Manchester, New Hampshire: Leveraging Trust in Local Institutions to Link Individuals to Treatment Manchester, New Hampshire: LEVERAGING TRUST IN LOCAL INSTITUTIONS TO LINK INDIVIDUALS TO TREATMENT OVERVIEW mental health issues. Upon evaluating the man, firefighters walked him over to a nearby Manchester is a mid-size city in the treatment center. They quickly realized that northeastern United States and home to many people in the community could benefit approximately eight percent of the state’s from such a service. Overdose call volume 1,2 population. Fifteen percent of individuals in had quadrupled in Manchester following the the city live below the federal poverty level, introduction and popularization of synthetic making Manchester one of the poorest cities opioids in Manchester around 2014. In early 3 in the state. Like many rural states across the 2015, the greater Manchester community country, New Hampshire struggles with illicit began meeting to try and develop a response drug use. Statewide, the overdose death rate to the marked increase of overdoses and is 37 per 100,000 population, the fifth highest deaths. MFD’s firefighter led referral initiative 4 in the nation. appeared to be a promising way forward. To combat the high rate of drug overdoses Accordingly, MFD launched Safe Station in the city, the Manchester Fire Department in May 2016. Within the first month of the (MFD) developed the Manchester Safe program’s operation, MFD assisted over 100 Station program, which serves as a “front people seeking help with SUD. door” to substance use treatment by Manchester is home to a number of programs providing referrals in a trusted, stigma-free and facilities that support individuals with environment. The idea for the program came mental health conditions and SUD. This case about in April 2016, after a relative of an MFD study focuses on the Safe Station program firefighter arrived at a fire station seeking and presents key takeaways for other cities help for substance use disorder (SUD) and and counties considering a similar approach. NATIONAL LEAGUE OF CITIES 1 Manchester, New Hampshire: Leveraging Trust in Local Institutions to Link Individuals to Treatment PROGRAM DESCRIPTION RESULTS Safe Station To date, more than 5,700 individuals have As part of the Safe Station program, accessed the Safe Station program in firefighters in Manchester’s ten fire stations Manchester, with an average of three to are trained to arrange for or directly provide six walk-ins per day related to substance 5 medical assessments for individuals seeking use. Utilization of the Safe Station program help with SUD. Medical assessments include increased by 30 percent in the first three checking vital signs as well as screening for months of 2019, compared to the previous 6 physical and mental health issues, and recent year. A 2018 Dartmouth study attributed drug use. If the individual is experiencing a the appeal of the Safe Station program medical emergency, they are transported to its immediacy, low-threshold access, to a hospital by ambulance or emergency centralized locations and the respectful and transport. Once these initial assessments non-judgmental attitudes of the firefighters 7 are completed, firefighters provide referrals in the program. According to a recent to local hospitals or to Granite Pathways, epidemiological analysis, Manchester Safe an organization that provides evaluations, Station participants were 53 percent less assessments, casework, and referrals to the likely to experience a non-fatal overdose and appropriate level of service. For after-hours 86 percent less likely to experience a fatal 8 referrals (between 11 pm and 8 am), clients are overdose after accessing a Safe Station. transported after triage to Farnum Center, the Cities throughout the country have replicated states’ largest addiction treatment facility, for the Safe Station model, including Nashua, short term stabilization or inpatient treatment. New Hampshire; Providence, Rhode Island; and Annapolis, Maryland. Firefighters either walk the client to a nearby facility (if within walking distance) or arrange transportation through a partnership with FINANCING AND the ride-sharing app, Lyft. In either case, the SUSTAINABILITY fire department will call local SUD service Safe Station is funded entirely through private providers in advance to alert them to a walk- donations and grants and receives no funds in or hospital dispatch. from the state or from federal agencies. The Upon initial referral, individuals may be program does not have a budget and calls are subsequently connected to mental health handled like medical walk-ins (which already services and/or medication-assisted treatment occurred before the Safe Station program (MAT) providers. Safe Station partners like began). Additional costs associated with the Granite Pathways follow up with clients to program are funded through donations. help them stay connected to treatment after referral and transportation from the fire department. The city chose to leverage the fact that fire departments are open 24 hours a day, 7 days a week, to expand access to SUD services. NATIONAL LEAGUE OF CITIES 2 Manchester, New Hampshire: Leveraging Trust in Local Institutions to Link Individuals to Treatment COLLABORATION ACROSS provides treatment navigation, recovery support, housing support, employment SYSTEMS support, health/wellness support, DCYF case The Safe Station program collaborates with navigation support, court support, and other a number of programs and services across services to children and parents affected various systems to support the individuals by SUD.13 Recently, Granite Pathways began they serve: offering screening, needs assessments, referrals and care coordination through the Farnum Center state’s Doorway program, discussed further Manchester Safe Station firefighters refer under “Lessons Learned.” individuals in need of affordable treatment for SUD to the Farnum Center, which The Mental Health Center of Greater provides comprehensive treatment and Manchester recovery services for people affected by Another referral site for people experiencing SUD across five state-of-the-art facilities.9 SUD or mental health issues is the Mental Primary services offered at the center include Health Center of Greater Manchester, which detoxification; outpatient and intensive has provided mental health services for outpatient treatment; inpatient treatment; adults, adolescents, and children since 1960. partial hospitalization; medication-assisted The center offers outpatient treatment, treatment; family services; and transitional SUD counseling, crisis stabilization, living. In 2018, the center opened a 16-bed assertive community treatment, supported Stabilization Unit in conjunction with the employment, and physical health and wellness Manchester Fire Department.10,11 If an individual programs to all individuals, regardless of is placed on a waitlist for SUD treatment, the ability to pay. Its Community Connections Farnum Center provides them with a safe program serves to divert individuals with transitional environment while they await mental illness from the criminal justice treatment. system by engaging them in appropriate treatment services.14 Working with community Granite Pathways organizations including the Farnum Center Individuals in need of SUD or mental health and the Manchester Fire Department, the treatment may also be referred to Granite Mental Health Center of Greater Manchester Pathways, a statewide organization that has sustained itself as a leader in improving provides outpatient services for people mental wellbeing. coping with SUD and mental health issues.12 Founded in 2009, Granite Pathways The Adverse Childhood Experiences promotes an evidence-based, self-help and Response Team (ACERT) peer recovery community to recover from ACERT is a collaboration between Amoskeag mental illness. Its programs have expanded Health’s Project LAUNCH (Linking Action to include peer recovery coaching, 12-step for Unmet Needs in Children’s Health), the programs, SMART recovery programs, Manchester Police Department, and YWCA support groups for family members and New Hampshire.15,16 ACERT consists of a a youth treatment center. In collaboration police officer, a crisis services advocate, and a with the New Hampshire Division of Children behavioral health professional who responds Youth and Families (DCYF), Granite Pathways to incidents in which children have been NATIONAL LEAGUE OF CITIES 3 Manchester, New Hampshire: Leveraging Trust in Local Institutions to Link Individuals to Treatment exposed to violence. Teams assess children In its first six months, The Doorway-NH and may refer them to support groups, served more than 3,200 individuals and made mental health counseling, early childhood 579 referrals state-wide, but in Manchester, education, or child-parent psychotherapy. the program poses a potential threat to the MFD firefighters can also refer clients directly sustainability of Safe Station.20 Despite Safe to ACERT program managers. MFD recently Station’s successes, the state chose Granite completed training with ACERT and expects Pathways as Manchester’s single intake to roll out additional education modules for point for SUD and allocated $9 million of firefighters in the near future. the SAMHSA grant to help the organization become a “hub.”21 This effort has resulted in two “front doors” to SUD treatment in ROLE OF CITY Manchester. LEADERSHIP Despite state funding and support for Granite The Mayor