http://www.behavioral.net/
August 16, 2013
Perspective: The Human Cost of New Mexico’s Behavioral Health Crisis
By Sarah B. Couch, LMSW
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:
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.
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.”
Here we are now, a month and a half into the shocking realization that the longstanding lighthouses of our community mental health system—our beacons of hope—are having their doors forcibly closed while the individuals who manage these agencies are bullied and shamed. This is an intentional process that is actively negating the human cost of such an inhumane and traumatizing endeavor. Perhaps most devastatingly, the voices of our entire behavioral health community have been silenced.
Systems change is about relationships; about knowing, understanding and embracing our differences to arrive at common goals, to make a collective impact, and to create a sustainable cultural shift in ideology and practice that improves outcomes. Over the past weeks, I have had opportunity to visit with some of my friends—people who use services, family members, advocates, some of the CEOs, and other providers who initially embraced me as a client, made a place for me in this community to advocate and use my voice, and welcomed me as a colleague. The commonality of these visits is powerlessness, not unlike what I experienced within the system so many years ago. This powerlessness is suffocating our state.
“What do we do when those who provide hope have lost their own sense of hope?”
Behavioral health services provide hope through connection. People’s lives are changed not because of the service they receive but because of the person who shows up and creates a space for change. New Mexico is known for its unique cultural diversity, its wide open spaces, its rural landscapes, and its abysmal outcomes as evidenced by our top and bottom place standings on national lists: suicide, drug overdose, child poverty, hunger, DWI. Those in the state’s behavioral health community willingly took on and advanced the monumental task of system change. Now, we have our efforts ripped from beneath us.
The antithesis of a transformed system is unilateral decision-making. To suggest that providers—and the people who lead them—are merely replaceable parts demonstrates a lack of understanding about the complexity of the treatment relationship, and lack of concern for people who are vulnerable.
How do we move forward when our foundation has been dismantled and privatized in a fiery show of political motivation and a sense of tyranny with no respect for the individuals—all of them—who are being affected? How do we sustain the work done when our governor single-handedly negated every initiative the community has invested in, when trust has been lost and a community sits in the grief and trauma of betrayal?
I don’t have the answers. With legal options exhausted, no sense of empathy from the state, and the federal government as our only potential hope, I have to believe that my community will sustain, that we will muster our collective strength, care for each other, lift our voices, and rise again. It’s hard to believe, though. It’s hard to look around at a sea of darkness and trust that light will ever return.
What is happening in New Mexico is terrifying. It serves as a warning to other states. An article published inThe Health Lawyer in December 2012, outlined the process that is now taking place in New Mexico. The article stated that the Affordable Care Act and revised policy guidance within CMS allow for this type of wide-sweeping assault on Medicaid providers.
Today, New Mexico is a canary in a coal mine and the resilience and resolve of all in the behavioral health community is being tested. Thought the final outcome here is not yet seen, I fear that what happened here will serve as a template for similar, shortsighted endeavors in other parts of the country.
Sarah B. Couch, LMSW, is an independent mental health practitioner located in Albuquerque, NM.
“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.”
Here we are now, a month and a half into the shocking realization that the longstanding lighthouses of our community mental health system—our beacons of hope—are having their doors forcibly closed while the individuals who manage these agencies are bullied and shamed. This is an intentional process that is actively negating the human cost of such an inhumane and traumatizing endeavor. Perhaps most devastatingly, the voices of our entire behavioral health community have been silenced.
Systems change is about relationships; about knowing, understanding and embracing our differences to arrive at common goals, to make a collective impact, and to create a sustainable cultural shift in ideology and practice that improves outcomes. Over the past weeks, I have had opportunity to visit with some of my friends—people who use services, family members, advocates, some of the CEOs, and other providers who initially embraced me as a client, made a place for me in this community to advocate and use my voice, and welcomed me as a colleague. The commonality of these visits is powerlessness, not unlike what I experienced within the system so many years ago. This powerlessness is suffocating our state.
“What do we do when those who provide hope have lost their own sense of hope?”
Behavioral health services provide hope through connection. People’s lives are changed not because of the service they receive but because of the person who shows up and creates a space for change. New Mexico is known for its unique cultural diversity, its wide open spaces, its rural landscapes, and its abysmal outcomes as evidenced by our top and bottom place standings on national lists: suicide, drug overdose, child poverty, hunger, DWI. Those in the state’s behavioral health community willingly took on and advanced the monumental task of system change. Now, we have our efforts ripped from beneath us.
The antithesis of a transformed system is unilateral decision-making. To suggest that providers—and the people who lead them—are merely replaceable parts demonstrates a lack of understanding about the complexity of the treatment relationship, and lack of concern for people who are vulnerable.
How do we move forward when our foundation has been dismantled and privatized in a fiery show of political motivation and a sense of tyranny with no respect for the individuals—all of them—who are being affected? How do we sustain the work done when our governor single-handedly negated every initiative the community has invested in, when trust has been lost and a community sits in the grief and trauma of betrayal?
I don’t have the answers. With legal options exhausted, no sense of empathy from the state, and the federal government as our only potential hope, I have to believe that my community will sustain, that we will muster our collective strength, care for each other, lift our voices, and rise again. It’s hard to believe, though. It’s hard to look around at a sea of darkness and trust that light will ever return.
“This has been my while life’s work; what will I do now?”
“This is not my best night. Somehow I have to find a balance…”
I read the messages from my community. I read them with sorrow and with a desire to take action, to do something. I send words of hope in response, knowing that each story I read is our collective story, that each moment of suffering is owned by all of us.What is happening in New Mexico is terrifying. It serves as a warning to other states. An article published inThe Health Lawyer in December 2012, outlined the process that is now taking place in New Mexico. The article stated that the Affordable Care Act and revised policy guidance within CMS allow for this type of wide-sweeping assault on Medicaid providers.
Today, New Mexico is a canary in a coal mine and the resilience and resolve of all in the behavioral health community is being tested. Thought the final outcome here is not yet seen, I fear that what happened here will serve as a template for similar, shortsighted endeavors in other parts of the country.
Sarah B. Couch, LMSW, is an independent mental health practitioner located in Albuquerque, NM.
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