Less than a month after Governor Martinez vetoed legislation that would provide additional help to the mentally ill and their families, members of an Albuquerque church were attacked by a 24-year-old man who most likely suffers from schizophrenia. The National Alliance on Mental Illness reports that in New Mexico, close to 72,000 adults
live with mental illness, but the public mental health system provides services to less than one-fourth of them. According to the Department of Health, there were approximately 32,500 visits to New Mexico hospital emergency departments for mental disorders in 2010. At an estimated average cost of $688 per visit to the emergency room, this represents an annual cost of $22.4 million, a large portion of which is at the local county's expense through its indigent fund. The New Mexico Sentencing Commission reports that one of every five arrestees in Bernalillo and Dona Ana counties receives mental health services. Persons in this segment of the mentally ill population don't take their medication as needed, miss appointments with therapists or other mental health treatment professionals, are unlikely to be employed and are poor advocates for themselves.
House Floor Substitute for House Health, Government and Indian Affairs Committee Substitute for House Bill 588 ("HB 588"), sponsored by Representative Rick Miera, went
before several legislative committees and passed both houses with only a single dissenting vote. HB 588 created community engagement teams composed of licensed and qualified mental health professionals to intervene before a mentally ill person spirals out of control, requiring hospitalization or incarceration. These locally staffed and locally based teams were tasked with making a personal connection ("engagement") with the untreated seriously mentally ill within our communities and linking this population not only to mental health treatment but also to housing, food, transportation and other essential services.
In her veto message, the governor agreed that mental health community engagement teams have merit. However, as is too often the case, the governor has discounted the collective judgment of the legislature in favor of her own. HB 588 placed this program in the Department of Health, which has a proven track record with similar community-based models involving populations that include those who suffer from mental illness or mental disorders, giving the state's ineffective and unproductive Interagency Behavioral Health Purchasing Collaborative a consulting role. The governor vetoed the bill in order to establish her own mental health community engagement team program under the sole oversight of the collaborative.
There are several operating and successful New Mexico examples of communitybased programs under the auspices of the Department of Health. The harm reduction program, which provides clean needles to addicts (many of whom have co-occurring mental disorders), and the crisis intervention teams established through the Emergency Medical Services Act are among them. At the recent New Mexico Public Health Association's health disparities conference, the Department of Health highlighted a very successful community-based program that provided pneumonia vaccinations to more than 2,400 elderly persons many of whom are homebound and suffer from dementia in two counties at a very low cost. Thus, the Department of Health has a successful track record of overseeing community-based programs that include populations suffering from mental disorders or mental illness.
HB 588 called for the Department of Health to establish a community engagement team pilot project and did not seek any state funding; in fact, there was an express provision that funding could come from sources other than the state, such as local governments, which are already footing the bill to deal with this population. In her veto message, the governor claims that the Department of Health which oversees the community-based programs mentioned above, runs the state's only mental hospital and collects data on emergency department admissions of the very group of mentally ill persons that HB 588 seeks to help does not have the requisite community behavioral health expertise.
The legislature's placement of this community engagement team program under the Department of Health was not an oversight; a major consideration for choosing the Department of Health to oversee the HB 588 community engagement teams was the Interagency Behavioral Health Purchasing Collaborative's track record one that does not include even one mental health pilot project that has been implemented or completed since the collaborative's inception under this and previous administrations. As the vice chair of last year's interim Behavioral Health Services Subcommittee of the Legislative Health and Human Services Committee, before which the collaborative made several presentations, I have been disappointed by the collaborative's performance on behalf of the state's mentally ill. In my opinion, the collaborative is all hat and no cattle. A fellow legislator who served with me on the subcommittee went so far as to suggest in open committee that the Interagency Behavioral Health Purchasing Collaborative be abolished.
Another reason the governor gave for vetoing HB 588 was that it was drafted too broadly and would "infringe on the privacy of people who do not have serious mental illness or who have no current mental distress or deterioration". The bill specifically limits community engagement teams to engaging and linking "a person with serious mental illness" to voluntary treatment and services and requires that team members have requisite mental health licensure and expertise to make a clinical determination that a person with a mental disorder or illness is unlikely to live safely in the community without support and that the person does not immediately require inpatient or emergency care. There was nothing in the legislation authorizing coercion; in fact, the bill expressly stated that community engagement teams would help the mentally ill person voluntarily seek treatment and other services. It is disingenuous for the governor or her staff to suggest that community engagement teams constituted under HB 588 would be any more intrusive than the volunteers who went door-to-door in two counties to vaccinate the homebound elderly under the Department of Health's community-based program described above.
I agree with Governor Martinez, who stated in her veto message that delivering effective services to people with mental illness is an important matter of public policy. After many years, it's time for the Martinez Administration to admit that the Interagency Behavioral Health Purchasing Collaborative has not fulfilled its promise to the state's mentally ill and to those who love and care for them.
Mary Kay Papen is a Democratic member of the New Mexico Senate, representing the 38th District since 2001.