Grading the States 2006: New Mexico - Narrative
It was in Albuquerque in 2002 that President George W. Bush chose to launch the New Freedom Commission, to improve the lives of Americans living with severe mental illness by transforming the mental health care system.
The choice was appropriate.
Despite being home to U.S. Senator Pete Domenici, one of the true national champions on mental health issues, the state historically has fallen short in meeting the need of its citizens for mental health services.
The state motto is "Land of Enchantment," but the mental healthcare system is anything but enchanting. Many advocates refer to it as the "land of entrapment"- it would be funny, except that lives literally are at stake.
The good news is that New Mexico seems to have woken up. There are signs of a commitment to innovation. In 2005, the state received a federal system transformation grant. Thanks to the leadership of Governor Bill Richardson, the state also has launched an experiment known as the Behavioral Health Purchasing Collaborative (BHPC), which has the potential to become a national model. It is a needed initiative—untreated mental illness costs the state's businesses, taxpayers, and families more than $3 billion annually.
The bad news is that New Mexico has many strikes against it. The state has the fifth-highest suicide rate in the nation, and the second-lowest spending per capita for state-directed mental health services. Poverty and rural ruggedness contribute to its precarious position. Compared to other Mountain States, New Mexico has the highest percentage of uninsured citizens below the federal poverty line.
A recent settlement with the U.S. Department of Justice documented problems in the Santa Fe County jail involving inhumane conditions and inadequate medical services for inmates living with serious mental illnesses. The county agreed to improve services, including pre-admission screening and better staffing. However, advocates say that the case is only one example of a pattern of shortcomings statewide.
On the positive side, the state has made progress with a mental health court in Albuquerque and Crisis Intervention Team (CIT) programs.
New Mexico has a good history of supporting peer-operated consumer services - it was one of the first Western states to pursue the strategy. Through programs such as the Wellness Recovery Action Plan (WRAP), the state has a strong recovery orientation. Despite the state's good intentions, however, advocates report that too much bureaucratic planning diverts resources from services.
New Mexico was the first to grant medication-prescribing privileges to psychologists. The merits of the initiative are still under debate. Other alternatives such as telemedicine were dismissed in favor of this more controversial move, but the state deserves credit for acknowledging a chronic shortage of psychiatrists and other providers. NAMI warns the state, however, to monitor and evaluate the policy carefully to ensuresafety and effectiveness.
New Mexico's BHPC combines revenue from 18 state agencies into a single system. Through a management agreement with Value Options, a private managed care company, the collaborative seeks to implement evidence-based practices (EBPs) and prioritize services according to consumer and family preferences.
The jury is still out on whether the BHPC experiment will succeed. There is some cause for concern. It appears that Value Options is seeking to introduce barriers to open access for psychiatric medications - a cost-cutting strategy that is "penny wise and pound foolish." Managed care models sometimes turn into managed cost models. Experience with managed care in other states too often reveals that people's needs are sacrificed in favor of private profit incentives.
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