Cut the red tape for behavioral health

The virtual destruction of New Mexico’s behavioral health system more than 10 years ago still reverberates today. For reasons that remain inexplicable, then-Gov. Susana Martinez’s administration froze Medicaid reimbursements to 15 providers, claiming they were defrauding the state. Martinez lacked proof when making the allegations, but the damage was done. An already shaky behavioral health system charged with providing mental health care to thousands of New Mexicans crumbled to bits.

Today, the depressing mess remains — identifiable only through scattered pieces of a system that hasn’t been rebuilt and is now under increasing assault from even more menacing threats: a lingering opioid epidemic; a frightening new player called fentanyl; and ever-present threats like alcohol abuse and mental illness exacerbated by a recent pandemic and a chaotic world.

Yet there are not enough providers — whether individual psychiatrists or counselors, or treatment centers or clinics — to meet the demand. As The New Mexican‘s recent three-part series on behavioral health care in the state pointed out, people cannot get access to what they need.

It is a state’s shame.

For three days, reporter Gabrielle Porter (“Crisis of care,” April 7, 8 and 9) laid out both the problems New Mexico still faces in providing necessary care to people in crisis, as well as sharing solutions to help us grow the behavioral health care system so sick people receive the care they deserve.

Porter told the stories of people released from institutions, whether hospitals or substance abuse centers, who have little assistance in transitioning back to everyday lives. We met Angela Velez, who battled homelessness and addiction, found an apartment, only to lose it all again and start the climb back. At every step, Velez met setbacks and challenges, including contracting a severe case of RSV that landed her in the hospital after a night at the shelter.

The problem is complex, and hardly unique to Santa Fe or New Mexico. Like much of the nation, the state lacks enough care providers — only 346 psychiatrists, 2,510 social workers, 2,028 licensed clinical counselors and 721 psychologists. The state does not have enough short- or long-term treatment centers, and too often, after treatment, individuals are on their own. Better after-care once an addict has gone clean can make all the difference in the treatment succeeding.

None of this is news to the elected officials and medical community of New Mexico, with many efforts underway now. The challenge now is to attack the problem strategically. This means combining the efforts of various agencies to avoid duplication of efforts and to share best practices.

Take increasing the workforce. The state needs more workers in the field of behavioral health. Increasing the number of workers involves coordinating efforts among the state’s Higher Education Department, Workforce Solutions and the Department of Health. Start efforts in high school and follow through to community colleges, as well as recruiting midlife workers who want different careers. The long-term initiatives could grow young people into future psychiatrists, psychologists, counselors and social workers, while the midcareer efforts could quickly add to the counseling and social worker ranks. Look at how New Mexico can recruit out-of-state professionals and put them to work right away.

Identify how to better reimburse providers — the state has money — and build on recent increases to Medicaid reimbursements. A Medicaid increase is taking place come July; it’s an opportunity to do more. Simplify the process. Through Porter’s reporting, we learned about some of the hoops people must jump through, both patients and providers. One sensible suggestion included shortening the intake process, so people in crisis and often without a home or transportation don’t have to visit an agency four times.

Necessary reforms will not happen overnight. But it cannot happen at all without a better, more comprehensive plan, one that sets short-term, intermediate and long-term goals with standards and benchmarks.

There are plenty of unknowns. But what we do know right now is this: People cannot get access and often are lost in a fragmented system with few guideposts and nowhere near enough coordination.

Our goal? Get people the access they need. Sooner, rather than later.

A decade of disaster is enough. Enough.