Dancing in the Rain

Kathy Bates

Earlier this summer, I had the pleasure of attending the 99 Faces of Mental Health Exhibit, sponsored by the PAIMI Advisory Council of NH. It was beautiful and very informative. I learned that there are four basic components of mental illness — depression, mania, anxiety, and psychosis — that we all experience symptoms of from time to time. Mental illness is not constant—it changes depending on the situation. No one experiences symptoms of schizophrenia or bipolar disorder all the time. The exhibit also emphasized that the support of friends and family, along with mental health treatment, is essential to recovery. In this post I will share what I've learned about mental health emergency services and peer support.

I've participated in counseling a couple of times, and it was helpful. However, I've been advocating for myself and others with disabilities for all my adult life, and when the subject of the behavioral health system is mentioned, I never really hear anything positive. I've heard statements like, "They can't find a mental health placement for my son, and he has been in the ER for a week" or "My daughter is so drugged up she's walking around like a zombie!" and "There is only one child psychiatrist for the whole state of NH."      

On May 11th, Governor Sununu issued an executive order calling for a complete statewide review of our mental health system. This action comes after the NH State Supreme Court's decision in favor of a woman stuck in an emergency room for 14 days while waiting for a mental health placement to receive services. Situations like this are all too common. The court said it was unlawful to hold anyone against their will without a hearing for more than 72 hours.

The Governor said, "This order will also review all mental health services across the entire state to determine if the providers we currently utilize are truly equipped and truly capable of meeting the need of New Hampshire citizens, and we are going to be exploring additional opportunities, both in and out of state in the private sector."

In 2019, the legislature was set to spend $20 million on expanding our mental health services. When the pandemic became part of our lives, the budget was cut, and plans were put on hold. With the Supreme Court's ruling, the community's mental health needs have become a priority. The state announced it would give community mental health centers more money to increase transitional housing for the people they serve. Hospitals that expand their psychiatric bed capacity by 50 beds will increase their reimbursement rates significantly. In addition, each of the 10 mental health centers across the state will operate a mobile crisis response unit, changing the way people in a mental health crisis receive services and reducing the number of people whose only choice is the emergency room. The state's 10-year mental health plan outlines these initiatives.

The Mobile Crisis Response Unit will work just like 911 emergency services except that the caller will dial 988—a number set up for mental health emergency assistance. This transition will be completed by July 16th, 2022. The service will be available to anyone in NH who may be experiencing mental health distress. Currently, if someone calls 211 or The National Suicide Prevention Hotline,1-800-273-TALK, they will be connected to their local mental health center hotline, which will remain operational during and after the transition is completed. A mental health professional will ask questions to understand the seriousness of the situation and decide if everyone involved is safe. During the phone conversation, the caller and the therapist develop a plan that is agreeable to both. It might include a referral to see a provider, suggestions about managing the crisis until seen by a therapist, or an emergency evaluation with a mental health professional if needed.

I really wanted to see how well this system was working, so I interviewed a clinician, Sarah Kirby, from the Greater Manchester Mental Health Center. She told me that the emergency response team had been in operation since 2016. She said anyone could call for help, "They could be experiencing anxiety, hearing voices, or having some kind of distress. We will ask them questions to determine if they are safe, and then we can go out to them where they are." The emergency room is not always a fit place for individuals in distress. "A lot of times people really don't need to be there," says Sarah. Services like the Mobile Crisis Response Unit are designed to help keep people out of the emergency rooms and hospitals. When I asked if the program was working, she quickly replied, "Well, we have a 98% success rate."

If she could change something about NH's mental health services or the system, Sarah said, "I would like to see co-occurring treatment for people who are dealing with both substance misuse and mental health issues. This is a really common problem. If someone has to go through mental health treatment, then go through substance misuse treatment, that is a lot. If they can get co-occurring treatment, it would help them reach their goals sooner." She also hopes that the state will invest more money into treatment. "If people need to go to the hospital, they should not have to wait for help in emergency rooms. There should be more beds available." There was a sense of urgency in her responses I really appreciated.

Peer support centers have also been an extremely important part of the mental health system. Ellen Tavino, a peer support program manager who works at Serenity Steps Peer Support Center in Berlin, NH, talked to me about why they're so important for recovery and living with a mental illness. Ellen said, "I'm not concerned with anyone's mental health diagnosis or what medications they are on. If someone comes in and they tell me they are feeling suicidal, I'm there to ask what happened and to listen to them. I don't make them sign a contract that says they won't hurt themselves. I'm just here to listen and make them feel safe."

The whole point of peer support is that people with lived experiences are helping each other. "I've been in their shoes, and I may not understand everything a person is going through, but I can relate to it on some level. People who have been hurt are the best people to help others who have been hurt." Ellen's lived experience and honesty about her mental health is invaluable to doing her job well and reducing the stigma surrounding mental illness.

From Where I Sit…  

Mental health issues have been more out in the open than ever before, which is an unexpected positive side effect of the pandemic. We've had to deal with living through a pandemic much longer that any one of us expected. For many of us, anxiety is just part of our lives now. The money, time, and energy we put into mental health services and treatment can help all of us learn how to better deal with the storm, and maybe even dance in the rain.