Mental Health

Citizens Count Editor

The New Hampshire government subsidizes mental health care by funding some outpatient and inpatient mental health services.

The state recently increased that funding thanks to a 2014 lawsuit, which found that New Hampshire needed to do more to keep mental health patients out of hospitals, instead treating them within a community care setting.

Find your local community mental health center to be connected to mental health services in your area

Outpatient Care in NH

Community mental health centers

New Hampshire provides funding for ten not-for-profit community mental health centers. This funding allows the centers to take on any patient in their area who needs help, regardless of his or her ability to pay.

The centers will bill patients who have insurance coverage, whether through a private insurer, Medicaid, or Medicare, but can use a sliding fee scale for uninsured or underinsured patients.

Even when these centers can bill an insurer, the rates at which they’re reimbursed for these services don’t completely cover costs. The funding the state provides—using a combination of state money and federal grants—is what enables them to keep their doors open.

Legal troubles and impact on funding

A large part of New Hampshire’s outpatient mental health funding is dictated by the terms of a 2014 settlement agreement.  That lawsuit argued that New Hampshire violated federal laws – particularly the Americans with Disabilities Act –  by failing to provide adequate mental health services in a community setting and instead relying too much on housing citizens with mental illness in hospitals.

Under the terms of the 2014 lawsuit settlement, New Hampshire had to provide funding to expand community mental health treatment as follows:

  • Develop Assertive Community Treatment (ACT) – teams that can provide regular services out in the community – to serve up to 1,500 individuals with mental illness
  • Develop mobile crisis services – teams that can visit a patient in crisis and provide services – in Concord, Manchester, and Nashua
  • Expand supported employment opportunities, which help individuals with mental illness find and keep employment
  • Expand supported housing, such as group homes and rental subsidies
  • Develop transition plans for residents of Glencliff Home and New Hampshire Hospital to move to community settings

As of the end of the 2017 fiscal year, an independent evaluator concluded that New Hampshire was meeting most of these requirements.  However, the evaluator noted that ACT teams were understaffed according to the terms of the agreement.  The state Department of Health and Human Services disagrees with that claim. 

Inpatient Services

In addition to outpatient, community-based mental health treatment, the state provides inpatient treatment for individuals with severe mental illness at New Hampshire Hospital.  There are also some patients living long-term at Glencliff Home, although the state is working to move those individuals back into the community.

Long waitlists

A long waitlist at New Hampshire Hospital was one reason for the 2014 lawsuit against New Hampshire – but so far increasing community-based treatment has not decreased demand for inpatient services. 

At the time of the lawsuit settlement in 2014, on any given day an average of 24 adults were waiting in hospital hallways and emergency rooms for a bed at New Hampshire Hospital.  In 2016 the average was over 30.  On August 21, 2017 there were a record 72 people waiting for beds at the state hospital.

Some of this increase is due to private hospitals around the state closing their inpatient mental health facilities.  The opioid addiction crisis has also placed more strain on the health care system overall.

Recent state budgets have attemped to address the waitlist issue by funding more mental health beds at hospitals. The state is also moving kids out of New Hampshire Hospital to a new facility, repurposing that space to accomodate more adult patients. 

Patients in prison?

New Hampshire Hospital has also faced criticism for its lack of a secure psychiatric unit.  In New Hampshire, an individual with mental illness who “present[s] a serious likelihood of danger to himself or to others” may be committed to the Secure Psychiatric Unit in the state prison without committing a crime. 

New Hampshire is starting work on a new 25-bed secure forensic hospital in 2020. Patients currently housed in the SPU will be moved to this new facility as soon as it is operational.

Insurance coverage for mental health treatment

A state law passed in 1994 requires insurers in New Hampshire to cover mental health treatment.  The federal Affordable Care Act also requires any insurer offering a plan on the health insurance exchange to cover mental health services. 

Furthermore, state and federal laws require any insurer that covers mental health services to cover those services and other physical health services in about the same way.  For example, insurers cannot require a much higher copay for a visit to a psychologist than for a visit to a primary care physician.

However, New Hampshire has not increased its Medicaid reimbursement rate for mental health services since 2006.  Many insurers also offer mental health providers low reimbursement rates.  These low reimbursement rates are a financial challenge for mental health professionals, and contribute to a shortage of mental health professionals in the Granite State.  According to the U.S. Department of Health and Human Services, there are shortages of mental health care professionals in every New Hampshire county except Cheshire. New Hampshire lawmakers responded to this problem in 2019 by adding an 8% increase in Medicaid rates for mental health and substance abuse services to the 2020-2021 budget. Those rates will take effect in January 2020.

PROS & CONS

"For" Position

By Citizens Count Editor

“New Hampshire should increase funding for mental health.”

  • According to the Treatment Advocacy Center, states should provide a minimum of 50 hospital beds per 100,000 people for patients with severe mental illness.  New Hampshire only provides 12 beds per 100,000 people. The state needs to dramatically increase the number of inpatient beds to meet minimum standards for Granite Staters in crisis.
  • The number of individuals waiting for a bed at New Hampshire Hospital has more than doubled in just a few years.  This rapid increase indicates a failure to meet the needs of citizens with mental illness before they reach a crisis point. 
  • According to the latest data from Mental Health America, roughly 1 out of 5 adults with mental illness in New Hampshire report they are not able to get the treatment they need.  This lack of treatment is due to high costs for treatment as well as a lack of available treatment providers.  While other states have even worse access to mental health treatment, it is still unacceptable to leave one-fifth of residents without treatment. 
  • According to the Centers for Disease Control and Prevention, New Hampshire has the highest suicide rate in New England, and the 18th highest rate in the United States.
  • New Hampshire’s practice of housing some patients in the Secure Psychiatric Unit of the state prison is unethical and potentially violates federal laws. New Hampshire needs to fund a Secure Psychiatric Unit at the state hospital or contract with an appropriate mental health facility out-of-state.

"Against" Position

By Citizens Count Editor

 “New Hampshire should not increase funding for mental health.”

  • New Hampshire is on track to meet every requirement of the 2014 lawsuit settlement, and the 2018-2019 state budget actually adds mental health treatment services above and beyond what the settlement requires.
  • While Mental Health America reports that roughly 1 out of 5 adults with mental illness in New Hampshire are not able to get the treatment they need, this statistic may not be as bad as it seems.  According to the same report, in 2014 New Hampshire ranked sixth in the nation for access to mental health treatment.  That ranking included nine measures of access, from the percentage of adults with mental illness receiving treatment to the size of the mental health workforce. 
  • According to the Henry J. Kaiser Foundation, in fiscal year 2013 – before the lawsuit required New Hampshire to increase spending on community mental health treatment – New Hampshire ranked 16th among states for per capita spending on mental health services, well above average.  Since then New Hampshire has more than doubled state funding for community mental health services.
  • Additional state spending on mental health services will not address the shortage of mental health professionals in the state.  If the state wants to strengthen its mental health care workforce, it should instead invest in programs that encourage university students to prepare for careers in mental health.  

LEGISLATIVE HISTORY

In Committee

Creates an interstate compact for psychologists to practice telepsychology from other states with patients living in New Hampshire and practice "face to face" psychology on a temporary basis in New Hampshire.

Signed by Governor

Creates an interstate compact for psychologists to practice telepsychology from other states with patients living in New Hampshire and practice "face to face" psychology on a temporary basis in New Hampshire.

Passed House

Requires the state Board of Education to adopt rules requiring teachers and administrators in the public schools to receive annual training in suicide awareness and prevention.

Signed by Governor

Authorizes the Insurance Department to enforce federal law which prohibits health insurance from imposing less favorable benefit limitations on mental health or substance use disorder benefits than on medical/surgical benefits. This bill also requires the department to evaluate compliance with this law and make the evaluations public.

Signed by Governor

Sets aside a total of $9.5 million to increase in-patient beds and affordable, supported housing opportunities for people with mental illness. This bill also requires health insurers to provide coverage for emergency room boarding for mental health reasons that is comparable to coverage for patients admitted for medical surgical reasons. The Senate amended the bill by increasing the total funding to roughly $10.6 million, including funding for a new mobile crisis team or behavioral health crisis treatment center. The Senate amendment also lays out more nuanced requirements for health insurance coverage of emergency room boarding and treatment for mental health reasons.

Tabled in the Senate

Authorizes the Department of Health and Human Services to contract with the Center for Life Management to provide school crisis response and prevention services in Rockingham County, and sets aside $800,000 for this purpose.

Signed by Governor

Establishes a commission to study the expansion of the mental health court system statewide.

Signed by Governor

Requires schools to develop a policy for preventing and responding to student suicide, and requires schools to train faculty, staff, and volunteers on suicide prevention.

Tabled in the Senate

Requires the Department of Corrections and Department of Health and Human Services (DHHS) to work together to operate the secure psychiatric unit of the state prison as a hospital until a new secure psychiatric hospital is built. This bill also tasks DHHS with constructing a new secure multi-purpose forensic psychiatric hospital. The House amended the bill to instead establish a Secure Forensic Psychiatric Hospital Advisory Council to assist DHHS in planning and constructing a new secure multi-purpose forensic psychiatric hospital. The Senate amended the bill to once again require DHHS to construct a new secure forensic psychiatric hospital.

Tabled in the Senate

Directs the Department of Health and Human Services (DHHS) to establish a psychiatric residential treatment facility at the Sununu Youth Services Center and to transfer juvenile patients from New Hampshire Hospital - the state mental hospital - to the new facility. The Senate amended the bill to instead direct DHHS to establish a new forensic psychiatric hospital, additional transitional beds for forensic patients or patients with complex behavioral health conditions, and a new acute inpatient psychiatric treatment facility for children.

Signed by Governor

Requires the Board of Mental Health Practice to issue an interim license within 60 days to applicants licensed in other states while awaiting final approval or denial of the application. The Senate amended the bill to require an interim license within 15 days. The Senate amendment also adds two members to the Board of Mental Health Practice.

Signed by Governor

Requires the Commissioner of the Department of Health and Human Services to submit a plan for implementation of the 10-year Mental Health Plan within six months of its finalization and to fully implement the 10-year Mental Health Plan within two years of its finalization. The Senate amended the bill to remove the requirement to fully implement the plan within two years, and instead require annual reports from the Department of Health and Human Services on the implementation of the 10-year Mental Health Plan.

Signed by Governor

Establishes a commission to study programs for individuals with psychiatric diagnoses and/or high risk behaviors, including criminal behaviors, who are being served in New Hampshire's developmental services system.

In Committee

Requires parity between mental health services and medical expenses for purposes of the spend-down requirement for persons receiving public assistance, such as Medicaid. The spend-down requirement provides an opportunity for people above the income limits for eligibility to become eligible after "spending down" their income on medical expenses.

Signed by Governor

Establishes a commission to study the business environment for mental health providers.

Killed in the House

Establishes a commission to study a public option program for health insurance in New Hampshire. The Senate amended the bill to instead authorize the Insurance Commissioner to enforce the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The House and Senate did not agree on a final version of the bill.

Signed by Governor

Makes minor changes to the procedure for determining a defendant's competency to stand trial. For example, this bill requires that if a court finds a defendant has regained competency, the court must schedule a trial within 60 days. This bill also replaces references to "involuntary commitment" with "involuntary admission."

Signed by Governor

Establishes a committee to study mental health and human service business process alignment and information system interoperability.

Signed by Governor

Allows experience as a master licensed alcohol and drug counselor to qualify as experience for licensure as a clinical social worker or clinical mental health counselor.

Signed by Governor

Requires a physician or APRN who is authorized to order involuntary emergency admission to the state mental health services system to make a written determination that physical restraints are necessary to protect the safety of the person and/or the public before restraints are used while a patient is being transported. The Senate amended the bill so that the physician or APRN decides on whether the patient should be transported by ambulance or law enforcement, but the transporter decides whether restraints are necessary.

Signed by Governor

Establishes a commission to develop and promote mental health curriculum and education programs in kindergarten through grade 12.

Signed by Governor

Allows disclosure of communications between a mental health care provider and his or her client so long as the disclosure is constitent with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA).

In Committee

Establishes a commission to study the causes of high suicide rates for emergency and first responders.

Killed in the Senate

Requires annual training in suicide awareness and prevention for teachers and administrators.

Signed by Governor

Reduces the number of hours or work experience required for licensure as a master licensed alcohol and drug counselor, a licensed alcohol and drug counselor, a licensed clinical supervisor, a clinical social worker, and a clinical mental health counselor. The House amended the bill to instead provide that supervision of candidates for licensure as mental health counselors or alcohol and drug counselors shall be at locations convenient to both the supervisor and the candidate.

Signed by Governor

Adds post-traumatic stress disorder and acute stress disorder to the definition of injury for the purposes of workers' compensation, adds emergency communication dispatcher to the definition of "emergency response/public safety worker," and establishes a commission to study the incidence of post-traumatic stress disorder in first responders and whether such disorder should be covered under workers' compensation.

In Committee

Establishes "extreme risk protection orders," based on evidence that there is "a significant risk of causing bodily injury to himself or herself or others," which would require the subject of the order to surrender any firearms to law enforcement.

In Committee

Requires parity between mental health services and medical expenses for purposes of the spend-down requirement for persons receiving public assistance, such as Medicaid. The spend-down requirement provides an opportunity for people above the income limits for eligibility to become eligible after "spending down" their income on medical expenses.

Vetoed by Governor

Sends $3 million to the Department of Health and Human Services to raise reimbursement rates for mental health and addiction treatment services. The Senate amended the bill to also send $450,000 to the Department of Health and Human Services for "emergency shelter and stabilization services for persons experiencing substance misuse."

Signed by Governor

Allows licensed physician assistants to provide various mental health-related services similar to those currently provided by physicians and advanced practice registered nurses.

Signed by Governor

Allows the Department of Health and Human Services to waive the work requirement in the child care scholarship program for applicants or recipients participating in a mental health or substance use treatment program. The child care scholarship program gives working parents under 250% of the federal poverty level financial assistance for child care.

Killed in the Senate

Prohibits the use of electroconvulsive therapy on persons under 16 years of age and individuals who are involuntary patients but who have not yet had a competency hearing. This bill also requires adults and guardians to sign a detailed written consent form before electroconvulsive therapy is administered.

Killed in the Senate

Prohibits the use of electroconvulsive therapy on any person 16 years of age and younger.

Signed by Governor

Requires the Department of Corrections to pursue accreditation of the secure psychiatric unit of the state prison as a psychiatric hospital. The Senate amended the bill to instead require accreditation as a behavioral health facility by the National Commission on Correctional Health Care. This bill also requires the department to submit a biennial report on provisions, standards, or practices that should be revised to improve treatment.

Signed by Governor

Creates a new account, funded by a surplus from the Children's Health Insurance Program, to fund the state the state loan repayment program and the developmental disabilities wait list. The state loan repayment program helps repay student loans for primary care providers working in places with a shortage of health professionals.  In particular, this bill authorizes $410,000 for the state loan repayment program and $5.4 million for the developmental disabilities wait list. This bill also authorizes the Department of Health and Human Services to use $3.4 million of state and federal funds to establish an additional behavioral health crisis treatment center or mobile crisis team. Lastly, this bill clarifies some of the law around involuntary emergency admissions for mental health, for example to accommodate new transitional housing program services.

Signed by Governor

Establishes the position of state demographer, establishes a commission on demographic trends, requires state agencies to prepare 10-year cost projections, and requires the legislative budget assistant to include demographic impact notes on legislation. A conference committee amended the bill to add many new provisions. First, the amendment raises some state employee salaries. The amended bill also appropriates $20 million for red list bridge repair and $10.4 million municipally-owned high traffic volume bridge projects, and sends $10 million to the Rainy Day Fund. Another $2.5 million is appropriated for transitional housing for those leaving mental health and substance use disorder treatment facilities. $300,000 is sent to the state loan repayment program, which helps employees in certain critical fields pay back student loans. The amended bill also appropriates $1 million to support "recovery friendly workplace programs" offered by nonprofits, such as programs that train employers how to reduce substance misuse in the workplace. Lastly, the conference committee revised the formula for "disproportionate share hospital payments," which go to hospitals for providing uncompensated care to low income patients.

Killed in the House

Prohibits the state from placing a person with mental illness in the secure psychiatric unit of the state prison unless that person has been charged with a crime in the past. This would require the state to establish a secure therapeutic psychiatric hospital, as the current state hospital is not equipped to house some patients who present a serious likelihood of danger to themselves or others.

Signed by Governor

Makes various changes to the regulation of psychology practitioners, including disciplinary proceedings, the disclosure of patient records, and educational requirements.

Killed in the House

Authorizes the commissioner of the Department of Corrections to establish a procedure for the involuntary administration of medication to inmates with a mental illness.

Tabled in the Senate

Requires the Department of Health and Human Services to develop a centralized system for transporting persons subject to involuntary emergency admission to New Hampshire Hospital and other designated facilities. At the time of this bill's submission, county sheriff departments handle transportation for persons subject to involuntary admission.

Signed by Governor

Establishes a committee to study mental health and social service business process alignment and information system interoperability.

Killed in the Senate

Establishes a procedure for the annulment of a mental health record.

Interim Study

Repeals the state definition of "mental illness" and replaces it with "mental disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders fifth edition." This bill also allows involuntary commitment for opioid addiction.

Signed by Governor

Establishes a commission to study current mental health procedures for involuntary commitment.

Killed in the House

Requires the Department of Health and Human Services to make an annual report on suicide deaths among individuals receiving services through the department.

Signed by Governor

Establishes a task force to determine the level of service to be provided to clients of community mental health centers. The bill was amended to make several changes to the child protection and mental health systems. For example, the bill adds a new category for reports of child abuse, "unfounded but with reasonable concern." The bill also requires the Department of Health and Human Services to develop a ten-year plan for the state’s mental health system.

Signed by Governor

Allows a law enforcement officer in another jurisdiction to hold an arrested person in need of medical treatment in temporary custody until that person is medically cleared to enter a correctional facility or jail. The Senate amended the bill to also allow police to distribute accident reports to the public.

Signed by Governor

Allows persons licensed as mental health practitioners in other states to practice in this state 60 days after application to the board of mental health practice, pending final approval.

Killed in the House

Extends the suspension of prior authorization requirements that relate to the ability of community mental health programs to prescribe medication that treats severe mental illness.

Interim Study

Permits a person who has been involuntarily committed to a mental health treatment facility to request a review hearing every two years.

Signed by Governor

Clarifies that the appropriations for developmental services contained in the 2016-2017 operating budget do not lapse until June 30, 2017. This bill was originally written to require the Department of Health and Human Services to make an annual report on the effectiveness of mental health treatment programs.

Interim Study

Prohibits any person committed to the state mental health system who has never been charged with or convicted of a crime from being admitted to the Secure Psychiatric Unit (SPU).

Signed by Governor

Extends the suspension of prior authorization requirements for community mental health programs to prescribe medication used to treat severe mental illness.

Signed by Governor

Establishes a committee to study the use of restraints when transporting a person subject to involuntary admission proceedings.

Interim Study

Authorizes the Department of Health and Human Services to establish a psychiatric residential treatment facility at the Sununu Youth Services Center.

Signed by Governor

Requires continuing education on suicide prevention for a license renewal from the Board of Mental Health Practice.

Killed in the House

Requires community mental health program personnel receive training related to suicide. This bill also establishes a committee to study increasing suicide prevention training.

Killed in the House

Declares that if a patient admitted to a facility is not of sound mind as determined by a physician or a court, the wishes of the patient’s immediate family or guardian shall take precedence over the provisions of the patients’ bill of rights.

Killed in the House

Establishes a procedure to annul a mental health record.

Signed by Governor

Declares that a managed care health benefit plan offering prescription drug benefits to Medicaid recipients shall not require prior authorization for certain drugs used to treat mental illnesses.

Killed in the House

Establishes funding for mental health first aid training programs.

Killed in the Senate

Appropriates money for the Valley Regional Hospital in Claremont to convert unused space to an involuntary commitment mental health facility.

Signed by Governor

Allows advanced practice registered nurses to authorize voluntary and involuntary commitment to state mental health institutions.

Should NH increase funding for mental health?

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Issue Status

This year, NH lawmakers are studying how to expand access to mental health courts across the state. A commission of legislators, public employees, advocates, and judges will write a report with recommendations in November 2020. Have an opinion about this issue? Reach out to the chair of the commission, Sen. Jon Morgan, and share your story. 

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