NH officials point to 'Mission 0' investments as key to reducing ER boarding for psychiatric patients

State Division for Behavioral Health leaders told the House Finance Committee on Feb. 27 that a package of investments—labeled “Mission 0”—has helped reduce the number of people waiting in emergency departments for inpatient psychiatric beds.

The department said the Mission 0 strategy coordinates six priorities: certified community behavioral health clinics (CCBHCs), crisis stabilization centers, care‑traffic control (real‑time bed coordination), expansion of designated receiving facility (DRF) beds, step‑down and supportive housing, and landlord incentives coupled with bridge subsidies for people awaiting federal housing vouchers. Officials said the combination has reduced wait times and improved bed utilization across the state.

Division Director Katia Fox said care‑traffic control gives receiving facilities and New Hampshire Hospital real‑time visibility into bed availability, which helps route patients more quickly to the right setting. “That has been really beneficial and helped us with that utilization so that we are closer to full utilization and not having beds go unused when somebody needs one,” Fox said.

Fox and other presenters described how the state’s crisis system operates as three linked pillars: an access point (the state 988/rapid‑response contact), mobile crisis teams that can be dispatched into communities, and crisis centers where people can stay for short observation and stabilization (roughly 23.5 hours) without triggering inpatient licensing thresholds. The access point contracts with a vendor (Carillon) for 24/7 telephone/chat/text access and triage; the 10 community mental health centers provide mobile crisis services.

Officials said the network includes designated receiving facility beds outside New Hampshire Hospital (65 at the time of the data cited), with Dartmouth Health adding five beds recently and 10 DRF beds required under the Catholic Medical Center acquisition, bringing the total DRF capacity outside New Hampshire Hospital higher. Fox said the state continues to expand step‑down housing and bridge subsidies that allow patients to be discharged from a DRF and free the bed for the next person in crisis.

Fox and staff said Mission 0 is not a one‑off project, but an ongoing set of services that must be maintained to avoid a return to prior levels of ER boarding. Committee members asked about risks tied to changes in Medicaid policy; Fox and Nathan White, the department’s chief financial officer, said they are monitoring federal‑ and state‑level changes closely because loss of coverage would increase uncompensated care and could undermine parts of the system that rely on Medicaid billing.

The department said its public dashboard reports wait‑time metrics — such as the interval from completion of involuntary emergency admission paperwork to placement in a DRF — and offered to circulate links to the committee. Officials also said Mission 0 has been achieved only at certain points in time and sustained progress depends on preserving the six pillars and their funding.

Proponents at the meeting credited a cross‑system approach — crisis access, mobile response capacity, designated beds and housing supports — for the improvement.

Ending: The division did not propose additional statutory changes during the presentation; instead staff asked lawmakers to weigh continued funding that supports the six Mission 0 pillars, and to consider the interdependence of funding streams as the committee reviews the governor’s budget.