Addressing the Health Impacts of a Changing Climate

540560303_e549e246dd_oFor many in Northern New England, the facts of climate change become reality during these winter months. We notice our ski areas opening later, winter tourism decreasing, and the sap running sooner. There’s grey-green grass outside our windows where we’d hope to see sparkling white this time of the year. While this unseasonably warm winter is just a single point of data in the upward trend of global temperature, it serves as a sobering prelude for what we can expect in the future. With the levels of greenhouse gases currently in our atmosphere, we’ve already bought decades worth of climate change.

The argument that our climate is not changing has become rare one, with over 200 nations committing to action and 99.9% of climate scientists agreeing that warming trends are caused by human activity. Here in the Upper Valley, we already have good data to show that temperatures, precipitation and storm events are all increasing, and that revenues from winter industries have fallen. At this point, the question is no longer if the climate is changing, but what to do about it.

There are two main approaches to addressing climate change – mitigation and adaptation – and we believe that successful efforts to better our future must incorporate both strategies. Simply stated, climate change mitigation includes actions that slow the rate of climate change. Because we know that greenhouse gases, like carbon dioxide, in our atmosphere are primary causes of global warming, solutions that reduce emissions are mitigation strategies. These tactics include improving our energy efficiency, insulating our homes and commercial buildings, buying fuel efficient vehicles and carpooling as well as leveraging clean and renewable forms of energy like wind, solar, and hydro power. Climate change adaptation strategies focus on coping with the impacts that we are already experiencing, and those that are projected to increase in the future. These efforts include everything from emergency preparedness plans for increases in extreme heat, precipitation and storm events, to changes in the ways we construct homes, businesses and roads. Adaptation also means diversifying the tourism industry to rely less on snow and cold, changing agricultural practices to reflect shifts in the growing season, and preparing our health systems for increases in heat related and vector borne diseases.

The health impacts of climate changUVClimate-Health-Adaptation-Plan-Nov-2015e are no small piece of the puzzle – and the Public Health Council of the Upper Valley is dedicated to finding ways to adapt to these effects and mitigate future ones. “We recently completed a preliminary assessment and plan to look at how climate change may affect health in the Upper Valley, with the help of the Upper Valley Lake Sunapee Regional Planning Commission and our UVAW partners. Though our area has seen worrisome changes on several climate related public health related indicators, such as an increase in the incidence of Lyme disease and a longer allergy season, we are most concerned about the rising number of hot days,” says Alice Ely, PHC Coordinator. Extreme heat events are calculated using three metrics: number of days over 90°F, number of days over 95°F, and average temperature on the hottest day of the year. Already we have begun to see increases in these numbers from the historical data (1980-2009), and by the middle of this century, northern New Hampshire is expected to experience a 2 to 4 fold increase in the number days over 90°F, a 3 to 7 fold increase in days over 95°F, and a 4 to 10 fold increase in the average temperature on the hottest day of the year.

It may seem strange to be worrying about extreme heat in our area – after all, we’re known for our snow and ice storms, not for sweltering summers. But one of the reasons the projected rise in the number of hot days is so alarming is that, by and large, New Englanders are not prepared to deal with extreme heat events or stretches of hot weather. Few homes have air conditioning units, and they are especially rare in lower income communities. While social services can draw on many resources to provide fuel and heating solutions in winter months, we have far fewer strategies for addressing cooling needs. As with winter storms, extremely hot days and stretches of heat are especially hazardous for vulnerable populations such as older adults, the disabled, people with existing health conditions, and low income groups.

In response to the concerns about the health related consequences of climate change in our area, the Public Health Council of the Upper Valley is partnering with the Upper Valley Adaptation Workgroup (UVAW) to host a community forum on this topic. At this Climate Change Impacts to Health event, we will be sharing information about how the climate is changing in the Upper Valley, what Vermont and New Hampshire are doing to adapt to changes in our climate, and how community leaders can work together to reduce the health impacts from a changing climate The PHC and UVAW will be introducing an upcoming project to address the impacts of extreme heat on older adult populations, and will be looking for feedback and partnerships for this work. The Public Health Council and our partners in the Upper Valley Adaptation Workgroup are looking forward to seeing you at this important discussion. Alex Jaccaci, Co-Chair of UVAW believes that “it will require leadership, creativity, problem solving, teamwork and drawing from our commitment to our communities and neighbors to get ahead of these challenges. But this is what we will do – turn these challenges into opportunities to be stronger and more resilient as communities and as a region.” We couldn’t agree more.

To RSVP for the Climate Change Impacts to Health Forum, visit:, and learn more about the development of an Upper Valley climate and health plan at

SAMHSA Releases New Smartphone Apps

people-hand-iphone-smartphoneThe Substance Abuse and Mental Health Services Administration (SAMHSA) is the lead agency on behavioral health issues under the Department of Health and Human Services. SAMHSA heads a number of public health initiatives that aim to reduce the impact of mental illness and substance misuse across the nation. In 2016, they’re hoping to make a bigger impact than ever by putting education, prevention and response tools directly into the hands of people who can make a difference – people like you! SAMHSA knows that it is often parents, coaches, primary care doctors and teachers who have the first contact with youth and young adults who are struggling with behavioral health challenges. To equip these individuals with the information they need to create healthy, safe communities, SAMHSA has recently developed four free smartphone apps. These apps are targeted at the issues of underage drinking, bullying and suicide prevention, and emergency behavioral health response.

Talk. They Hear You. is an app designed to prepare parents and caregivers for a conversation with their child about underage alcohol use and its dangers. The interactive app allows you to practice bringing up the topic of alcohol in a simulation, and teaches the do’s and don’ts when it comes to talking to your child about underage drinking. Finally, the app give suggestions of what questions to ask, how you can think about following up, and what key points you should try to get across in a conversation about alcohol.

KnowBullying helps parents and caregivers engage in the most effective bullying prevention strategy – frequent, honest, and caring conversation. Research has shown that parents and caregivers who spend at least 15 minutes a day talking to their child can boost their confidence, build trusting relationships, and develop their skills for facing bullying. The app features conversation starters and tips for having meaningful discussions, as well as ideas about the right time to talk with your kids about bullying. The app teaches the warning signs that can help you recognize if your child is engaging in bullying or is being bullied, and it provides targeted prevention strategies based on age group. There’s also a special section for educators to learn about preventing bullying in the classroom!

Suicide Safe is targeted at primary care providers, who are often the first or only medical contact for individuals struggling with mental health challenges. Almost half of the people who die by suicide have visited a primary care doctor within a month of their death, and SAMSHA’s app is designed to help those providers integrate suicide prevention strategies into routine patient care. The app guides providers through a 5 step evaluation and triage process, and provides sample cases so that doctors can practice using the technique. Suicide Safe also helps providers start the conversation, access important information, and locate nearby treatment resources.

The Behavioral Health Disaster Response App has a multitude of pre-downloaded, easily accessible resources in case of an emergency and limited internet access. The guides, which are specific to many types of traumatic events, also come with tip sheets, information for parents, teachers and first responders, and a directory of behavioral health services in the affected area. The app is designed to help caregivers provide effective support during all stages of a disaster response, and promotes the concept that everyone has a role to play during an emergency.

The PHC encourages teachers, providers, and parents to check out these free apps at As a network of caring community members equipped with trusted information, we can all play a role in supporting those who are living with mental illness.

Students Helping Students Through Mental Health First Aid

YMFA2FullSizeRender “I participated in the Youth Mental Health First Aid (YMHFA) training in March of 2015. When I arrived, I met a group of students who were all passionate about making a difference in their schools and communities. It was amazing to be surrounded by people my age that cared as much as I did about youth mental health. It was great to see a representation from many different schools in the area, including Hanover, Lebanon, Mascoma, Hartford, and Stevens.

The beginning of the training focused on the broad subject of mental health. We learned about different mental illnesses and how to interact with those who have them. We learned the correct way to refer to those suffering from mental illnesses – for example, saying “the person with schizophrenia,” rather than, “the schizophrenic”. The two terms mean the same thing, but the first one recognizes the illness as just part of the person, instead of letting the illness define the person.

Next we looked at various hypothetical scenarios in which our peers needed help with regard to their mental health. Small groups of students were each assigned a scenario; the groups discussed how to help their peers and presented their ideas to the larger group. Then the other groups had time to give feedback on that group’s approach to the problem and other possible solutions. These scenarios were helpful because they showed us that often we are not the ones providing help. Often we are the one who brings the friend to the school counselor, the one who helps the friend talk with his or her parents, or the one who goes to the friend’s sibling and expresses concern.

After the scenarios, we practiced listening to a peer, assessing the situation, and helping the peer get support. Part of this involved asking, “Have you thought about killing yourself? Do you have a plan?” These words are very difficult to ask, and I was grateful for the opportunity to practice, though I hoped I would never have to use them in a real situation. Just months after the training, though, I asked my friend those questions. My friend needed help and I was able to see how severe the situation was. I am so glad I knew what to ask and how to ask it. I was able to help my friend receive treatment.

The YMHFA training helped me to support my friends, my classmates, and even complete strangers. I would recommend this program to anyone who is interested in supporting other teens with mental health issues. Even if there is not a specific mental health issue involved, the skills from this training can still be very useful. I believe there should be a group of students with knowledge of mental health in every high school in the country – it would help students live healthier, happier, longer lives.” – Submitted by Ella Williams, Hanover High School

West Central Behavioral Health made a commitment to provide training in Mental Health First Aid and Youth Mental Health First Aid several years ago as one way to make our communities more supportive of people living with mental illness. This evidence-based program is usually for adults who want to help others experiencing mental health crisis or recognize when mental illness may be a factor in their interactions with others.

About two years ago, a Destination Imagination Team at Lebanon High School completed a community service project entitled “Students Helping Students Through Mental Health First Aid,” which brought a slightly modified version of the training to a group of upper level students. After a successful trial run, Katie McDonnell, at West Central Behavioral Health, reports, “We worked with a leadership group of students and advisors at Lebanon High who applied for, and received, a 3 year grant to provide two trainings per year to high school juniors and seniors who were identified as ‘mature.’ This is critical because the subject matter is quite powerful, and requires a level of maturity. Our trainings have been very successful with this population. I believe so strongly that the students are KEY in being educated about this topic. They are often the first to notice something may be going on with a peer, so providing them the information and some skills on how to help is SO important.” The grant allowed the Lebanon students to reach out to students in neighboring schools to spread the training around.

To learn about MHFA and YMHFA training opportunities in the Upper Valley, go to:

Photo of MVHI Annual Meeting

Exploring Impact of Public Health Council at MVHI Annual Meeting

Photo of MVHI Annual MeetingOn Wednesday, January 20, 2016, at the most recent Mascoma Valley Health Initiative (MVHI) Annual Meeting, Executive Director Alice Ely led an encouraging and productive discussion on the growing impact of the Public Health Council (PHC). The quickly growing PHC seeks to bring together the major health players in the Upper Valley area to develop strategies and partnerships to combat the most pressing public health issues facing local communities today.

The first panelist to speak was Margaret Brown, the Manager of Dartmouth-Hitchcock’s Community Health Department. She spoke on Dartmouth-Hitchcock’s evolving role with respect to public health and how the PHC is helping to facilitate the growth of DHMC’s recent initiatives through its local members and their expertise.

Second to speak was Julia Griffin who currently serves as the Town Manager of Hanover. Under the state’s unorthodox (public health) system, Griffin, and other town managers like her, are tasked with administering mandated welfare and other health-related commissions. Noting this in her discussion of her work, she praised the PHC for its ability to incentivize progress on community health initiatives through collective action and interest.

Finally, Marjorie Matthews, an Upper Valley Volunteer and Advocate for the National Alliance on Mental Illness, elaborated on how instrumental the PHC has been in bringing Crisis Intervention Team Training to local police stations as well as advancing the discussion on mental health in general. Speaking from years of personal experience, she said, “We may have voices, we may have causes, but we don’t have the ways to make those things happen. The Public Health Council has provided the agent to make it happen.”

Moving forward, the PHC plans to turn connections into action and begin working on specific projects, says Director Ely. These projects include initiatives in substance misuse prevention, aging health, and oral health. In the emerging area of community health, the PHC is truly showing itself to be a leader able to make a significant impact in the Upper Valley region. As Julia Griffin put it, “The Public Health Council has put itself on the map and is hopefully now a model for the rest of the state.”

During the Business portion of the Annual Meeting, the Board of Directors bid a fond farewell to long-time Board Members, William Boyle, MD, Nancy DuMont, and David Beaufait, MD. These distinguished individuals have served in various leadership roles on the MVHI Board for more than six years each and will be sorely missed.  Also during the Annual Meeting, Board Members elected Nathan Miller, of Enfield, to a new three-year term on the Board of Directors. Julia Griffin, of Hanover, was elected Chair of the Board; Shawn Russell, of Dorchester, was elected Vice Chair of the Board. Lisa Bujno, of Wilder, will serve as Treasurer. MVHI works to protect and promote the health of our community and hosts the Public Health Council of the Upper Valley, the Mascoma Valley Prevention Network, and the Indian River Youth 2 Youth program.

Crisis Intervention Team Training for Behavioral Health


Police-woman-crisis-intervention-1024-678If your loved one has a heart attack, you call 911 and expect an ambulance and EMTs to respond. If your loved one has a mental health crisis and you call 911, police officers will respond and your loved one may be arrested or transported to an emergency department by patrol car. If the responding officers lack the skills needed to manage a mental health crisis, the situation can escalate and terrible consequences follow, traumatizing all involved. To improve responses to such situations, the city of Memphis created a Crisis Intervention Team Training Program  for its officers. This program, a national model, defines mental illness as a medical issue rather than a criminal problem and encourages treatment rather than incarceration.

Thanks to Lt. Matt Isham of the Lebanon Police Department, New Hampshire’s chapter of the National Alliance on Mental Illness (NAMI), and West Central Behavioral Health (WCBH), local Crisis Intervention Team (CIT) training at the Lebanon Police Department was begun in 2013. With the Public Health Council’s help, our first regional CIT training was offered at Hartford’s Police Department in November, 2015. More training sessions will soon follow with even small departments able to participate. Family members are thrilled to see our local police chiefs enthusiastically embrace this training and are happy to partner with them and mental health care providers to create better outcomes for our loved ones.

The PHC supports this program as part of its priority of improving care in our communities for people living with mental illness. CIT provides law enforcement officials with 40 hours of training in various aspects of behavioral health, de-escalation techniques, and develops community, health care, and advocacy partnerships.  CIT improves the safety of patrol officers, consumers, family members, and citizens within the community and reduces stigma and the need for further involvement with the criminal justice system. Because many community mental health and health care partners are involved in the training, CIT provides a forum for effective problem solving regarding the interaction between the criminal justice and mental health care system and creates the context for sustainable change.  Some research into CIT suggests positive impacts in police officers knowledge, attitudes, and skills relative to people living with mental illness; and CIT training appears to increase the likelihood of referral or transport to mental health services and decrease the likelihood of arrest during encounters with individuals thought to have a behavioral disorder.

Submitted by Marjorie Matthews, Donna Stamper, and Alice Ely