Santa Fe’s behaviorial health services demonstrate the effect of the nationwide transition in mental health care that began in the 1950s, but has never been completed. Institutions were phased out, but community mental health centers never fully took their place.
Health care policy scholars have a word for what happened instead: transinstitionalization. The result is a landscape of stopgaps, temporary fixes and poorly funded programs unprepared to handle the mentally ill.
“The county detention center is the de facto psych unit,” Cooke says.
When the Santa Fe County Sheriff’s Office transports people in the midst of mental health crises to CSV, they are often deflected to the Santa Fe County Adult Detention Facility, even if the individuals are not facing charges, Sgt. William Pacheco tells SFR.
The jail has two psychiatrists, three therapists, and a mental health director, case worker, social worker and mental health administrative assistant on staff to deal with the influx of inmates with mental health issues. Facility psychiatrist Dr. Eli Fresquez says there is at least one inmate on suicide watch at any given time, and approximately 10 percent of the jail’s population is suffering from mental health issues. About 35 percent of detention officer training is dedicated to behavioral health issues, such as recognition of mental illness signs and symptoms, issues with psychiatric medications, and mental illness crisis management.
“I think we are the largest mental health provider in the area,” Fresquez says.
“Most of them are going [to the jail] because the hospital is not admitting them,” Judge Vigil says. “It’s not ideal; it’s terrible, They shouldn’t be in jail; they should be in a mental health facility. But nobody wants to pay for it so the taxpayer is being required to pay for it, through corrections.”
Some of the mental health patients who are being held on criminal charges probably wouldn’t be there if they had received adequate intervention for their mental health crises.
“People with bipolar disorder or paranoid schizophrenia are usually in a psychotic state or a manic-depressive state at the time of their commission of the crime,” Judge Vigil says. “That does not excuse the crime because they still have a basic understanding that their actions are inappropriate; it’s just their mental health is really causing them to do things they wouldn’t normally do if they were properly medicated and in treatment.”
In Homeless Court, Yalman sees the same faces over and over. These are the people who have slipped through the cracks between CSV, the PACT Team and other local mental health services.
“There’s delays getting them into programs…in the meantime, they’re having all these problems and the problems are with the law,” Yalman says. “The resources are just not sufficient, and they’re overburdened…the jails become sort of a repository for the mentally ill, which isn’t what their purpose is.”
St. Elizabeth’s already tight budget is strained further by an unfunded service they provide for people who are discharged from CSV but are too sick to be on their own. Respite care, as it’s known, serves many mental health patients—despite there being no actual health care workers or mental health professionals at the facility. In addition, respite guests tend to stay two or three months at the shelter, which is supposed to have a 30-day limit. CSV’s revolving door is a familiar phenomenon to St. Elizabeth’s staff.
“It’s very difficult to get people into the behavioral health ward when people are in crisis, and to keep them there long enough so they can actually alleviate whatever the crisis is,” Tang says.
One of the hardest things for George and Veronica Vigil to accept about their son’s death is that they had no idea he went to CSV, or that anything out of the ordinary was happening with him, until they found out he was missing shortly before his body was discovered. Veronica spoke to her son approximately a week before his death, when he was riding the New Mexico Rail Runner Express back from Albuquerque after a shift at Presbyterian Hospital. He was his usual happy-go-lucky self, she says.
That’s the scenario that people with mentally ill friends or family shudder to imagine: What would happen if they weren’t there to advocate on behalf of the vulnerable patient? Santa Fe NAMI President Louise Drisdale says she had to learn how to get her mentally ill son the care he needs.
“When you’re in the depths of trauma in your family, all you want is somebody to help you fix it; and when you don’t know the right questions to ask, it’s really, really hard,” Drisdale says. “You depend on the people who should know what they’re doing…I believed the system would take care of [my son], but it doesn’t happen like that. If there isn’t somebody to advocate for them, that’s where they fall through the cracks.” SFR