Editor’s note: This is the last of a three-part series comparing Albuquerque and Tucson’s handling of individuals with mental health issues.
A delegation of government, community, business and health care leaders, organized by the Greater Albuquerque Chamber of Commerce, went to Tucson in January to learn how Pima County improved mental health care so dramatically over a period of 30 years.
They came away impressed, and it is easy to see why. The two previous stories in this UpFront series describe a system designed to get people help in a hurry, put police resources to better and more efficient use, treat the mentally ill rather than criminalize them, and build a system of services that helps troubled people not only survive a short-term crisis, but also obtain the care they need to recover from their illness.
The health professionals and police officers they met in Tucson came away impressed, too, by how determined their visitors from New Mexico were to create a true system of mental health care, beginning with a crisis response center for the mentally ill patterned after the Pima County center.
The New Mexicans understand they cannot and should not merely copy the Pima County system. First, we don’t have the money. Arizona receives almost three times as much Medicaid funding from the federal government as we do.
Arizona state government spends $209.44 on mental health care per capita per year, according to the National Association of State Mental Health Program Directors. New Mexico state government spends $131.44. Arizona’s median personal household income is 11 percent higher than ours.
More important, the experts say, Bernalillo County needs its own solution, one that builds on its strengths and existing programs, and recognizes its weaknesses.
Bernalillo County has taken the lead on reforming local mental health services, largely because nearly half of the county jail population receives mental or behavioral health services. The City of Albuquerque is in the mental health business, too. Its Family and Community Services Department has a $4 million budget for seven mental health programs.
An attempt to nail down how much Bernalillo County government spends on mental health reveals both strengths and weaknesses.
On the plus side, the county is spending money on many good and deserving efforts to help people. There are grants to such well-regarded programs as PB&J Family Services and Youth Development Inc. An estimated $14 million of county indigent care funding for the University of New Mexico Hospital goes to mental health care. The county spends $1.1 million on a supported housing program that serves 75 people. It spends a total of about $4 million for out-patient substance abuse treatment, jail-based treatment, and DWI enforcement and prevention.
On the minus side, the county is spending money on so many efforts it has difficulty keeping track of them all, difficulty telling which programs are complementary and which are redundant, and difficulty determining how successful they are individually and collectively.
I asked for a list of programs and the funds spent on them, expecting there would be a line item in a computer printout of the county budget that would say “mental health” or something like that. Instead, Tia Bland, the county’s public information director, slogged through documents, phoned agencies, and tried to assemble a spreadsheet of programs and expenditures that she could share with the Journal. She identified more than 50 different programs operated by dozens of different nonprofit organizations, companies and governmental agencies.
Recipients included a cab company that provides free rides to intoxicated people, the State Police to help fund sobriety checkpoints, Healthcare for the Homeless, supported housing programs, treatment programs and The Crossroads, which helps formerly incarcerated women reintegrate into society. It took her hours to gather the information.
In all, Bland accounted for more than $8.3 million in spending over the past couple of fiscal years, not counting spending in the county jail.
This is not a knock on the county. I suspect most state and local governments would have a similar struggle because health care delivery in general and mental health care delivery in particular is not systematic.
Agencies identify needs, they make a case to a government agency to fund the needs and the funds are expended. There are many people putting their fingers into many holes in a leaking dike. There is no one responsible for understanding why the dike is leaking and then fixing it.
Albuquerque-area private mental health care providers pull their hair out trying to find safe housing for patients leaving the hospital. The county funds six housing programs, most of them operated by nonprofits. The programs are small, most accept only a specific type of client – a homeless child, for example – and there is no organized mechanism to get a patient into a housing program, no mental health system czar guiding people where they need to be.
If a provider is willing to work for hours that can’t be billed to an insurance company, it may be able to find a housing placement for the patient. Otherwise, the patient is usually expected to figure out his or her next move on his or her own.
This is the real success of Pima County: it has a system. Not only is there one door – the crisis center – where people in trouble can find a way into the system, but also specialists guide people to the programs they need once they go through that door and there are support systems to help keep them in programs they need while they recover.
Bernalillo County officials understand this and they expect the $20 million in new gross receipts taxes annually that they’ll begin collecting July 1, coupled with the money we’re already spending, will allow them to stop plugging holes and start fixing the dike.