Riverbend Community Mental Health - 2022 Annual Report

BOARD OF DIRECTORS

James Doremus, Chair

Frank Boucher, Vice Chair

John Barthelmes

Mark Broth, Esq.

Leslie Combs

Christopher Eddy

Benjamin Hodges

Nicholas Larochelle, MD

Rabbi Robin Nafshi

Bradley Osgood

James Snodgrass

Carol Sobelson

Johane Telgener

Kara Wyman

EX OFFICIO

Lisa K. Madden, MSW Chief Executive Officer Riverbend Community Mental Health

Robert P. Steigmeyer Chief Executive Officer Concord Hospital

SENIOR LEADERSHIP

Lisa K. Madden, MSW Chief Executive Officer

Chris Mumford, LICSW Chief Operating Officer

Crystal Welch, BS Chief Financial Officer

Paul Brown, MD Chief Medical Officer

Jaime Corwin, BA, PHR, SHRM-CP VP of Human Resources

Sarah Gagnon, LICSW VP of Clinical Operations

Brian Asselin VP of Information Services

Sheryl Putney, BS VP of Quality Assurance

Andrea Beaudoin, AS Senior Executive Assistant

2022 IN REVIEW

A LETTER FROM JIM DOREMUS, RIVERBEND BOARD CHAIR

On behalf of the Riverbend Board of Directors, CEO Lisa Madden, and staff, we hope this letter finds you and your loved ones safe and well. Even as our world becomes increasingly complicated and complex, Riverbend continues to fulfill its mission of meeting the mental health needs of our community. We are emerging from the challenges of COVID as a more progressive, innovative organization and a leader in the field. Riverbend’s enduring education efforts to eradicate the negative stigma associated with mental health, broad array of evidence-based treatment solutions, and creative approach for addressing work-force development continues to surge forward and help make our community and state a better place to live and prosper.

Riverbend is a leader in New Hampshire when it comes to educating and increasing awareness for our community and state on issues related to mental health. As we all know, the negative perception associated with individuals afflicted with mental health issues is cruel and damaging. Riverbend’s persistent and compassionate efforts to inform us all through Mental Health Awareness Month offerings, Mental Health First Aid Training, and the long-running initiatives Change Direction NH (Know the Five Signs) and This is My Brave are working. These are helping to change the culture of mental health by increasing awareness of the impact of mental health issues, humanizing and accepting individuals living with mental health challenges as valued members of our society, and recognizing that there are treatments and solutions that work.

Mobile Crisis, an innovative program that Riverbend initiated a few years ago, has evolved into the state-wide resource, New Hampshire Rapid Response (NHRR). NHRR provides urgent mobile crisis and stabilization services to New Hampshire residents experiencing a behavioral health and/ or substance use crisis. New Hampshire’s ten Community Mental Health Centers work together to provide a collective, collaborative system of care via regional and cross-regional deployment responses 24/7/365 across the lifespan. NHRR is a vital component of NH’s wellness, offering services without

geographical boundaries to all NH residents in a manner that is responsive, equitable, and empathetic to the unique needs of individuals and families.

Virtually every organization is contending with a shortage of employees; Riverbend has been no exception. In addition to market-rate wage adjustments, our creative approach emphasizes the broader work experience and environment through a wide menu of offerings to our employees. These include a re-invented tenure bonus system, on-site chair massages, increasing the number of employees in the State Loan Repayment Program, Peer and Manager support groups, and much more. Combined, our efforts are making a significant and tangible impact showcasing Riverbend as a supportive and attractive employer and a great place to work.

We move into 2023 building upon the successes of the past year while focusing on responding to the increased demand for our services and expanding our advocacy. This Annual Report highlights some of our work from 2022 and how we have positively impacted the lives of those we serve. I would like to thank the Board of Directors, our amazing staff, and our supporters whose commitment and dedication is truly making a difference.

With Appreciation,

Jim Doremus

Jim Doremus, Board Chair

Jim Doremus, Board Chair, Riverbend Community Mental Health

WE TREAT. WE EDUCATE. WE ADVOCATE.

A FORWARD FROM LISA K. MADDEN

Greetings!

I recently spent time reviewing Riverbend’s last two Annual Reports. They span a time we now refer to as the “COVID Era” and attest to a period rife with unparalleled challenges, but in these reports, I also see a written history of how those trials were overcome: with resilience, versatility, and resolve.

In this 2022 Riverbend Annual Report, we take what we’ve learned from the past and step toward a new era of possibility. This is an especially opportune time to reflect, because the 2022 Annual Report marks the 60th year of Riverbend’s history. It’s a history that began with The Community Mental Health Centers Construction Act, which was signed into law in 1963 by President John F. Kennedy. We’ve come a long way since 1963, and as we look ahead, we see that there is so much left to do.

The theme for this Annual Report focuses on three mission-driven activities at the heart of what Riverbend is about:

• We Treat — assisting people of all ages with their mental health concerns and challenges.

• We Educate — sponsoring informative events and reaching out to schools, first responders, civic organizations and community groups to inform and fight stigma.

• We Advocate — connecting with legislators and other advocacy groups to petition for meaningful change in the State’s approach to mental health.

Inside we’re featuring some key voices from within Riverbend. The leaders of many of our treatment programs are eager to share some achievements of this past year. They highlight, too, some possibilities they are excited about as they look ahead to the unfolding of 2023.

And in the spirit of education and advocacy, this Annual Report includes a very brief look at the New Hampshire lawmaking process along with some ideas about how we each can become more involved. So, it’s with great appreciation for our staff, clients, and many vital partners in central New Hampshire, that I offer you our Annual Report for 2022.

Enjoy,

President & CEO Riverbend

Lisa K. Madden, CEO, Riverbend Community Mental Health

AN ABRIDGED TOUR OF THE LEGISLATION PROCESS IN NEW HAMPSHIRE

A new law begins with an idea. That idea can begin in the imagination of anyone from a private citizen to the Governor. Then that idea must be sponsored by a member of the New Hampshire House of Representatives or Senate. That member submits a legislative service request to the Office of Legislative Services. There it is drafted into a bill using proper form and language, and is assigned a bill docket number beginning with HB (for a House Bill) or SB (for a Senate Bill).

The drafted bill is next reviewed, approved, and signed by the sponsoring legislator(s). It’s then submitted to the Clerk’s Office of the relevant chamber. Referring to the bill by number only, the House or Senate adopts a motion to introduce it. The bill is read twice in the early session and is assigned to a committee by the House Speaker or Senate President.

In New Hampshire, every bill referred to a committee must have a public hearing unless the rules are suspended by a two thirds majority of the members present. At the beginning of the public hearing, the committee chair announces the number and title of the bill, and anyone wishing to testify (in favor or against the bill) rises, addresses the chairman,

gives their name and address and, if appearing as a lobbyist, states such to the clerk.

Those supporting the bill alternate in speaking order with those opposed at all hearings. Those wishing to give testimony leave their names with the committee clerk and are called in order, and if a citizen cannot be physically present, a written statement may be submitted to the clerk of the committee. When all testimony has been heard, the chair declares the public hearing closed. The committee then votes on whether to:

• Recommend that their legislative chamber pass the bill,

• Refer it back to committee for further study, or

• Kill it.

If the bill is recommended for passage and then passes the chamber in which it originated, it is sent on to the other body where it goes through similar procedures: public hearing, committee recommendation, and a vote by the full chamber.

If either chamber disputes the language or the provisions of a bill, a conference committee composed of members from both chambers

resolves the disagreement. Appropriation Bills – bills which propose the expenditure of government funds – are sent to the Finance Committee of the originating chamber. An amended bill must be passed in identical form by both the House and Senate before it is sent to the Governor. If a bill has been amended by the non-originating body, it is sent back to the originating body for its approval.

When a bill has passed in both the House and the Senate, it is sent to the Committee on Rules and Enrolled Bills where the bill is examined for clerical errors. Once the bill is signed by the Speaker of the House or Senate President, the bill is forwarded to the Secretary of State who transmits it to the Governor, who has five days to veto it, sign it into law, or let it go into effect without a signature. If the bill is vetoed by the Governor, a two-thirds vote of both the House and Senate is required for an override. If an override vote is successful, the bill becomes law. Each bill includes a specific date that it is to go into effect.

WHAT YOU CAN DO TO ADVOCATE

The NH General Court meets annually from January to June, and you can participate in the legislative process in a number of ways. One is to offer testimony on proposed legislation, either in person at the State House or Legislative Office Building or in written comments addressed to the committee that’s hearing the bill.

Public hearings are held on every single bill or resolution introduced in NH. There are more than 1,000 in a typical year. So there are many opportunities for you to offer testimony, whether you’re a board member or a parent, a neighbor or a counselor.

Legislators see lobbyists and advocates regularly, so they are often more attentive to the testimony of members of the public. Also, while data and numbers are important for policymakers, hearing stories from real people is often more compelling. Personal stories and experiences can make a pivotal difference in how an issue is voted on. Here are some basic guidelines for giving public testimony:

1. Be prepared. Read the legislation before the hearing. The text is on the general court website.

2. Be brief. At many hearings, speakers are limited to 3 – 5 minutes. Don’t go on longer than your allotted time or the message you want to deliver will lose its impact.

3. Talk about what you know. Provide real-life examples that relate to the subject at hand, and be clear about why the proposed bill should be passed or rejected.

4. Offer more. If you are asked questions by committee members that you aren’t prepared to answer, offer to provide additional information after the hearing.

Sending letters or emails to your local representatives and Senators with comments/questions about bills, rules, and the state budget is another effective way to engage with policymakers. Many legislators will highlight in their own testimony or floor speech the number of calls or emails they have received, pro and con, on a bill.

Beyond the State House is an administrative rulemaking process, the continuation of the legislative process. Here State agencies develop, propose, and hold public hearings on rules that implement the laws. This is another opportunity to offer testimony, both at the State agency and the Joint Legislative Committee on Administrative Rules (JLCAR) levels. A weekly rulemaking register is published on the general court website. There you can find notices of rules and their public hearing dates.

Finally, Governor and Council — a 5-member body unique to NH known as G&C — meets every two weeks and must vote to approve all State contracts over $10,000, as well as nominations from the Governor for agency, board, and judicial positions. The lengthy agendas for G&C are posted on the Secretary of State’s website on the Friday before every Wednesday meeting of this body. While there is little opportunity to offer public comment at the G&C meetings, calls to Councilors prior to the meetings are sometimes needed to alert them to concerns or problems about a contract or other item.

Your voice really does matter.

TREATMENT

INTRODUCTION BY DR. PAUL BROWN, RIVERBEND’S NEW CHIEF MEDICAL OFFICER

What an exciting time this is to be a psychiatric provider. There are many promising therapies available already, with many more about to emerge into general use soon — hopefully this year. I am quite excited about the apparent efficacy of psychedelics for treating a broad range of addictions as well as severe depression, suicidal ideation, and post-traumatic stress disorder (PTSD). Psilocybin has shown remarkable outcomes in studies on refractory depression as well as intractable addictions, particularly alcoholism. Other psychoactive drugs like MDMA have also shown significant promise in the treatment of PTSD. Many in our field believe we are entering a “Golden Age” of the use of these and other psychedelics in psychiatry.

Another potential leap forward comes from encouraging research in the treatment of schizophrenia that has not responded well to other treatments. Xanomeline, when combined with Trospium to make the Xanomeline easily tolerable, has shown a remarkable effect on refractory psychosis. This combination has also brought about dramatic improvement in both positive and negative symptoms of severe Schizophrenia in Phase 3 clinical trials. Xanomeline has a mechanism of action that has never been enlisted to treat Schizophrenia before. It is likely to be quickly approved as a stand-alone treatment and also for use in combination with other existing medications in cases where those treatments alone have not produced the desired symptom remission. Many believe it will be approved for use as early as this year, and it could be a game-changer for the profession and some of our clients.

In recent months, the FDA has approved use of transcranial magnetic stimulation (TMS) for anxious depression and in treating refractory Obsessive-Compulsive Disorder. TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to address symptoms of depression and anxiety. This is an exciting, novel approach to brain stimulation that appears to be well-tolerated by clients. It has received growing interest for a broader range of indications with each passing year.

I was originally drawn to psychiatry because it was a field with so many exciting frontiers to explore and seemingly limitless potential for new understanding and innovation. We are learning more about the remarkable human brain with each passing month, and I am confident that evolving developments within psychiatry will offer us all a healing and hopeful journey in 2023 and in the years to come.

RIVERBEND PROGRAM UPDATES FOR 2022

PSYCHIATRIC EMERGENCY SERVICES

HEATHER GAYLORD, DIRECTOR

In September of 2015, Riverbend launched New Hampshire’s first mobile crisis team, and since then this team has served the people of Central New Hampshire. It has since been joined by emerging mobile crisis counterparts that served the southern part of the state in Nashua and Manchester. On January 1st, 2022, as part of the effort to serve all State residents equitably, a new system of care was initiated, and all of the remaining community mental health centers needed to launch their own mobile crisis services. New Hampshire’s mobile crisis service capacity grew with the addition of seven new teams. This expanded system of care is managed by Beacon Health Options. It’s accessed via the New Hampshire Rapid Response Access Point (NHRRAP). NHRRAP now serves as the central call center for all the state’s behavioral health crisis calls and for mobile crisis team deployments.

Working collectively, all ten mental health centers now

respond to requests for mobile crisis response. Teams are deployed based on availability without reference to caller location or ‘catchment area.’ This enhances rapid access and timely response for people in crisis. The NH Rapid Response system serves people of all ages who are dealing with behavioral, mental, and substancerelated crises in real time, 24 hours a day, 365 days a year. In 2022, NHRRAP:

• Answered more than 25,000 calls,

• Engaged in more than 600 text and chat conversations,

• Fulfilled more than 5,000 same or next day crisis stabilization appointments, and

• Deployed mobile crisis teams more than 6,250 times, throughout New Hampshire.

As we enter our second year of statewide mobile response utilizing the NHRRAP system of care, we look forward to ongoing system refinement, improved communication, and the development and utilization of additional integrated tools for referral and follow-up.

CAROLYN WELCH, DIRECTOR

As we enter the New Year, I am pleased to highlight 2022’s many positive developments in Riverbend’s Residential Programs, beginning with grant funding secured by our Development Office which made it possible to renovate all of our residential sites. Twitchell House’s windows were replaced with new, energey efficient windows and additionally received fresh coats of paint. Our Fayette Street and Mill House residences also received paint, in addition to new flooring and kitchen and bathroom upgrades. Finally, Mill House also received a generous grant for all new furniture!

New vans were secured in 2022, allowing residential staff members to take residents on trips ranging from breakfasts together at area restaurants, drives to see holiday lighting displays, and time at the Deerfield Fair as well as the ocean. We also brought clients to a variety of concert events and helped with access to recreational bowling.

We look forward to the great things that 2023 will bring to Riverbend as a whole. And here in Residential Services, we anticipate many more outings for our residents, fully staffed programs, and fewer COVID worries and restrictions.

FRANKLIN LOCATION

SUSAN LUNT, DIRECTOR

The Franklin Adult Team is currently fully staffed and has enjoyed so much success with its ongoing Dialectic Behavior Therapy (DBT) group that we have initiated a second one. And the new DBT group is enjoying consistently strong attendance. Both groups are scheduled to continue through the winter of 2023 and, in all likelihood, well beyond.

We are also looking forward to expanding other group therapy offerings. Currently, they include an Illness Management and Recovery (IMR)-based group, a “Beating the Winter Blues” group, and a “Tools for the Emotions” group.

The Franklin Children’s team continues to be busy, and looks forward to further serving the Franklin community.

CHILDREN’S INTERVENTION PROGRAM

MELISSA

COLBY, DIRECTOR

I am so proud of all that the Children’s Program accomplished in 2022. In the COVID era of staffing shortages and increasing need for services, our dedicated, talented staff keeps thriving, overseeing an expanding program supporting young people and families with grace. We are committed to our mission and to collaborating with all child-serving agencies to respond to the needs of our community.

In 2022, we expanded services for adolescents struggling with substance use. Our staff members have been trained in the tools and methods of the Seven Challenges, an evidence-based practice designed to evaluate the risks and consequences of adolescent substance use, recognize the needs that are being met, and then identify what is needed to bring about a positive change.

Our Autism Team has been so versatile throughout the pandemic, restructuring to meet all challenges. In 2022 we launched a clinic-based Applied Behavior Analysis (ABA) program. We have an energetic, talented, fully staffed team working to teach functional communication skills to children with autism.

I am beyond excited to continue the expansion of these

initiatives in the upcoming year! It continues to be an honor to lead this amazing program and be a part of all the great work being done here.

CHOICES AND THE DOORWAY

SHANNA LARGE-REUSCH, DIRECTOR

In 2022, our Choices and Doorway teams worked together to develop an expansion of our Medication Assisted Treatment (MAT) model. This harm reduction program went live in early April. It is based on the Medication First Principles as listed below:

• Clients receive pharmacotherapy as quickly as possible

• Maintenance pharmacotherapy is delivered without arbitrary tapering or time limits;

• Individualized psychosocial services are offered as a condition of pharmacotherapy;

• Pharmacotherapy is discontinued only if it appears to be worsening the client’s condition

At Choices, this translates to clients entering the program, completing an assessment, and being able to see a Medication Provider quickly, sometimes on the same day. Before each follow-up appointment, clients meet with a Recovery Support Worker who evaluates their recovery and assists with any needs they might have. This expansion has grown steadily since April and is now 42 clients strong, making up about half of the MAT program. It is genuinely meeting the needs of clients in the community.

to have one of these boxes, and The Doorway Team is developing an operation plan to maintain the supply of the boxes, provide training for partner businesses, and register the boxes’ locations on Google Maps.

Based on its success, this project may expand to include other concerned communities. The goal is to enable individuals to access naloxone anonymously and easily throughout the area without barriers.

COMMUNITY SUPPORT PROGRAM

SHEILA MULLEN, DIRECTOR

At Riverbend’s Community Support Program (CSP) we continued to offer one of our core services: Dialectical Behavioral Therapy (DBT), a comprehensive, evidencebased treatment modality for individuals diagnosed with Borderline Personality Disorder. The weekly combination of structured individual therapy and skills group meetings provides a strong educational component to this treatment. CSP offers many DBT groups to help meet clients’ needs and recovery goals in a variety of ways.

Entering 2023, The Doorway Team is collaborating with our Public Health Network to obtain approval for the distribution of naloxboxes in the downtown Main Street area. Individuals from the NH Harm Reduction Coalition are creating a list of partner businesses who would like

Pre-DBT is the first phase of DBT. We offer two PreDBT groups which run for 12 weeks each, offering an introduction to DBT skills and the structure of group treatment. One does not need to be connected to an individual therapist to join these groups. The next phase is a 48-week DBT group which meets weekly for 2 hours. During this phase, participants have an additional hour of individual DBT therapy each week. These groups teach core skills in the areas of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. To join full DBT, clients must work with an individual therapist supporting the client by reviewing orientation materials and giving informed

consent. Once full DBT has been successfully completed, participants can elect to further their DBT skills in a Graduate DBT group -- meeting weekly for 1 hour – which allows participants to maintain their skills while also sharing support with their peers . Grad DBT refreshes DBT skills for clients who have graduated from the full program.

Our newest DBT offerings expand the client population for whom DBT skills are effective. We offer a pre Radically-Open DBT (RO) designed to bring DBT skills to clients considered “over-controlled” and includes diagnoses like Anorexia Nervosa and Obsessive Compulsive Disorder. This group is a precursor to a planned full RO DBT group which will run for 30 weeks, targeting mindfulness, interpersonal integrity, and social connectedness skills. The group teaches clients how to turn off “threat system” physiology to improve selfexpression through communication and facial and body signaling. Clients in DBT Prolonged Exposure (PE) attend a full 48-week group and additional individual sessions weekly to use exposure techniques targeting symptoms of PTSD. Individual PE sessions use in-vivo experience tasks, imaginal exposure, and processing to target traumatic memories and the associated symptoms that cause distress in daily life. These are used in conjunction with DBT skills to effectively treat PTSD.

We are so proud of the robust DBT program that our talented clinicians have worked diligently to create. We look forward to having a positive impact on our clients and their recovery goals.

RIVERBEND COUNSELING

ASSOCIATES

LYNN ANNE PALMER, DIRECTOR

In the face of the pandemic and social, economic, and political issues, our community experienced a rise in mental health challenges. Riverbend Counseling

Associates (RCA) has continued to receive frequent calls for services, along with robust referrals from the community and from other organizations.

This year our Admissions Team underwent an intense training in assessment and identification of client levels of risk. They became increasingly proficient in recognizing risk and, led by a Senior Clinician, the Triage Team has helped those most at risk to receive treatment in a timely manner. RCA has also increased its collaboration with other programs within Riverbend to get clients the appropriate levels of care as quickly as possible.

RCA continues to respond to client and community requests for high-quality telehealth services. Many clients find that the convenience of telehealth is key to making their treatment possible. Utilizing telehealth has also allowed us to hire some of our workforce from outside of the immediate area. In so doing, we’ve been able to access a larger talent pool during this employment crisis. RCA has excellent part-time clinicians available now via Telehealth Services only. This is in addition to our larger community of full time staff who do a mix of telehealth and in-office work.

RCA’s energies also continue to support educational opportunities that improve our therapists’ expertise and the services we can offer to clients. Several of our staff were trained this year in EMDR, as well as other related trauma interventions. Staff regularly attended workshops on Suicide Prevention and Postvention, Polyvagal Theory, and much more.

RCA has supported the Pelvic Medicine Program at Concord Hospital for several years. We also continue to support UNH Law by providing two hours of drop-in time per week, during the school year. This is to support their students who can use help with coping skills. For those with greater mental health needs we have a clinician who provides onsite and telehealth counseling to UNH Law students.

SPOTLIGHT ON OUR ANCILLARY PROGRAMS InSHAPE

MARSHA RICH, PROGRAM MANAGER

The InSHAPE program supports participants with increasing physical activity and modifying eating habits to help them facilitate improvements in their physical and mental health. Although the program was shortstaffed for more than half of 2022, InSHAPE was able to provide individual and/or group interventions for more than 130 individuals in Riverbend’s Community Support Program (CSP).

Individual physical activities included exercising at the YMCA or other gyms, walking, snowshoeing, hiking, and developing home exercise routines. With the loosening of Covid restrictions, InSHAPE was able to offer outdoor group physical activities such as apple picking, mini golf, “Fun in the Sun” games in the park and fielding an InSHAPE team for Concord Hospital’s Rock ‘n Race. InSHAPE also offered indoor groups at Twitchell House and the West Street Ward House, as well as telehealth group yoga.

Nutritional education included instructing participants in choosing and preparing foods that bring them closer to attaining their health goals. Common activities included trips to the grocery store, cooking projects, conducting web searches to obtain health-conscious recipes and nutritional information, and developing strategies for portion control and healthy snacking.

from InSHAPE and started paying for their own gym membership which they continue to regularly use. Other clients progressed, this past year, from individual weekly meetings to monthly or bimonthly accountability checks or group-only support. Some InSHAPE participants have paired up with each other to walk or attend the gym. Many have lost pounds and/or inches, while others have made significant changes to their eating and physical activity habits.

The energetic InSHAPE staff continues to educate, support, encourage and model healthy living activities for CSP clients through 2023 and beyond!

Watch this moving video featuring staff, clients, clients’ families and supported employment employers who highlight the important work that the Supported Employment Program has to offer!

Increasing independence and establishing sustainable wellness habits is a major goal of the InSHAPE Program. So, during 2022 six participants “graduated”

BEHIND THE SCENES: A MOBILE CRISIS STORY

BY HEATHER GAYLORD

It’s Friday afternoon in the state’s capital, the sky is an overcast metallic grey, and mist hovers in the air above the traffic on Warren Street. In his second-floor apartment, Jonathan Doe sits on the edge of his sofa after a night of restlessness, his forehead resting in his hands. He is 38 years old with a history of Bipolar Disorder, depressive type, and at this moment, he feels the lowest he has felt in months. Jon is experiencing a mental health crisis.

He struggles to find meaning as his thoughts meander: intrusive, lonely, and relentless. The weight on his chest is making him fight to breathe. A cascade of suicidal thoughts, in waves, crashes over him. His head feels swollen in his hands. The pressure behind his eyes is unrelenting and his vision is blurred. Forcing his gaze to his right, Jon looks to his cellphone on the coffee table at the end of his sofa. More than anything, he simply wants to feel better, to feel normal again. With great effort, he reaches out, lifts his phone, and dials 988.

Within moments, a clinical phone chimes at a New Hampshire Rapid Response Access Point (NHRRAP), and a calm, kind voice greets his. A well-trained representative talks with Jon, assuring him that she is there for him, reminding him to just gently breathe. Her supportive voice offers measured directives and invites Jon to share his thoughts. Jon doesn’t notice it, but even in these few moments, the ache in his head and the heaviness pressing on his chest have decreased. He is being heard by someone who cares, and he feels safe enough to begin to describe the pain he is internalizing. He says

what for too many is a shameful, stigmatizing truth: “I need help. I feel like I’m drowning. I don’t want to die, but I can’t stop hearing myself think that it might be best. I’m really scared.”

The representative knows exactly what to do next. She keeps providing Jon with a listening ear and a warm, trained voice. And not too far from Jon’s apartment on Warren Street, an alert chimes at the office of the Riverbend Mobile Crisis clinical team. Ready to deploy 24 hours a day, every day of the year, a Master’s level clinician and Peer Support Specialist (PSS) accept the request from the New Hampshire Rapid Response Access Point representative. While the PSS gathers a mobile crisis deployment bag brimming with resources and supportive information, the clinician talks to Jon to confirm his address, provide an estimated time of arrival, and reassure him that friends are on the way. For the first time in months, Jon doesn’t feel alone as the clinical team arrives. The weight on his chest — known to counselors as anxious distress — lightens enough to offer Jon measurable relief. Already, there’s a world of difference since he dialed 988 nearly an hour before.

To maintain Jon’s anonymity, the team’s car bears no symbols or signs, and the team members are in plain clothes and non-identifiable. To any outsider it would appear that Jon was being visited by a couple of friends. After knocking on the door, the team affirms their arrival, sharing again their first names which they had previously shared with Jon on the phone. Jon greets the team in with a sigh, still riddled with anxiety, beads of sweat on his brow. As they begin to talk, Jon paces, releasing more stress as his hands clench and unclench rhythmically. He is exercising a self-soothing measure that he feels comfortable using while the team listens.

After a while, Jon is relaxed enough to sink into a chair at his kitchen table, and the team joins him. They begin to explain what Jon might expect during their assessment. It will be a shared effort to bring resolution to Jon’s distress and reduce the symptoms which had culminated in his suicidal ideation. The Peer Support Specialist aids Jon in employing breathing and relaxation techniques to alleviate restlessness

and bring focus to his thoughts, drawing upon their own lived experience to validate Jon’s. The clinician conducts a brief yet thorough assessment of risk with Jon, working to identify protective factors which will inform a plan of care to keep him safe. Jon denies active substance use, reports social alcohol intake, and denies any plan or intent to harm himself. He has a history of inpatient hospitalization and did have one suicide attempt eight years earlier.

The team calls his case manager at the Community Support Program (CSP) at Riverbend and together, they are able to expand upon his crisis plan by identifying specific strategies to maintain his wellbeing. One action step has Jon and the team calling his brother, Mark. This results in Jon being able to stay with his brother for the next two days until he can meet with his outpatient prescriber. As the crisis team reviews Jon’s medications with him, he is able to identify some worsening symptoms following a particular medication change. Upon clinical consult with Riverbend psychiatric providers, it’s believed this could be a contributing factor to his current experience of suicidal ideation.

With the support of the mobile crisis team, psychiatric consult, and his brother, Jon identifies a safety plan. He will employ the coping skills he has been taught and watch for warning signs and triggers to monitor how he feels and reduce risk. Jon has access to firearms in his home and Mark agrees to secure them at his home for the time being while Jon addresses his mental health symptoms.

Before the team departs, a peer follow-up call is scheduled for the next day to ensure that Jon is well supported and that the goal of maintaining his safety and monitoring symptom impact is achieved. The clinician reminds Jon and Mark that if his symptoms worsen, their supportive services are available around the clock each and every day via the NH Rapid Response Access Point.

Hours later, in the quiet of that same evening, Mark Doe looks in on his brother in his spare bedroom, ready to ask if he needs anything else for the night. He stops himself before he can speak a word. His kid brother is already sound asleep, hugging his pillow just like he did when he was a little boy.

TREATMENT, EDUCATION & ADVOCACY: A TRIAD FOR SUCCESS

BY KAREN AND ED PRIVÉ

Ed and I met almost thirty years ago when I was at a high in my life – clean and sober for four years, a couple years off the streets and stable on the right medications. Ed was just getting sober, after being hospitalized for his own mental health and substance use issues. We attended many of the same recovery meetings, and began a friendship. After several months, we began dating.

We’ve been through a lot together – including helping our son through his mental health issues, my going to back to school, and Ed’s bout with cancer. We’ve always supported each other and tried to walk through everything together –the good, the bad and the ugly.

In spite of being active in therapy and taking my medications as prescribed, emotions about my past started to catch up with me. I threw myself into my work and volunteering, desperate to prove to myself and the world that I was still OK. It didn’t work. Memories were replaying in my brain.

The symptoms of my mental illness began to intensify. Suicidal thoughts and hallucinations were near-constant companions. I wanted to die.

I was hospitalized several times over the course of a few years. During one hospitalization I was reintroduced to Dialectical Behavioral Therapy (DBT), and it was suggested that I find a new therapist that was DBT-trained. I wanted to retain my current therapist, and participate in a DBT group, but the only groups I could find were in community mental health centers (CMHC). I was in Riverbend’s catchment area, but would need to give up my current mental health care providers. I had been with my therapist for over eighteen years!

Meanwhile, Ed was my rock – my soulmate, and my lover. He fought on my behalf with hospital staff, and insisted I get the best treatment available. During an inpatient stay in 2018, Ed helped me decide to pursue DBT and switch my care over to Riverbend. As time went on with my treatment, there was a lot of improvement. I was more stable, feeling better about myself, and was able to start working part-time.

As a caregiver, Ed says he must learn more about mental health, and what he can do to support me. He’s tried to fix me – we both agree that doesn’t work! There have been few resources available for him to learn tangible skills in supporting my mental health journey. There have been providers – including Riverbend employees – who have taken the time to connect with Ed to be of assistance in understanding my journey.

Sometimes this education comes at a time of crisis, such as when I was seeking help for suicidal ideation last year. We were trying to navigate getting help in a less than ideal situation, and Riverbend’s team (including mobile crisis) was able to include Ed in meetings about what was going to happen. It helps me to have my partner included in my

Karen and Ed Privé

care and my plan development. More education should be offered to family members and friends who support their loved one as they move through their challenges.

Ed notes that the Riverbend team brings their A-game in every interaction, and has always made him feel like an important part of the treatment team. I’ve always given Riverbend permission to talk to my husband, and we are both grateful for the time they have spent with him.

We have also been supporters of Riverbend’s productions of This Is My Brave. These shows are a great way to educate the community about what it really means to live with mental health issues and/or substance use disorders. We live productive lives – we’re parents, colleagues, partners, friends, artists, and ordinary people, who happen to have certain challenges.

Both Ed and I have also been involved in advocacy at the legislative level. We have each spoken at legislative hearings

about matters affecting mental health and the state’s mental health systems, as well as with other politicians and candidates. The state cannot know about what’s needed at the ground level without the voices of the people. We are the ones experiencing and witnessing the failures of our mental health system. We also need to give praise when things work well.

Someone with a broken arm needs prompt attention and care. So does someone in a mental health crisis – not waiting in the back of an emergency room for days or weeks, isolated and not receiving treatment. Ed often says, either everyone counts, or no one counts. At Riverbend I feel like I

Karen and Ed Privé have been together for over 29 years. They are mental health advocates, believing that storytelling saves lives and spreads hope. Karen’s blog about her journey . They live in Franklin with their black lab Gracie and cats Hope and Dusty.

Concord (1949)

Franklin (477)

Pembrooke (240)

Pittsfield (217)

Penacook (205)

Hillsboro (202)

Allenstown (195)

Weare (185)

Northfield (165)

Boscawen (159)

Manchester (153)

Epsom (136)

Loudon (136)

Bow (128)

Henniker (96)

Warner (75)

Hopkington (72)

Chichester (64)

Contoocook (62)

Bradford (56)

Webster (51)

Laconia (50)

Deering (46)

Andover (43)

Canterbury (42)

Dunbarton (42)

COMMUNITY EDUCATION HIGHLIGHTS IN 2022

Education is a key component to the non-clinical services that Riverbend offers to staff and community members alike. One of these education opportunities is Mental Health First Aid, led at Riverbend by Jaime Corwin, VP of Human Resources.

Mental Health First Aid (MHFA) is a national program that teaches participants to respond to the signs of mental illness and substance misuse. “Two new trainers were certified in Mental Health First Aid in 2022,” said Corwin. “Currently we have two certified members on staff. We held one Riverbend-sponsored MHFA training in 2022 and have another planned in May of 2023. Our goal is to offer two classes for staff each year. In addition, we aim to offer both condensed and formal community class trainings in MHFA. HR staff participate in multiple workplace safety workshops and conferences each year, and in April 2022, I became certified to teach First Aid, CPR, and AED. We have orchestrated monthly classes since that date, and so far 42 staff members have been trained.”

Human Resources and other Riverbend staff members

also frequently attend live and virtual events to reach out and educate the community about Riverbend and the services they offer by setting up a table with promotional information. These events also serve to potentially recruit new staff.

The Children’s Intervention Program has continued to provide important education opportunities for members of the community by collaborating with the Department of Education over the summer by extending their camp services.

Melissa Colby, Director of the Children’s Intervention Program, explains some of these efforts. “In several camps throughout the region, staff provided daily mental health support to campers while also offering training and consultation to camp counselors. During the school year, we collaborated with all of our region’s school districts, holding monthly consultation meetings with each school and providing co-located therapeutic in-school services and therapeutic groups. Our 2023 goal is to increase the number of summer camps we work with and expand school year

services to include after-school programs.”

All of Riverbend’s programs are continually seeking to make connections with local community partners and to provide education and training opportunities where needed, with the overall goal to educate the community on where these valuable resources can be found and to help eliminate stigma for those who need and receive treatment.

Educated Community, a Riverbend Board-designated work group, meets monthly and primarily focuses on creating a robust month of events during May, which is nationally recognized as Mental Health Awareness Month. Riverbend celebrated Mental Health Awareness Month in 2022 with special events to educate, inspire, and entertain.

The 2022 Magnify Voices Expressive Arts Contest was held at the Tupelo Music Hall on May 4th. Young people in grades 5 through 12 showcased their work to help raise awareness, erase stigma, and advocate for change.

International speaker, corporate trainer, and Author Kim LaMontagne held a virtual workshop on May 11th, focusing on Wellness in the Workplace and on creating a ‘culture of safety’ in the workplace environment.

Novelist Donald Antrim was the guest of Gibson’s Bookstore on May 17th. There he discussed his latest book, One Friday in April: A Story of Suicide and Survival. “Those who suffer from mental illness and die by (or ‘of’) suicide do not take their own lives,” says Antrim, “but they have their lives taken from them.”

The powerful and empowering showcase titled This Is My Brave was performed at the Bank of NH Stage in Concord. For the fourth consecutive year, this storytelling event featured original songs, poems, and essays about what it’s like to live with a mental illness and addiction. All four performances that have been sponsored by Riverbend are available on YouTube. This is My Brave 2022 is available at: https://youtu.be/YJ3m9eHmmsQ.

Riverbend’s Training Committee, a committee comprised of members from each department of the agency that meets monthly. The committee maintains all offered trainings at Riverbend, both required and elective. They review evaluations compiled of currently offered trainings to ensure that trainings are kept up to date, and altered as needed. The committee is responsible for developing new training content needed across all departments of the agency. Such topics arise from observations brought by committee members, or suggestions from staff to the committee that are reviewed during monthly meetings.

The committee ensures that clinical staff licensure requirements are met by providing comprehensive trainings that are submitted for professional continuing education credits. The committee’s goals are to ensure that all staff in the agency receive the training they need to complete their job, and are offered trainings that will allow them to further grow in their field and careers.

Riverbend will continue to make efforts to educate our staff and communities. Get involved by following Riverbend on social media and visiting their website at www.riverbendcmhc.org.

EDUCATION BY THE NUMBERS

Internal Trainings Offered to Staff: 282

External Trainings, Presentations & other Community Education Events: 33

Educational opportunities for staff are cultivated via

FINANCIAL REPORT

FOR THE FISCAL YEAR ENDING JUNE 30, 2022

Last year, Riverbend closed the year with an unanticipated operating margin due to several factors;

•Riverbend worked closely with the MCO’s to attain a 50% MOE forgiveness. This saved Riverbend nearly six hundred thousand dollars.•Riverbend was a recipient of HRSA and CDBG granted funds to help support operations and deferred maintenance in facilities. These funds were one-time funds that amounted to nearly $1.4 million.•Personnel Costs due to open unfilled positions.

The result of these factors was a positive operating margin. The positive results are being heavily reinvested into staff recruitment and retention.

THANK YOU TO OUR SUPPORTERS

THE LISTS BELOW CONTAIN THE NAMES OF THE INDIVIDUALS, FAMILIES, BUSINESSES, FOUNDATIONS, AND COMMUNITY ORGANIZATIONS WHO GENEROUSLY SUPPORTED OUR MISSION WITH GIFTS MADE TO RIVERBEND BETWEEN JANUARY 1ST AND DECEMBER 31ST, 2022. WE ARE TREMENDOUSLY GRATEFUL FOR THE AMAZING SUPPORT OF SO MANY CARING PEOPLE, AND IF YOUR NAME OR THAT OF YOUR COMPANY, FOUNDATION, OR ORGANIZATION IS MISSING OR PRINTED INCORRECTLY, PLEASE LET US KNOW SO THAT WE MAY CORRECT OUR ERROR.

RIVERBEND LEADERSHIP CIRCLE

Our leadership circle recognizes those who make cumulative gifts of $1,000 or more throughout the calendar year.

Visionary $20,000+

Cogswell Benevolent Foundation

Concord Hospital – Community Services Fund ***

New Hampshire Charitable Foundation

Collaborator $10,000-$19,999

Dartmouth-Hitchcock Concord ***

Dobles Foundation

Rolfe and Rumford DAF of the New Hampshire Charitable Foundation * TJX Companies

$5,000-$9,999

Benjamin W. Couch Trust

Harvard Pilgrim Health Care *

Janssen Pharmaceutical ** Merrimack County Savings Bank ***

Steward $2,500-$4,999

Town of Andover

Steve and Jane Cohen **

Northeast Delta Dental **

FRIENDS

$500-$999

Anonymous (2)

Bailey’s Carpets

Peter Bender and Anne Margaret Ostberg

JH Spain Commercial Services, LLC

Town of Warner

$1,000-$2,499

Associated Grocers of New England

Mr. and Mrs. John Barthelmes **

Peter and Peg Blume ****

Borislow Insurance

Frank and Debra Boucher *

Mark Broth, Esquire

Canterbury United Community Church

Dr. Dennis Card and Dr. Maureen McCanty *

William L. Chapman ***

Concord Female Charitable Society **

Concord Hospital

Constantly Pizza

Dorn Family Fund

Elvira F. Downs, MD ***

Dragonfly Fund of the New Hampshire Charitable Foundation

Finisterre Fund of the New Hampshire Charitable Foundation **

Karen Green *

Leslie Combs *

Barry Cox and Nancy Kane *

Glenn and Susanne Currie **

Anthony and Martha D’Amato **

Davis & Towle Insurance Group

James Doremus and Susan M. Murray *

Duane Scott and Jennifer Hess **

Robert Thompson and Lucy Hodder *

Benjamin Hodges

Karen Jantzen * ◊

Gayle Kimball and Paul Silberman

Dr. Bryce Lambert ***

Ledyard National Bank

Mason & Rich *

Skip and Carolyn McKean

Scott and Lisa Metzger

Allison S. Moskow

NAMI New Hampshire *

Northway Bank

David and Mary Reudig Family

Fund of the New Hampshire Charitable Foundation **

Gary and Carol Sobelson * Granite United Way ***

Cinde Warmington

The Dumais Family Charitable Fund at the New Hampshire Charitable Foundation

Episcopal Diocese of New Hampshire *

James Fitts

Steven Gordon and Lucy Karl

Every * represents five years of consecutive giving. Bolded represents membership in The Multi-Year Leadership Society. A ◊ represents membership in The 365 Club.

Daniel Luker and Karen Slick ***

Donald and Jessica Martin

Donald Pfundstein and Roberta Brunelle *

Rath, Young, and Pignatelli PC

Jeffery and Jill Savage **

The Honorable David H. Souter **

Robert and Mary Bryan Terry ***

United Way of Southern Maine

USI New England

Elaine Walczak

Hope Zanes Butterworth ***

$250-499

Dr. Hilary Alvarez and Alex Steeter **

Drs. John and Julie Bassi

Roland Berube *◊

C. Thomas and Margaret Brown *

Caron & Bletzer, PLLC

John Chisholm

Jordy Cornog ****◊

Jeremy and Jaime Corwin **◊

Rich Cote

Sarah and Peter Crow

Lynn Durand and Jane Sullivan-Durand

Christopher Eddy *

BJ Entwisle ***

Denise Fairbank

Kathleen Hall *◊

Melissa Hanrahan

Helms & Company

John and Roberta Hollinger

Dale and Jayna Klatzker

Nicholas Larochelle

David and Henrietta Luneau

Lisa K. Madden ◊

Rabbi Robin Nafshi *

Chris and Tina Naimie

Rodney and Carolyn Patenaude ***

Robert Quinn

Jim Rosenberg

Donald and Miriam Shumway

Scott and Claudia Walker

John F. Jr. and Patricia Weeks Fund of the New Hampshire Charitable Foundation

Robert and Binney Wells

$100-249

Anonymous (1)

ADA Traffic Control

Mary Ann Aldrich

Steven Chamberlin and Heather Frye

Sarah Crabtree

Deering Community Church, United Church of Christ ***

Janet and George DeVito **

Jennifer Frizzell

Carol and Dan Goodenough

Charles Gunn and Amy Patenaude *

Dr. Christian Hallowell and Ms. Cindall

Morrison *

Philip and Brenda Hastings

Catherine Kiernan

Harry and Chris Kirsch ***

Michael and Mildred Lafontaine

Denis and Pauline Laliberte

Karen Levchuk

The Honorable John Lynch and Dr. Susan

Lynch

The Honorable James MacKay

Frances McCrea

Susan B. McLane

Dr. and Mrs. Joseph Meyer

Jeffery A. Meyers, Esquire

Shannon Mills, DDS *

The Honorable Howard Moffett

Robin Moore and Susan Deforest

Douglas and Marcia Moran

Meghan Morgan

Margaret E. Morrill

Allan Moses ***

New Hampshire Center for Nonprofits

William Norton

Bradley Osgood

Ruth and Nick Perencevich ***

William Politt *

Dr. Lori Pyter

The Simoes Family

James Snodgrass

Alexander E. Sturke and Laurie A. Ciardi

Terry Sturke and Tom Bell ***

Ms. Sarah Sweet *

Kurt and Elaine Swenson

Annmarie Timmins *

Wayfair

Jack and Lori Weston

Up to $99

Amazon Smile

Alison Arnstein

Jolen N. Aubin

Andrea Beaudoin *

The Benevity Community Impact Fund

Page Cannon

Noel Cassen

Dellie Champagne ◊

Kenneth Chenette

Dr. and Mrs. Mark Ciocca *

Danielle Cohen

Tim Cronin *◊

Sharon W. Czarnecki

Peter Daigle

Rachel Eades

Philip Emma and Luanne

Morgan-Emma **

Leo and Lorraine Graciano

Doris and Mark Hampton **

Doug and Judy Hatfield ***

Tia Horner

Councilor Linda Kenison

Robert Kleiner

Rachel Lally

Bryanna Marceau

Sandra May

Gary and Susan Seidner **

Jen Shaw

Andrew Supplee *

Valley of the Sun United Way *

Penelope Vaine

Jess Vaughn

Kevin Warriner

Carolyn Welch

Larry and Susan Wolfe

Rebecca Wolfe

IN KIND DONORS

We would like to give a special thanks to all the individuals, businesses, and community organizations that donated groceries, personal hygiene items, household supplies, and warm winter clothes for our clients.

Constantly Pizza

Kim Contant APN Capitol Craftsman Romance Jewelers

Grappone Auto Group

Donald and Jessica Martin

Laura Fucella and EatXactly Sweet Cafe

HONOR & TRIBUTE GIFTS

In memory of Susan Brown Finisterre Fund of the New Hampshire Charitable Foundation

Every * represents five years of consecutive giving. Bolded represents membership in The Multi-Year Leadership Society. A ◊ represents membership in The 365 Club.

In memory of Karen DuFault

Anonymous

In memory of Rose & Philip Foglia

Elvira F. Downs, MD

In memory of Rose & Philip Foglia

Elvira F. Downs, MD

In memory of John P. Foss

William Politt

In memory of Susan Leadbeater

Karen Jantzen

In memory of Beth Anne Sweet

Anthony and Martha D’Amato

Philip and Brenda Hastings

Harry and Chris Kirsch

Gayle Kimball and Paul Silberman

Ms. Sarah Sweet

Sharon Sweet

In memory of Raymond H. Sylvester

ADA Traffic Control

In honor of Nancy Girouard

Chris and Tina Naimie

In honor of Ted Lambrukos

Dr. Lori Pyter

In honor of Rebecca Wolfe

Larry and Susan Wolfe

RESTRICTED GIFTS

Child Impact Program (ChIP) of Children’s Services

Rolfe and Rumford Donor Advised Fund of the New Hampshire Charitable Foundation

The Dumais Family Charitable Fund of the New Hampshire Charitable Foundation

Choices Addiction Treatment and Recovery Services

Concord Hospital – Community Services Fund

Granite United Way

CSP

Gayle Kimball and Paul Silberman

Food Insecurity

Peter Bender and Anne Margaret Ostberg

IMR

Concord Hospital Community Services Fund

Information Technology Services

Concord Hospital Community Services Fund

InShape

Janssen Pharmaceutical

Benjamin W. Couch Trust

Mill House

Cogswell Benevolent Trust

Parenting & Prevention

TJX Companies

Beth Sweet Fund

Ms. Sarah Sweet

Gayle Kimball and Paul Silberman

Anthony and Martha D’Amato

Philip and Brenda Hastings

Harry and Chris Kirsch

Sharon Sweet

Twitchell House Gazebo

Dr. Dennis Card and Dr. Maureen McCanty

CHAMPIONS FOR MENTAL HEALTH

Presenting Sponsors

Dartmouth Health

Harvard Pilgrim Health Care

Host Sponsor

Delta Dental

Advocate Sponsors

Concord Hospital

Janssen Pharmaceutical

JH Spain Commercial Services, LLC

Mentor Sponsors

The Colony Group

Mason & Rich

Alison Moskow

NAMI NH

Northway Bank

Rath, Young & Pignatelli

USI New England

ASSOCIATES SPONSORS

Drs. John and Julie Bassi

Peter and Peg Blume

Sarah and Peter Crow

Lynn Durand and Jane Sullivan-Durand

Helms & Company

Gayle Kimball and Paul Silberman

Jim Rosenberg

Jeffery and Jill Savage

Donald and Miriam Shumway

FRIENDS

Associated Grocers of New England

BJ Entwisle

Jennifer Frizzell

Karen Levchuk

Allan Moses

William Norton

MENTAL HEALTH AWARENESS MONTH

Underwriting Sponsor

Dartmouth-Hitchcock Concord

Visionary Sponsors

Associated Grocers of New England

Borislow Insurance

Harvard Pilgrim Health Care

New Hampshire Charitable Foundation

Advocate Sponsors

JH Spain Commercial Services, LLC

Ledyard National Bank

Merrimack County Savings Bank

Friends

Bailey’s Carpets

Caron & Bletzer, PLLC

Davis & Towle Insurance Group

Mason & Rich

Allison S. Moskow

NAMI New Hampshire

Northway Bank

Community Partners

Constantly Pizza

This is My Brave

Gibson’s Bookstore

Choices

Doorway