Last night I attended a meeting in Portsmouth with the New Hampshire Commissioner of Health and Human Services on the state’s 10-Year Mental Health Plan. It was clear from the comments at the end of the presentation, from parents and other attendees dealing with serious mental health issues, that this issue is raising concerns throughout New Hampshire.
I went to the presentation with a friend because I think it’s important to hear what other people think. One of her first comments, after we left the presentation, had to do with the ability of the state to deal adequately with some of these important mental health issues. We talked about the similarities to a comprehensive plan like Obamacare. Did Obamacare fix the nation’s health care crisis? I think at this point the overwhelming answer is no. Obamacare was a comprehensive approach to fixing some of the problems in healthcare. This 10-year plan is a comprehensive approach too. I’m leery of comprehensive plans because of the issues we are now seeing with Obamacare.
The DHHS PowerPoint presentation in Portsmouth left me with many concerns and questions, which I raised at the end during the Question & Answer session. I’m not sure how many of my questions will be addressed by DHHS in the final version of the 10-Year Plan since I didn’t see anyone taking notes.
My main focus was on how this plan would impact local schools in New Hampshire. I explained that some schools are now assessing and treating children for mental health without parental knowledge or consent, which would seem to go against the very first “supporting value” in the DHHS presentation: “The person (and their family) is the driving force in their healthcare decisions and an equal partner in the planning and delivery of care.”
With that in mind, I raised these concerns and questions.
1) Especially when it comes to working with children in public schools, ethical boundaries must be spelled out for anyone involved in mental health assessment and treatment of children.
2) DHHS offered in its presentation an incomplete list of focus groups consulted in the development of the 10-Year Plan. No groups of pastors or clergy were listed. Were they consulted, since they are dealing on the front lines with people experiencing mental health challenges?
3) There was no mention of consultation with focus groups consisting of psychologists and hospital-based nurses. Were they consulted?
4) Privacy is a concern with any student data, including data collected in school as part of mental health screening, assessment, or treatment. Specifically, what kind of data will be collected? On whom? By whom? Who has access to the data? Is parental consent sought and respected?
5) What kind of training is required for anyone working with students on mental health concerns?: Who within the school will receive the training? Will training someone actually give them the qualifications needed to deal with difficult mental health challenges? This needs to be detailed if parents are supposed to trust schools to be partners in healthcare.
6) The DHHS outline of the 10-Year Plan mentions “behavioral health in primary care.” What does this mean?
7) Also mentioned in the outline: “Multi-tiered support in schools.” What does this mean?
8) The public needs details on exactly what this 10-Year Plan plan entails for public schools. That plan needs to emphasize that highly qualified individuals will assess and treat students. The need for parental/guardian informed consent must also be spelled out.
9) Proposed actions for “infusion of resources” were listed in the Plan outline, yet no cost estimate was provided.
10) An outside consulting agency, Antioch, helped to develop this 10-year mental health plan. Was this the best approach, versus utilizing New Hampshire individuals closest to this problem and having them offer solutions?
11) Programs targeting students need to be scrutinized for effectiveness and be administered with the knowledge and approval from parents in the district. How will effectiveness be measured?
12) Valuable resources shouldn’t be spent on a comprehensive approach in the schools. Instead, target children who truly need assistance and make sure assistance comes from licensed and highly qualified mental health professionals. Teachers and guidance counselors are not therapists and should not be expected to assess and treat children with serious mental health issues.
It’s important to remember that DHHS Commissioner Jeffrey Meyers played a critical role in pushing for Medicaid coverage for gender reassignment surgery for children. He was working on changing the coverage before any public hearings on the needed rule change. This was against the protocols for rule changes. He has left me with serious concerns about the kinds of rules he intends to implement in the future without public hearings, including rules to govern implementation of the school-based aspects of a 10-Year Mental Health Plan.
The public-information tour is attempting to generate support for a 10-Year Plan that leaves out critical information. We were told no costs could be provided until after DHHS receives all of the feedback. However, some kind of estimate should have been determined.
I think there were opportunities missed when developing this plan. At this point, I don’t have confidence in what has been proposed.
I hope that these feedback sessions are taken seriously and that details will be provided in the future.
This issue is big, difficult and challenging. It’s important that DHHS get it right before implementing any kind of plan going forward.
Everyone needs to be educated about the 10-Year Mental Health Plan, and offer feedback about it to Commissioner Meyers and Governor Sununu. I can’t support the 10-Year plan in its current form.