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Report: Revisions to NH Health Care Essential for Individuals with Mental Illness

By Matthew Gianino, Institute on Disability / UCED
December 16, 2009

A new report from the Institute on Disability (IOD) and the New Hampshire Bureau of Behavioral Health documents the need to fundamentally revise New Hampshire’s approach for treating mental and physical health and substance use disorders.

“New Hampshire's approach to health care fails to systematically incorporate a comprehensive approach to health -- an approach that recognizes the reality that people’s health is an integration of their physical and mental well-being,” says report author Peter Antal, an IOD researcher. “This is evidenced by limited expertise in emotional / mental health care among primary care providers, high staff turnover at community mental health centers, and an inconsistent coordination of services across major service sectors in New Hampshire.”

The report, “New Hampshire’s Prescription for Mental Health Care,” utilizes a range of local and national research to document the factors that make achieving and maintaining good health particularly challenging for those living with mental illness. For example:

  • Despite the fact that those living with mental illness make up a substantial portion of the population and represent all major aspects of society, they tend to face greater health challenges and annually pay medical care costs that are almost three times higher than those without a mental illness ($6,840 in claim payments per privately insured member with a mental illness in 2007 vs. $2,407 per member without a mental illness)

  • Community resources are often scarce, as 50% of mental health providers surveyed indicated they don’t know where to refer people for needed services.

  • Those living with more severe forms of mental illness face greater challenges as they are more likely to rely on a low income to support themselves and are at increased risk of homelessness, not having transportation to access care, and becoming victims of violent crime.

Antal notes that the need for change is linked not only to the factors above as well as current discussions around health care reform, but also to the fact that demand for mental health services is increasing while supports for care are being drastically reduced. Without substantive change, more residents will not receive the care they need at a level and length necessary to help ensure successful recovery. Not only does this negatively affect individuals with mental illness by reducing their ability to be actively involved in their communities, but it also creates substantive long term costs for every state resident -- costs that could be minimized if the appropriate and less costly supports are put in place.

In looking ahead to the NH Bureau of Behavioral Health’s efforts to support positive changes in the mental health care field, Bureau Administrator Erik G. Riera emphasized the need to develop innovative and sustainable solutions that will support improvement in services across health care providers. “Given the continued drop in financial support for mental health services across the state and the increase in projected demand, it will be imperative that we work across service sectors to create a more effective and sustainable system of health care for individuals living with mental illness,” says Reira. “This will involve working with the state's Mental Health Council as well as mental health counselors, primary care providers, consumers and their families, insurance companies, employers, and other state and national advocacy groups."

“To create change,” says Antal, “we need a strategy and dedicated action to proactively meet the long-term needs of populations with complex health issues. A successful strategy will need to address a number of barriers, including the lack of mental health expertise among both primary care and mental health care providers; the limits of health care parity concerning insurance coverage and how this shapes access to health care; limited coordination among those providing health and social services to those with mental illness; and the need for public understanding to break down some of the myths about mental illness and what it means to achieve and maintain good mental health.”

The report is the result of a joint project between the Institute on Disability and the Bureau of Behavioral Health. For more information and to download the complete report, visit http://iod.unh.edu/pdf/PMHS09_brief.pdf.  

The Institute on Disability at UNH was established in 1987 to provide a coherent university-based focus for the improvement of knowledge, policies, and practices related to the lives of persons with disabilities and their families. Its mission is to advance policies and systems changes, promising practices, education, and research that strengthen communities to ensure full access, equal opportunities, and participation for all persons.


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