The Children’s Program serves the needs of children and youth from three years of age through high school graduation (or 22 years of age, for young people who need longer to complete their secondary education).

“We are pleased to have staff available to meet the needs of children and youth through these important stages of their development,” said Melissa Colby, director of the Children’s Program. “Families of children or young people in need can start this process by calling us and expressing an interest; from there, we have capacity to get people in for their initial assessment within 30 days.”

A wide range of services are available, including:

• Individual and family therapy
• Case management
• Functional support
• Medication management

For more information and to begin the process, call the admissions department at 603-228-0547, and select Option 3. 

All intakes are through Riverbend’s Children’s Program at 105 Loudon Road in Concord, NH.

As part of Riverbend’s continuing commitment to serving people in need, walk-in intakes for mental health services are now expanding, through our Community Support Program (CSP).

Intakes for adults 18 years and older are now available daily (Monday-Friday) from 8:30 a.m. to 1:30 p.m.

“The clinicians and staff at CSP are excited to offer these expanded walk-in intake hours to better serve our community,” said Sheila Mullen, director of Riverbend’s Community Support Program. “By having daily walk-in intakes now five days a week, we hope to reduce barriers for those seeking needed mental health treatments. The response to prior walk-in intakes has been positive and has reinforced the need for accessible options for treatment.”

A wide range of services are available, including:

• Case management
• Functional Support
• Therapy
• Medication Management
• Dialectical Behavior Therapy (DBT)
• InShape – fitness program
• Illness Management & Recovery (IMR)
• Supported Employment
• Housing Supports

All intakes are at Riverbend’s CSP offices at 10 West Street in Concord. For more information, call (603) 225-0123. ]]> 12561 /this-is-my-brave-nh-2022/ Thu, 26 May 2022 19:07:59 +0000 /?p=10851 ]]> 10851 This Is My Brave | Concord, NH nonadult /through-pandemic-and-economic-hardship-the-doorway-is-still-open/ Mon, 11 Apr 2022 15:59:47 +0000 /?p=10770 By Shawne K. Wickham New Hampshire Sunday News

When Gov. Chris Sununu announced that everything was shutting down back in March, 2020, Shanna Large-Reusch remembers her first thought was, “Please don’t close the liquor stores.”

That response might seem counter-intuitive for someone who works in the treatment field — Large-Reusch is director of substance use disorders at 51���� Mental Health Center in Concord. But she feared what would happen to her clients if the pandemic shuttered state liquor stores.

“Do you want to see a lot of people in withdrawal and dying because they can’t get their alcohol?” she said. “I want my clients to be able to get something so they don’t die and they can engage with us.”

The state kept the liquor stores open, and liquor sales went through the roof.

Throughout the crisis, The Doorway, the state’s “hub-and-spoke” program for substance use disorders, continued to connect residents with treatment and recovery services.

The fact that the treatment community was able to continue providing services in such unprecedented circumstances is a testament to “the resilience of the people we serve and our providers,” says Jaime Powers, director of the Bureau of Drug and Alcohol Services at the state Department of Health and Human Services, which runs The Doorway in 10 locations statewide.

Life has been difficult for everyone over the past two years, but for those with substance issues, it was even tougher, Powers said.

“One of the things we always said to people leaving treatment was: ‘Get connected, go to meetings, don’t isolate,’” she said. “And now all of a sudden, all of those very healthy things we typically told people to do, everyone was saying, ‘Don’t do that. Stay away from people.’”

Those struggling with substance abuse have been “the loneliest of the lonely” during the pandemic, said Large-Reusch, from Riverbend, which runs The Doorway in Concord.

“Ninety-nine percent of our clients have mental health diagnoses as well — and the other 1% are lying to themselves,” she said.

“People use substances to find relief, to numb, sometimes to feel wanted,” she said. “And now you’ve basically locked them up in their houses and exacerbated that depression that they might have had .…”

Add the political divisiveness, explosion of conspiracy theories and uncertainty over COVID-19. “The call had to be very strong to just keep using,” Large-Reusch said.

Creativity under stress

Powers said New Hampshire’s 10 Doorway hubs “did this amazing pivot” to offer remote services when the pandemic struck.

“It’s more incredible that they were able to do that, given that they’re all hospital-based,” Powers said. “And the hospitals were certainly not focused on the Doorways, and rightly so.”

Many people who need services don’t have reliable phone or computer access, Powers said. So Doorway staff got creative, designating unused office space for evaluation and intake where clients could have access to a computer and phone, sometimes communicating with a care coordinator in an adjacent office.

That’s what they did at The Doorway in Concord, Large- Reusch said.

“Most of our clients don’t have the ability to get on a Zoom and they don’t have phone time,” she said. Places where clients used to be able to use public Wi-Fi, like coffee and doughnut shops, she said, “weren’t letting people inside.”

They tried using telehealth at first, but it wasn’t ideal, she said.

“The opposite of addiction is connection,” Large-Reusch said. “We need to connect with our clients. They need to see us.”

So, “We pivoted,” she said.

They would put a client in one office, and connect them with Doorway personnel in a different room via computer. That way, if someone needed in-person help, she said, “We were able to get to them very quickly.”

Peter Fifield, director of the Doorway operated by Wentworth-Douglass Hospital in Dover, said the number of clients coming in dropped after the crisis began, but that doesn’t mean people were not using.

“Recovery is hard in general,” he said. “Things like pandemics, I don’t think, make for fertile ground for recovery because things are just fundamentally harder.”

It’s important for those new to recovery to make new friends, Fifield said, “because your old friends are the ones you used with.” But as the pandemic made everyone more isolated, he said, connecting with new people could feel impossible.

The Dover Doorway building is across the street from the main hospital, and Fifield said they also used technology to connect people and keep them safe.

“We could have a clinician in one room assessing the person and then we’d Zoom up to our psychiatrist,” he said. “The person would leave with everything they needed, and we’d clean up the room.”

They even set up a quarantine space where clients who had some symptoms could still come in to be evaluated, he said.

Happy to hold steady

Fatal overdose numbers have plateaued in New Hampshire in recent years, with 416 deaths projected for 2021.

That’s either encouraging — overdoses are not increasing here as they are elsewhere — or discouraging: Although the state has invested more than $100 million in federal funds to create The Doorway, the number of people dying from drugs has not declined.

Large-Reusch from Riverbend prefers to think of it as a win. “To us, that kind of means that we’re doing what we need to be doing,” she said.

“We would love for no one to ever overdose again,” she said. But she said, “As long as the number stays similar, we feel like we’re doing the work we need to be doing.”

As someone who has spent her career in the treatment field, DHHS’s Powers said, “I’ve always said my goal is to have to shut my own doors.”

“The reality is that that is unlikely to ever happen,” she said.

But there are more resources available today and it’s making a difference, providers say.

New Hampshire’s “robust” recovery community, Powers said, is critical to the effort.

“Somebody who has had a substance use disorder, most likely their social group is built around that substance,” she said. “So having that new pro-social group and having it ready and waiting is going to go a long way toward lowering those numbers.”

Powers said more must be done on the prevention side to really change things. “It’s a whole lot easier to stop something from happening than to reverse it once it has happened,” she said.

Workforce also continues to be an issue in New Hampshire, and finding treatment beds “can still be challenging,” she said.

But not everyone needs a 28-day residential program, which used to be the norm, Powers said. Individuals who have family support may benefit more from outpatient or partial hospitalization programs, she said.

Hard cases, more to come

With things opening up, Large-Reusch said, her Doorway is now serving clients with “a higher level of need than we’ve seen before.”

She expects caseloads to increase. “It kind of terrifies me to think what all these economic changes are going to do to my clients as well,” she said.

“Because if we thought it was hard before COVID to find housing and now there’s no housing to be found even for people that have the money to do it, what kind of strain is that going to put on people?” she asked.

Some point out that users manage to find the money to buy drugs. “Yes, they probably can, but that doesn’t mean that they’re not maybe doing more illegal things to get more money,” Large-Reusch said.

In her view, one policy change that would make a difference for such individuals is decriminalization of drug crimes.

“That allows people to get into recovery, maintain recovery and then get a job that can help support that recovery,” Large-Reusch said. “Because the jobs that people who have felony records get are not jobs they can fully function on and support families.”

Fifield from the Dover Doorway agreed.

“It’s funny because we call substance use a chronic medical condition,” he said. “But we treat it like a crime.”

“That’s like if someone with diabetes, if they go to the doctor to get treatment, they get arrested for eating a Snickers,” he said.

Still what gives Fifield hope, he said, is many people’s “willingness and readiness to see this differently.”

No one is immune

New Hampshire now has diversion programs and drug courts that try to get people into treatment and healthy activities instead of jail, he said. Policymakers are embracing some harm reduction programs, such as safe syringe programs. Hospitals are using social workers and recovery coaches to connect overdose patients with the Doorway.

Fifield said he sees more compassion across the board. “Maybe it got personal for them,” he said.

Some people might be surprised at who seeks help for substance use disorders, Fifield said. “People think that they are ‘other’ and when you ‘other,’ you can set yourself apart from them and treat them in a certain way,” he said.

But in truth, he said, “They’re just like you and me. Substance use disorder does not discriminate. We’re all just a little bit away from knowing someone, or being that someone yourself.”

Riverbend’s Large-Reusch said it’s her clients who give her hope.

“I love my clients because these are spectacular people with skills of survival that I will never have,” she said. “And if they can gain some time in recovery, what they can do to give back to the community and to the world is just incredible.”

She thinks of a recent client, a man in his early 60s who was addicted to heroin and spent time in jail and then in the hospital. After he was discharged, he spent a rainy night sleeping in a dumpster before he found his way to the Doorway, where the staff gave him warm, dry socks and some coffee. “He was just happy to be inside,” Large-Reusch said.

“And we have helped him,” she said, choking up.

The Doorway staff connected the man with sober housing and got him into medication-assisted treatment. The last time Large-Reusch saw him, he had gained weight — and confidence, she said.

“He’s just opened up and really blossomed,” she said.

“That’s just one story of a million that we have here.”

By Annmarie Timmins

The state’s 10 community mental health centers would be able to expand services significantly and offer statewide mobile crisis response under a contract going before the Executive Council Wednesday.

“This is really transformational and something I have not experienced in my 20 years,” said Brian Collins, executive director of Community Partners, which serves greater Dover, and president of the New Hampshire Community Behavioral Health Association. “I will tell you that we are on the precipice of something that is positive.”

The 10 contracts total $52.4 million and would give some centers nearly 50 percent more than what they get now from the state Department of Health and Human Services to serve low-income residents. In addition to a mobile crisis team, each center would add six supported housing beds, an employment counselor, and services for people who are deaf or hard of hearing. Some centers would also start integrating medical and mental health services for clients 18 to 35; develop mental health supports in schools; and one would add a small residential program for people dually diagnosed with severe mental illness and either a developmental disability or acquired brain disorder.

A few questions remain, however. The creation of statewide mobile crisis response teams, planned for in 2019 but never implemented, promises to make the greatest impact by connecting providers with people in the moment, while they are still at home, before they go to an emergency room. DHHS officials have said the statewide mobile crisis response unit is one of their top priorities, but they have not yet been able to hire someone to run the call center, which is expected to resolve 70 percent to 80 percent of calls over the phone. At its last meeting, the Executive Council tabled the department’s proposed $9.3 million contract with Beacon Health Optics of Boston to run the center over concerns that Beacon is seeking payment up front. Councilors have asked the department to revisit the terms with the company.

Second, hiring staff to provide these expanded services will also be a challenge. Many of the state’s 10 centers already have 25 to 40 clinical staff vacancies. William Rider, CEO of the Mental Health Center of Greater Manchester, said staffing shortages led his agency to add the supported housing beds to an existing facility rather than build a new one because doing so would allow the center to use existing staff for at least some of the additional work. The increased contacts that will go before the Council Wednesday are part of DHHS’s larger effort to expand treatment to help people manage their illness in their own communities and avoid crisis visits to emergency rooms. In May, DHHS also significantly increased its rates to hospitals and long-term care facilities in exchange for an additional 50 in-patient psychiatric treatment beds. As those beds have become available, the number of adults waiting days in emergency rooms for treatment has dropped, from 42 in mid-May to two on Monday. The number of children, however, has hovered between 20 to 25 since then.

“Over the last several years, Gov. Chris Sununu and the state Legislature have made significant investments to support the state’s 10-Year Mental Health Plan and Children’s System of Care,” said DHHS spokeswoman Kathy Remillard. “This comprehensive approach to providing essential mental health services and supports across the lifespan is in the process of being implemented to transform how the state addresses the behavioral health needs of individuals, families, and communities.”

Jay Couture, CEO and president of the Seacoast Mental Health Center, said the expanded contract will allow her center to not only add a mobile crisis unit but also expand its supported community housing program to 14 beds, allowing it to help more people who can live and work in the community with the support of a group home setting. Couture’s center already integrates primary and mental health care, a practice she said allows both types of practitioners to have a better understanding of their clients’ needs. The contract would allow the center to hire someone to coordinate the in-school counseling program, allowing the center to have a better understanding of students’ needs. “There’s a lot of good stuff in (the contracts) in terms of providing expanded services,” Couture said.

Rider, whose treatment center in Manchester would receive an additional $3.7 million in the proposed contract, said additional funding is critical to maintaining timely services for clients. The Manchester center is one of three in the state to already have a mobile crisis unit, a crucial service but also one that has cost the agency about $2 million since it started five years ago. This contract would be a chance for Collins and his team at Community Partners to create a mobile crisis response unit as well as bring on an employment counselor to work with clients who would like to work but need help finding the right job and navigating employment benefits and the Medicaid benefits they rely on for counseling. “We are excited about it and daunted by it,” he said. “It will require more clinicians, and there is still a clinician shortage in the state. This is not something that will be like turning on a light, but we are rolling up our sleeves and ready to get to work.”

Everyone has Mental Health!

This past year has taken a toll on all of us. It has disrupted our lives in ways we had never imagined.  Many of us feel lonely and others feel anxious.   We are all experiencing heightened levels of uncertainty.

And what we are facing at Riverbend is an epidemic of mental health and addiction with unprecedented numbers of individuals seeking services.

Your gift will support all those seeking treatment to get the care they deserve.

Video messages will be posted on May 1, 2021.

You will learn risk factors and warning signs; gain a better understanding of depression, anxiety, trauma, psychosis, and addiction disorders; and explore a 5-step action plan for helping a friend or loved one, as well as learning where to turn for help.

This virtual class is taught in 2 parts:

• Part 1 : Self-paced online 2 hour class
• Part 2: Virtual classroom with two (2) Certified Mental Health First Aid Instructors

This course requires 2-hours of self-paced pre-work that MUST BE COMPLETED prior to attending the 5-hour virtual classroom. Links and instructions for the self-paced pre-work will be sent via email to participants enrolled by May 5, 2021. Once the pre-work is completed, participants will receive a link to the virtual classroom portion scheduled for May 15, 2021.

After completing the pre-work and virtual classroom portion of the training, you will become certified in Mental Health First Aid for three years.

Registration deadline is  May 5, 2021