Measuring Mental Health Costs
May 3, 2010
Demand is up for mental health services in New Hampshire, but resources to provide them are dwindling. And more are on the chopping block, including the Anna Philbrook Center, the state’s facility for treating children and adolescents with severe mental health needs.
Children would still be treated, but at the main wing of the New Hampshire Hospital, instead. Fourteen adult beds would be eliminated to make room for the kids. It is not clear at this point how the state’s obligation to educate the children would be met or who exactly would pick up that bill.
Closing Anna Philbrook
The Philbrook building (named for Granite State pioneering child psychiatrist Anna Philbrook, who directed the state’s Child Guidance Clinics from 1945 to 1966) is widely considered to be in a state of disrepair. Closing it and eliminating certain related staff are projected to save about $2.4 million.
“My concern is their focus is on saving real estate costs rather than underlying services,” says Rep. Liz Merry (D-Sanbornton). Even though the building is not in good shape, Merry says, at least the children at Philbrook are getting appropriate services for their needs.
Mike Cohen, executive director of the New Hampshire chapter of National Alliance on Mental Illness, agrees. He’s concerned about moving the children to a facility that is unfamiliar, not designed for children, not set up with an accredited school, and lacking the child-specific, expert staff the kids already know.
Cohen is also very concerned about the elimination of the 14 adult beds at New Hampshire Hospital. “That is more like 400 bed nights,” he estimates. “And at the time when the demand on the community is growing.”
Cohen says that although the budget accounted for a 1 percent increase in demand for mental health services, that demand is now looking more like a 12 to 13 percent spike.
The implications of reduced services ripple into communities in many ways, according to Cohen. It often starts with more psychiatric emergencies among adults going untreated. “But the ER is not necessarily the best place to get treated,” Cohen says. Law enforcement and local police are also implicated, responding to calls for loitering and other disturbances from mentally ill adults.
If children don’t get adequate services, demands on their pediatricians increase. And if mental illness is not treated in the primary care offices, it can fall to local school systems.
“Reducing in-patient services would work fine if you were bringing commensurate services to the community to deal with it,” Cohen says. “But you’re reducing them, too. It’s a recipe for disaster.”
Cohen is referring to proposed caps on services provided by the state’s 10 regional community mental health centers. They serve about 47,000 mentally ill adults every year. “They’re the most severe cases in terms of illness,” Cohen says, “and they’re not going to go away.”
Community mental health centers provide 24-hour emergency services, assessment and evaluation, individual and group therapy, case management, community-based rehabilitation services, psychiatric services, and community disaster mental health support. Cohen says, “We can’t afford as a state to have ‘the community mental health centers] collapse.”
Evaluating Success
But are the community mental health centers, or services at Anna Philbrook, for that matter, working? It’s a question that Cohen himself admits there’s little data to answer with.
“The mental health centers themselves more measure satisfaction than effectiveness,” he says. In other words, a patients may be asked how they liked the services provided. “That’s different from measuring the effectiveness,” Cohen says. “I think the whole system has to do a better job of measuring effectiveness.”
He thinks DHHS Commissioner Nicholas Toumpas has an eye on this. After all, Cohen says, “If you have scarce dollars, you want to pay for those things that have a body of research attached to them [that show] they work.”
But it’s not black-and-white for Cohen. “To do it well takes resources. And when it comes to closing beds at a hospital or measuring success, right now I’d rather keep the beds open,” he says.
Liquor Commission Update
New Hampshire has a new Interim Liquor Commissioner in Earl Sweeney, who’s taking a leave of absence from the Dept. of Safety to fill the position. Gov. Lynch appointed Sweeney and the Executive Council approved him for the job after Lynch fired Commissioner Richard Simard, who was charged with driving while intoxicated last month.
The appointment still leaves one vacancy in the three-member Liquor Commission. Mark Bodi is on paid leave while the N.H. Attorney General investigates his conduct in a Keene area enforcement action.
© 2008-2010 Niles Media “Front Door Politics” all rights reserved.
Filed under: Government, Health, Uncategorized, mental health, state budget
