Throughout January, Granite Staters in emotional and mental health crisis reached out 4,152 times to a new program designed to streamline mental health services in the state.
“It has taken us a bit by surprise. It’s a pretty heavy response,” said Eric Eason, an account executive with Beacon Health Solutions (cq), a national company that was awarded the contract for administering New Hampshire’s Rapid Response Access Point.
The program launched on Jan. 1, providing a centralized system of phone, text or chat support to people in crisis. ‘Crisis’ is self-defined and could mean anything from feeling overwhelmed or anxious to having suicidal ideation. The program aims to provide an equitable, low-barrier access point to mental health services for anyone who needs them.
“The purpose is to get you the help you need,” said Jenny O’Higgins (cq), senior policy analyst with the Department of Health and Human Services’ Division of Behavioral Health.
Moving mental health services forward
The Rapid Response Access Point streamlines services that already existed in the state and provides new services, O’Higgins said.
When someone calls the line, Beacon employees with mental health training try to deescalate the situation and get the person or their loved one at an appropriate level of care. Providers might connect the caller with a same-day or next-day appointment with a mental health provider, for example, which happened 144 times in January. These urgent appointments are newly funded under the program, which relies on state and federal funding, said Eason.
If the situation requires a higher level of care, the access point might dispatch one of ten rapid response teams, which travel to a person in crisis within one hour and connect them with care. The teams were dispatched 564 times last month.
Rapid response teams existed before the access point, but having them dispatched from a single location is critical, said Susan Stearns (cq), the executive director of the New Hampshire chapter of the National Alliance on Mental Illness (NAMI NH). Under the new system, if a team is already responding to a crisis when another call comes in from their region, a team from another area of the state can be deployed, cutting down on waiting times.
“There’s that real time awareness of where the resources are, where the people are, and trying to make sure we get them where they need to be,” said Stearns. “That’s something we’ve advocated for for a long time. It’s a huge step in New Hampshire’s mental health services.”
Another major change is the ability to chat or text the access point, which is particularly important for young people. Data from the national crisis text line show that 14 to 17-year-olds are most likely to reach out for help via text, O’Higgins said.
“Everyone in New Hampshire should have access to the same services and across the lifespan,” O’Higgins said.
Taking a burden off ERs, law enforcement
Overall, the Rapid Response Access Point system is designed to offer people more options for crisis care, beyond going to an emergency room or calling the police.
“This ensures people are connected more quickly with the right level of care, rather than going to an emergency department, or winding up — because of a law enforcement response — arrested and incarcerated,” said Stearns.
Prior to the Rapid Response Access Point, NAMI’s after hours voicemail directed people in crisis to call 911; now, it refers people to the Rapid Response Access Point. Anyone who has that number can tap into a network of mental health care in New Hampshire, Stearns said, whereas previously people needed to know where to call.
“It was very fragmented in terms of how you got [help],” she said. “It requires you to have a certain amount of knowledge and ability to navigate a system.”
Before the access point, community mental health centers didn’t have next-day appointments, so people had to wait weeks or more for an initial appointment. Sometimes that caused their health to deteriorate, sending them to the emergency department. Others in mental health crisis went to the emergency room because they didn’t know how else to access care, Stearns said. During COVID, about half of people presenting in emergency departments for psychiatric illness were new to the mental health system, Stearns said.
NAMI NH has advocated against emergency room boarding, which occurs when people in mental health crisis are held in emergency rooms, often for days, until a bed in a psychiatric unit is found. The new response point is “a lynchpin” in the efforts to reduce ER boarding, Stearns said. That’s particularly important during the pandemic, when ERs are already overwhelmed, and spending days in the hospital can put people at risk for contracting COVID, she added.
However, rapid response hasn’t solved the problem. On Feb. 1 there were 14 children and 17 adults waiting for psychiatric beds in the state, according to NAMI NH. While the new system represents progress, it’s not a panacea for the shortage of care in the state, said O’Higgins.
“You don’t do system transformation in days or weeks or months,” she said.
In true emergency situations — when someone is an eminent threat to themselves or others — people should still call 911. If needed, the Rapid Response can dispatch first responders. But those situations only make up a very small percentage of mental health crises, Eason said.
“There will always be some contact between law enforcement and crisis,” he said. “We don’t exclude them from this process at all.”
The rapid response system helps ensure that people get help from responders with appropriate training. When your house is on fire, you want the fire department to respond, Stearns said.
“This is making sure that people experiencing a mental health crisis get a mental health response.”
Not your father’s mental health system
The Rapid Response Access Point is paid for by state and federal funding, according to the Department of Health and Human Services (DHHS). This fiscal year the program received $19.4 million, which includes funding for the launch of the program. For fiscal year 2023, the program is allocated $16.5 million in funding.
Eason said a major measure of the success of the program will be how many people are diverted from a higher level of care. Best practices and New Hampshire law require that people who receive mental health services be treated in the least restrictive environment necessary. Someone whose condition can be managed with care from a community health center should never be put in an in-patient program unnecessarily, for example.
The access point is part of a large change in mental health crisis response happening nationally. On July 16 2022, 988 will become the national three-digit phone number to connect with mental health and suicide prevention services. In New Hampshire, calls to 988 will route to the Rapid Response Access Point, said O’Higgins.
Beginning this spring, Beacon will host community collaborative meetings. These will bring together stakeholders in the access point — including community mental health centers, schools, law enforcement, advocacy groups like NAMI and people who utilize mental health services — to share their experiences with the system thus far, and suggest improvements.
“That’s how we’re going to continue to get it right and identify pitfalls to make sure New Hampshire has the system it needs,” O’Higgins said.
The Rapid Response Access point is part of the state’s 10-Year Mental Health Plan, which aims to expand access to full—spectrum mental health services in the state. There are still challenges, including a shortage of healthcare workers that need to be addressed, and the access point won’t solve the state’s mental health care crisis overnight, O’Higgins said. And yet, it’s a strong start.
“The system that we have today is better than the system that we had last year,” she said. “We’re moving in the right direction.”
This article is being shared by a partner in The Granite State News Collaborative. For more information visit collaborativenh.org.