Between July and December last year, 743 people seeking detox or a short sobering stay were turned away from the Bernalillo County facility that provides such services.
The problem?
Mostly staffing.
County officials say they have struggled to maintain a sufficient workforce at the CARE Campus, a Southeast Albuquerque site providing a range of free programs for people with substance use and behavioral health issues.
The campus currently has 71 vacant jobs, leaving it 52% staffed. The shortage has at times been even worse; there were 90 vacancies a year ago, according to information provided by the county.
Coverage has been so lean that an employee calling in sick could on occasion force the 24/7 detox unit to temporarily halt intakes until a replacement could be found for the shift, a situation made more dire by COVID regulations.
“Sometimes we were having to close (to new clients), because we didn’t have enough staff,” interim Behavioral Health Services Director Jessica Jaramillo recently told the Bernalillo County Commission.
Hiring has begun to improve after back-to-back pay raises, and the county has made other changes to better serve the community, but manpower shortages still prevent CARE from operating at full steam.
The CARE detox program — the largest government-run detox center in the county, according to a spokesman — is currently limited to 30 people, though it actually has physical space for 48.
The “Observation & Assessment” sobering unit is designed for 60 clients but is capped for now at 20.
That means some people who show up wanting to get clean are told there is no room at a time when drug overdose deaths are soaring.
According to state Department of Health data, the Bernalillo County overdose death rate rose 170% from 2017 to 2021, the most recent year figures are available.
Dr. Bill Wiese, who worked in addiction and behavioral health for 15 years, called detox a public safety issue and a critical step toward recovery.
He warned of grave consequences when it is not available.
“If these things aren’t going on,” he said referring to detox programs, “then not much is going on. And these people just end up — more of them die faster and sooner, it really comes down to that.”
John Chavez, a CARE Campus program supervisor, said turning people away is never easy.
“It’s nothing that you ever want to do,” he said. “It hurts to have to tell somebody, ‘Sorry that we can’t bring you in.’ ”
Employee retention
Jaramillo said CARE employees have been fleeing to better paying jobs, sometimes with other government agencies.
“A lot of our competitors were taking a lot of our staff,” Jaramillo said in a public meeting last month.
The issues prompted Bernalillo County officials to raise salaries for certain jobs twice since last fall — substance abuse technician leads now earn 42.5% more than they did about five months ago — something that seems to have boosted the ranks and lowered the facility’s turnaway rate. Jaramillo credited county management for recognizing the situation.
“We’ve got to do something. We’ve got to keep people, because it’s a hard job. It’s not an easy job,” Jaramillo told the Journal in an interview. “Dealing with individuals with substance abuse and mental health (issues) — it’s hard.”
Chavez said many of the employees who come in, only to leave soon after, were never truly committed to the job in the first place. He said some new employees figure out early on that “this isn’t their cup of tea.”
“It’s a tough clientele, you’re dealing with a lot of different personalities, a lot of alcohol abuse, a lot of drug abuse, and then tied in with some mental health issues.… You have to be the person who wants to deal with that clientele,” he said.
Chavez said fentanyl has exacerbated the situation, with an estimated 8 out of 10 intakes now detoxing from the drug. He said the synthetic opiate is “the biggest and the scariest that we’re dealing with.”
The drug has killed hundreds of New Mexicans over the past few years and Chavez said those who don’t die have a harder time getting, and staying, clean.
“It beats up their bodies way more severely, in my opinion, than heroin or alcohol, like sooner,” he said. “You can see them coming in and you can see how they’re physically changing.”
Observe and assess
In addition to raising wages to boost staffing, the county has made changes that have reduced the number of turnaways.
That includes the October debut of the “Observation & Assessment” unit, or O&A, which replaced the Public Inebriate Intervention Program.
PIIP started 10 years ago as a place for inebriated people to briefly stay while being monitored — perhaps en route to the campus’ 10-day detox program — instead of costlier trips to the emergency room or jail.
O&A is similar to PIIP but operates around the clock instead of just overnight, serving those under the influence and, as of now, those requesting mental health care.
Often, Jaramillo said, individuals waiting for a detox bed to become available are starting in the O&A unit instead, where they can remain for up to 23 hours and 59 minutes per stay.
On a recent weekday morning, the O&A room was quiet and dimly lit with dozens of empty recliners spread across the floor, ready for incoming clients. Dozens of extra recliners were clustered in the corner — officials said they cannot be filled due to the staffing shortages.
Only two men napped in the room’s recliners around 11 a.m., but employees said the area would fill up by nighttime.
In addition, the CARE Campus now is referring some people it cannot accommodate to the city of Albuquerque’s West Side homeless shelter.
The majority of the clients coming to the county facility are homeless and, Jaramillo said, some of them are more interested in a place to sleep than a detox program. That makes the shelter a viable option.
“They just kind of need a place to stay overnight,” she said.
The county’s turnaway numbers have fallen 60% since O&A opened, according to figures presented to the county commission. Jaramillo said the results of this quarter — which ends March 31 — should reflect continued improvement.
County Commissioner Walt Benson lauded the progress given the tremendous demand for the services.
“There are so many people out there who need the help when they’re coming and, to have to be turned away, it’s not a good thing,” Benson said during a commission meeting last month.
The CARE Campus turned away 463 people from detox/PIIP from July through September 2022 due to capacity issues. There were 280 from October through December.
It’s unclear how that compares with past years since the county only recently started tracking that data, but Jaramillo acknowledged the scale of declining county service to over 700 people in a six-month period.
Though the county recorded 4,285 detox or PIIP/O&A intakes during the same timeframe, about 1 in 7 people who wanted space was turned away.
“It was hard,” Jaramillo said.
The detox and O&A are offered at no charge to clients, take walk-ins and, Jaramillo said, may be the only option for some people, particularly those already banned from other programs.
So far this year, the campus has recorded 188 turnaways for various reasons, which could also include clients who do not meet admission criteria but also staffing challenges.
Pay increases
Jaramillo said the county competes with the city for behavioral health employees, particularly Albuquerque Community Safety.
The city launched ACS in 2021 to dispatch behavioral health workers and other non-police responders to 911 calls related to homelessness, inebriation and mental illness. The growing department now has 48 of its 51 responder positions filled, according to spokesman Connor Woods.
ACS’ lowest-tier responders make $20.48 per hour after probation; responders with more education and experience earn up to $31.50 per hour.
Woods said the city does not know how many came from Bernalillo County because it does not track former employer information.
Though there is medical staff on-site, CARE relies heavily on “technician” positions to operate; technicians, for example, monitor the O&A unit. Technicians are trained on the job and do not need to have previous medical training or special certifications.
Entry-level technicians were making $13.56 per hour last fall; two recent raises brought them to $18.48 — the equivalent of $38,438 per year.
Substance abuse technician lead pay jumped to $24.84 per hour from $17.43, while community case managers now earn $27.18 per hour (23.9% more than last fall).
The county also boosted wages for positions that require licenses, such as clinical social workers/clinical counselors, who now make $32 per hour. The county’s crisis response clinicians received a 22.1% pay hike to $38.93 per hour — the exact same pay they earn at the city.
Gonzales said he recognized at least five current ACS employees as former county employees, but there is no exact count of how many people have left the county for the city.
Though he’s seen many people come and go from CARE, Chavez said he wouldn’t want to be anywhere else. Growing up in a tough neighborhood, watching friends die of overdoses — Chavez said he was drawn to the work.
“With these people, you get to actually see a level of success,” he said, pointing to the rewarding part of the work he does.
It starts with watching their personalities emerge and hearing their aspirations unfold — to watching them fulfilled; getting a job, reuniting with their families.
For Chavez, a sense of duty outweighs the tough times.
“I’m not going to lie … it’s heartbreaking. And it’s gut-wrenching, and it sucks to see it. But the part that discourages you is the part that needs to encourage you also,” he said. “Like, if not for us, who? If we’re not going to be here doing it, then who is?”
