A little over three months ago, a working group began meeting weekly to hash out where New Mexico’s largest county is faltering in its support of residents’ behavioral health and how it could improve. The Bernalillo County Behavioral Health Initiative Working Group recommended Wednesday that the county start by building an actual system of care.
The seven-member working group includes providers and representatives from the county, City of Albuquerque, state and district court. Group facilitator Tim Karpoff kicked off the presentation to the commission by outlining its six recommendations to help fill in the holes that exist in the behavioral health care the county provides.
“The biggest service gap is there’s no system. So, the solution is a lot more complex than just funding more services,” he told commissioners. “When we talk about service gaps, that in itself almost acknowledges from the get-go that we have a fragmented system.”
The group says that means collaborating more across jurisdictions and organizations — including with partners like the city, state and University of New Mexico Hospital — and expanding its network of providers and facilities.
Member Gilbert Ramirez, deputy director of the city of Albuquerque’s Behavioral Health and Wellness Division, said the metro area has more crisis support available than ever before, referencing Albuquerque Community Safety and the county and UNMH’s Crisis Triage Center expected to be completed next year.
“But what is the system that coordinates entry into each of those or out of each of those? That does not exist,” he said. “And we would be failing our community if we invested funding in these systems but kept them siloed.”
As a means of improving the coordination of the county’s eventual “system” of care, the group recommended improving how it tracks and shares data, including developing standard forms for health assessments and releasing information to partner agencies.
Member Pam Acosta, the senior program manager for the Behavioral Health Initiative, says the county has already been working on this. She gave an example of a hypothetical patient who’s received care from multiple county, city and community providers.
“How do we all connect to know what we’ve done with him?” she asked. “So we’re not having him repeat his story, not having him complete another assessment, and we’re not referring him somewhere that didn’t work out for him.”
The working group also recommended that the county restructure its Behavioral Health Initiative to streamline internal processes. The initiative was created in 2015 following the death of James Boyd, a person with mental health challenges who Albuquerque police shot and killed. Voters approved a tax increase to fund expanded services that provides the BHI around $25 million annually from the gross receipts tax, according to the recommendation report.
Working group members said they support the creation of a deputy county manager for behavioral health to oversee the initiative, which is already in the works. They also want to adjust the structure of the initiative’s volunteer advisory committees, which it said are time-consuming, not coordinated enough and not staffed by the right people. Instead, it would like to see a single volunteer advisory council and a few proposal review committees weigh in on the county’s spending priorities. The advisory council would be made up of representatives from the city, state, tribes, courts and schools along with fellow providers and funders of local behavioral health services.
Commissioner Eric Olivas supported changing up who’s at the table.
“It’s not just wonderful, passionate individuals who care,” he said, referring to existing volunteers. “But they’re wonderful, passionate individuals who are key links in that system.”
As part of restructuring the BHI, the group suggested improving how the county measures the success of its work, building benchmarks into its contracts and setting aside funding for program evaluations.
Some of the working group’s recommendations focused on expanding behavioral health-related services — in particular for people who are unhoused and those leaving the county jail.
In order to increase the availability of housing across the county, working group members told the commission that it should make eligibility criteria more inclusive and consider zoning changes. Member Lisa Simpson, founder of Crossroads for Women, said the type of housing support most often available through the county, city and federal government is vouchers for individual apartments, which isn’t always a good option for people with high behavioral health needs.
“It’s hard for them to stay in it because they need more support,” she explained to the commission.
The county has one permanent, single-site supportive housing program, Hope Village, and the working group recommended it develop more, in addition to group homes.
Additionally, the working group wants the county’s Metropolitan Detention Center to better connect those leaving incarceration to care. Ramirez, who represents the city on the working group, said the jail needs to improve its release process so people aren’t let out in the middle of the night, unable to immediately connect to services with regular business hours.
“It would prevent the level of crisis that will then hit our psychiatric emergency centers and that failed opportunity for good reentry plans to make sure they’re sustainable in the community, and thriving on a path that’s not stigmatizing or criminalizing behavioral health as the issue,” he said.
In order to get this work done, the working group would like to see the county build on the tax revenue it uses to fund behavioral health services. It said the county could take more advantage of Medicaid reimbursements, for instance, by assisting its providers in accepting the federal insurance for patients with low incomes and becoming a Medicaid provider itself.
County Manager Julie Morgas Baca said the county has intentions to do just that, but needs to hire additional staff with expertise in Medicaid administration and train its staff before it can happen. She said there isn’t yet a timeline for rolling that out.
“It is very important,” she told KUNM. “So, it is on the front burner for sure.”
The working group also flagged opioid settlement and state capital outlay funds as potential ways for the county to diversify how it pays for expanding its behavioral health services.
In addition to simply continuing the initiatives already underway that are related to the group’s recommendations — like hiring a deputy county manager for behavioral health and expanding data infrastructure — the working group has asked that the county commission formally adopt its recommendations and hold community conversations about them. A timeline for those next steps has not yet been set.
