The Mental Health Side of Health Care


Added Funds for Mental Health a Helpful Start

By Phil Wyzik, CEO, Monadnock Family Services

With good reason, the mental health side of health care has captured much attention in the Granite State and the country lately.  Mostly a subject only discussed by people directly affected by behavioral health issues, their families, or providers and funders of services, recent months have seen a great deal of press about mental illness and our system designed to address it. As someone who has work in community mental health for decades, this attention is unprecedented, welcome, and long overdue.
We have this new focus on mental illness because of tragedies that can’t be ignored.  If we were smart about things, we can reduce the likelihood of these problems too.

First, New Hampshire is witnessing a shortage of safe and effective hospital based interventions for people whose illness has reached a point of severity that requires a specialized level of institutional care.  Each day, dozens of desperately ill people wait in community hospital emergency rooms until a bed is vacated by a patient at New Hampshire Hospital.   For both adults and children in this situation, the fewer and fewer voluntary psychiatric beds in hospitals won’t do, since the seriousness of their symptoms has surpassed the threshold for safety that these facilities are designed to handle.

Second, the shocking murder of 20 children and 6 adults in Newtown CT in December has etched itself onto our public consciousness unlike other such acts in recent years.  The slaughter of these innocents by a young man with obvious problems is not easily forgotten.   In the wake of this nightmare, new calls for a renewed look at mental health services have come from the President, State and local governments and the public at large.

To be sure, there are signs of hope.  For a number of years, our state has had a detailed 10 year plan to improve mental health care that was broadly designed, comprehensive in scope, and widely embraced by many constituencies when it was proposed in 2008.  Since then however, the state’s economic decline saw fewer and fewer dollars invested in the mental health system. Now the Governor’s proposed budget attempts to reinvest in the plan with $28 million.  This infusion of resources would add inpatient beds, new residential programs and other necessary services.

Another hopeful prospect is the opportunity to expand Medicaid, the largest payer of mental health care in the country, for a new cohort of people under the Affordable Care Act, that marks its third anniversary this month.   It’s estimated that the expansion would bring health insurance to approximately 100,000 NH residents  and give them what many of us get from our employers – a way to pay for the care we need and a lesser risk of economic disaster from unpaid medical bills.  With health insurance, the burden of illness in someone’s life is lessened; this seems good for society too.

Helpful as these things are, we all need to be aware that, even if they come to pass,  they address mental health problems far ‘down stream’ in the course of the illness,  long after much damage has been done to the individual, their family, and their future.  Many in the mental health field now think that it takes about two years after the first start of a symptom of mental illness until a solid formal diagnosis might be established.  It may take many more years after that before a person accesses professional help.

Common sense tells us that problems are much easier solved when they are small.  Our US health care system, however, delays services until illnesses loom large, deeply embedding themselves into every aspect of someone’s life.  Holding back on care makes for more complex and more costly solutions.

Thankfully, much is being understood about how to prevent mental illness in the first place, and what to do at the first sign of difficulties.  For example, it’s now very clear that keeping children away from adverse childhood events like neglect, trauma, bullying and poverty greatly enhance mental health in later years.  Similarly, getting them access to care sooner lessens the risk of substance abuse, academic and social problems and suicide.  Skill building and resiliency training in schools has also proven to be effective.  Assertive community treatment, something that’s part of Governor Hassan’s budget, is undeniably helpful.

While New Hampshire urgently needs more financial support for its mental health system that has been hobbled by difficult economic times in the state,  we also need to consider what public health interventions we can make ‘up stream,’ long before the need for expensive care arises. 

Given the nation’s pattern of deficit spending that has gone on for many years, lawmakers warn that we are leaving a legacy of debt for our children and grandchildren.  If we continue to address health care problems only after they are frightfully severe, we’ll also be leaving them a legacy of illness that’s bound to spark more tragedies for everyone.