State takes steps to fill gaps in mental health care
The Santa Fe New MexicanApr 08, 2024
Apr. 8—It wasn't long ago when
"I was smoking, like, 60 blues a day," Bye said, using the street name for oxycodone pills that contain fentanyl. "I don't know how I made it."
Bye, 37, of
He's got a routine that works for him — practicing Brazilian jiu-jitsu at a local gym, exploring a newfound passion for energy work and attending regular group meetings by phone with a Santa Fe Recovery Center outpatient group.
"The positive in my life today is greatly influenced by all the negative that I experienced," he said.
A person's mindset and commitment to sobriety are crucial, he said. He had been to detox before last year, but it took a strong desire for sobriety to build what he has today. "Until you're ready to change and you're committed to stop suffering," he said, "you won't change."
Nearly as important, Bye said, was that detox and inpatient services were available to him at the right time. Many people in need of services in the state find themselves discouraged by monthslong waitlists.
Behavioral health specialists, state officials and people like Bye who have struggled with addictions and other behavioral health disorders agree
"Having [intensive outpatient services] and even just more treatment facilities and detox programs in the state would help out immensely, especially if it's ... covered by Medicaid and Medicare," Bye said. "A lot of private rehabs in this state aren't covered by state insurance, so a lot of people aren't able to get to ones that are available because they don't have the right insurance, and it's so expensive."
State approach to improvements
State leaders say efforts are underway to bolster
"If we can increase our workforce, if we can increase some of those products that [
Boukas said the state wants to boost funding for certified community behavioral health clinics, which offer a range of services.
Funding also has been awarded to the All Faiths Children's Advocacy Center in
Boukas noted the state's
Human Services spokeswoman
"We continue to make efforts for that to make it easier for people to access the number, also providing support in Spanish, for veterans, for the LGBTQIA+ communities, for Indigenous communities," she said.
The crisis line, which serves as a first behavioral health contact for many residents, is likely to play a major role in getting people access to broader services as it grows, she added.
On the education front, the
The state is now preparing to role out Turquoise Care, the newly revamped Medicaid program, which Piña said will include implementing more holistic policies for care and try reduce administrative burdens for providers.
Increasing Medicaid reimbursements is a top priority, Boukas said. In recent months, the state introduced higher rates for five evidence-based behavioral health practices: dialectical behavior therapy, eye movement desensitization and reprocessing, functional family therapy, multisystemic therapy, and trauma-focused cognitive behavior therapy. Providers who offer these therapies are now receiving between 9% and 205% more for the services compared to Medicaid reimbursement rates for psychotherapy.
"That's something that providers were telling us would help them," Boukas said.
Cutting back red tape
Other officials, patients and families have their own ideas of changes they say could help
State Sen.
Under the current system, a new provider who wants to serve Medicaid patients has to get licensed and also has to complete lengthy certification processes with each insurance company acting as a managed care organization in the state's Medicaid program, Centennial Care,
"The fact that you've been certified by two others or three others or one other doesn't cut any ice," he said. "And until you're certified by them, they won't pay you to see clients."
The state could require insurers to accept and reimburse any practitioner licensed by the state,
He also believes the state should support community college-level programs that get people on the path to behavioral health careers, and should find a way to make graduate-level education in behavioral health fields — like psychiatric nursing, clinical social work and counseling — free.
"Why are we making them ... go into debt in order to get a credential that we then are desperately in need of?" he said. "We could ask that they stay in
Expanding residential programs
"The myth is that you don't need to go into residential programs, you can ... get cured just as easily from outpatient programs," he said. "I don't think there's any evidence that shows that." Outpatient programs are cheaper to provide, he noted, "and that's why we do them."
One way to meet the growing need for residential programs, he said, would be to expand services and staff at existing inpatient facilities — such as the
"One state hospital for a state like this just doesn't make any sense,"
During this year's legislative session,
Embracing medication treatment
Some who work in addiction treatment say there's a need for to shift attitudes and policies around the use of medication.
Now a residential services manager at the Santa Fe Recovery Center, Sanchez grew up in Española, where she "didn't have the best childhood."
"[I] started doing drugs really, really young," she said. "I started IV heroin when I was 14, [and] kind of went through a lot."
She went through "many" recovery programs, starting when she was about 20, she said, but they didn't stick until she got pregnant.
Quitting heroin while pregnant isn't simple, however. Sanchez's doctors told her she needed to get on medication and recommended methadone, a drug that helps block the pain of withdrawal while also curbing the euphoric sensations of getting high.
"They were like, 'If you withdraw, you're going to kill the baby,' " she said. "... I totally account that for saving my life. I don't think I would have been able to do it without it."
Sanchez eventually decided to make substance abuse treatment her work.
"It's been one of the toughest journeys of my life, but also the most fulfilling," she said.
Sanchez said some people criticized her for using methadone to help her get off drugs, an attitude she still hears today about both methadone and Suboxone.
"I've heard people tell me, 'Oh, you're on methadone? You're not clean,' " Sanchez said. "Like, no, dude. I'm staying alive."
"Maybe what we need is a system like Medicaid saying, 'Hey, look, methadone is an evidence-based practice, and so is Suboxone, and if you are a facility that takes Medicaid you should be serving people [with] these evidence-based practices,' " Ruybalid said. "That would help us open up who we're trying to serve."
Sanchez and others say there are steps to improve
While programs have grown since Sanchez started her recovery, so have their waitlists, she said. "I feel like [addiction] was not as prevalent as it is now. Like, you look around, and there's people everywhere, homeless — you can tell they're out in the spectrum [of addiction]."
Socioeconomic factors are driving that trend, she said: The cost of living has risen, while drugs have become more readily available and family values are eroding.
"I think we need help," she said. "It's lacking a lot."
Bye, the former Santa Fe Recovery Center client, said meeting that need will take a lot.
"With the growing number of addicts in the state and in the country and in the world, the need for rehabilitation, as opposed to, like, throwing people in jail, needs to be more prevalent," he said. "... To accommodate the need and all the people requiring services is going to take a tremendous of funding, not just statewide but federally."
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