from more than 40 in March, and from two years ago, when the average number of boarders waiting for services was 49, according to Ken Norton, executive director of NAMI New Hampshire. 

Meanwhile, the pandemic has generated new challenges. In an April letter to NAMI members and supporters,Norton noted rising levels of stress and anxiety due to uncertainty, social and economic isolation and disruption of education that accompany the pandemic. “While the COVID surge may be for the moment behind us, the mental health surge is likely in front of us,” he said.

A national survey by researchers at Johns Hopkins University in Baltimore in April found that 13.6%, or more than one in eight, adults in the United States “reported symptoms of serious psychological distress.” Two years ago, only 3.9%, or one in 25 adults, reported such symptoms. 

Hardest hit groups: young adults (24.0%), adults in households with annual income below $35,000 (19.3%), Hispanic adults (18.3%).  The lowest level of distress was in adults at least 55 years old: 7.3%.

The survey found a measure of loneliness had also risen, although less dramatically. In April, 13.8% of adults reported that they “always or often felt lonely.” Only 11% of adults reported that degree of loneliness two years earlier.

Other distress indicators have fallen during the pandemic. For example, the volume of calls to a nationwide suicide hotline operated by Headrest, a Lebanon nonprofit, dropped off to about 110 a month compared to 150 prior to the public health crisis, according to Cam Ford, the organization’s executive director. 

While no one knows what caused the drop-off in calls from individuals coping with suicidal feelings or ideas, some staff members have speculated that “people are home right now, with their families, and not isolating so much,” Ford said.

Perhaps some of those family conversations met the need described by the Headrest watchwords, “just call, so you can talk to somebody,” Ford added. 

And in Vermont, the Valley News reported last week, there were 17 deaths by suicide in May, well above the five-year average of 9 deaths due to suicide. In addition, calls from Vermonters to a national suicide lifeline went up nearly 30% that month.

Tracking the pandemic’s impact on mental health remains an inexact exercise. A research letter published June 8 by the Journal of the American Medical Association looked at medical records in five hospitals in eastern Massachusetts during the pandemic and found “an acute reduction in the assessment and documentation of psychiatric symptoms.”

That could be a warning sign of unmet needs for psychiatric care, according to the authors, who are doctors at Massachusetts General Hospital in Boston. “Symptoms are likely to be increasing while access is decreasing,” they wrote. “Strategies such as telemedicine are urgently needed to ensure that another consequence of the pandemic is not neglect of psychiatric illness.” 

The use of digital tools to connect caregivers and patients has proved quite successful at Groups Recover Together, according to Heather Prebish, a leader of its New Hampshire unit. Groups, a provider of medication-assisted treatment for substance use disorders, in 2014 opened in Claremont the first in what has grown into a multi-state network of centers.

The switchover to telemedicine involved periods of acclimatization, Prebish said. Participants had to learn to apply in the virtual groups such established norms as prohibitions on smoking or leaving the room, she added. 

Things have gone well enough that Groups has surveyed its 5,000 nationwide clients about the pros and cons of using more telehealth in post-pandemic treatment, she said.

The COVID pandemic’s impact on the Granite State preexisting epidemic of opioid use remains unclear. The tally of drug overdose deaths by the New Hampshire Office of Chief Medical Examiner fell slightly in February, from 39 in 2019 to 34 confirmed or pending testing in 2020. Preliminary totals indicate a possible small year-to-year decline in March as well as a small year-to-year increase in April.  

In 2019, the state pathologists confirmed 411 overdose deaths, down from a 2017 peak of 490. 

The current 10-year mental health plan, which was issued 17 months ago, pointed to New Hampshire’s high death rates from opioid overdoses and suicides as evidence of unmet needs for behavioral health services. The plan said that although state spending on mental health care had increased to $164 million in fiscal 2019 from $97 million six years earlier “the fundamental cause of (New Hampshire’s) inadequate mental health service array is insufficient and unreliable funding over a period of years.”

The pandemic's effect on mental health care reform remains to be seen. “We still have a ways to go,” Sununu acknowledged.

Sununu said that the goal is to bring down to near zero emergency room boarding, including by adding capacity at the state's flagship mental health hospital in Concord and at other facilities: "We're looking at making additional investments into additional capacity."

The current plan’s comprehensive approach – which includes enhanced services for children, suicide prevention and peer support – has gained “strong, bipartisan support,” Norton said. 

The plan incorporates commitments to community service enhancements that New Hampshire agreed to in a 2014 settlement of a class-action lawsuit that alleged failings in the state’s behavioral health services violated the civil rights of those with mental illness. Noting New Hampshire's history of mental health care breakthroughs, Sununu said that he believed the state "can be the best in the country again at community-based mental health."

Contact Rick Jurgens at rjurgens_2000@yahoo.com or 802-281-6641.

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