Evaluation of the Capacity of the New Hampshire Behavioral Health System

Opportunity

The New Hampshire Legislature called for a comprehensive system evaluation to identify statewide behavioral health system needs, gaps, and recommendations. Under contract with the Department of Health and Human Services, HSRI and partners at the Technical Assistance Collaborative used a mixed methods approach that consisted of three main elements: reviewing existing documents and reports, conducting interviews with a range of key informants, and analyzing data provided by DHHS and other constituents.

Approach

Combining quantitative data with constituent perspectives

Working within a two-month timeframe, we conducted a mixed methods evaluation that included interviews with 55 constituents around the state, including:

• Community Mental Health Center directors
• Hospital administrators
• Peer support agency staff
• Law enforcement officers
• First responders
• Mental health service consumers and family members
• Advocates

We also examined more than 53 existing reports, documents, and datasets, and analyzed quantitative data on service capacity, utilization, and characteristics of people served through Community Mental Health Centers, acute care and specialty hospitals, the state’s psychiatric hospital, peer support programs, supported housing programs, and Assertive Community Treatment programs.

System mapping

We developed health system maps to display services available to individuals with mental illness or substance use disorders in New Hampshire. Where possible, we organized these by Community Mental Health Center region so the state could compare this inventory of services and bed capacity to utilization patterns.

As part of the study, we examined the types of services and numbers of beds available in each of the state’s 10 Community Mental Health Center regions.

The findings

We found several gaps contributing to bottlenecks at various spots in the system, resulting in people experiencing “boarding,” or waiting for days or weeks in an emergency department for a hospital bed or transfer to another inpatient facility. Based on utilization data and population size, New Hampshire did not appear to be facing a significant shortage in the number of inpatient beds. Thus, the report focuses on a series of short- and long-term recommendations on different points in the larger behavioral health system, including:

• Crisis prevention recommendations focused on community-based services that can help people reduce or potentially avoid crises. One recommendation was to increase peer support services that offer diversion or transition services (e.g., recruit and certify additional peer specialists).
• ED diversion recommendations focused on how to better serve individuals when they do find themselves in crisis and in need of crisis services. One recommendation was to develop and expand crisis alternatives (expand use of peer respite, establish alternative to ED for law enforcement).
• Disposition recommendations focused on how to better transition individuals who do receive inpatient services back to the community. One recommendation was to establish community…based forensic services as a step…down for individuals in New Hampshire Hospital who are able to transition.

Our team also made a number of broader system-wide recommendations, focused on issues that were cross-cutting or impacting the behavioral health system at multiple points. For example, one recommendation was focused on workforce development (e.g., consider curriculum on best practices, develop peers in workforce throughout the system).

Impact

Through an analysis combining qualitative and quantitative data, we determined that increasing access to community-based services is critical to better meeting the behavioral health needs of New Hampshire residents.

After the study, the state decided to redirect funds that were previously set aside for designated receiving facility beds for involuntary admissions to housing services. The state is also using our recommendations as the foundation for its 10-Year Plan for Mental Health.