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Mental health care homes study: No new rules

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New Mexico state government has studied whether mentally disabled people are getting appropriate housing after they leave the state hospital in Las Vegas, N.M., but no new regulations were developed.

Shela Silverman, director of the nonprofit Mental Health Association of New Mexico, points to a 2010 House Joint Memorial concerning board and care homes in Las Vegas.

The state Department of Health was asked to convene a committee to study how licensure could work to ensure that people being released from the New Mexico Behavioral Health Institute “are admitted to the appropriate residential care facilities.”

After meeting with consumers, advocates, home operators and other state agencies, the first recommendation a DOH committee provided the Legislature was not to initiate any new regulations or processes. The reason given was “state budget and DOH resource constraints.”

However, the committee also recommended that the Las Vegas hospital and DOH’s Division of Health Improvement work with operators to develop minimum standards and draft regulations for homes. It also suggested that state oversight be established through contractual agreements with operators, which currently don’t exist.

“The issue is what are the minimal health and safety standards that should be used to contract?” said Silverman.

That issue has been highlighted anew by the deaths last fall of two former NMBHI patients who died of carbon monoxide poisoning in the storage shed they were paying to live in north of Las Vegas shortly after they left the hospital.

Nancy Koenigsberg, legal director for Disability Rights New Mexico, said one thing that needs to be ironed out is how boarding homes are defined.

“At the present time, the DOH doesn’t consider these boarding homes to be assisted living facilities, so there is not enough safe, adequate housing for people with mental illness or disabilities, and that’s true all over the state,” she said. “Without supervised living facilities, boarding homes are pretty much the last resort.”

Koenigsberg would like to see boarding homes classified as assisted-living facilities, making them subject to state oversight. But, “if they were to be licensed as assisted-living facilities, the DOH would need funding and staff in order to provide oversight. It would essentially be an unfunded mandate,” she said.

Koenigsberg said assisted-living facilities are defined as those that provide “assisted activities of daily living.” She argues that boarding homes often provide the same services, including meal preparation and attending to personal needs.

But that only addresses part of the problem, Koenigsberg said.

“The question is how can our fractured behavioral health system bring more housing to people who otherwise might be on the streets? Creating a safety net for these people needs to be part of the discussion,” she said.

“What frustrates me is people look at bits and pieces without looking at a system of care comprehensively. If, for example, we change boarding homes to assisted-living facilities, it doesn’t create housing, it doesn’t create integration and it doesn’t create transition support.”

Koenigsberg expects the state Legislature to eventually revisit what’s contained in the joint memorial, or lawsuits could force the issue. But something needs to change, she said.

“At minimum, there needs to be monitoring of health and safety. It needs to be a part of the system of care where there is oversight for this type of option and this type of option shouldn’t be the only one available,” she said.

What would Silverman like to see done?

“First, they have to start discharging people only to licensed boarding homes, but those boarding homes need to be reviewed by the people at the state hospital,” she said. “You also have to have licensed people trained to administer meds and they have to be able to pass a background check. And if they’re licensed, you have to have standards. Right now, there are none.”

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