The Search for Solutions in Mental Healthcare

By Rosemary Ford, Melanie Plenda

NH PBS and Granite State News Collaborative

It’s no secret that New Hampshire is in a mental health crisis. The National Alliance of Mental Illness in New Hampshire (NAMI) reported that 221,000 adults in New Hampshire have a mental health condition. That’s more than five times the population of Concord. But there aren’t enough providers to address those conditions, or beds available for those experiencing a crisis. 

In this week’s episode of The State We’re In we discuss the current mental health crisis facing New Hampshire, why these issues are so important to New Hampshire residents, and what solutions and resources are available for Granite Staters. We also look at a year-long mental health awareness series done in partnership with the Seacoast Media Group and The Union Leader. Joining us is Seacoast Executive Editor Howard Altschiller, Union Leader President Brendan McQuaid, NAMI New Hampshire Executive Director Susan Stearns, and the “guiding spirit” of the series, Senior Director of External Affairs Dartmouth-Hitchcock Health and former Chief Justice of the New Hampshire Supreme Court John Broderick.  

Melanie Plenda:

John, can you talk to us briefly about how you got into this space and the work you've done regarding mental health over the last several years? Have things changed since you first got involved? Has there been some sort of movement on mental health issues one way or the other?

John Broderick:

In the last seven years now I’ve put on 100,000 miles and spoken to tens of thousands of kids in 350 gyms and auditoriums all over New England, and it has so opened my eyes about what's happening with young people – not just in New Hampshire, it translates across New England. We need to start normalizing and talking about it, dealing with it. And this generation, this younger generation – I love these kids, they are amazing – a lot of them are suffering with anxiety and depression. They talk to me about it because I'm vulnerable when I speak to them. And they'll talk to one another, but they often don't talk to parents or grandparents because they feel stigmatized by it. But what I've been trying to say for seven years is that nothing will change until we start talking about normalizing it. Demythologizing. The people I'm talking about are our kids, our neighbors, our families. And for generations, as we all know, it's just not been a topic that people wanted to deal with. I do think that has changed and the younger generation will change it, I'm confident. But I don't want to wait another 20 years. 

Melanie Plenda:

A question for everyone: what is the most pressing mental health issue facing NH residents today?

Susan:

The number one reason people call our NAMI information and resource line is about struggling to access care. That can be accessing an initial appointment through a community mental health center or a local private provider, right up to folks who are boarding in emergency departments – an issue that has been going on in our state for over a decade – and waiting for a bed in an inpatient hospital. So that is clearly a huge issue. Something that we have certainly seen evolving over the last few years as well is this exacerbated children's mental health crisis in our state. We have definitely seen the impact of the last three years of COVID and a lot of the social issues we have struggled with as a society as well – they have had a tremendous impact on the mental health of our youth.

Howard Altschiller:

I echo everything that Susan just said. One thing you hear from a lot of people is not just that the resources aren't out there or that we have a resource shortage, which we do, but that trying to figure out how to get the resource you want to access is incredibly complicated and incredibly difficult. If you're in crisis or you have a family member in crisis, it shouldn't be so hard to get the help you need. The other message that comes through loud and clear is that treatment works, and that the people who are able to get the treatment they need benefit from it the vast majority of the time. But it's very difficult, both because there's a shortage, and because there's not a clear pathway to access what you need. There's just a lot of hurdles to jump through to get where you need to go. The other thing I would point to is the whole issue of stigma that John and Susan and this series have really been trying to address, in that we need to talk about it. People need to feel comfortable asking for the help they need, and know that they'll be supported, and know that it’s just as if they broke a bone or if they were having a heart attack, they’d get physical care. Mental care is the same thing.

Brendan McQuaid:

I would just reiterate the access to care problem. For people to be able to get the help that they need, when they need it, when someone is in what to them is a mental health crisis. And because we have this lack of awareness of mental health problems, sometimes that does not get realized until it's at a later stage. So what we've seen in our reporting and the reporting that Howard and his team have done, is you read stories of people who realize they need help and can’t get an appointment for six or nine months. It's not that the resources don't exist, it's that they're not there immediately when the person is having the issue.

John Broderick:

I agree with what I've said. And there are reasons for it. We don't pay people enough to do mental health work. We don't reimburse them at the same rate that we reimburse others who deal with physical illness. And the best way I could describe it, I think this will help people understand the problem: if somebody listening here today had someone in their family fall and break their leg, we would call 911. That ambulance would come within 10 minutes. If somebody in your family is having a mental health crisis, who do you call? When do they see you? Who pays for that? And for how long? None of those issues are relevant to the broken leg, but that is paralyzing when it comes to mental health. We just don't have the providers. And we don't have an insurance system that underscores that we're supposed to have the same benefits for physical and mental health. Don't kid yourself. We don't. A lot of those visits are capped, reimbursement rates are not what they should be. It's a systemic problem. But unless and until enough of us are willing to say, hey, my mother, my father, my cousin, my brother, myself, and I can't get help, and I'm not going to do that anymore, nothing will change.

Melanie Plenda:

The series has reported on the impact that mental health has had on a variety of different groups. Can you give us the highlights of those articles? Are there any common themes? 

Howard Altschiller:

Our series started by focusing on youth largely because of John's influence. We had one article with the headline “The kids are not all right”, and it was kids in their own voices talking about what's going on in the pressures they're facing, and then the anxiety they're feeling. And because the series launched as we were emerging from COVID, I know that had a big influence on things. We did a piece on the veterans, which I found very moving and very frustrating in a way because we asked so much of our veterans and everyone says the right things, but then when it comes time to help, the help is not always there. We've done stories on student athletes and the pressures that they’re under from a very early age and the expectations that they have on them. And these are similar to some academic expectations that some students feel that are causing them great, great stress and anxiety. We've done stories on the elderly and the impact of isolation. We've covered quite a bit of ground. And really there's so much more that we could be doing going forward. I know I have a story list in my own head of things that I'd like to pursue.

Melanie Plenda:

Have there been any surprises along the way? Did reporters find something you weren’t expecting?

Brendan McQuaid:

For me, the biggest surprise I've seen out of the reporting that we've done is just how many stories there are. And that we've been able to find people in all of these groups who are affected by this crisis in so many different ways as Howard mentioned, from student athletes, to students, to the elderly, to a firefighter, to veterans – some of the people that we think are sort of the toughest mentally out there. Everyone has struggles, every group has someone who is dealing with mental health as an issue. And it's been surprising for me to see all of those stories. Like talking about the athletes, it's not just student athletes, it's also professional athletes that are dealing with this on a regular basis. So it's the kind of thing that affects a much wider group of people than you might expect. And mental health doesn't pull any punches. It doesn't play favorites. It has a wide effect on a lot of different people and groups and everyone in between.

Melanie Plenda:

What are some of the challenges those seeking help face in New Hampshire? What can be done to create change right now?

Susan Stearns:

We talked a little bit about the struggles to access care. I think there's also the difficulties with navigating the systems. When folks are experiencing (or their loved one) a really challenging time, it can be a very challenging system to try and make your way through. It should be that you can access that care in a timely fashion. We see problems with systems that are siloed. For example, co-occurring mental health and substance use disorder disorders are extremely common, yet those are still two separate treatment systems. There are some places that are doing some great co-occurring work, but we need to make sure that people get that comprehensive integrated care that they need. Similarly, we often see this sense in health care of, everything above the neck is separate from everything below the neck – that primary care is often very separate from mental health care. I don't know about you, last time I looked my head was connected to my body 24/7. So we need to do better with expanding integrated care. There's been a lot of great foundations laid in the state. But there's more for us to do. And I would be remiss not to talk about the issue of homelessness and access to safe housing. The reality is that if you don't have a safe place to lay your head at night, it's really hard to engage in treatment, let alone be successful in treatment. We need to really make sure that folks experiencing mental health challenges have their basic needs met as well. I also want to mention that a study came out from the CDC talking about the impact of our youth, particularly our young girls, who are showing incredibly increased risk of suicide and self harm. That doesn't mean we shouldn't be worried about our young boys, those numbers are up as well. And especially the children from diverse backgrounds, in terms of ethnicity and culture have our greater risk, and also our LGBTQ youth. We know that their risk here is significant in terms of suicide and anxiety and depression. And we need to ensure that we have systems that are designed to meet the needs of all Granite Staters, and ensure they have timely access to life-saving care.

Melanie Plenda:

What is the state’s 10-year mental health plan, and what progress has it made since launching in 2019? 

Susan Stearns:

The 10-year mental health plan has really been our guiding document. The plan was developed with a broad array of stakeholders, including people with lived experience and families, so it really set forth this roadmap for us. There has been a great deal accomplished: there were 14 priority recommendations in the 10 year mental health plan. They included things like an increase in Medicaid rates. We certainly saw things like rapid-response come into play to help address issues around emergency boarding. We've seen expansion of our children's system of care with a program called Fast Forward that provides high-fidelity wraparound services to families that have children with the most need. The state purchased Hampstead Hospital to create a state of the art children's facility and residential treatment facility. That is something that happened during this time of COVID, which again speaks to how we can indeed move forward with these big, difficult projects even during difficult times. Further, the state made investment in more transitional housing and invested as well in expanded housing vouchers through a bridge subsidies program. A step up step down program was launched. There have been a number of things that have moved forward in the 10 year mental health plan. And there's been a lot of investment, no question. The problem is that, in launching the 10 year mental health plan in 2019, it was perhaps going to require more even then, and then we have the exacerbation of COVID. So we know that what we have is a wonderful foundation, and we need to build upon that and dig deeper into the 10 year mental health plan – expand it, continue our collective work together. The reality is this is everyone's responsibility. We all have a role to play, and we need to continue to work collectively to resolve these issues and ensure Granite Staters across the lifespan have access to the health care they need, including mental health care, when they need it.

Melanie Plenda:

Tell us about the Five Signs campaign you launched. What is the goal of the campaign? 

John Broderick:

The campaign is to really educate kids and adults on the five most common signs of a mental health problem, not diagnostic of a specific problem. You'll recall years ago a lot of people died of strokes and heart attacks, and we didn't know what to look for to know what was happening. And then we all smartened up and now we call 911 and thousands of lives have been saved every year. I'm not a clinician by any means, but there are a lot of reasons for mental health problems from adverse childhood experiences to DNA to chemical imbalance. I think a lot of what I'm seeing is that we have redesigned childhood in America. We've shortened childhood but professionalized childhood. The kids I’ve talked to are under enormous stress, they’re over-organized, they’re over-competing. These kids are growing up in a 24/7 universe. None of us did that. I think a lot of what we need is for communities to stop the high speed film of 24/7 life and take a look at what's happened to a lot of young people and ask ourselves, What can we do to change that? And not all of it requires inpatient treatment. A lot of it requires a trusted adult, requires someone who's supportive of them and not judging them every day on the latest grade, their latest club, their varsity sports, how many minutes they played. There are a lot of people over their skis on a lot of those issues, and it is having an adverse impact on kids. I think that is a larger discussion, but trust me, it needs to be discussed.

The State We’re in a weekly digital public affairs show is produced by NH PBS and The Marlin Fitzwater Center for Communications. It is shared with partners in the Granite State News Collaborative, of which both organizations are members.