On December 19, 2013, New Hampshire entered into a comprehensive settlement agreement with the U.S. Department of Justice and a coalition of private
plaintiff organizations to expand and enhance the capacity of mental health services in integrated community settings over the next six years.
New Hampshire’s U.S. District Court formally approved this Mental Health Agreement on February 12th, 2014.
The Agreement requires regular compliance reviews and public reporting by an independent monitor or “expert reviewer.”
There are very specific goals, with time frames over the next several years, on which the expert reviewer will review and report back our progress to the court, as well as be available to provide technical assistance.
The Agreement has a goal that is shared by all of us: Improving the lives of individuals who are recovering from a serious mental illness, to provide the supports
and services that will allow them to remain in the community and pursue their personal goals while reducing the occurrence of crises that result in visits
to the emergency room, involvement with the criminal justice system, and admissions to New Hampshire Hospital (NHH) and the Glencliff Home.
The main areas of the Agreement are:
1. Transition Planning, providing each individual in NHH and Glencliff with effective transition planning that “…sets forth in reasonable detail the particular services and supports, including their scope, frequency, and duration, that each individual needs
in order to successfully transition to and live in an integrated community setting…” (Mental Health Agreement, p.15). When the necessary resources are
not available, we will work to develop them. When individuals are not interested or are ambivalent about returning to the community, we will make sure that they consistently have opportunities to learn more about how they might safely transition,
including periodic meetings with representatives from their region’s community mental health center and opportunities to visit their community.
2. Mobile Crisis Response Teams will be established in the most populated areas of the state (Concord in 2015, Manchester in 2016, and Nashua in 2017). These are teams that will be comprised of clinicians trained to provide behavioral health emergency services and crisis intervention services, and will also include at least one peer specialist, providing 24/7 services and supports with the ability to respond at the site of the crisis, including at the individual’s residence. These teams will also have crisis apartments available to reduce or eliminate individuals’ need for admissions to NHH, Glencliff, or any other institution.
3. Assertive Community Treatment – Enhancing community mental health centers’
Assertive Community Treatment (“ACT”) teams, so that the mental health
system can provide ACT to at least 1,500 people at any given time. ACT teams
consist of a multi-disciplinary group of between 7 and 10 professionals, including
a psychiatrist, a nurse, a Master’s-level clinician a functional support worker, and a peer specialist, as well as members who have been trained and are competent to provide substance abuse support services, housing assistance, and supported employment.
4. Supported Housing, providing scattered-site, permanent, supported housing
to hundreds of additional people throughout the state, special residential
community settings to help people with complex health needs who in the past
have had difficulty accessing the necessary community services.
5. Supported Employment, providing additional and enhanced supported employment
services, following Dartmouth’s evidence-based model, to hundreds of
consumers around the state. Services include job development, job finding,
job carving, job customization, co-worker and peer supports, self-employment
supports, re-employment supports, time management training, benefits counseling,
job coaching, transportation, workplace accommodations, assistive technology
assistance, specialized on-the-job training, and, if not already provided,
individually-tailored case management and supervision.
6. Family and Peer Support, assuring that there are effective family and peer
support programs to meet the needs of families of consumers throughout the State. The family programs will “…teach families skills and strategies for better
supporting their family members’ treatment and recovery in the community,”
while supporting the peer support programs to “…help individuals develop
skills in managing and coping with symptoms of illness, in self-advocacy, and
in identifying and using natural supports.”
[Source: Greg Burdwood, Aging Issues, Fall 2014]