Behavioral Health Services for N.H. Kids Lacking Coordination; Bill Seeks to Change That

May 10, 2016

When it comes to helping children with problems like anxiety, depression or substance abuse, a lot of people become part of the decision-making process. There's often  the local school district, primary care doctors, and community health workers -- and sometimes even the courts or DCYF. 

At times, a child can get lost in the middle. A bill this session aims to change that by making sure all the parties involved work together to reduce costs and improve outcomes for kids.

When Suzanne Smith’s teenage daughter was diagnosed with bipolar disorder, she struggled to find her some kind of help.

“There weren’t any resources or any knowledge of anything," said Smith, who lives in Berlin. "The area that we’re from, you have to travel quite a distance – there is absolutely nothing up there.” 

She said the local school district in Berlin didn’t know what to do. Eventually, the courts got involved and  her daughter was admitted to the New Hampshire Hospital, where she stayed on three separate occasions.

Smith said she needed someone to help make sense of how her daughter could get help. 

“It was just a nightmare – a total nightmare and our daughter was extremely resentful to us,” Smith said.

The bill before lawmakers would help parents like Smith navigate different agencies and organizations. 

If passed, the measure would create something called a framework of care to coordinate everyone involved in helping a child through issues such as anxiety, eating disorders and depression. The hope is, in addition to better care, this approach will save money, said the bill’s lead sponsor, Republican senator and gubernatorial candidate Jeanie Forrester.

“Putting this system of care together and everyone working together you are going to see those costs reduced," Forrester said. "Not only are the children going to get the care they need, hopefully keep them out of the system, but you help everyone."

Sixteen other lawmakers from both sides of the aisle are co-sponsoring this bill, including more than half the Senate. It also has the backing of both the state Department of Education and Department of Health and Human Services.

The proposal uses those two departments to create the framework but does not add new services, so no state money is attached to the bill for the first year. But additional money is included in the following three years to pay for more staffing: roughly $180,000 annually.

The bill also calls for more tracking of available resources so agencies can better build on existing services and reduce duplications.

This collaborative model is nothing new. In fact, many states, including Maine and Massachusetts, have adopted similar approaches.

Michael Skibbie of the state’s Disability Rights Center said its a model that's been proven to work.

“Most jurisdictions see a drop in the rate of residential placements. They tend to see a drop in things like drop-out rates. They see improvements in measures of family well-being. They even see the improvement in the rate of employment of caregivers,” Skibbie said.

On average 500 children are treated at the New Hampshire psychiatric hospital each year.
Credit Paige Sutherland/NHPR

On average, 500 children are treated at the New Hampshire state psychiatric hospital each year, at a cost of $1,350 per day. 

Mary-Ann Cooney of DHHS said passing this bill would also send a strong message to the departments that addressing this issue is a priority for the state.

“When the Legislature takes a stand and puts forth legislation that directs departments to work together then that gives us – the departments – a little bit more of an emphasis on the issue you want us to work on,” Cooney said.

The state's 10-year mental health plan from 2008 has already built a blueprint on how to address mental health statewide, but Ken Norton with the National Alliance on Mental Illness of New Hampshire, said that plan only refers to adults.

“So there hasn’t really been a clear roadmap for how to proceed with children mental health services,” said Norton. 

And because there’s no coordination of care, Norton said many families don’t know what’s out there.

That was exactly Suzanne Smith’s problem more than a decade ago when her daughter left the New Hampshire Hospital. Her daughter ended up dropping out of high school and still struggles with her illness.

But Smith’s going through it again. Last year her 13-year-old son, who suffers emotional and anxiety issues, left that same hospital, but this time Smith said it was a little better. She was connected to resources within her community through a trial program that aims to do what this legislation would establish more permanently.

The Fast Forward Program began on a trial basis through a federal grant, but that money runs out this year. The program works to build on existing care in the community and ensure all parties involved, including the local school district, are part of the conversation. In total, 37 children were accepted into the program, including Smith’s 13-year-old son.

“If it wasn’t for the constant encouragement from the programs, he would have been lost, he would have been done for," Smith said. "It’s just so totally amazing to see the progress that he’s accomplished."

Smith’s son has been out of the hospital for more than a year and a half and plans to start high school in the fall.

But according to the Department of Health and Human Services, hundreds of families in New Hampshire could benefit from such a model if this legislation passes and expands this framework statewide.

In March, the bill passed the Senate unanimously and if it passes the House Wednesday it will head to Gov. Maggie Hassan, who’s said she’ll likely sign it.