The Hippo


Jul 23, 2019








The Mental Health Center of Greater Manchester is in the process of putting together the city’s mobile crisis unit. Photo by Ryan Lessard.

Better late than never

The rollout timeline for the Manchester mobile unit is based on a 2014 class action settlement agreement, which was the culmination of a lawsuit against the state by disability advocates who charged that there were insufficient services for the mentally ill. The terms of the agreement lay out a set of reforms and initiatives to be rolled out over time that aim to eliminate wait lists for beds and provide more community mental health services.
The original plan, set by the settlement agreement, was to launch the fully staffed and resourced unit in Manchester by June 30. But the state Department of Health and Human Services started the contract bidding process late, according to Bill Rider, president of the Mental Health Center of Greater Manchester.
MHCGM submitted its proposal in January and was told it was a finalist in May, and in June the Executive Council voted to approve the contract.
To be up and running at the start of July with a full team and beds, Rider says they would have needed the bidding process to have started sooner.
“We really weren’t in a position to create the team until we knew that the state had, A, selected us and, B, the Executive Council approved the contract,” Rider said
DHHS spokesperson Jake Leon said he can’t comment on what caused the delay for Manchester’s procurement process, citing confidentiality rules. But he said the process started on time. The plan was to award the contract to Manchester by April, so something delayed the final approval process.
Concord went through some hold-ups in its mobile crisis unit rollout as well. Riverbend was awarded the contract in April 2015, as planned, but the state budget impasse between Gov. Maggie Hassan and the Republican-led legislature delayed the funds until a compromise was reached in mid-September. 
“Things were a little slow to get off the ground in terms of funding, and there were some delays by the state,” said Riverbend CEO Peter Evers.
Evers said getting the contract approved on schedule offered the certainty needed to start some hiring, but they couldn’t open the program until after the state provided the $1.2 million in funding, which came two and a half months after it was due last July. 

Psych squad
Manchester assembling its mobile crisis team for community mental health

By Ryan Lessard

 When a suicidal teen or someone suffering from severe depression in Manchester looks for immediate help, they usually end up in a hospital emergency room. But when a new “mobile crisis unit” is rolled out this fall, those calls for help could end with a therapist knocking on their door instead.

House calls
The Mental Health Center of Greater Manchester is putting together this mobile crisis unit right now, with hopes to start small and become fully operational by next spring. It will become the second unit of its kind in the state; Concord’s unit has been in operation for about a year. 
These mobile crisis teams are meant to keep more people in their community and out of emergency rooms by addressing needs early. Without intervention, some of these mental health symptoms can progress to the point of needing acute hospitalization, which is one of the main things the overall community mental health system is getting built up to prevent.
The Manchester mobile crisis unit hopes to begin partial operations in early fall.
“Our first step would be to recruit the leadership, and hopefully we’ll do that fairly quickly,” said Patricia Carty, the chief operating officer of MHCGM. 
The program director will be a master’s-level clinician, and the teams will be made up of other master’s-level clinicians and peer support specialists. 
By about September, Rider plans to open the triage line and start with some mobile response, but with a skeleton crew, they won’t be able to offer 24-hour coverage right away.
In some cases, police with Crisis Intervention Training will buddy up with team members if the situation is deemed risky.
The settlement also calls for each mobile crisis unit to have four crisis beds available for situations where individuals need a respite away from their home for a brief period up to seven days.
“Sometimes, when people are in crisis, the environment they’re in … is kind of a toxic factor for them,” Rider said.
Last month, they received preliminary planning board approval to construct two apartments with two beds each and crisis team offices on the fourth floor of the old Hoitt’s Furniture building, above the planned HOPE for New Hampshire Recovery Center. 
Rider expects they won’t be completed until around December or January depending on how construction goes.
Concord’s mobile unit
In Concord, the mobile unit is overseen by the Riverbend Community Mental Health Center. 
Riverbend CEO Peter Evers said it was able to start the hiring process last fall, after the state provided the $1.2 million in funding, which came two and a half months after it was due in July. They then had to hire a cohort of peer support specialists who could be trained together and round out the rest of the master’s-level clinicians needed to offer full coverage, and Evers said it took months to get to that point.
“To get a mature mobile team, you probably need a year, and a great deal of that is not only building the workforce, it’s getting the word out,” Evers said.
While crisis beds were offered in Concord at other locations, the four required beds for the mobile crisis unit weren’t available until this past April. They now have nearly 30 staff, 15 of which are master’s-level clinicians and 12 of which are peer support specialists. The unit also has a psychiatric nurse practitioner working on the team half time to prescribe drugs as needed.
According to the latest independent report on the progress of the settlement, Concord’s mobile crisis unit had 39 hospital diversions in October 2015 and that had risen to 93 by April 2016. Mobile assessments increased from 179 to 253 over that time, mostly from self-reported crises.
Rider expects the same sort of timeline will play out in Manchester.
“We hope to be rather robust in our operations by next spring, which is pretty much on track for how it worked for Riverbend,” Rider said.
Uphill road 
One staffing problem Manchester faces more than Concord is its proximity to the Boston market.
“Manchester’s difficulty is the big pull from the south. There are many licensed clinicians who will go to Boston because the pay is higher; that’s what they do,” Evers said.
Plus, other area programs are hiring to ramp up efforts to respond to the opioid epidemic.
“We’re competing with all of the substance abuse programs that are starting up, we’re competing with the VA and we recently lost a nurse practitioner to the VA in Boston. So it is a challenge,” Rider said.
MHCGM’s COO Patricia Carty said they will need to hire 24 new people to be fully staffed and offer 24-hour coverage. 
Rider said they have some existing relationships with regional colleges and universities that feed them a steady supply of interns they can later hire, but a lot of those get hired for existing openings already.
“I’ve got to say that recruitment is a difficult thing,” Rider said.
One solution would be to reform the state’s licensing requirements for out-of-state clinicians and providers, according to Evers.
“It’s so ridiculous in this state. What people have to do to prove reciprocity to come to New Hampshire absolutely gets in the way of us attracting people from out of state. We really need to do something about that,” Evers said.
Manchester’s unit is getting $1.3 million from the state each year but plans to add $700,000 of its own money to that. Rider said that will likely come from patient fees charged to insurance companies, fundraising and philanthropy. 
Nashua is the next city required to launch a mobile crisis unit, by June 30, 2017. DHHS expects to open the bidding by January and sources on background believe Harbor Homes and Greater Nashua Mental Health Center will likely submit proposals.
If you live in the Concord area and wish to contact the Mobile Crisis Unit triage line, call 1-844-743-5748. 

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