Addressing behavioral health care crisis in S.F.
Collaboration of organizations work to reset services provided at hospital’s ER, Sobering Center
Kathy Armijo-Etre, a vice president of Christus St. Vincent Regional Medical Center, knows firsthand the toll that addiction can have on a family.
“My dad died here, and he had an addiction,” she said during an interview at the hospital.
Armijo-Etre is working with a group of medical providers, county officials and community nonprofits to reset the way Santa Fe approaches behavioral health services, including treatment for suicidal ideation, depression, and drug and alcohol addiction. The collaboration will lead to changes in how care is provided at the Christus St. Vincent emergency room and the Santa Fe County-owned Sobering Center, a 15-bed facility near the hospital that has offered addiction treatment services for more than a decade.
St. Vincent, which has operated the center since 2010, informed the county earlier this year that it planned to shut the facility down, but later rescinded the decision. Still, hospital officials said in February that the closure was still a possibility, raising concerns among advocates. As part of the new plan, the hospital will hand over management of the Sobering Center, at 2052 Galisteo St., to the nonprofit Santa Fe Recovery Center, a fully accredited rehabilitation center.
One of the county’s goals in starting the Sobering Center was to keep people with alcohol and drug abuse disorders out of jail and out of the hospital’s emergency room. The problem persists. But members of Christus’ emergency medical staff aren’t just treating addiction, officials say. They’re treating patients with a range of behavioral health con-
ditions in a county whose rates of alcohol-related deaths, fatal drug overdoses and suicides are nearly double the national rates.
Every day, medical workers in Christus’ emergency room see some 140 patients. About 15 of them have a serious behavioral health concern. Many are repeat patients with more than one behavioral health diagnosis.
“It’s not about just alcohol or drug use anymore, but trying to get at the underlying reason the person abuses,” said Lillian Montoya, the hospital’s chief operating officer. “The complexity has changed.”
“We need a much bigger strategy to respond to the behavioral health crisis,” Armijo-Etre said.
By midsummer, the hospital will open what it calls an emergency assessment room, or triage area, for patients who need behavioral health care, rather than emergency or trauma care for a physical or life-threatening conditions.
The triage area will be more casual than a typical hospital unit, with recliner chairs and even mattresses on the floor. More importantly, it will have trained treatment workers and peer counselors who can steer patients to appropriate services, such as detoxification or inpatient residential care at the Sobering Center.
Christus plans to fill 10 new positions to support the triage unit, said Susan Kammerer, the hospital’s clinical manager of behavioral health.
“When they come into the ER, they will be treated by behavioral health experts,” she said.
The triage area also will provide relief for the 52,000 medical patients each year who go to the emergency room for heart conditions, bone fractures or traumatic injuries. Behavioral health patients can sometimes be disruptive to those seeking other care.
“That waiting room is sometimes like a pressure cooker,” Montoya said.
The Santa Fe Recovery Center, preparing to take over the Sobering Center on July 1, has been providing in-patient and outpatient detox and addiction treatment services since 2005. It is the only rehab center in the county accredited and licensed to offer such care by the Commission on the Accreditation of Rehabilitation Facilities.
While Christus was unable to seek Medicaid reimbursements for providing some types of clinical and support services for Sobering Center patients because it didn’t have the accreditation, the Santa Fe Recovery Center can bill Medicaid. That means more money will be coming into Santa Fe County to treat patients struggling with drug addiction and other conditions.
Christus, through its community giving program, has pledged to help support the Recovery Center.
County Manager Katherine Miller said the county also hopes to help support the detox program by transferring a $400,000 grant from a state DWI program.
The county plans to finalize a lease agreement with the Recovery Center in the next few weeks that will waive rent costs in exchange for the center’s services for indigent people.
The Recovery Center serves 300 patients a year at its main facility, 4100 Lucia Lane, with detox and outpatient services and residential treatment, including a program that helps wean people from opioid addictions using the prescription drug Suboxone.
But the center’s 23 residential beds are typically at capacity.
Sylvia Barela, executive director of the Recovery Center, said the new partnership will allow the nonprofit to double its inpatient residential services. But many needs remain.
The county still does not have a facility for patients who need 24-hour medically supervised detoxification — a necessity for people coming off hard drugs like cocaine or benzodiazepines who need cardio monitoring, Barela said. That service is only available in Albuquerque.
And, she said, the county needs a residential program just for women, where people seeking addiction treatment can stay for a few weeks at a time and feel safe with young children.