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Collaboration is how to solve the mental health crisis in a pandemic

In February 2013, I wrote an Op-Ed about a new record number of individuals who were stuck in New Hampshire hospital emergency departments waiting for a psychiatric inpatient bed for an involuntary emergency admission (IEA). There were 44 individuals waiting on February 4, 2013. Eight years later, on February 4, 2021, there were 85 individuals waiting in hospital emergency departments because there were no beds for their IEA admission. Thirty-five of those waiting were children. Let that sink in.

This number does not include the number of individuals waiting for a voluntary psychiatric bed. Let that sink in, too.

Thirteen years after the publication of “Addressing the Critical Mental Health Needs of NH’s Citizens: A Strategy for Restoration”; seven years after the Community Mental Health Agreement was implemented; two years after the 2019 Ten Year Mental Health Plan was published; and one year into the COVID-19 pandemic, we are still struggling to eliminate what has become known as “The Waitlist.” Why? It is not for lack of effort at all levels of the provider community and State agency and State government entities.

At various times we have had calls for more inpatient beds, more community beds, more community services such as mobile crisis units, more clinical staff, or adequate and sustained funding. In non-pandemic times the answer is that we need all of this. But we are not in non-pandemic times. We are close to hitting the one-year anniversary of life with COVID-19.

We have been an under-resourced mental health system for years, but this pandemic has had a profound impact on mental health in our state. Anxiety, depression, suicide risk. All have increased. Outpatient and inpatient mental health services are stretched beyond maximum capacity. Clinical providers are trying to meet patient need while they balance remote work, remote learning for their children, and the impact of COVID-19 within their own families.

Local and national media outlets report challenges with accessing mental health care due to a dramatic increase in demand. This is coupled with the ongoing workforce shortage in this field. My center has had an open position for a child psychiatrist since early March 2020. The community mental health centers report on vacancies every month that average nearly 210 vacant positions statewide – which translates to 8.4% of our workforce. Private mental health providers report full caseloads, too.

When COVID-19 was heading toward its peak, temporary inpatient sites were set up in anticipation of overwhelming demand for individuals with the virus. We are not anticipating overwhelming demand for mental health services; we are living in a time of overwhelming demand. To the credit of the leadership of the Department of Health and Human Services, New Hampshire Hospital has once again begun to admit youth to their facility. This is a temporary change seeking to relieve the burden on hospital emergency departments and get youth to the appropriate level of care in a timelier manner.

We cannot solve this longstanding issue with temporary solutions, but temporary solutions are needed to stabilize the system as we strive yet again to make a plan that is both clinically and fiscally viable. We need more inpatient beds, more community beds, more community services such as mobile crisis units, more clinical staff – and all of this will require adequate and sustained funding.

The most important piece to solving this puzzle will be the collaboration needed to implement workable solutions. We are grateful for Governor Sununu’s continued commitment to addressing the mental health and substance use disorder needs of the citizens of NH. We are also thankful for the willingness of our legislators, such as Senator Jeb Bradley and Senator Tom Sherman and others, to work across the aisle to convene stakeholders in productive conversations. We must all come to the table willing to provide adequate and sustained funding to workable solutions. It is possible.

I have written this story before. Let’s try for a different ending this time. I am willing to do all I can. Are you?

Jay Couture is president of the NH Community Behavioral Health Association and President and CEO of Seacoast Mental Health Center Inc., in Portsmouth.

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