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Fixing behavioral health system could take years

ALBUQUERQUE, N.M. — Before Pima County in Arizona developed a behavioral health care system that officials around the country are trying to emulate, there were years of strife, tension, egomania, turf protection and politics.

That’s normal, said Chris Carson, who once ran ValueOptions in New Mexico and is now chairman of Connections AZ Inc., which runs behavioral health care systems in Tucson and Phoenix. New Mexico will go through the same thing and can survive it, if we are determined, persistent and united as a community in our desire to help our mentally ill residents, Carson said.

Carson spoke to the Journal after his presentation to the Greater Albuquerque Chamber of Commerce board of directors last week.

Indeed, there was a glimpse of the predictable tension at Tuesday’s Bernalillo County Commission meeting. The commission easily approved the hiring of Community Partners Inc. of Tucson to help it develop a business plan and a governance structure for a new behavioral health system.

Then Commission Chairwoman Maggie Hart Stebbins introduced a resolution to organize a working group that will try to identify all of the behavioral health programs that are out there. The working group would invite the city of Albuquerque, the state, private groups and anyone else to join the effort. The goal, Hart Stebbins said, is to bring together all potential funders to explore how they might collaborate both in contributing and distributing funds.

Commissioner Wayne Johnson supported the idea but asked that instead of acting on its own the commission try to craft a joint resolution with the Albuquerque City Council. It would be a way of starting the collaboration the Arizona experts say we’ll need, Johnson said. Hart Stebbins replied that since the county enacted a gross receipts tax increase to raise $20 million for behavioral health services, it is appropriate the county lead an effort to bring some rationality to spending. The resolution passed 3-1, with Johnson casting the dissenting vote.

Left unsaid was that City Councilors Brad Winter and Ike Benton have written a resolution calling for the city, county, state and University of New Mexico to organize a behavioral health authority that will utilize “the combined resources of the parties” and govern the administration of the tax the county enacted.

In an e-mail, Hart Stebbins observed “this proposal gives the county commissioners, who actually passed the tax, just two votes out of 10. There’s also no mention of this authority making decisions about spending city or state tax dollars.”

Tensions between entities is natural, normal and even desirable, Carson said. The four managed care organizations spending Medicaid dollars on behavioral health care in New Mexico cannot have identical interests with, say, the UNM psychiatric hospital, he said. City government and county government interests are bound to diverge. As smitten as some of us are with Pima County’s approach, the city of Tucson, Pima County and the University of Arizona took ages to get on the same page, Carson said.

As much funding as you can find from as many places as possible has to be secured, he said. You need political leadership, the buy-in of the entire community, from private practitioners to police officers, and lofty goals. You need a board of governors that is committed to the system’s success, not just to the success of any individual organization that is part of the system. Everyone needs to check his ego at the door.

That is precisely the kind of organization the county commissioners said Tuesday they are expecting Community Partners to help build.

There is an element of déjà vu in all of this.

Pam Hyde was human services secretary for much of Gov. Bill Richardson’s administration. She made her share of enemies in New Mexico, but she was brilliant, energetic and had the thickest skin in Santa Fe.

Hyde identified 13 major agencies and countless smaller operations in state government that spent money on behavioral health services. As with county government today, no one was quite sure where all the money went or whether it was well-spent. A health care provider might receive funding from three or four different entities to provide the identical service to the identical client, and none of the entities knew it.

Richardson ordered Hyde to create a collaborative of agencies to streamline the system, coordinate care, end redundant spending, focus money on the best programs and measure results. That’s pretty much what we’re trying to do at the city and county level now. Carson, then with ValueOptions, helped create and administer the collaborative.

The minute Hyde left the state to run a major federal mental health agency in Washington, D.C., the plan began to unravel, Carson said.

A successful system has to be bigger than one person or one government, even one as big as Bernalillo County, Carson said. It will depend entirely on getting everyone committed to the success of the whole system.

Don’t be surprised if getting that commitment takes years, he said.

UpFront is a daily front page news and opinion column. Journal writer Winthrop Quigley can be reached at