Photo of MVHI Annual Meeting

Exploring Impact of Public Health Council at MVHI Annual Meeting

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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

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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

Taking on the Opioid Crisis

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The States of New Hampshire and Vermont both admit they are in the midst of an opioid epidemic, with overdose deaths in New Hampshire predicted to top 400 by the end of 2015 and Vermont communities scrambling to curb the related crime devastating numerous communities.

Both states have taken significant steps to begin to bring this epidemic under control, though there is likely more that still needs to be done.

Vermont is implementing a comprehensive strategy that includes increased access to treatment, especially medication assisted treatment. Their plan also includes distributing Naloxone, a medication which can temporarily reverse the effects of an overdose allowing time for emergency medical care to intervene.

In response to the opioid crisis in New Hampshire, the state has created the campaign Anyone.Anytime.NH to educate the public and professionals about addiction. This campaign is designed to help anyone affected by this crisis, including people experiencing addiction, parents, family and friends of those experiencing addiction and health care, safety, and other system staff working with people who may be experiencing addiction.

New Hampshire authorities are also working to make Narcan (aka Naloxone) more available. Regional public health networks, PHC included, are hosting community events that offer training in the use of Narcan and provide free Narcan kits to individuals who are concerned about someone’s opioid use.  Some pharmacies, using standing orders from a physician, are able to provide Narcan to anyone who wants it. First Responders in New Hampshire are looking for more and better training on how to direct victims to treatment and recovery services.

In New Hampshire, the NH Heroin Task Force spent the last few months of 2015 developing a series of proposals intended to address the crisis. Some of the proposals relate to increasing criminal penalties for dealing, improving the Prescription Medication Monitoring Program, removing insurance barriers to accessing treatment, and many more. Many of these proposals must still be considered by the legislature in the form of bills and consideration will begin early in 2016.

For anyone concerned about heroin and other opioids in the communities or families, there are resources available – albeit not enough – and people should be encouraged to reach out for information and help.  In New Hampshire, start at Anyone.Anytime. In Vermont, start at the HealthVermont website.

A Brief History of the Public Health Council Priorities

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PCH_Logo1_blue_03The Public Health Council of the Upper Valley is dedicated to facilitating leadership on regional public health priorities, fostering collaboration to improve effective action, and making sure we know how much has changed.  The community health improvement planning process, started in late 2014, has been the PHC’s approach to getting started. We recognize that needs will change, knowledge about effective strategies will evolve, and our capacities for coordination and collaboration will grow. For these reasons, we understand that this “improvement planning process” will be an ongoing part of our work and that this document represents our best thinking at this point in time.

In the later part of 2013, members of the PHC’s Executive Team reviewed relevant needs assessment data from the previous ten year period. The goal was to identify the top health-related issues of concern, particularly those issues that had shown little improvement over time. The thinking was that our purpose, as a collaborative leadership body, was to find new ways to tackle these problems collectively. Some of the conclusions from this review include recognition that despite the fact that the Upper Valley Region mirrors or exceeds the strong health status of the states of NH and VT, there are significant variations in health and well-being between individual communities and residents. These disparities appear to be primarily related to income. Lower income residents, including many skilled workers, have significant challenges with housing, access to health care, and transportation.  Housing costs often push them to the edges of our region, making access to jobs, job training, and health care a challenge driven by access to transportation. Another factor is that distance from health care increases the time required to get to and from appointments; time that many working people cannot afford.

In 2014, PHC members worked together to review the health-related needs of our communities and establish a set of priorities for collaborative action. The Upper Valley Agenda for Public Health (link to document) lays out the priorities and the measures we will use to measure our progress. The priorities established include:

Healthy Community

  • Improve oral health
  • Decrease substance misuse
  • Promote healthy weight
  • Decrease heart disease
  • Increase cancer prevention
  • Increase preventative care and access to care

Safe Community

  • Reduce preventable injuries
  • Improve community conditions for elders
  • Decrease incidents of sexual assault and relationship violence
  • Reduce violent crime
  • Ensure preparedness for public health emergencies

Supportive Community

  • Reduce adverse childhood experiences
  • Increase supports for aging in community
  • Ensure access to behavioral health and substance abuse services
  • Increase caring response to people with behavioral health and substance abuse concerns

Vital Community

  • Increase number of people in living-wage, full time jobs
  • Increase access to affordable and safe housing
  • Increase transportation options connecting people to jobs, shopping, and services
  • Increase social capital

Members of the PHC acknowledge that our list of priorities is ambitious and we are not able to work on all of the priorities immediately or simultaneously.  Our approach has been to start where there is current momentum, resources, and willing partners. The other priorities remain in the developmental phase as we look for opportunities to bring them to the forefront; these opportunities might include new interest in the topic, new stakeholder activity that provides a foundation to build from, or new funding opportunities.