By ELLEN GRIMM
Granite State News Collaborative
The Manchester Doorway is located in a renovated commercial mill building more than two miles from CMC, (Kate Brindley Photography)
In 2020, Catholic Medical Center took over the Manchester Doorway from Granite Pathways, which had overseen both the Manchester and Nashua Doorways. In Nashua, Southern New Hampshire Health stepped in.
Established in 2019, the Doorway program includes nine Doorway sites around the state that serve as entry points for people to access a range of addiction services. The federally funded statewide initiative was established to address the opioid addiction crisis
Some of the largest amounts in State Opioid Response (SOR) federal grants have gone to Doorway sites. In fiscal year 2022, CMC received about $2.2 million in SOR grant money. The total awarded amount for SOR to NH to date is $114,231,915.00. Another SOR grant is in the pipeline – this one for $28.5 million, an increase of $400,000 over last year, according to the state's Congressional delegation.
The Manchester Doorway is located in a renovated commercial mill building more than two miles from CMC, and about a mile from the city's commercial downtown area. “Our heaviest volume is really walk-in traffic,” according to Tim Soucy, senior executive director for Community Health and Mission at CMC.
Some people also continue to show up at Manchester fire stations, although the Safe Station program, which provided 24/7 help with addiction at all city fire stations, officially closed in 2021 after the Doorways took over. Although signs posted at fire stations say the Safe Station program is no longer in operation and include instructions to call 211 or visit the Manchester Doorway, they also encourage anyone experiencing an emergency to call 911 and “Ring the Doorbell.”
“People still show up,” said Chris Hickey, EMS Officer at the Manchester Fire Department. “We’re not going to turn anybody away,” he said. “It’s not uncommon for us to bring them in the vehicle to the Doorway.”
Hickey sees firsthand the worsening addiction problem, particularly opioid-related incidents. As of August, according to the American Medical Response Ambulance, Manchester was on pace to have the highest number of suspected opioid-related deaths in a one-year period since 2017. The federal government estimates more than 100,000 people died from drug overdoses in 2021, the highest number of annual overdose deaths ever recorded. The vast majority of those deaths involved opioids.
Some people also continue to show up at Manchester fire stations, although the Safe Station program, which provided 24/7 help with addiction at all city fire stations, officially closed in 2021 after the Doorways took over (photo Ellen Grimm)
Room for Improvement
“What makes our (Doorway) different – it's kind of a byproduct of us taking over midstream – is we do not do our own clinical evaluations of clients who come in,” Soucy said. Assessments are done off site, at Families in Transition or the Farnum Center in Manchester. “Then they come back. And then our case managers work with the client, based on their clinical assessment, to help get them placed at the right spot for treatment.”
Soucy acknowledges this arrangement could be improved. “If we can have a clinician at the Doorway there's less chance that we might lose somebody moving from the Doorway to Farnum or FIT and back to us. So it provides for better continuity of care when you have your own clinician on site.”
It's an investment that has been difficult to make under current funding circumstances, he suggested. “I think we've been waiting to get some ongoing assurances of continued SOR funding before bringing a clinician on staff and going through that process.”
One possible solution: linking to the CMC behavioral health department, he said. “So we're trying to see if that's an option for us and what that would look like,” he said.
According to Jennifer Sabin, State Opioid Response Director at the N.H. Department of Health and Human Services, getting a clinician on site in Manchester is a priority, so that the site is in line with all other Doorways, which include on-site evaluation as a core service.
Deborah Welch, the Manchester Doorway's practice manager, said inadequate behavioral health resources has been a major challenge. “It's just very, very much needed.”
Also difficult is getting people into inpatient medical detox treatment, the first stage of treatment when a patient takes medication in a clinical setting to manage acute withdrawal symptoms. “In most cases there is a wait,” she said.
Despite these challenges, Welch said, “Ultimately, there are success stories out there. At some point there will be more success stories.”
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