Report: Incremental progress in kids’ mental health system

New Hampshire has made “important incremental improvements” in establishing a system of care for children with behavioral health needs, though significant gaps in services remain, according to an annual progress report issued by the state.

Building on years of work by advocates, state agencies, school districts and providers, the Legislature in 2016 directed the state departments of education and health and human services to develop a comprehensive that both helps children and reduces reliance on ineffective, expensive interventions. Goals include coordinating care for children across multiple service systems – for example, those in the child protection or juvenile justice systems – and ensuring that services are family-driven and community-based.

The most recent report, completed in December, outlines progress on multiple fronts. Schools are now able to be reimbursed by Medicaid for behavioral health services provided to all children covered by the program, not just those with individual education plans. The state is expanding a program called FAST Forward, which serves children with severe emotional disturbances and helps with peer support, respite care, transportation and other expenses. And for the first time, children will be included in the state’s forthcoming 10-year plan for mental health services.

“These are very large system changes, and I know that that sort of change doesn’t happen overnight,” said Erica Ungarelli, director of the state’s Bureau for Children’s Behavioral Health. “So I am pleased about both the progress and the prioritization that mental health in general in the state is getting right now.”

According to the report, access to treatment remains a statewide challenge, as most mental health centers have long waiting lists for services and children often wait in hospital emergency rooms. The report also highlighted several areas in which the state falls short, including the availability of mobile crisis units, services for children under age 3 or over 16 and sub-acute treatment options.

“We have community-based services like the community mental health centers and FAST Forward, and then we have psychiatric hospital services – New Hampshire Hospital or Hampstead Hospital,” Ungarelli said. “Other states have different options in between those two. New Hampshire doesn’t have that full continuum yet.”

Ann Morando of Nashua recently applied to the FAST Forward program seeking help for her 15-year-old daughter, who has been hospitalized for an anxiety disorder and other mental health conditions 10 times since the age of 8.

“We’ve tried everything else that I can think of,” she said. “I almost think this is our last chance.”

Morando said she strongly agrees with the report’s conclusion that families face delays in accessing services, and services are disjointed.

“There’s a lack of continuity, from when you go to the ER, when you go to a therapist, everyone has different information,” she said. “It’s so important to have everyone on the same page.”

Ken Norton, director of the N.H. chapter of the National Alliance on Mental Illness, said he agrees with the gaps identified in the report but said overall, the state definitely is making progress. He said he is particularly encouraged at the cooperation among agencies required under the legislation.

 “One of the things the report doesn’t emphasize enough is just the breaking down of the silos between the Department of Education and the Department of Health and Human Services,” he said. “That’s huge.”

For the article in the Concord Monitor, click here.

Click here to see the full Year 2 report.