The messages come late at night. Each morning, I open my phone, my Facebook, my email and find a steady stream of anxiety and despair:
“Tell me what’s happening—I see the news and don’t understand! I’m worried about my kids. School is about to start and we need more therapy now, but our therapist says she doesn’t know if she will still be employed next week.”
“My son lost his behavioral management worker and is out of control. I am worried he will need to be hospitalized.”
On June 24, 2013, a newspaper article stated New Mexico had performed an audit at the cost of $3 million dollars. This audit, the paper stated, was performed on 15 of the state’s leading mental health agencies who collectively serve about 85% of the publicly funded population who receives behavioral health services. This works out to about 30,000 individuals. The paper reported the audit found widespread overbilling and credible allegations of fraud. Additionally, the article stated the state was not releasing audit details and was freezing all Medicaid funds to the audited agencies. Agency staff learned this news in the article published to the public. In the past month and a half, agencies have closed their doors as 5 corporations—at the cost of about 18 million dollars for a three-month “transition” period—have been brought in from Arizona to take over our local community mental health agencies. News stories have heavily sided with the administration and been unwilling to voice the experiences of those directly affected.
Despite the state’s relentless cry that services will not be interrupted, they already have been. The human cost of such an endeavor cannot be quantified in the same way we can quantify units of service-$67.61 for an hour of therapy-or fees to out of state contractors-$300 per hour for the transition CEOs. The human cost will, no doubt, show up as increases in incarceration, emergency room usage, and suicide.
“I am so afraid. I’m not eating or sleeping. I’m worried about my own mental health and how I will continue.”
“My son only trusts his current doctor—she was the 5th we tried—what will my son do if she leaves or is fired from our agency?”
New Mexico has long been regarded as a forward-thinking state in its willingness to try on transformational initiatives in its behavioral health system. In 2004, monumental legislation was passed which braided the public funds of 15 state agencies, ran the funds through a managed care organization, and promised more efficiency and accountability for public dollars. The Interagency Behavioral Health Purchasing Collaborative was tasked with creating cohesive policy across systems which serve people with behavioral health needs and their families. The legislation included sweeping change across New Mexico’s behavioral health system and integrated language and values from the President’s 2003 New Freedom Commission on Mental Health report. The new language, which included the terms recovery, resiliency, strength- based, person-centered, and culturally competent, was offered to those providing services as well as to those receiving services as the way New Mexico would function.
Armed with millions in federal transformation grant dollars and a vision of better outcomes, New Mexico blazed ahead, asking the foundational pillars of our community mental health system, people who use services, and family members to join in the process. This is where I come in. Just 10 months out of my 11th inpatient hospitalization and angry at the systemic injustice I had experienced, I bought into the transformation and charged ahead as a leading advocate for behavioral health systems change. My local community had so much hope. We believed our voices mattered and that we were creating something together.
With the perceived national success of its transformation initiative, New Mexico applied for and received a federal System of Care grant to further incorporate the promise of collaboration and improved outcomes within our youth and family service systems. Local agencies strove to mold existing policies and practices—antiquated, coercive, and provider-centric—into new approaches that would embrace our collective vision. CEOs and clinical directors sat in meeting after meeting with the state, people who used services, families, and advocates as we strove to collaboratively hammer out the details within a Medicaid reliant, centralized government set up.
What the state asked communities to do was to embrace a localized model without ever empowering localities to implement local practices. Provider agencies were tasked with applying to be Core Services Agencies with a laundry list of unfunded mandates and few benefits. It was destined to fail. And it did. However, none of us could ever have envisioned the way failure would show up.
“So many tears, and laughs, and memories…gone.”
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