Should Doña Ana County build a new mental health hospital?

Feb. 07--LAS CRUCES -- A report released this month is recommending a two-step approach to adding 30 new hospital beds in southern New Mexico to accommodate adults with severe mental illness.

The study, carried out by New Heights Group for Doña Ana County government, recommends ultimately building a $15.5 million public facility in Doña Ana County to serve the region. But, until that can be built, an "interim" solution is "the possibility of a partnership with an existing facility," which would mean paying for expanded capacity at a provider who's already in place, according to the study's executive summary.

The proposal would be aimed at improving care for adult residents -- especially the uninsured -- with mental illness who periodically require involuntary hospitalization for days, weeks or months at a time to be stabilized after a psychiatric collapse, officials have said. Now, such hospitalizations -- which are ordered in serious instances by a district judge -- happen at the state-run psychiatric hospital in Las Vegas.

But the study notes that facility, known as the New Mexico Behavioral Health Institute, is a four-hour drive from Las Cruces, a distance that puts a "significant burden on local agencies that are responsible for transporting patients, as well as for patients themselves and their families." Local officials have expressed concerns about the costs of those transports.

Local mental health advocate Ron Gurley, who was among those interviewed by the study consultants, said he feels the findings are a step forward from past studies carried out about the need for a psychiatric hospital in southern New Mexico. That's because the recent study does recommend eventually building a new public mental health hospital. Past studies have simply recommended giving money to existing private providers to expand their capacity, he said.

Gurley said he supports the idea of a contract to expand services immediately, but only if it was for space to allow mental health hospital services to operate as an outpost of the state's Las Vegas hospital, complete with state-arranged staffing and oversight. He doesn't back the idea of giving existing hospitals more money to expand their existing operations, something he said would lack accountability.

"The key to that one is that it has to be run by the state," he said.

The report's executive summary, provided to the Sun-News by the county last week, didn't include a detailed proposal for implementing the recommendations, but did indicate that a task force involved in creating the report should move to create a plan for implementing them. The plan would identify "key tasks and responsibilities, realistic milestones, funding requirements and sources, and strategies for engaging key stakeholders at the local, regional and statewide levels."

County Commissioner Wayne Hancock, who participated in the task force meetings, said data summarized in the study came from all 12 counties, but not all of them participated directly. He said he has spoken with representatives from each of the counties.

"They were all very, very interested in this and willing to cooperate and find a solution for the southern part of the state," he said.

In addition to generating a recommendation, Hancock said the report is beneficial because it will lay a foundation for the county to add the mental health hospital proposal to its infrastructure priorities list, which in turn is used by the state in awarding capital outlay dollars from state lawmakers..

"This study gives us the capacity to do a budget request in the future," he said.

Different view

Overall, the study, which covered a 12-county area in southern New Mexico that contains about 600,000 people, examined three possibilities for creating more public, in-patient beds for mental health care: "partnering" with an existing facility, buying an existing facility and building a new facility.

Officials with Memorial Medical Center, a privately owned hospital that leases its buildings and grounds from the city and county, responded to the findings in the recently released executive summary. Steven Ruwoldt, hospital COO, said among the study options examined, he supports the idea of working with an existing facility to expand capacity. For starters, he said in an email that there is capacity at a local psychiatric facility, Mesilla Valley Hospital.

"The city/county/state could make financial arrangements to support the uninsured," he said via email. "Partnering with an existing facility would be a lot less costly than building a new one."

Secondly, Ruwoldt said, a partnership with an existing facility would be "a lot less costly than building a new one. Thirdly, staffing another hospital "would be difficult," given an ongoing shortage of not only physicians but also nurses and social workers in the area.

"Expanding MVH (Mesilla Valley Hospital) would require a few more physicians but would not need a WHOLE TEAM that covers the hospital 24/7," he said in an email.

Last, Ruwoldt said, a new psychiatric hospital would duplicate the behind-the-scenes operations of a hospital -- the billing, administration, housekeeping, purchasing, registration and other aspects -- creating inefficiency in the health care system.

Continuing challenge

MMC does have a 12-bed psychiatric unit that has been typically as a starting point for adults experiencing mental health emergencies who've been taken into custody -- referred to unofficially as "protective custody" -- by law enforcement. A certain provision of state law allows officers to do so for the purposes of a mental health evaluation, which is different from a criminal arrest. But the hospital, citing difficulties with staffing, has struggled the last few years to operate the unit, known as Five West, sparking objections from mental health advocates in Las Cruces.

Asked about the current status of the behavioral health unit, Ruwoldt said: "Memorial continues to provide behavioral health services but has had continual challenges finding physician and mid-level staffing coverage."

If a psychiatric patient at MMC or Mesilla Valley Hospital is deemed in need of longer-term involuntary treatment, a state judge can order the person be taken to the state mental health hospital, overseen by the New Mexico Department of Health. It's this type of hospitalization capacity that's proposed to be expanded in the recent study.

According to the study, all of the 12 counties reviewed by the consultant are "designated as health professional shortage areas for behavioral health." Several experts have discussed for years in shortages in behavioral health staffing in Las Cruces.

Some local officials have discussed ways to try to improve recruiting new behavioral health staff to the area.

Mesilla Valley Hospital couldn't be reached for comment for this article.

Costly proposition

In all, 150 admissions into the state mental health hospital's civil division -- there are also separate admissions tied to the criminal justice system -- in 2014 stemmed from residents within the southern New Mexico study area, according to the report. That amounts to about 21 percent of NMBHI's adult patients within the civil side.

Gurley said the economic deck involved with hospitalizing severely mentally ill residents is stacked against private entities trying to offer the service. Private facilities either must earn a profit or, in the case of private non-profits, must at least break even. And psychiatric hospitalizations for serious adult mental illness -- such as schizophrenia and bipolar disorder -- are an expensive undertaking, often ranging into the thousands of dollars or tens of thousands of dollars per stay. Reimbursement for services rendered, unless someone has a sound private insurance plan, doesn't match the expense.

Gurley said private mental entities can survive by offering a range of services, not only hospitalization for severe mental illness. But he said offering psychiatric services alone won't turn a profit, a financial reality that trickles down into patient care. Sometimes it results in curtailed services. And sometimes it results in fraud, he said.

"It's pretty hard to treat the adult mentally ill in the private sector," he said.

A key exception to the profitability rule of thumb, Gurley said, is privately owned mental-health hospitals that cater to wealthy clients. There are some in surrounding states, but not in New Mexico.

Because of the financial challenges, Gurley contended the longer-term hospitalization services belong in the purview of state governments.

"They're really responsible for this, as they should be, instead of cost-shifting this to the counties, like they've done," he said, noting that residents with mental illness often wind up in jail for lack of treatment options.

The long-range goal of building a new mental health hospital would entail not only upfront construction costs, but also a yearly operating expense of an estimated $6 million to $7 million dollars.

Doña Ana County Health and Human Services Director Jamie Michael declined to comment about the study last week and referred questions about it to Hancock.

Long-range goals

The proposed new hospital isn't likely to be built soon, Gurley said.

"We're probably looking at five or six years at the best," he said.

But Gurley said the study is a start, especially if it leads to expanded services in the interim that are run by the state.

Hancock said the next step he'll take is contacting each of the 12 counties to ask if they'll each appoint a county commissioner to a work group. That panel could work on a more-formal "joint powers agreement, so we could all be involved in the process."

Hancock said the Burrell College of Osteopathic Medicine that's being started on the New Mexico State University campus also has expressed interest in being involved in the project. He said he's trying to arrange a meeting with Gov. Susana Martinez and the college to talk further about the possibility.

"We're moving forward, and I'm very pleased," he said. "I really appreciate the professionalism of the report."

Diana Alba Soular may be reached at 575-541-5443, dalba@lcsun-news.com or @AlbaSoular on Twitter.

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