SFR Talk: Help In Hard Times

Violanda Nuñez founded Ayudantes (1316 Apache Ave., 505-438-0035) in 1979 with two fellow social workers. Ayudantes (Spanish for "helpers") provides low-cost mental health and addiction rehabilitation services in Santa Fe, Española and Las Vegas. Its new blog provides information on its services and answers reader questions about mental health.

SFR: What brought you to Ayudantes?
VN: It was primarily a response to what was currently being provided in the community. We felt that we could do better and different. At the time, services were based on a medical model. There was no real therapy, we felt, and it was primarily for medication dispensing and very little systems work. We felt there needed to be more of a systems approach to treatment as opposed to just, 'Here's a pill.'

What do people come in for most commonly?
A lot of people are coming in because they're feeling helpless and hopeless and, when that happens, they come in for support. They're also feeling fragile. A lot of people, specifically in Santa Fe, if you aren't part of the 5 percent of people who are wealthy and don't have to worry about money, you are struggling. And you're marginal anyway, economically, so this puts them in a panic mode.

Have you seen a shift in the population you treat due to the current economic conditions?
No, because folks who are at the higher economic levels typically already are connected into helpers in their area. We're primarily for the indigent, the low-income; they know about us and they come. Those who are at the higher economic range are tied into their caretakers. Within that system, I believe they'd probably take care of one another.

What kinds of success stories have you seen?
The problem with identifying success stories is that, once they leave here, we rarely see them again. Success would be, to us, that within six months, they're no longer in jail; they're no longer committing crimes; they're staying on their medications; they've developed a support system. That's how we measure success—that when they leave here, we know they have a system in place. Unfortunately, the funding sources don't always measure it that way.

So how's it going with those funding sources, anyway?
The state has contracted with OptumHealth [a managed-care vendor of behavioral health services], and they're for-profit. And any time you base your services on a for-profit system, something's going to suffer. And what has suffered is small agencies [News, March 4: "Value Judgements"]. I think larger agencies can absorb all the requirements that managed care puts on them, but smaller agencies, we don't have the infrastructure to support all of the requirements that OptumHealth has of us: Do we hire a full-time chief financial officer or do we hire two half-time therapists on contract? What managed care imposes is a good thing, but the system doesn't provide the money to support that. The system provides reimbursement for direct services for patients; they don't provide money for the administrative part of it.

Will that affect you in the long run?
Oh yeah. I'm not certain if we're going to be able to continue. That's where we are. It would be a sad thing because I think we're very needed in the communities that we serve. I think we provide very good services. We hire qualified folks to provide these services, and they cost. But like I said, the infrastructure just isn't seen as worthy of additional funds.

How has Ayudantes adjusted to the financial situation in recent years?
We started out really small­—it was all volunteer. I didn't get a paycheck until maybe a year into it. But it grew: At one point in our history, in about 2001, we had 60 staff. We had a budget close to $2.6 million. We're down now to $1.1 million. It may even be less; I don't know; it keeps shrinking. It's been difficult, but we've survived, and I'm hoping that we will continue to survive. I'm not sure how it's going to work out, but I'm the eternal optimist. Something's gotta give. And if it's not meant to be, it's not meant to be, but it's not because no one has tried.

Santa Fe Reporter