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How N.H. is building a new system for handling mental health emergencies

 In the city of Manchester, local mental health workers started working with law enforcement long before the state launched it's new crisis response system for people experiencing mental health crises.
Photo by Jeffery Hastings
Jeffery Hastings
In the city of Manchester, local mental health workers started working with law enforcement long before the state launched it's new crisis response system for people experiencing mental health crises.

Note: This story includes mention of self-harm and suicidal ideation. If you or a loved one is in crisis, contact the National Suicide Prevention Lifeline or New Hampshire's Rapid Response Access Point for help.

In his 17 years at the Nashua Police Department, Lt. Charles MacGregor has lost count of how often he’s heard the refrain: “I didn’t know who else to call.”

MacGregor knows police aren’t the right fit for every call that comes their way, especially when people are experiencing a mental health crisis.

But in New Hampshire, longstanding gaps in the state’s mental health system have meant police are often the de facto first responders when someone’s in crisis. At times, that has meant those who need treatment don’t get the help they need, instead facing arrest or other dire consequences. An investigation from the Concord Monitor last year found fatal police shootings in New Hampshire disproportionately involved people with mental illness. Interactions with law enforcement can also carry heightened risk for people of color or marginalized communities that have historically faced police bias and violence.

Those gaps in New Hampshire's mental health system have also led many hospital emergency rooms to serve as the first line of treatment for people who end up waiting days or weeks for more appropriate care.

At the start of this year, though, New Hampshire began to radically reshape how it handles these kinds of emergency calls — with the goal of making it easier for people in crisis to get the help they need.

Since January, Granite Staters have been able to reach out to New Hampshire’s Rapid Response Access Point, by calling or texting 1-833-710-6477 or starting an online chat through this website. An alternative to the 911 system, the service is meant to help connect people with local resources, like a follow-up appointment with a local clinician or a mobile crisis team of mental health workers that can meet them in person.

Getting this new system underway has required lots of work from state officials, mental health workers, police and people who have experienced mental health challenges firsthand. But all the while, they’ve also been preparing for another big change that is expected to send more calls into this system: Starting this Saturday, the National Suicide Prevention Lifeline will now have its own three-digit number, 988. As part of that change, most people with a 603 area code who text or call 988 will be routed to the state’s new Rapid Response Access Point.

While New Hampshire is farther along than many other states in building this new infrastructure for handling mental health emergencies, it’s still a work in progress. As with any complex system of this kind, both the people using the service and those trying to make it work behind the scenes have reported some growing pains since the new system first launched: inconsistent response times, occasionally unhelpful interactions with dispatchers and more. And the officials in charge of making this all work acknowledge they’re still figuring it all out, and trying to be receptive to these concerns.

“You can both celebrate that we have a better system than we did and say it's not good enough,” said Jenny O’Higgins, who has been overseeing the rollout of these new systems with New Hampshire’s Division of Behavioral Health.

Rapid Response Access Point users report mixed experiences with the new system

When Joshua, whose last name NHPR agreed not to share to protect his privacy, first called New Hampshire’s Rapid Response Access Point in February, he felt like he’d finally found a crisis service that worked for him. In the past, he said a call to another hotline resulted in a traumatizing interaction with local police. But in this case, two mental health crisis workers showed up at his home within about 15 minutes.

“I didn't feel like they were interrogating me,” Joshua said. “It was just like a conversation about how I was doing.”

The state’s new mental health hotline has helped to send mental health workers directly into the community for these kinds of conversations more than 2,800 times between January and May, according to data shared by state officials. In that same time, the crisis line received over 11,000 chats, texts and calls. Those numbers are expected to increase significantly as the new 988 suicide prevention line becomes more widely used.

But Joshua and others said there’s still work to be done to improve their experiences when they ask for help.

When Joshua called the crisis line again several weeks ago, he said the dispatcher seemed fixated on his identity rather than the substance of the crisis that prompted him to call for help. To Joshua, who is trans, it felt like the person was trying to “educate himself on what being trans is.”

Later in the same call, Joshua said he told the dispatcher he was having urges to self-harm, to which the dispatcher replied that he’d never come across a “man who cut himself.” Perhaps on a better day, Joshua thought, the comments would have been easier to brush off — but at the time, he wasn’t in a good place.

“Being trans, that made me feel like I was less than a man,” Joshua said.

That kind of interaction, at a moment of intense vulnerability, ran counter to the stated goals of the service: to make people feel supported when they’re in crisis. It also made Joshua more nervous to call the hotline again — but because his first experience was so positive, he said he would still consider it.

A representative for Beacon Health Services, the company that runs New Hampshire’s virtual call center for its mental health hotline, said they take equity and training seriously.

“We would never want someone to have that kind of experience,” Wendy Martinez-Farmer said, when asked about Joshua’s call, adding that the company would want to look into what went wrong.

Joshua’s not the only one who’s had less-than-encouraging interactions with the state’s new system.

Rebecca Bennett, of Concord, said she called the Rapid Response Access Point when her son expressed threats of violence and suicidal ideation. She remembers being told a mobile crisis team would be deployed, but no one ever showed up.

Still, others have had more positive experiences. Another woman, who asked NHPR not to share her name publicly, said she and her daughter have called the line almost two dozen times and have received invaluable support both over the phone and in person. She credited the Rapid Response Access Point with helping her daughter to accept substance misuse treatment and enroll in state health insurance.

O’Higgins, the state official overseeing the implementation of this new system, said she welcomes this kind of real-world feedback and said people can email her team directly at

“I don't think anyone can build this without those voices,” O’Higgins said.

N.H.’s mental health crisis response is starting to move away from law enforcement

This shift in how New Hampshire handles emergency calls for mental health help has also required local police to adjust their approach.

Historically, police have played a role in a variety of incidents that call for mental health assistance: whether someone in crisis might call 911 to ask for help, or whether law enforcement are called in for other situations, like those involving domestic violence or overdoses, where the parties involved need mental health support.

But whether outside mental health services are called in to help with these incidents depends on lots of different factors — and lots of judgment calls from dispatchers and law enforcement. For example, if dispatchers believe a 911 call involves a situation that’s likely to turn violent, or someone involved has access to weapons, they might steer the call toward police instead of a mental health team. Different police departments also have different policies on when to bring in mental health support.

“It will be an evolution,” said Mark Doyle, who has been working on this transition with the state Department of Safety for over a year.

At the same time, Doyle and others working on this transition said they’re also trying to overcome skepticism from some law enforcement officials who might not yet trust this fledgling mental health emergency system to handle calls that have long been their responsibility.

Sgt. Emmett Macken, of the Manchester Police Department, can relate to that feeling. His department started trying to work more closely with local mental health professionals five years ago, long before the statewide transition began.

“I wanted no part of this at the outset,” he said.

Patricia Carty, CEO of the Mental Health Center of Greater Manchester, said building trust between her staff and local law enforcement took time. The first night the city tried out this new partnership, she recalled, police officers and mental health workers didn't sit in the same room together.

“It was the most uncomfortable six hours,” Carty said.

 Staff at the Greater Manchester Mental Health have had an emergency team that has worked with local law enforcement for the past five years.
Courtesy of Kari Sanborn
Staff at the Greater Manchester Mental Health have had an emergency team that has worked with local law enforcement for the past five years.

But as time went on, Macken and Carty said their teams came to appreciate how this partnership has improved public trust and helped Manchester residents get connected with the resources they need.

As Macken and state officials try to encourage police departments across New Hampshire to adopt a similar mindset, they’ve heard from some officers who found the new system inefficient. In some cases, officials said police described getting stuck on the phone answering what, to them, felt like an unnecessarily long list of questions from the dispatcher on the other side, who was trying to thoroughly triage the situation.

State officials said they’re trying to make sure this process works more smoothly for everyone, including law enforcement.

O’Higgins, with the New Hampshire Division of Behavioral Health, said the state has taken steps to avoid this kind of redundancy. Now, she said, officials who call the crisis line and identify as a first responder can make an immediate request for a mobile crisis team, rather than sitting through additional questioning.

Elsewhere, Nashua Police Department Lt. Charles MacGregor said his officers have also run into other challenges with the new system. In some cases, he said, they’ve assured people in crisis that mental health workers were on their way, only to learn that the team wasn’t actually available due to staffing shortages or other limitations.

MacGregor knows these hurdles don’t have a simple solution. But he’s advocated for better communication so officers in the field are aware of what resources are and aren’t available.

“It’s getting better,” he said.

O’Higgins said state officials realize this system hasn’t been perfectly smooth for law enforcement, but she hopes these early problems won’t dissuade entire departments from making use of the Rapid Response Access Point.

“When something doesn't go as planned, let's fix it together,” she said, “But don't never call again.”

If you or someone you know might be thinking about suicide, contact the National Suicide Prevention Lifelineat 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889). Starting July 16, you can also contact the hotline by calling or texting 988. You can also get mental health support by calling or texting New Hampshire's Rapid Response Access Point at 833-710-6477.

Copyright 2022 New Hampshire Public Radio. To see more, visit New Hampshire Public Radio.

Alli is NHPR's All Things Considered intern.
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