After many attempts to find the right therapist, Katie Pope, who was going through a rough patch in her marriage, had almost given up. She had nearly resigned herself to the belief that she would never find someone she could truly open up to.

“I was done just kind of talking about the same thing with different people and not going anywhere,” said Pope, 34, a mother of three from Boscawen.

But in 2021, everything changed when she finally connected with a therapist at Riverbend Community Mental Health Center in Concord.

“She was like a saving grace,” said Pope. “She truly turned so much of my life around and truly made me a better person.”

For almost three years, Pope worked through her issues with the same therapist, feeling a sense of stability and progress she hadn’t known before. But after a session in May, her world was shaken.

Her therapist broke the news that Riverbend’s adult outpatient practice would be shutting down by the end of the summer.

She walked out of her May session, not realizing it was their last.

This closure affects not just Pope, but also 350 other patients who learned that Riverbend was shutting down its adult counseling services on 105 Loudon Road due to severe financial challenges.

Lisa Madden, the president and CEO of Riverbend, described the decision as “thoughtful but painful,” announcing that its adult outpatient practice would close its doors on Aug. 16.

Over the past 15 months, Riverbend has faced a staggering drop in revenue.

The shift from a public health emergency to ‘normal’ operations, along with the reduction in Medicaid eligibility, significantly contributed to the situation, compounded by the difficulty in meeting market demands for competitive compensation.

Madden said another factor is that the payment rates from commercial payers have not kept up with the salary expectations of mental health professionals.

By the end of the 2024 fiscal year, Riverbend is expected to have a deficit of more than $4 million.

“Collectively, we are all working together at different levels of the organization to do whatever we can to improve our financial situation, while ensuring we remain focused on providing top-level care to the community each and every day,” said Madden.

Other services offered by Riverbend like residential programs, children’s services and more will still be provided.

Losses plague state’s mental health centers

Roland Lamy, executive director of the New Hampshire Community Behavioral Health Association, noted that the situation at Riverbend is not unique and most of the 10 community mental health centers are experiencing operating losses.

The main reason is the Medicaid redetermination process that started in 2023 which led to more people losing their Medicaid coverage, causing an increase in uncompensated care for hospitals and healthcare providers.

For nonprofit and safety-net facilities, like the community mental health centers that rely on Medicaid as their primary payer source and serve a high proportion of low-income and uninsured patients, Medicaid unwinding has made the financial strain particularly more severe.

“They’re losing money at the end of the fiscal year,” said Lamy. “There’s just more and more and more financial pressure on centers to be able to provide access, afford staff and compete for scarce resources.”

When asked if other community mental health centers might face the same fate as Riverbend if changes aren’t made, Lamy said it’s “always a possibility.”

“We have 10 nonprofit healthcare entities. There are a number of services rendered that are below cost to provide those services,” he said, explaining the impact of uncompensated care on the centers. “When your costs are going up every year, the cost to keep a building and the cost to keep workforce and provide benefits and all those things go up each year, if you don’t have corresponding increases in your revenue stream, it does jeopardize some services.”

At Riverbend, while some people will continue seeing their counselors until the last day of service in August, Pope will not.

“It’s really depressing and I’m really nervous for all of these other people,” said Pope.

Riverbend had provided a two-month notice to staff, allowing them to explore their options, whether to stay or seek alternatives.

Her therapist, a part-time staff member at Riverbend, decided not to stay on.

Two weeks after hearing the news from her therapist in May, Pope received a letter from Riverbend officially announcing the closure of their outpatient adult services.

“I just looked at it and I tore it up because it really just seemed like they didn’t care,” said Pope, expressing her frustration.

Not enough mental healthcare workers

The closure of Riverbend’s outpatient services has left many clients feeling abandoned and disheartened.

Many people have been on Riverbend’s waitlists for weeks, if not months, hoping to connect with mental health professionals. Now, they’ll need to join a waitlist at one of the other mental health centers within their geographic reach.

Across community mental health centers, many positions remain unfilled, which is part of a larger crisis impacting mental health services throughout New Hampshire.

Compensation and the difficulty of finding qualified professionals are major contributing factors, said Lamy.

According to the U.S. Bureau of Labor Statistics, New Hampshire’s average annual wage for substance abuse, behavioral disorder and mental health counselors has steadily increased since 2020, rising from $46,610 to $57,110 in 2023.

Despite this growth, New Hampshire’s average wage for mental health workers slightly lags behind other New England states.

For instance, in 2023, Vermont’s average pay for these workers was $58,880. The highest-paying state in New England in 2023 was Connecticut, offering an average annual wage of $61,100.

“A high rate of inflation and uncompensated care spike in some ways it makes it hard to continue to invest in the workforce,” Lamy explained. “But I would say that we’ve done a reasonable job with retention rates.”

In the last budget session, the state allocated nearly $11 million to community mental health centers. However, there’s a pressing need for more investment in areas like student loan repayment to attract new professionals, increased compensation for providers at every credential level, and enhanced education and training opportunities.

“There are both things that we can do that require monetary investment and things that we could do administratively from a policy perspective that would really help our workforce and access,” said Lamy.

Since the pandemic, the demand for mental health services across the country has surged, and in New Hampshire, this trend hasn’t returned to pre-pandemic levels.

In fact, the severity of mental health illnesses has increased, noted Lamy.

“I say that because it does feel that the centers are producing more encounters for services with basically the same amount of people in the workforce,” he said. “So more units of service are provided with basically the same workforce, and so kudos to our existing workforce.”

The centers are seeking solutions to stay afloat and plan to collaborate with legislators in the next session to alleviate the pressure on New Hampshire’s mental health facilities.

Meanwhile, residents like Pope must endure long waitlists, navigate access issues, and hope their counseling centers don’t stop services.

Left without a counselor for over a month, Pope is reluctant to seek out another, not wanting to start from scratch in finding someone she can open up to help her navigate her emotions.

“I know I would benefit 100% from talking with somebody, but the amount of time it took to find the right person was just so long,” she said. “It’s almost not even worth it in the end.”

Sruthi Gopalakrishnan can be reached at sgopalakrishnan@cmonitor.com

If you need help

Veterans: To connect with a Veterans Crisis Line responder anytime day or night, dial 988 then Press 1

National Suicide Prevention Lifeline: Call or text 988 or chat at 988lifeline.org

National Alliance for Eating Disorders: Call the helpline at +1 (866) 662-1235

The Trevor Project: A national 24-hour, toll-free confidential suicide hotline for LGBTQ youth. If you are a young person in crisis, feeling suicidal or in need of a safe and judgment-free place to talk, call 1-866-488-7386. Veterans: To connect with a Veterans Crisis Line responder anytime day or night, dial 988 then Press 1.