LAS CRUCES – An effort by Doña Ana County to help keep people with severe mental health conditions from getting caught in a revolving door of arrests and hospitalization is getting off the ground .
After launching in April, the Assisted Outpatient Treatment program, funded by a $2.8 million federal grant, has five clients so far, officials said Thursday during behavioral health summit hosted by the county. And the caseload is expected to grow quickly.
Brian Stettin of the Treatment Advocacy Center, a nonprofit that pushed for New Mexico state laws authorizing assisted outpatient treatment, told summit attendees the program helps meet a certain need in the mental health system. It serves a relatively small number of clients with big needs who tend to use a disproportionately large share of resources.
“We’re not saying this is a cure-all for everything that ails the mental health system,” he said. The AOT program is aimed at countering a certain condition that people in a mental health crisis can have: the inability to recognize they’re experiencing an illness, Stettin said. And because of that, they fall out of the treatment process, which can lead to a downward spiral in their condition. They often then wind up in the county detention center or involuntarily hospitalized.
“We’re trying to create a pathway out of jail for someone,” he said.
Health care providers, such a hospitals, refer patients to the project. The patients appear before a district court judge, who mandates outpatient mental health care. Professional staff at La Clinica de Familia, the main Medicaid-funded behavioral provider in Las Cruces, develop a person’s care plan and provide the treatment.
The main benefit, Stettin said, is that both clients and health-care providers tend to respect the authority of a judge’s involvement. In other states, the more frequently a judge checks in on the person’s status, the better the patient’s adherence to their care regimen.
“What we’re relying on is the ‘black robe effect,'” he said. “Judges generally are considered authority figures in our lives.” People who also have a severe substance abuse problem likely aren’t a good fit for the program. But an addiction doesn’t necessarily preclude people from successfully participating, Stettin said.
Once involved with La Clinica de Familia, the client most likely will be plugged into an intensive type of care and services known as Assertive Community Treatment, said Rosario Olivera, behavioral health director for the clinic system. The 24-7 service, which is like a “hospital without walls,” can entail medication treatment, substance abuse therapy, mental health therapy and access to a case manager and a nurse.
Once a person’s mental health condition stabilizes, he or she can be moved to a lower-level of care, Olivera said.
State Sen. Mary Kay Papen, D-Las Cruces, who was instrumental in passing legislation that allowed for assisted outpatient treatment, was among the roughly 50 attendees at Thursday’s summit. The Las Cruces police and fire departments and representatives from health insurance companies also attended the session, held at the Las Cruces Convention Center.
Doña Ana County government sponsored summit on Assisted Outpatient Treatment patient care and. an initiative to help people with a mental health condition who are in Jail. Thursday July 13,2017 (Photo: Josh Bachman/Sun-News)
The law authorizing outpatient treatment doesn’t contain much in the way of enforcement power. There’s no forced medication. A patient isn’t liable for contempt of court or involuntarily hospitalized for lack of compliance, according to Stettin. But there’s always the possibility that a health care provider could trigger the beginning of a legal process that ultimately can lead to involuntary hospitalization — something that clients tend to be aware of and that does promote cooperation with their outpatient treatment plans.
Hospitals that have just treated clients are the main entities that will refer people to the assisted outpatient treatment program, officials said. Locally, Memorial Medical Center, which runs a psychiatric treatment division, is involved in the program, but the county plans to work with other hospitals as the program becomes more established, said Jamie Michael, director of the Doña Ana County health and human services department.
The county has hired a coordinator, Dylan Pell, to oversee the program. He said part of his job so far has been to try to improve communication and find ways to smooth gaps between several separate systems.
“Even though we all share the same values and desires to see that people with mental health conditions get help, the way the court system, the way the hospitals work, they don’t perfectly weave into each other,” he said.
Stepping Up Initiative
The summit also focused upon another Doña Ana County project, known as the Stepping Up Initiative, that’s aimed at keeping people with mental illness out of the detention center as a means of treatment.
Michael said the project has been going on about a year and a half and mainly has entailed planning. But a few components have taken effect, such as La Clinica de Familia having stationed a staff person at the county detention center to coordinate with inmates who are being released from the facility.
The county has a contracted mental and behavioral health provider, Corizon, which can treat inmates when they’re in the facility. But the La Clinica staff person is able to coordinate the patient’s behavioral health care as he or she is being released from the detention center, Michael said.
Chris Barela, Doña Ana County Detention Center administrator, told attendees the county spends about $6.5 million per year on inmate health care, about one-quarter of which is dedicated to behavioral health care. Over the past decade, attitudes have been changing at the detention center to recognize mental health care as a big need among detainees, he said.
$2.8MGrant award for Assisted Outpatient treatment to reduce jail time and hospitalization for residents with mental illness
5Number of people enrolled in the fledgling program1Number of new county staff to run AOT30-40Number of clients expected to be served in Doña Ana County this year
17Number of federal grant recipients to launch AOT pilot programs
Attendees also heard from Micah Pearson of Las Cruces, recently elected as a national board member for the National Alliance on Mental Illness, who discussed the importance of peer-support specialists. They’re people with a mental health condition who’ve also been trained to help other people navigate health care and criminal justice systems. Peer-support specialists help promote patients staying engaged in the the treatment process, a role that’s increasingly being recognized within the mental health field, he said.
Representatives from a fledgling program in the city of Santa Fe that’s aimed at diverting people from jail who struggle with addiction presented details about that project. The effort, called LEAD, doesn’t penalize people for failing to be drug-free but rather encourages them to reduce the risk of harming themselves or other people.
Diana Alba Soular may be reached at 575-541-5443, email@example.com or @AlbaSoular on Twitter.