Workforce, insurance rates barriers in youth mental health response

U.S. Sen. Jeanne Shaheen, D-N.H. and center top row, hears from stakeholders dealing with an all-time number of children and young adults waiting in emergency rooms to get mental health services. They said work force shortages and insurance reimbursement remain big challenges to delivering care

A severe workforce shortage and battles with insurance companies for reimbursement remain barriers for New Hampshire to recover from the highest incidence of youths in mental health crisis in its history, according to experts in the field.

That milestone came on Valentine’s Day, when 51 children and young adults having a serious mental health episode were in hospital emergency rooms waiting for a treatment bed, according to state officials.

During the first quarter of 2021, the average number of youths in ERs each day was 16.

That’s consistent with national trends, which have confirmed since the COVID-19 pandemic began, mental health struggles among young adults were worse than in any other age group.

“For young people they are coming, getting and asking for health care, that’s the only silver lining to this,” said Ken Norton, executive director with the state chapter of the National Alliance on Mental Illness, during a virtual meeting on the issue that U.S. Sen. Jeanne Shaheen, D-N.H., hosted on Friday.

This was a far cry from three years ago when Gov. Chris Sununu celebrated a very different transition point.

The child and adult “boarding room” crisis group had been brought to an all-time low, averaging single digits for an entire month and zero on several individual days.

In response to this year’s worsening trend, Health and Human Services Commissioner Lori Shibinette in March ordered the opening of a temporary 10-bed unit for adolescents in New Hampshire Hospital.

Heather Moquin, the current CEO at New Hampshire Hospital, said this helped stabilize things, but systemic challenges remain.

“We have seen unprecedented numbers of referrals of kids to emergency rooms in crisis while our adult burden for beds has been steady,” Moquin said.

“It’s so important to hear about investments in COVID relief for schools because this seems to be directly in correlation to the isolation in the schools.”

Dr. John Hinck, a psychiatrist working at NH Hospital and Dartmouth-Hitchcock Medical Center, said it wasn’t long ago that hospitals in Manchester, Concord, Berlin and elsewhere had their own psych beds.

Now only Hampstead Hospital and NH Hospital have in-patient beds, Hinck said.

“We simply need more child and adolescent beds,” Hinck said. “Large hospital systems look to consider this.”

Steve Ahnen, president of the New Hampshire Hospital Association, said more capacity is needed in the “entire continuum of care,” which includes mobile crisis units and home-based services.

“Whenever we have people waiting in the emergency room for care, one is too many,” Ahnen said.

Jodie Lubarsky, director of child, adolescent and family services with the Seacoast Mental Health Center, said the return to five-days-a-week for public schools this spring will help for a time.

“Our biggest concern is the second wave that will come in the fall. We’ve got a few weeks here where kids are back in fall, but then there’s the summer break,” Lubarsky said. “I think those transitions in the fall are going to be challenging.”

Virtually every stakeholder told Shaheen that filling vacant jobs was the biggest problem, whether it’s finding nurses, doctors, social workers or school counselors.

Jeanna Still, a director with the Mental Health Center of Greater Manchester, said her last three job applicants took better-paying posts at the federal Department of Veteran Affairs and state agencies.

Still urged Shaheen to look into whether there could be higher reimbursement for her staff paid to be trained to deliver “evidenced-based practices.”

Chris White, owner of the for-profit Endurance Behavioral Health of Seabrook said he can deliver more services to children in Massachusetts. The Granite State won’t accept his billing codes because he’s not a nonprofit, he said.

“I personally fight with the insurance companies every day to get the services that the kids need,” White said. Shaheen said later this spring she will hold a series of events to highlight workforce issues and more federal support for mental health programs.

“This is an ongoing challenge and we all have to work together to address it,” Shaheen said.