LAS VEGAS, N.M. – This town is home to the only state-run psychiatric hospital in New Mexico. And each week, two Doña Ana County sheriff’s deputies transport people who are in crisis on a 350-mile trip north for treatment here.
Doña Ana County taxpayers spend up to $30,300 each year for 52 to 60 of these trips, according to county estimates.
Sometimes, a patient must be taken by ambulance, which adds about $4,000 to the county’s costs if the person is uninsured, officials say. An involuntary hospitalization lasts, on average, 11 days, largely at taxpayer expense, while patients are treated to a point of stability before being sent on another 350-mile trip home.
The hospital isn’t at capacity; officials say it had an 83 percent occupancy rate last year. But mental health advocates in Doña Ana County have argued the distance creates hardships for southern New Mexico mental health patients and their families.
A branch of the hospital is needed in the southern part of the state, some say, to make it easier for families there to visit patients and to ease the burden on law enforcement.
On a recent autumn day, the sprawling, 300-acre campus of the New Mexico Behavioral Health Institute stood against a backdrop of picturesque mountains and turquoise sky in Las Vegas. State Sen. Mary Kay Papen, D-Las Cruces, is familiar with the facility both as a lawmaker and from her family’s own experience. A grandchild was hospitalized there involuntarily earlier this year for treatment for a mental illness.
Papen was among those who said the distance can make it difficult for southern New Mexico families to visit their loved ones.
“It’s expensive and it’s time-consuming, and you have to leave your job to do this,” Papen said.
Studies have produced mixed results when examining whether family visits shortened patients’ psychiatric stays in hospitals. But generally, experts said one of the goals in treating mental illness is promoting healthy social interaction. Many facilities are making a push for more family-friendly spaces and policies. The Las Vegas facility welcomes family visits.
Still, “having a facility in the southern part of the state somewhere would be a tremendous advantage for family members as well as people who are suffering from mental illness,” Papen said.
The state has faced severe budget woes in recent years. Cuts have been handed down to universities and state agencies. It would likely take a coalition of local governments and the state to fund a hospital expansion into southern New Mexico, some officials say.
There are divergent views about what should be done. At least one prominent official doesn’t believe a new psychiatric hospital is the right approach.
The need, the cost
The psychiatric hospital in Las Vegas accepts all state residents, regardless of their ability to pay for services, if they show up at the facility and meet the admissions criteria — mainly that they pose a threat to themselves or other people because of their mental state.
The larger institute that operates the hospital includes other units – one that treats people charged with crimes whose competency is in question, a long-term nursing home, a unit focused on rehabilitating teen sex offenders, and an outpatient mental health program that serves a three-county area around Las Vegas.
The psychiatric hospital unit treats people who’ve been ordered by a judge to be admitted for treatment. In the 3rd Judicial District that covers Doña Ana County, state Judge Mary Rosner presides over closed-door hearings each Friday at Mesilla Valley Hospital and Memorial Medical Center, where a psychiatrist testifies about the need for hospitalization.
In the fiscal year that ended June 30, 72 residents from Doña Ana County were treated at the adult psychiatric hospital in Las Vegas. That was nearly 10 percent of the hospital’s caseload, said hospital Administrator Frances Tweed. Though a person could voluntarily show up there and ask for treatment, she said most patients from southern New Mexico were ordered into treatment by a judge.
Doña Ana County hired a consultant, New Heights Group, about two years ago to study a proposal for a southern New Mexico mental health hospital to serve a 12-county area. A 14-person task force that included Papen, Las Cruces City Councilor Jack Eakman, former Doña Ana County Commissioner Wayne Hancock, a representative from the National Alliance on Mental Illness and a representative from the hospital in Las Vegas met in November 2015 to discuss the proposal.
The group recommended a two-step approach toward establishing a 30-bed behavioral health hospital in southern New Mexico, a summary report stated. The hospital would serve as a “ ‘hub’ for the further development of a comprehensive system of mental health care for the residents of southern New Mexico,” the report stated.
The estimated cost was $15.5 million for construction, and $6 million to 7 million each year for operations.
An interim step could entail a renting out space in an existing facility, the report stated.
Unlike some other officials, Doña Ana County Health and Human Services Director Jamie Michael doesn’t believe building a branch of the state hospital in southern New Mexico is the right approach. She instead favors the idea of renting out space in an existing facility. The county suffers from a health provider shortage, and Michael said a new hospital would “further stress” that situation.
Several ideas have been floated for how a publicly funded behavioral health hospital could work in southern New Mexico. Among them:
- Beds could be rented in existing Doña Ana County hospitals through a contract with the state behavioral health hospital. The expense could be paid for solely by the state, solely by local governments, or shared by both.
- Local governments could pay for a new building, and the state could pay to expand its Las Vegas operations into Las Cruces. Local governments could shunt money to the state for a portion of the operating costs.
- The city, county and other local governments could band together, as they currently do for the local 911 call center, to pay for building and running a hospital without state help.
- The city could opt to build a hospital and pay for its operations on its own, and plan to recover some costs by seeking reimbursements from other area governments whose residents are treated there.
Las Cruces City Councilor Greg Smith said these are the types of considerations that must be ironed out. That’s why a legislative study is needed.
Regardless of whether the state takes on the costs of the project, Smith said it will need state authorization to move forward.
OK, but who will pay for it? “I would say ideally, the state would have the resources to take the whole thing on,” said Smith, who’s Papen’s son-in-law. “This would be a satellite facility.”
Eakman, a retired nonprofit hospital administrator, said he wants the Legislature to carry out its own hospital-expansion study next – not to duplicate what’s already been done but to figure out how a new facility would tie into the state’s network. He also said the state should shoulder much of the burden.
“We don’t have the resources in southern New Mexico to do this on our own,” Eakman said.
But he’s willing to consider local help. He said officials could gauge residents’ interest in voting on a local tax increase to pay for behavioral health care, akin to one passed in Albuquerque. In 2014, Bernalillo County voters OK’d imposing a 1/8 of 1 percent gross receipts tax to fund behavioral health projects. It results in a 12-cent charge on a $100 purchase of most goods and services, generating up to $20 million per year.
More recently, Santa Fe County voters rejected a smaller tax increase aimed at paying for public safety and behavioral health care. Separately, the Santa Fe County Commission imposed a similar tax hike without going to voters.
The city of Las Cruces has a pot of money that theoretically could be tapped to help fund a psychiatric hospital in southern New Mexico. The city’s share of the so-called Telshor Fund – proceeds paid to Doña Ana County and the city in the mid-2000s for leasing Memorial Medical Center to a private company – currently totals about $40 million. It’s grown over time because the city has invested a portion. And each year, the city council awards a portion to community groups, like a local food pantry — an amount officials recently bumped up to $400,000 annually.
The county, on the other hand, slashed its share of funds paying a huge legal settlement. Still, there is $8.5 million remaining. County officials plan to use this to pay for operating their built-but-not-open Crisis Triage Center, which would serve as an urgent care facility for certain residents with mental illness. That funding will dry up in a few years.
The role of the crisis center would be different from a psychiatric hospital. County officials envision the former as a landing place for people just released from jail to connect to resources like housing and outpatient mental health care, and as a place to keep people who are facing minor, mental-health-related charges from jail in the first place. The proposed hospital, meanwhile, would be tasked with providing intense inpatient psychiatric care.
Las Cruces Mayor Ken Miyagishima said he “absolutely” backs the establishment of a southern New Mexico branch of the state psychiatric hospital. He said the city and other local governments could help pay back bonds used to build the facility. One possible funding source, Miyagishima said, is about $8 million the city and county are still owed from the MMC hospital lease.
But while the mayor said the city may be willing to help build a hospital, he believes the state should pay to operate it because it would serve residents from other counties as well. Eakman agreed, saying it’s possible “some” money in the Telshor Fund could help with construction.
Miyagishima doesn’t support spending more from the city’s Telshor Fund than is already being doled out to community groups. To maintain the current annual level of spending, the fund will have to grow to keep pace with inflation, he said. He also doesn’t support a city tax hike for behavioral health, noting Doña Ana County already has a tax in place dedicated to indigent health care.
Michael said the county’s indigent health care tax dollars are already fully used each year and even supplemented by an extra $1 million from other county revenues. Some goes to the state to supplement Medicaid payments. Other funds pay for ambulance services and medical care for low-income residents and cremation services for people whose bodies are unclaimed by family.
Papen said the idea of local and state government sharing the costs would be more palatable to the Legislature than the state shouldering the full burden. As it is, the Las Vegas hospital’s campus needs improvements, she said.
State Rep. Doreen Gallegos, D-Las Cruces and member of the Legislature’s behavioral health subcommittee, said she would “love to see” a state hospital in the southern part of the state, but she doesn’t see it happening without “some tax reform.”
“Until we get some new revenue, it’s going to be hard to expand services,” she said.
City officials recently added the hospital study to its list of priorities for the upcoming session of the N.M. Legislature in January, specifying it should be a state project.
Smith said in a “worst-case scenario,” the city could take the project on by itself, funding it through a combination of the Telshor Fund, a bond and possible grant revenues. That would be difficult, he said, but possible.
Tweed, who’s been administrator of the hospital in Las Vegas for about a year, said she hasn’t researched the proposal to build a branch in southern New Mexico. If there’s more money, she said she would rather see it used for expanding outpatient services. That would help keep patients in their communities and help them get medication and counseling they need, she said.
Las Crucen Micah Pearson, a member of the local and national boards of the National Alliance on Mental Illness, agreed that improving outpatient and other services for clients does reduce the need for hospitalization. But even with improvements in those services locally, he said a portion of the population will still need the more intense care hospitalization provides.
Smith said the strain on families caused by the lack of a nearby public hospital has a societal cost.
“We know this is a need in the community,” he said.