Heidi Cloutier is the co-director of training at the University of New Hampshire Institute on Disability. Her role supports behavioral health providers to learn about and implement evidence-based practices.

She spoke with us about the We Are Here video project, which amplifies the voices of those who have experienced challenges accessing behavioral health services in New Hampshire.

Tell us a little bit about the We Are Here Project.

Heidi: We’re working to strengthen services in our behavioral health care system to address disparities, and to better understand barriers to accessing those supports. We interviewed New Hampshire residents about their experiences accessing mental health and substance use treatment, and produced four short videos that have attempted to amplify the voices of those who have experienced challenges accessing behavioral health services. Four major themes emerged from the interviews: education, healthcare, language and communication, and access and culturally responsive care. What we heard pointed to systemic barriers. Our intention in raising up these stories is not to shame or blame anybody. As Maya Angelou said, ‘We do the best we can until we know better. And when we know better, we do better.’ We emphasize that in our facilitated discussions and presentations as well. We’re working to raise awareness, prompt sustainable change and celebrate what is working well.

What does the distribution for these videos look like? Who has been using them?

Heidi: We first hosted a screening with the interview subjects to get their feedback before we released the videos. That helped ensure that participants were comfortable with the final edit and felt well represented. Then we began sharing the videos at various behavioral health conferences in New Hampshire and regionally where we would reach a large number of behavioral health providers, direct service professionals and administrators in community mental health, substance use treatment, or school counseling. The majority of individuals requesting access to the material will view it for their own professional development. The videos are also being used in academic settings including human development and family studies courses, social work curriculum, trauma graduate certificates and the mental health graduate program.

What has the response to the videos been?

Heidi: The videos are challenging people’s assumptions – and some providers express frustration about not knowing where to start to make a change, or that they have limited power to improve systemic barriers and discrimination. Direct service providers don’t always feel like they can influence larger policy issues. We've facilitated discussions about what individual providers can do to advocate for strong policies to support language and communication access, or outreach and recruitment of all populations, and not screen some individuals out because they might be harder to coordinate language and communication access for, for example. Providers and patients often have the same goals around culturally competent care. But when we're operating with limited resources, sadly, decisions about data collection and outreach to historically marginalized communities are often not prioritized.

What can providers do with the resources they have to help facilitate that systems-level change? And what can they do on an individual level?

Heidi: Video participants said they want their providers to treat them with dignity and respect. That doesn’t take systems change. Some of our failures stem from not recognizing our own privilege, or not recognizing differences – especially at the pace that providers are expected to operate, and the caseloads that they’re expected to manage. There are so many barriers to accessing care, and having conversations is key – with administrators, with boards, with decision-makers, and with policymakers. We need to better understand the factors that harm youth and families, and advocate for better language and communication access. Flexibility and choice within the system is also an issue. Many families have multiple jobs and responsibilities. They must often rearrange their entire work or childcare schedule to get to a behavioral healthcare appointment. And if they can't access that care because of communication issues, or feel that their provider doesn’t understand their experience or their identity, that can be off-putting – and lead to someone not following through with care.

What’s an example of systems-level change that individuals and organizations need to work to address?

Heidi: Limited resources is a big problem. Each of us individually, and within our organizations, and within our systems, make choices about what to prioritize – with our schedules, with our time, with what's important to us, with our funding. It's true that our behavioral health systems are operating with limited resources, and that our providers should be paid more. But if we truly care about access and equity, we have to prioritize funding for it so we can serve individuals who need care.

Is there anything else that you want to mention either about the project itself, or about access in general in New Hampshire?

Heidi: Given the demands of the workforce, it's challenging for organizations to develop and implement plans to engage underserved communities. We talk a lot about how to engage people who face barriers to accessing mental health care and substance use treatment and support. It takes a lot of work to go out and meet with faith leaders and community leaders, and people who work in our behavioral health systems don’t necessarily have the time and resources to do so. And those who do so are doing it outside of their normal work hours, and they’re burning out.

What are we making progress on in New Hampshire – what’s going well?

Heidi: Individual providers are beginning to understand the complexity of culture, and we’re seeing great progress in providers recognizing their own implicit biases. We need to understand that we all have implicit biases and that those biases can discourage someone from getting care. As we learn more about individuals’ experiences, we have a better understanding about what culturally responsive care looks like. My role is to help students and new professionals understand the complexities of why someone would not want to engage in care. And I think that the younger generation is much more aware of culture, and aware of how to create inclusive environments, and they’re bringing that into the world and changing our workforce. Organizations are recognizing the importance of language and communication access. They’re changing how they use data to identify disproportionate outcomes for patients they’re serving. They’re more aware of the need to partner with patients in designing their care. We’re starting to see a shift away from tokenism – from having individuals with lived experience on governing boards just to check a box – and instead partnering and recruiting more diverse experience in the workforce. We are also hearing great successes with NH Wraparound and Care Coordination providing more culturally responsive care.

How can people access the We Are Here videos?

Heidi: We have a link directly on the Institute on Disability website, where folks can complete a short survey about who they are and how they intend to use the videos, and then gain access. By listening to the stories highlighted in the videos, and reflecting on their practice, individuals and organizations can increase their cultural competence and take steps toward strengthening the behavioral health system in New Hampshire.