10-year plan envisions hub-spoke model for mental health

CONCORD, N.H. (AP) — A proposed 10-year plan for New Hampshire’s mental health system envisions a regional hub-and-spoke model that provides access to a continuum of services, from prevention and early intervention to crisis and inpatient care.

The draft plan released by the Department of Health and Human Services on Tuesday was developed over the last several months, based on input from hundreds of people involved with the system. It calls for an approach similar to how the state is combatting the opioid crisis — people would call a central portal to get connected to someone at a regional hub who would then work with them to assess immediate needs and the appropriate level of care.

Patients would be connected to a network of “spokes” — local outpatient mental health services, mobile crisis teams and peer support — and regional hub staff would follow-up to track outcomes and make adjustments.

“If we make strategic investments, New Hampshire can reduce stigma, eliminate inequities in access to care, and offer all of its citizens a coordinated continuum of high quality services,” the draft plan states. “The right care at the right time will reduce more severe manifestations of distress, manage them more effectively when they do arise, and nudge more of our population toward a state of well-being.”

Transforming the system won’t be cheap. The plan calls for nearly $24 million in state funding in the next two-year budget alone. But officials say insufficient and unreliable funding over the years has resulted in inadequate services and a perception that New Hampshire attaches less value to mental health than to other aspects of health “and the least value of all to the mental health of our most vulnerable citizens.”

Children, the elderly, those living in rural areas, people with substance misuse problems and those involved in the legal system find it particularly challenging to get appropriate help, the proposal states. Its authors argue that if the plan is implemented, fewer people will need to seek mental health care in hospital emergency rooms, and none of them will wait for extended periods for specialty. Such waiting has become a growing problem in recent years, sparking a class action lawsuit this month, and advocates argue immediate action is necessary.

Ken Norton, director of the National Alliance on Mental Illness of New Hampshire, said having a 10-year plan is important for long-term reform, but the emergency boarding crisis needs to be addressed now. But he was pleased to see that the plan includes expanding mobile crisis response beyond the three currently available regions and making such services available for children as well as adults.

“NAMI New Hampshire is hopeful that fully enacting the 10-year mental health plan will promote hope, help and recovery, and improve the lives of people impacted by mental illness in New Hampshire,” he said.

Republican Gov. Chris Sununu called the proposal an “excellent foundation” from which to build the final plan. The Department of Health and Human Services will hold a public hearing on the plan Dec. 3, and will accept written feedback through Dec. 10.