CONCORD — New Hampshire’s mental health system, once a national model for community-based care, needs an immediate infusion of $24 million over the next two years, according to the latest iteration of the state’s 10-year mental health plan.

The 52-page roadmap to restoring much needed services was released in draft form on Thursday for public review in the run-up to a public hearing and legislative action.

It points to a system plagued by long wait times for psychiatric hospital beds, limited access to care, a critical shortage of psychiatrists and mental health professionals and excessive reliance on hospital emergency departments — one of the worst places to deal with a mental health crisis.

“Underlying it all, in the minds of many, is the need to increase funding for mental health,” according to the executive summary of the plan, drafted by state officials and stakeholders in a process that was required by 2017 legislation and guided by the Center for Behavioral Health Innovation at Antioch University of New England in Keene.

The bulk of the recommended new funding to rescue the system comes in the form of $10 million to increase Medicaid reimbursement rates so that mental health service providers can continue to operate, recruit new professionals and retain them once hired.

Many of the mental health services in the state are paid for through the Medicaid program, with rates set by the state. New Hampshire Medicaid rates, among the lowest in the nation, are at the heart of the crisis, according to the report, which also cites lower than average payments by commercial carriers.

The plan calls for $1.5 million to create a centralized portal for accessing mental health care, particularly in emergencies, in a structure that mimics the “hub-and-spoke” model being developed to address the opioid addiction crisis.

Other recommended investments include $1 million to expand early intervention programs and another $1 million for community education and workforce development, which would include training and support programs.

The plan also calls for $500,000 to be spent on new positions in the Department of Health and Human Services — including a housing specialist, liaison with the Department of Corrections, an infant and early childhood mental health specialist, a liaison to the Department of Education and an access coordinator.

The balance of the $24 million would go to outpatient services, transitional housing and new mobile crisis units.

And all of that’s just in the first two years of a 10-year plan.

Rapid deterioration

If New Hampshire has learned anything about mental health in recent years, it’s that a once-great system can decline rapidly if poorly funded, and then take decades to restore.

The plan released last week echoes the last 10-year plan released in 2008, which also recommended increased reimbursement rates for Medicaid, more community-based services and more mobile crisis units.

That plan was derailed by the Great Recession, which led to significant across-the-board budget cuts that hit health and human services particularly hard.

But the dismantling of the state’s community health network and reduction in psychiatric beds was already underway well before the recession hit.

In 1990, New Hampshire was ranked second in the country for mental health care in a report commissioned by the National Alliance on Mental Illness (NAMI). By 2006, NAMI’s report gave the state a “D” rating, stating that “New Hampshire demonstrates how much funding can be cut in 16 years and how impermanent even exemplary service systems can be.”

The Division for Children, Youth and Families has yet to recover from the funding cuts.

Total funding for the child protection agency, which has been in crisis for years, is just now returning to pre-recession levels despite significant investments in the 2018-19 state budget.

“Most stakeholders we have encountered believe that the fundamental cause of New Hampshire’s inadequate mental health services is insufficient and unreliable funding over a period of years,” according to the 10-year plan authors.

Under court order

The state is still under court supervision for its compliance with a 2013 settlement of a class action lawsuit brought by the Disabilities Rights Center of New Hampshire and the U.S. Department of Justice, citing violations of the Americans with Disabilities Act.

Six residents with psychiatric disabilities named as plaintiffs cited prolonged and unnecessary hospitalization in state institutions due to a lack of community-based mental health services.

In settling the case, the state agreed to invest an additional $30 million over a four-year period beginning in 2014.

Mike Skibbie, policy director at the Disability Rights Center, says the new plan, if implemented, will move the state in the right direction.

“As the plan recognizes, community-based services help people with mental illness lead more independent and meaningful lives and are more cost-effective. They also move the state toward compliance with the mental health agreement,” he said. “The state should direct its investments toward that effort, rather than toward restrictive institutional care.”

Ken Norton, executive director at NAMI-NH, is optimistic that this 10-year plan will get more traction than the 2008 version.

“Obviously the big difference is that we’re not entering a period of recession as we were in 2008,” he said. “The other big thing is that the 2008 plan was silent on children, and it’s become clear in the past 10 years the need for comprehensive children’s mental health services is enormous.”

Norton also believes the political climate has changed.

“I’m very optimistic,” he said. “We have a governor who has said we are in a mental health crisis, and we have bipartisan recognition that in the upcoming (legislative) session, we really need to address this.”

A public hearing on the proposed plan is scheduled from 5 to 7 p.m., Monday, Dec. 3, at the Howard Recreation Center Auditorium, 99 Pleasant St., Concord.

dsolomon@unionleader.com