New Mexico’s behavioral healthcare system needs new thinking

That’s the conclusion of research our organization has conducted on the public revenue and resources dedicated to fighting substance abuse and mental disorders in the Land of Enchantment.

Certainly the crisis is severe. Alcohol-related deaths are rampant. The drug-overdose rate remains among the highest in the country. More citizens here have mental illnesses than the national average, and the prevalence of suicide is greater here than in all but three states.

But what’s more depressing than the reality of the behavioral-health epidemic is state government’s inconsistent and failure-ridden attempts to address the problem.

In 2002, “Behavioral Health Needs and Gaps in New Mexico,” an investigation commissioned by the Legislature, concluded that there was “no identifiable behavioral health system leader with responsibility or authority across the behavioral healthcare systems in the state.” In addition, the “benefit packages of the various behavioral health systems within New Mexico” were “not organized to maximize available resources or to provide incentives to providing care that has been proven to be effective (evidence-based or promising clinical practices).”

In response to the report, legislators and then-Gov. Bill Richardson created the New Mexico Behavioral Health Purchasing Collaborative, overseen by the Human Services Department, to bring leadership, focus, and accountability to the state’s public system of behavioral healthcare. But reports by the Legislative Finance Committee have repeatedly found that the collaborative hasn’t performed nearly as well as its creators hoped.

Even worse, radical policy shifts — including “carving out,” then “carving in” behavioral-health services for Medicaid recipients, and the brutal, partisan fight over Gov. Susana Martinez’s 2013 suspension of Medicaid payments to nonprofit providers due to suspicions of fraud — have taken a heavy toll.

No one can change the mismanagement and chaos of the past. The goal now is to move forward with sound principles and policies. A good place to start is with the flawed assumption that the only thing wrong with New Mexico’s behavioral-healthcare system is a lack of revenue.

Our examination found that states with high-performing systems do not necessarily spend more on substance abuse and mental illness. The key is to use what funding is available in the most effective ways possible. In 2014, legislative researchers found that the state spent just “11 percent of its … funding on proven and effective (behavioral-healthcare) programs for adults, even though past studies have recommended greater spending on these services.”

An expansion of mental-health courts would be a wise investment. Diverting an offender with behavioral issues from jail is an early intervention measure proven to be effective. Columbia University’s Paul S. Appelbaum wrote that most recent research shows that participation “is associated with reduced rates of rearrest and reincarceration compared with ordinary handling by the courts and correctional system.” Mental health courts exist in the Albuquerque-Santa Fe region, but not elsewhere in the state. Otero County is exploring a court of its own, and others should follow.

For those with a chronic condition who refuse help despite multiple arrests and/or hospitalizations, a stronger approach is need. Assisted outpatient treatment is a court-ordered plan that can include medication, tests, therapy, training or counseling. In the words of the Treatment Advocacy Center’s Brian Stettin, that type of treatment “leads to reduction of hospitalization and criminal acts,” and reduces the number of “people … getting treated in jails or prison for mental illness.”

New Mexico adopted AOT earlier this year, but was one of the last states to do so. However controversial the process remains, it’s now incumbent upon local governments and the courts to use the tool to help behavioral-health sufferers and taxpayers alike.

Finally, New Mexico’s behavioral-health workforce is inadequate — a harsh reality exacerbated by the governor’s decision to expand Medicaid under Obamacare. For fiscal and economic reasons, there is little chance for a quick turnaround. But training public employees in mental health first aid, and expanding the state’s system of peer support, can help compensate for an insufficient number of professional caregivers.

Dowd Muska (dmuska@riograndefoundation.org) is research director of New Mexico’s Rio Grande Foundation, an independent, nonpartisan, tax-exempt research and educational organization dedicated to promoting prosperity for New Mexico based on principles of limited government, economic freedom and individual responsibility.