By Patrick Adrian
THE KEENE SENTINEL
LEBANON — As demand for mental health services grows in rural New Hampshire, Dartmouth Health and partnering hospitals are providing behavioral training to employers and schools, aimed at encouraging mental health support for their workers and students.
In January, Dartmouth Health received a three-year grant totaling more than $1.3 million from the federal Health Resources and Service Administration to deliver a series of training courses to educators and regional employers. These classes guide workplace leaders in ways to better support workers or students with behavioral health needs, a term that applies to all mental and emotional health, including substance misuse.
The project strives to further targets developed about five years ago to improve mental health and substance use treatment in New Hampshire, according to Dr. Sally Kraft, vice president of Population Health at Dartmouth Health and the project sponsor.
Dartmouth Health’s project partners include two of its affiliates, Cheshire Medical Center in Keene and New London Hospital, and the North Country Health Consortium and Community Health Services Network in Littleton.
“This grant was not designed to increase the number of psychiatrists or psychologists,” Kraft said. “It’s really designed to think about all of the people who could provide services for mental health.”
According to Kraft, access to mental health care has traditionally been a challenge in northern New England. The demand for mental health services outpaces the region’s ability to meet the needs, and this disproportion has only worsened since the pandemic.
Rural populations statistically have higher overall health issues than urban populations, Kraft said, including higher rates of chronic diseases and higher rates of risk factors that often lead to serious illnesses, such as smoking and obesity. Many rural communities also have higher rates of poverty and more limited opportunities for employment and career growth.
According to 2020 data from the federally funded Rural Health Information Hub, New Hampshire’s poverty rates are highest in predominantly rural counties: Coos (15 percent), Sullivan (8.9 percent), Cheshire (8.8 percent), Grafton (8.6 percent) and Strafford (8.2 percent).
With the exception of Grafton, these counties also reported the highest rates of obesity, all over 30 percent of residents, and three of the counties — Coos, Sullivan and Strafford — reported the highest rates of diagnosed diabetes, each over 10 percent of residents.
Access to mental health services are also more challenging in rural areas — including in the Monadnock Region — due to limited public transportation, geographical distances and a sparseness of service providers, Kraft explained.
Even with newer technologies like telehealth — which connects patients to health professionals through virtual platforms, a popular alternative to in-person visits amid the COVID-19 pandemic — many rural communities still lack the broadband infrastructure to access the Internet.
For New Hampshire businesses, employees’ mental health becomes even more important due to the region’s ongoing workforce shortage, Kraft said.
The project, while planning to shift attention to workplaces in the fall, launched its first training course for educators and school administrators.
Since the pandemic, schools have seen a dramatic rise in discipline problems and a spike in discipline problems, adverse student behaviors and cases of depression and anxiety, according to Kraft. Administrators, teachers and support staff have undergone “enormous stress,” Kraft said, to meet their students’ needs while simultaneously trying to fulfill their educational duties.
The first course series, titled “Students in Distress”, ran from April to June. The course attracted 115 participants, comprising school administrators, counselors, nurses and social workers, representing schools across New Hampshire and Vermont, Kraft said.
The training included identifying at-risk students, responding to pupils in distress, understanding the inpatient hospitalization system and the broader network of available care providers and community organizations available to students in need.
This fall, the project will launch its workplace-centered training course, “Effective Strategies for Supervising Mental Health Peer Specialists,” which will focus on an employee support system using “peer specialists,” employees with a personal experience with mental health or substance-use treatment, to serve as mentors or a support to other employees.
Peer-support systems have been used effectively in workplaces around the country to support employees with mental health or substance misuse issues, Kraft said. To be effective, mentors or peer participants must be properly trained to understand their roles, as they are not licensed medical professionals. Workplace supervisors also need to have a basic understanding of behavioral health issues and how to create a supportive work environment.
The course will also introduce ways for employees to transfer their mentoring skills to new career paths, such as social work or counseling.
“[At Dartmouth Health], we feel that our role is not only to train the future workforce for the licensed healthcare providers, [but] to build capacity across the whole health care system,” Kraft said.
Phil Wyzik, CEO of Monadnock Family Services, a community mental health center in Keene, said peer-supports in schools or workplaces, when properly implemented, can be a beneficial resource to individuals with mental health needs.
“Any effort to create more supports, or to have more capacity for people to discuss [their stresses] is a good thing,” Wyzik said.
Training of mentors or peers is essential, Wyzik stressed. Peer-support programs are not substitutes for medically supervised care and some individuals may be in situations that require immediate medical attention.
The Dartmouth Health courses follow a collaborative model called Project ECHO (Extension for Community Healthcare Outcomes). Designed at the University of New Mexico in Albuquerque, ECHO connects instructors and learners through virtual technology, expanding the course access to a wider region of participants and allowing participants to learn from one another by sharing experiences and ideas.
“The ECHO format is particularly well-suited for people to learn from each other,” Kraft said. “[While] the content and knowledge shared by the medical expert [during the course] is very valuable, maybe more valuable is that we can create a community of learning.”
Though mental health professionals, such as psychiatrists or psychologists, lead the courses, most of the sessions are devoted to dialogue between the course participants, rather than lectures.
Many educators said they found this approach beneficial, Kraft said. In addition to hearing the similarity of challenges and experiences occurring across all schools, educators learned of effective “zero-cost” approaches colleagues use to manage student behaviors. One example included a daily “meditation break,” during which everyone in the school — students and staff — stop to meditate quietly.
Kraft hopes that, through the workforce behavioral training project, New Hampshire moves toward a more comprehensive system for delivering mental health care, one comprising a balance of clinical services and community-centered support.
“The idea is to build across the entire continuum of care, to better meet the needs of our entire population,” Kraft said.
The training course on mental health peer-specialists will begin on Sept. 28 with a two-hour session and continue with hour-long monthly sessions from October through April 2023.
The course is free. To learn more about the training, including registration, and other Project ECHO courses at Dartmouth Health, visit connect.echodartmouth-hitchcock.org.
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