On mental health, money, not good intentions, will determine the course, by John McGauley

The mental health system in Keene, and in New Hampshire, leaves much to be desired.

Last month there was a presentation at Cheshire Medical Center, where the bureaucrat in charge of the N.H. Department of Health and Human Services talked about the state’s initiative to develop a new 10-year mental health plan.

The plan — and remember this is just an initiative “to develop” a plan — calls for a series of stuff I thought of as pie-in-the-sky Christmas wishes, things like a new “portal,” which is a hotline people can call to find out where to get help. It also suggests bolstering the state’s mental health workforce and “strengthening” aspects of what it calls the “continuum of care.” Then it mentions expanding peer supports, increasing prevention and early intervention, adding mental health beds for people in crisis and supporting them as they transition back into the community.

To me it just sounds like a lot of bureaucrats and administrators went on a week-long retreat, had some fun and a lot of coffee, and put together a power-point presentation that they’re walking around the state. A portal? What the heck is that?

I know these people are all well-meaning and sincere, and probably care a lot about mentally ill residents, but do you think the 400 bozos that make up our grossly over-peopled N.H. House are going to spend any money on a “portal” for mentally ill people, or any of this other stuff? The mental-health people will be lucky to walk away with about five grand to fund another planning retreat.

And I’ll tell you why. It’s all about money. Medicare, Medicaid and health insurance companies reimburse far less for mental health care than for other illnesses and afflictions, a long tradition in this country.

For docs, nurses and other people in medicine, there’s simply no money in treating people with mental problems. There are good souls who do it out of the kindness of their hearts, but they don’t make much money. For the majority of those in medicine, they act just like you and I do — we hustle for the money, if we can.

Mental health care is the red-headed stepchild of health care, both nationally and here, the Granite-head State. You know what the average salary is for a mental-health care worker in New Hampshire? $37,000. You know what the state’s average salary is for a psychiatrist, the M.D. at the top of the food chain in the field? $175,000. That’s the same average salary for a doc in family practice, which is the other red-headed stepchild. A psychologist gets about $75,000, and that’s a person with a doctorate.

You know what an orthopedic surgeon makes in this state? On average, $470,000! There are 206 bones in the human body, so that’s $2,281 for each one of them, even all the little-bitty ones in your foot. The doctors who perform those assembly-line colonoscopies make nearly as much, as do dermatologists, radiologists, neurologists, rheumatologists and oncologists.

There hasn’t been an in-patient mental health unit at the Cheshire Medical Center for almost two years, and when you click on their web icon that reads “Behavioral Health,” which means mental health, a page comes up that tells you curtly “It’s closed.” Might as well just be a trapdoor.

So, you come to the hospital, or the cops haul you to the hospital because you’ve been screaming down at Central Square that your dog is telling you to kill people, and what do they do? They throw you into the emergency room and put you in a room and lock the door, and you might stay there for a couple weeks until a room opens at the state mental hospital in Concord. What do they do there? They put you in another room, but at least you’re in the state capital and you might have a view of the gilded dome.

If, on the other hand, even though you’re hearing voices, they can figure out a way to give you a couple of colonoscopies, replace your hips, X-ray and CAT Scan you until the cows come home, then you become a profit center.

I’ve said this before. People rush to the money. If for some strange reason psychologists and psychiatrists began making half a million and the hospital got reimbursed for a mental health patient as they do for an old-timer who gets three new hips and two pacemakers, they’d be out trolling for crazy people.

This 10-year mental health plan will be officially released just before an Oct. 25 hearing in Concord about it. Now, understand it’s just an initiative leading to a plan that someday might be written down in some report. The hearing might get some media coverage, but once the plan hits the House floor, it will go through the usual thrashing machine, and there won’t be anything left of it except some shreds of paper on the floor.

Now, let me say this. There’s a guy named Joe Schapiro running for the N.H. House in November. He’s a Democrat, with a heavy social-work background. He’s very liberal, so I don’t think we’d agree on much. However, he said this at that presentation at the hospital:

“We can have the best plan in the world, but if we don’t have leadership — but mostly money — to implement it, it’s not happening.”

Joe is right, right, right. If he can get elected, and I think his chances are pretty good, and he can persuade, convince, lobby and throw elbows for increased funding from those other 399 stingy reps, he’ll have my support.

Author and local radio talk show host John McGauley writes from Keene. He can be reached at mcgauleyink @gmail.com.

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