The good news last week that the state Department of Health and Human Services’ Division of Behavioral Health had struck a deal to gain access to up to 10 beds at the Brattleboro Retreat for youths in crisis was almost immediately undercut by news that actually none of those beds are free right now.

Such is the situation in mental health these days, not only in New Hampshire, but elsewhere as well.

The Retreat, long a mainstay of Vermont mental health and substance-abuse treatment, has also been receptive at times over the years to Granite State referrals. However, Keene-area patients, including children, have not been referred there in recent years. New Hampshire’s contract with the Retreat, using $684,000 in federal funds through Medicaid, would ideally pay to treat 100 or so youths over the course of the coming year. It could also be renewed for up to four more years.

So even if the beds aren’t available right now, any availability will be a plus.

“Any investment in the mental health system for kids or adults in New Hampshire is a welcome thing, and beds closer to Cheshire County is not something we’ve had in quite some time,” Phil Wyzik, executive director of Keene-based Monadnock Family Services, told The Sentinel’s Olivia Belanger. The problem locally has been particularly acute since Cheshire Medical Center shut down its youth psychiatric ward in 2016. It closed its main mental health ward soon after, citing difficulty retaining a psychiatrist. (A hopeful sign: The hospital this year added a psychiatrist to its staff and is now offering outpatient psychiatric services to its primary-care patients.)

But the situation predated Cheshire Medical’s moves. In fact, the hospital was as much a victim of the real problem as any other provider: too-low Medicaid reimbursement rates. Medicaid pays for a huge percentage of mental health services, especially for youths. It’s a federal-state partnership, but the state is the one setting rates paid to New Hampshire providers. And New Hampshire has historically low-balled those rates.

The cumulative effect has been twofold.

To begin with, mental health staff can’t make enough money here to stay with their jobs. As Wyzik said two years ago, “When your revenue doesn’t match the pace of your business, you can’t pay people what the market pays or keep premiums low and you are forced to cut corners.” And at Maps Counseling Services in Keene, a clinician said they’d had to turn away nearly 100 patients in a week because they just didn’t have enough clinicians to see them.

New Hampshire raised its Medicaid reimbursement rates for mental health in 2020, for the first time in 14 years — and still lags other New England states by a wide margin. Now, in year two of a pandemic that’s exacerbated mental health issues, agencies are finding they simply don’t have the staff to meet the demand.

The other issue with the state’s approach is that if you don’t pay enough for services, insurers won’t offer coverage and providers won’t invest in facilities. Thus, there’s a shortage of psychiatric beds in the state. After all, why do business in a state that’s paying $90 for a psychiatric evaluation if you can get $120 for the same service in Massachusetts?

As a result of the limited care capacity, about 30 teens and younger children are waiting — often for two or more weeks — in emergency departments statewide for a bed to open up on a given day, according to a report by N.H. Health and Human Services Commissioner Lori Shibinette. That’s unacceptable in a state that annually ranks in the top 10 in per-capita personal income.

The state’s Behavioral Health Division ought to be commended for the Retreat agreement. At a time when every resource is needed to attend to a growing crisis, such outside-the-state thinking should be encouraged.

The proposed purchase and expansion of Hampstead Hospital, with which the state now contracts for youth psychiatric placements, may help.

But the real solution is incentivizing companies to provide more psychiatric beds in the state and upping Medicaid reimbursements to a point where mental health workers are attracted to New Hampshire positions rather than fleeing them.

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