APHA Annual Meeting: PHC Was There

This November, two Public Health Council of the Upper Valley members and several individuals from the Health Promotion Research Center at Dartmouth (HPRCD) presented local work at the American Public Health Association (APHA) Annual Meeting in Atlanta, Georgia. The event, which took place from November 4th – 8th, centered on the overarching theme: Climate Changes Health. Throughout the conference, keynote speakers explored how our changing climate impacts human health both directly and indirectly, and how it creates and perpetuates health disparities across our country and the world. The APHA Meeting also includes sessions that cover many other public health topics. With nearly 12,000 people in attendance, the APHA Meeting allowed attendees to network with, learn from, and educate one another.

Tobacco and Electronic Nicotine Delivery Systems Use

Stephanie Kelly discussing ENDS use in NH youth with Dr. Stan Glantz, professor, tobacco researcher, and activist based at University of California, San Francisco.

Stephanie Kelly, of the HPRCD and PHC’s Oral Health Work Group, attended sessions on oral health and tobacco cessation efforts. Her poster presentation, titled “Tobacco and Electronic Nicotine Delivery Systems (ENDS) Use Among New Hampshire Youth, 2010-2015” discussed how New Hampshire youth’s patterns of e-cigarette use relate to national trends, and how prevalence of e-cigarette use varies by gender and high school grade level. Kelly’s poster was well received by other tobacco researchers, who drew connections between New Hampshire’s data and their own anecdotal experiences. [Stephanie’s Abstract]



APHA Members Learn About Rural Aging in Community Groups

Emma Hartswick, former PHC Fellow, presenting her work on rural aging in community groups.

Emma Hartswick, a former fellow at the PHC, also attended the conference to share a community listening project she conducted with Upper Valley residents. Her oral presentation, titled “Exploring Successes, Challenges and Next Steps for Rural Aging in Community Groups” featured the voices of local leaders who are working hard to help their neighbors retain their agency and autonomy as they age, despite the added challenges imposed by a rural environment.

When Hartswick began the project in the winter of 2015, her goals were to understand what services Aging in Community groups offered, how they provided them, and what the Public Health Council could do to support their important work. Looking back two years later, our community’s efforts to support older adults impressed people who attended the talk, and many supported our conclusion that large public health and clinical partners should turn to local organizations to set priorities and guide future work.

APHA Provides Exciting New Information

Now working as a Case Manager and Child Development Coordinator for Boston Health Care for the Homeless Program, Hartswick also attended sessions on mental health, substance use, social justice and maternal child health. “There was so much to learn! I’m really excited about the ideas and approaches I can take back to my team now.” Hartswick said she was struck by how interdisciplinary the conference was, with topic sessions often melding key themes from multiple areas.

Jam packed with posters, talks, booths, round tables and panels, the APHA Annual Meeting both sparked new questions and affirmed current ideas. “It was cool to see how many of our PHC priority areas were big topics of the Annual Meeting,” said Hartswick; “it made it feel like we’re heading in the right direction, on the cutting edge, but not alone.”

Flu Season: We Are Ready!

Flu season is upon us and the Public Health Council of the Upper Valley wants to prevent the spread of this uncomfortable and sometimes fatal illness. Through five free flu vaccine clinics in communities throughout the Upper Valley, we recently provided over 1,100 free flu vaccines to youth and adults.

As with all Public Health Council initiatives, this was a collaborative effort. We want to thank our many partners. Dartmouth-Hitchcock generously donated all the regular and high dose vaccine given. Thirty-four students from the Geisel School of Medicine volunteered over 140 hours of time to administer the vaccines. The Public Health Council’s Medical Director, Bill Boyle, supervised the clinics. We are also grateful to current and former members of our Board of Directors who helped at the clinics. We also received critical support from Plainfield Caring Neighbors, Mascoma Community Health Center, Rivendell Academy students, HealthHUB School Clinic, Upper Valley Medical Reserve Corps, and Vermont Law School for staffing the clinics.

Most importantly, we want to thank the 1,100 people who came to get their flu shot for protecting themselves and their loved ones from this preventable illness.

Flu is deadly, but preventable

The flu results in approximately 12,000 to 56,000 deaths every year in the United States, according to estimates from the Centers for Disease Control and Prevention. In New Hampshire last year, there were 47 influenza-related deaths, including two pediatric deaths. The good news is that flu can largely be prevented with annual vaccines. If you missed one of our vaccine clinics, flu shots are still available from your primary care provider or at various local pharmacies.

The Public Health Council is dedicated to protecting and promoting the health our communities. Whether we are preventing illness, building innovative oral health programs, or expanding summer meals programs for children, we are always bringing people together to find solutions that work for our region. It is our pleasure to serve the Upper Valley.

A Broader View of the Mental Health System Crisis in NH

Recent press reports and opinion pieces regarding the mental health system in New Hampshire have focused on the shortage of psychiatric beds at NH Hospital and its impact on local hospital emergency rooms. Daily email updates from the Department of Health and Human Services starkly report the numbers of adults and children with a mental illness waiting each day for a bed, which have shown a steady increase year to year.

Governor Sununu and key legislators who witnessed the emergency room backup first-hand at Concord Hospital earlier this year were inspired to re-write and make more robust what was initially a modest proposal for a new Ten-Year Mental Health Plan – HB 400 – and add money to fund it in the state budget. At the same time, the NH Community Behavioral Health Association (CBHA), the organization that represents NH’s ten community mental health centers, was advocating for workforce funding in the budget, but our request was upstaged by the bed shortage and hospital ER situation.

There is no doubt that the investments made in and attention given to mental health this year by the Governor and the Legislature are positive steps forward; however, CBHA sees two inherent problems with this approach: one is that policymakers are reacting to an immediate crisis and not addressing the underlying structural weaknesses of the mental health system; another is that adding more psychiatric beds, ACT teams and mobile crisis units to the mix does not mean that services are going to be delivered if we don’t have the people to do the work.

Greatest Need is Workforce Development

Some basic investments in workforce development programs could encourage people to enter and stay in the mental healthcare field. The ten community mental health centers currently have over 170 openings statewide and the wait time for an appointment can run several weeks. Medicaid rates at the centers are at 2006 levels, which has a direct impact on the centers’ ability to attract and retain qualified staff. CBHA asked the House and Senate to fund rate increases for our clinical staff this year but the new services in HB 400 and the budget were seen as more critical.

Meanwhile, the centers compete for staff with hospitals, MCOs (the insurance companies which manage the state’s Medicaid managed care program), schools, FQHCs, and other healthcare providers, almost all of whom can offer higher salaries and benefits. The upshot is that people who need mental health services before they get to a crisis level and need hospitalization are not getting help when and where they need it. Adding more beds to the system will not take care of the root of the problem, which is a weak and underfunded community-based system. Increasing rates beyond the 2006 level is the simplest fix.

Another relatively easy fix to the workforce problem is to relieve the community mental health centers of some of the administrative burdens imposed by the State and the Medicaid managed care program. CBHA’s suggestions range from eliminating some paperwork burdens required of staff, to consolidating data, reporting requests, and audits. One of the most commonly voiced complaints in staff exit interviews relates to the oppressive burden of paperwork.  An example CBHA outlined for the Governor’s office, following his request for a list of administrative rules that could be eliminated, shows that staff at one community mental health center must complete and sign 56,300 documents per year. These documents are in addition to the documentation for intake, therapy, and psychiatry services that clinical staff must also complete.

Simply put, a rate increase for community mental health centers and some relief from the administrative rules that unnecessarily burden our staff could make a significant difference in solving the workforce problem. And that in turn could help reduce the number of people who wind up at the other end of the system: needing a psychiatric bed at NH Hospital and sitting in a hospital ER while they wait for one.

There was much progress for mental health made in 2017, but we need to do more. The State and the community mental health centers worked together in 2008 to develop the original Ten-Year Mental Health Plan, which was celebrated for its vision but never fully realized because of inadequate funding. CBHA is glad to participate in the new Ten-Year Plan directed by HB 400, which we hope will lead to a more structurally sound and adequately funded mental health system for the future.  Let’s get to work and start making a better mental health system for New Hampshire.

Suellen M. Griffin, MSN, is President of the NH Community Behavioral Health Association and President and CEO of West Central Behavioral Health in Lebanon. Ms. Griffin is also an active member of the Public Health Council of the Upper Valley’s Advisory Council.

Lebanon Police Department’s Crisis Intervention Team

Article first published in The Lebanon Times, Summer 2017 issue. Reprinted with permission.

Lt. Matthew Isham

The Lebanon Police Department’s Crisis Intervention Team (CIT) is a community partnership with mental health professionals, hospitals, and other local agencies. Lebanon police officers who participated in the training received 40 hours of specialized instruction in dealing with behavioral health crises due to mental illness. After completing the training, the officers are better prepared to recognize signs of mental illness and safely de-escalate situations with individuals in crisis. Based on a national model started in Memphis, the program defines mental illness as a medical issue rather than a criminal problem and encourages treatment rather than incarceration. This model for community policing brings together law enforcement, mental health providers, hospital emergency departments and individuals with mental illness and their families to improve responses to people in crisis.

Sharing a Best Practice

Lieutenant Matt Isham started the trainings in Lebanon, and later worked with police forces in Hartford, Haverhill, Sullivan County, and the Vermont Forest Service to share the training across the area.

Crisis Intervention Team Depends on Partners

To implement the trainings, the Lebanon Police Department works in coordination with a diverse team of volunteers and professionals from Dartmouth-Hitchcock, West Central Behavioral Health, the National Alliance on Mental Illness (NAMI), the Public Health Council of the Upper Valley, and many more. Marjorie Matthews, a volunteer with NAMI New Hampshire says, “Matt is really the hero of this story. He saw the need, found the national Crisis Intervention Team model, and started the training here in Lebanon.”

The Right Thing to Do

The CIT program is focused on identifying, de-escalating, and diverting situations involving mental health crises. Once these situations are identified, the cases can be sent to the Mental Health Court in Grafton County through Halls of Hope. Lieutenant Matt Isham says, “It was the right thing to do. We have a lot of calls involving mental health issues or in crisis, so the more training we can get, the better for our officers.” Lieutenant Isham is especially grateful for the partnerships and collaborations that they have been able to create through the work with the Crisis Intervention Team. Both private and public entities provided training free of charge, and made a commitment to the intensive training. “It’s a total community and Upper Valley initiative that we started here in Lebanon and with the help of the Public Health Council,” Lieutenant Isham says. “The more officers have the knowledge, the more they will be able to help.”

Donna Stamper is a NAMI New Hampshire volunteer who has participated in six CIT trainings in the Upper Valley. She feels passionately about working with the Lebanon Police Department and other local law enforcement agencies to help address mental health issues in the community. She says that the key is to avoid the cycle of individuals going to jail instead of getting the help they need. Stamper says, “Lives can be saved by these diversion tactics.”

NH Opioid Addiction Prevention, E-Resources, and Support Website

Opiods were once thought harmless.In the spring of 2017, a group of Dartmouth students participated in a Neuroscience class, “Motivation, Drugs, and Addiction.” They were intrigued by the social ramifications of their classroom learnings. To explore their interests, they compiled a lot of useful information. The students then decided to share that information by designing a website. That site, NH Opioid Addiction Prevention, E-Resources, and Support (NHopes), is a collaborative effort between students at Dartmouth College, local researchers, and New Hampshire community organizations. All these partners seek to provide accessible scientific information regarding the current opioid epidemic in NH. NHopes is designed to be a welcoming, informative experience for those interested to explore and learn about the extent of the opioid crisis, how opioids act on the body, and about recovery and resource options.

The website uses info-graphics and simple explanations to explain who is affected by the opioid epidemic, what is happening in the epidemic, and why opioid use has exploded.

Samples of NH Opioid Website Content

Hotspot Study
Dr. Lisa Marsch and colleagues at the Dartmouth Center for Technology and Behavioral Health conducted a study in NH designed to understand what gave rise to the opioid crisis. She and her team interviewed 75 Fentanyl and heroin users and 36 emergency personnel from the fire, police, and medical departments. See more…

Carfentanil is an analog of fentanyl that is 100x as potent as fentanyl.

Carfentanil is an analog of fentanyl that is 100x as potent as fentanyl. Carfentanil has recently been reported in New Hampshire and has been attributed to 6 deaths so far in 2017. Carfentanil is lethal at small doses compared to both heroin and fentanyl (see image), and it is resistant to overdose reversal drugs.

A Social Impact Practicum

This site is made possible through the Social Impact Practicum (SIP) initiative at Dartmouth’s Center for Service. This program integrates community-driven opportunities for experiential learning into undergraduate courses at Dartmouth College. For more information, please contact Ashley Doolittle, Ph.D.

Partnering with Our Community

The Dartmouth students partnered with ALL Together to build this website. ALL Together is recognized as the Substance Misuse Prevention workgroup of the Public Health Council of the Upper Valley.  It is also nationally recognized as a Drug Free Communities Coalition.  ALL Together is supported by the New Hampshire Bureau of Drug and Alcohol Services, the New Hampshire Charitable Foundation, the Substance Abuse and Mental Health Services Administration (SAMHSA) and by Dartmouth-Hitchcock.