When first responders in Santa Fe County encounter someone in the throes of a mental health crisis, the choices for where to go next are severely limited.
There's the emergency room at Christus St. Vincent Regional Medical Center, where workers treat more patients for mental illness than any condition. Or there's the county jail, where approximately 67 percent of those incarcerated have mental illness.
"Those are the two options," says Juan Rios, spokesman for the Santa Fe County Sheriff's Department.
Neither is ideal. Emergency room visits are expensive, and taxpayers often end up footing the bill. Jails by definition aren't designed for treating people with mental disorders.
"That's just not a good way to spend community dollars, having them end up in criminal justice settings or high-end medical centers," says Pamela Hyde, former head of the national Substance Abuse and Mental Health Services Administration.
For years, advocates have pushed for a third option: a place, known as a crisis triage center, for people with mental illness to center themselves before re-entering their community. Such a place could offer refuge for an addict on the cusp of relapse, a schizophrenic experiencing a psychotic episode or anyone else with mental illness who needs time and space to settle down.
Santa Fe County officials recently devised a plan to build a crisis triage center. Voters will decide in November whether to commit taxpayer funds to making that plan a reality.
Two questions on the November election ballot address the possibility of establishing a crisis triage center in the area. One asks voters whether the county should borrow up to $5 million to fund community health facilities. (One of five bond questions on the ballot.) The other, this one non-binding, proposes increasing gross receipts taxes by .125 percent to create ongoing revenue for mental health services.
"I feel that with misdemeanors—trespassing, sitting on a bench, urinating in an alley—those offenders would be better served going to this crisis triage center," says Dr. Merritt Ayad, director of mental health at the county's Adult Detention Center. In 1999, Ayad helped set up a mental health emergency services system in New Orleans. "That's better than spending months here, because it could actually help prevent them from coming back in the future."
Inspired by facilities in Tucson, Arizona, San Antonio, Texas, and Marion County, Oregon, planners envision a center open 24 hours a day, seven days a week. Service would be available to individuals for up to 23 hours at a time. Rooms would be furnished with recliners, as opposed to beds, to emphasize the short-term nature of triage stays.
Once a patient becomes stabilized, staff would assess what caused them to tick in the first place and attempt to connect that person to appropriate services. More severe mental health issues could send someone to the 12-bed mental health unit at Christus St. Vincent or maybe the Behavioral Health Institute in Las Vegas. (Behavioral health and mental health are interchangeable terms.) For ease of access, planners are looking for a spot near the hospital, according to Rachel O'Connor, county director of health and human services.
Crisis triage centers for years have been part of the service array in communities across the country, but recently the facilities have become a "growing phenomenon," according to Hyde. New Mexico cities started showing interest more than a decade ago, but actually getting a center up and running has proven challenging. Snagged by insufficient funding, a crisis center in Doña Ana County has remained unopened for years.
Santa Fe County does not yet have a definitive timeline for its proposed center, O'Connor says. County health administrators are currently working on a business plan to look at potential funding streams for the center on top of tax revenue. State funding and grants from private foundations are possibilities, O'Connor says.
"I'm glad that this is finally happening, but it still doesn't cover everything," says Mary Lou Ortega-Shaw, president of the Santa Fe chapter of the National Alliance for Mental Illness. Ortega-Shaw says the 23-hour service period isn't long enough for some crises and would like to see more long-term options.
The triage center proposal adds to a growing list of mental health initiatives local governments have pushed in recent years. The city in 2013 enacted Law Enforcement Assisted Diversion, a program that directs low-level drug offenders straight to treatment, rather than jail. And last year, the county launched a Mobile Crisis Response Team, a program run by Presbyterian Medical Services (not Presbyterian Healthcare Services, the primary care organization) that dispatches therapists straight to people in crisis.
The proposal for a crisis triage center stems from a four-county mental health summit, hosted by Santa Fe County in May at the Eldorado Hotel. Professionals from a wide array of fields, including healthcare, law enforcement and corrections, all provided input that organizers funneled into six priorities for mental health in the region. Crisis triage center services topped that list.
County commissioner Miguel Chavez, who organized the summit, says he took cues from a national movement called the Stepping Up Initiative, which aims to reduce the number of people with mental illnesses in jails. He says the 2013 behavioral health shakeup, in which the state's biggest mental health providers shuttered amid unsubstantiated accusations of fraud, put the onus on counties to help fill new service gaps.
For Chavez, it's personal. Around the time he joined the commission in 2011, an immediate family member was diagnosed with bipolar disorder. The family member was recently incarcerated at the Adult Detention Center for missing a court date. Chavez says his family's experience with mental illness helps him put the issue into perspective and make this initiative a priority before he steps down next year.
He tells SFR, "As someone in that position, I felt like I couldn't hide it anymore. I couldn't sweep it under the rug, not just for myself, but the community."