“Over the past two and a half years, we have made bipartisan progress to strengthen community-based mental health care and increase crisis-support services, helping to alleviate the strain on our hospitals’ emergency rooms,” Governor Hassan said. “When fully implemented, this mobile crisis unit response program will offer critical resources to help people with mental illness remain in community-based settings and provide them with the resources and support they need to lead healthy lives.”

A psychiatric crisis can be difficult for everyone. Individuals, families, first responders, healthcare providers, and others have limited resources and training, and until now have had no option except the emergency room.  This process often adds to the crisis.

“We commend Riverbend on the deployment of its mobile crisis unit, a critical new effort to respond to mental health emergencies in the Concord region, 24 hours a day, 7 days a week,” said DHHS Commissioner Nick Toumpas. “The mobile crisis unit will help individuals receiving treatment remain in the community, reduce ER visits and hospital stays, and serve as a state model for community-based mental health emergency and crisis intervention services.”

“Riverbend is honored to have been awarded this contract by the State of New Hampshire and are looking forward to rolling out services over the next few weeks,” stated Riverbend’s CEO Peter Evers. “Our goal is to provide rapid assessment and targeted services to help individuals in the least restrictive setting and avoid lengthy and costly hospital emergency room visits.”

Beginning Tuesday, September 1, 2015, Riverbend’s Mobile Crisis clinicians are available 24/7 by telephone – 1-844 -7-HELP4U (1-844 -743-5748) – to provide telephone response to a psychiatric emergency.  Field response for adults will be operational from 8:00 am to midnight, 7 days per week. Services may be provided in community settings, private residences, or other locations in response to requests by police, providers, community-based agencies, family members, guardians or the individual in crisis. Plans are to expand field response to around the clock services and to have the program’s crisis stabilization apartments operational by September 30th.

Concord Monitor staff

Sunday, August 30, 2015
(Published in print: Monday, August 31, 2015)

Starting Tuesday, 51°µÍř Mental Health Services is expected to roll out its official launch of New Hampshire’s first mobile crisis unit response program.

The program – designed to serve as a way to diffuse mental health emergencies in the community to avoid hospitalization and prevent future issues for the person in crisis – was mandated as part of the state’s settlement in a class-action lawsuit several years ago.

The lawsuit alleged that the state was needlessly institutionalizing those with mental illnesses and, as part of the settlement, New Hampshire was required to set up a series of reforms meant to bolster its system of community-based mental health supports. This first mobile crisis unit was supposed to be up and running by June 30, but the contract was not finalized until June 24, which contributed to delays in its rollout.

In the months since the contract was approved, Riverbend CEO Peter Evers said the organization has worked to pick up the pace on launching the units as swiftly as possible: hiring a program director, along with several staffers and peer specialists. And, even ahead of its official launch, Evers said Riverbend has already begun incorporating the mobile crisis response model into its existing work to respond when people call the organization seeking help.

Beginning Tuesday, the mobile crisis unit will officially launch its live phone answering service (available 24 hours a day) and its field response (which will be operational from 8 a.m. to midnight). Starting Sept. 30, according to Riverbend staff, the field response component will operate around the clock and the program’s crisis stabilization apartments will also be ready for use.

When fully operational, the program will offer four apartments where people can stay for up to a week after the onset of a crisis. During that time, program staff will work on discharge planning in addition to providing support services, Evers said.

Eventually, the entirety of the program – the crisis apartments, an “urgent care center” for mental health – will be located at Riverbend’s Pillar House location at 40 Pleasant St. in Concord, Evers said.

The goal of the program, in addition to providing more immediate supports for people experiencing mental health crises and reducing strain on hospital emergency rooms, is also to provide supports for people to manage their mental health over the long term

When someone is assisted by the mobile crisis unit, Evers said they’ll also be given an opportunity to do advance care planning for how to respond during future emergencies – ideally, to give them the tools needed to stay in their communities and out of an institutional setting.

Evers, who oversaw the launch of a similar network of mobile crisis response services in Massachusetts, is hopeful that this new model will serve as a kind of one-stop shop where people can turn for assistance on a range of mental health issues.

“Assessing a situation and helping people through it is one of those unmeasurable benefits of a system like this,” Evers said, adding that it ideally will serve as “a point of reference that a community comes to, to know where they can get that information.”

The program is geared primarily toward adults – as is the focus of the state mental health system overall – but Evers said he hopes to see more work done to expand services for younger clients, too, in the future.

(Casey McDermott can be reached at 369-3306 or cmcdermott@cmonitor.com or on Twitter @caseymcdermott.)

Monitor staff

Sunday, March 8, 2015 (Published in print: Sunday, March 8, 2015)

New Hampshire is moving forward with a plan to open its first mental health mobile crisis response team in the Concord area.

Essentially, the crisis unit serves a purpose similar to that of the urgent care centers that have otherwise popped up in New Hampshire and across the nation in recent years. Instead of leaving someone in crisis to turn to a hospital emergency room, the unit would offer an on-call team of trained mental health professionals to provide support to someone – on-site, in their in their homes, or elsewhere in the community.

This project stems directly from the state’s , the outcome of a class-action lawsuit that alleged New Hampshire needlessly institutionalized people with mental health problems and provided inadequate community-based services.

For the first unit in Concord, here’s what the state was looking for when it released its request for proposals in January: The mobile crisis center would have to be able to respond around the clock, seven days a week, to someone who calls the center looking for help with a mental health crisis – meeting someone at their home or elsewhere in the community, if necessary, or providing on-site services. The underlying goal, the state said, is to avoid “unnecessary hospitalization, incarceration or admission to (an institutional environment).”

The center would operate a phone triage line where a masters-level clinician would be able to talk someone through their options and provide help within an hour. The mobile crisis team, as a whole, would include a peer specialist and an on-call psychiatrist or an advanced practice registered nurse.

The center would also be responsible for operating at least four “community crisis apartment beds” – meant as an additional alternative to sending someone to a hospital or another institutional setting. The crisis team would need to be prepared to help people for up to a week “following the onset of a crisis,” according to the state’s request for proposals, and should provide additional help beyond that one-week window as needed.

Eric Borrin, the health department’s director of contracts and procurement, said the state received only one application. Borrin couldn’t specify the timeline for when that applicant would be evaluated or how soon the department would make a decision to finalize the contract. The state, , said the contract would go into effect in April (or on another date approved by the governor and the Executive Council) and would run through June 2018.

Peter Evers, CEO of 51°µÍř Mental Health, confirmed that the Concord-based provider applied for that spot to operate the mobile crisis unit. The project would likely be a natural fit for Evers, who arrived in New Hampshire after having spent years working to launch and expand a similar mobile crisis program in Massachusetts.

The value in a mobile crisis unit, as Evers explains it, goes beyond simply acting as a buffer between a person experiencing a crisis and emergency or institutional settings. By connecting that person with someone who can listen to their concerns and talk through their options, Evers said this model restores a level of dignity to an experience that can sometimes feel dehumanizing. A crisis team member ideally would talk someone through a series of questions – How are you feeling? Would you like to come and talk, or would you like someone to meet you? – and give that person more agency in determining their immediate treatment needs.

“You’re constantly giving people options and choices, which by the way is incredibly empowering to people when they’re in crisis,” Evers said. “You offer choices to people. The idea, again, was – well, let’s not send people to higher levels of care when they don’t need to go.”

When someone shows up in an emergency room, on the other hand, Evers said there tends to be an almost “magnetic pull” toward inpatient services or hospitalization. In a community-based setting, Evers said there’s more of an opportunity to help someone without resorting to an institution – and, perhaps, to connect them with services like substance abuse counseling or other needed supports that might alleviate other problems that could be exacerbating their present mental health crisis.

As of January, the state Department of Health and Human Services projected a cost of about $5.6 million between 2015 and 2018, including about $4.05 million in state general funds, for the mobile crisis teams. This reflects the cost not just for the inaugural crisis unit in the Concord area, but also for additional units planned in the coming years in Manchester and Nashua.

Those locations are specified in the mental health agreement, but they are also the areas that represent some of the highest volume of individuals requiring emergency services or admissions to New Hampshire Hospital, according to the state’s Bureau of Behavioral Health Interim Director Geoffrey Souther.

“Concord is a logical first starting place,” said Ken Norton of the National Alliance on Mental Illness, “given its proximity to New Hampshire Hospital, given the numbers of people who come from not just the Concord area but statewide who had been shown to be coming to Concord Hospital emergency department looking for crisis services, given the fact that the executive director at Riverbend has previous experience with running a mobile crisis response unit.”

(Casey McDermott can be reached at 369-3306 or cmcdermott@cmonitor.com or on Twitter @caseymcdermott.)

Monitor staff

(Published in print by Concord Monitor: Wednesday, December 31, 2014)

Data and dialogue. That’s what Stephen Day, the man tasked with evaluating New Hampshire’s progress in fixing its community mental health system, is keeping his eye on as the state works to implement reforms stemming from a class-action lawsuit it settled last year.

In the first installment of what are slated to be at least biannual progress reports, the expert reviewer cautions that it is “very early” in the implementation of the state’s mental health agreement and would be “premature to reach any conclusions about meeting the performance and quality requirements” ordered under the settlement. The was issued Friday and can be found under the “Community Mental Health Agreement” section on the Department of Health and Human Services website.

Still, Day points to several priorities for gauging New Hampshire’s mental health improvements in the months ahead. First, there’s the task of figuring out what New Hampshire should measure and how to measure it. Identifying important data sources and developing ways to track that data over time should – as with other aspects of addressing the state’s mental health challenges – be a collaborative process, Day writes in the report.

In the next six months, according to his report, Day plans to pay careful attention to discharge planning at New Hampshire Hospital and Glencliff 51°µÍř; the initial rollout of mobile crisis services in the Concord area; efforts to connect people living in supportive housing with necessary services; and the continued development of Assertive Community Treatment teams, among others. Emergency department “boarding” will also be closely watched, Day notes in the report, because issues in that area are “likely to be symptomatic of issues in the overall mental health system” that would affect the settlement’s goals.

The class-action lawsuit, filed in February 2012 by the Disability Rights Center and the U.S. Department of Justice on behalf of six plaintiffs, alleged that New Hampshire unnecessarily institutionalized people with mental illnesses and possessed inadequate community resources for helping people avoid emergency situations. In December 2013, the state agreed to a settlement – estimated to cost $6 million in this biennium and $23 million in 2016-17 – that called for an expansion of community treatment, housing, supported employment and mobile crisis teams.

As part of that settlement, the parties selected Day – a former top official with the Massachusetts Department of Mental Health and a co-founder of the Boston-based Technical Assistance Collaborative – to monitor and evaluate New Hampshire’s work to improve its mental health system. The organization Day co-founded has worked with agencies across the country to develop “proven solutions to the housing and community support services needs of low-income people with disabilities and people who are homeless,” according to its website.

Day started his work as expert reviewer in July. Since then, much of his time has been spent familiarizing himself with the institutions and individuals who play a role in New Hampshire’s mental health system. His first report outlines these efforts: meetings with state health officials, the attorney general, members of the state’s Mental Health Coordination Team and others; visits to the state’s community mental health centers, support groups, and Concord Hospital’s “Yellow Pod” behavioral health emergency department; reviews of “voluminous data and documents relative to the (community mental health) agreement,” among others.

Though unavailable to speak about the initial report yesterday, Day said in an August interview that his role as reviewer consists of three main responsibilities: providing technical assistance in implementing the reforms from the mental health settlement; reviewing and reporting on the state’s progress in that implementation; and, if needed, mediating disputes between the parties involved. The settlement, he said in August, provided “a good roadmap for making appropriate improvements in the mental health system.”

Amy Messer, legal director for the Disability Rights Center, said the firm is pleased with Day’s work so far and looks forward to working with others to improve the system in the years ahead. Messer said she was glad to see Day’s notes on the importance of trying to alleviate the pressure placed on New Hampshire’s emergency departments because of mental health issues.

Ken Norton, executive director for the New Hampshire chapter National Alliance on Mental Illness, said this initial report seems to set up a solid foundation for evaluating the state’s progress. Norton, too, was glad to see the emphasis on emergency department boarding, as well as Day’s appreciation for the “strong collaboration” already in place between the community mental health centers and the state.

But to Norton, reading this initial summary felt kind of like starting a good book – but not being able to read past the first chapter, at least not until there’s more action on the benchmarks outlined so far. Now, Norton said, “It really makes me want to see that next report.”

(Casey McDermott can be reached at 369-3306 or cmcdermott@cmonitor.com or on Twitter @caseymcdermott.)