Should Doña Ana County build a new mental health hospital?
Las Cruces Sun-News (NM)Feb 08, 2016
The study, carried out by
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
But the study notes that facility, known as the
Local mental health advocate
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
"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
County Commissioner
"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
Officials with
"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 (
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
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
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
Some local officials have discussed ways to try to improve recruiting new behavioral health staff to the area.
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
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
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
Doña
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
"We're moving forward, and I'm very pleased," he said. "I really appreciate the professionalism of the report."
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