Within Reach

As Santa Fe County looks to break ground on a new, taxpayer-funded triage center to help people in the throes of psychological crises, one of its most ambitious goals is to rupture the stigma of getting help for mental health.

Community Services Department Director Rachel O'Connor acknowledges there is a desperate need to assist the roughly 2,500 people in the county living with severe mental illness, many of whom are also homeless and addicted to alcohol or drugs. But she insists that the crisis center, which may not be open until 2019, won't only be for this population.

Anybody "can have situational crises," O'Connor says. "People lose their jobs, go through divorces, they have hard times in their lives—you can spin into a crisis relatively quickly. … Those issues are just as important as someone who might have a severely disabling mental illness."

The one-eighth percent gross receipts tax that Santa Fe County Commissioners approved to finance operations at the crisis center went into effect Jan. 1, and last month, the county put out a request for proposals for a primary partner to help decide where to locate the center and how best to plug different services providers into the effort.

In addition, the county recently entered into a contract with the Santa Fe Recovery Center for a detox program that would also receive funding from the city and Christus St. Vincent hospital and be co-located with the crisis center. At present, there are no plans for other long-term inpatient psychiatric treatment at the facility. Yet, taken altogether, O'Connor hopes it will be the new frontline for people experiencing acute mental distress, displacing law enforcement and the emergency room as a first step for such services. The county estimates the new tax increment will bring in $1.6 million each year to pay for programs and staff, while it plans to use $2 million in capital funding from a bond to construct the center.

The center aims to serve two main functions. The first, O'Connor says, is to "relatively quickly stabilize a person [seeking psychiatric care], and hopefully navigate them into a more appropriate level of care. The second thing is we have providers who work day-to-day with people who may suddenly escalate into a higher level of care than they can support; where that person can come almost in an emergency type of situation to the crisis center, and then go back to their long-term care situation."

O'Connor imagines several agencies besides the primary partner having a staffed presence at the center. "We're hoping to co-locate navigation services here, for example, HUGS [Christus St. Vincent's High Utilizer Group Services]. We're hoping to have reps from LEAD [Law Enforcement Assisted Diversion], we're hoping to have representatives from the PATH [Projects for Assistance in Transition from Homelessness], which runs out of Life Link, and from the MIHO [Mobile Integrated Health Office], which is run out of the city."

"Navigation services" is county-speak for having people on staff who talk to patients and figure out what they need, whether it be drug counseling, shelter, postpartum care or other services. Many of the agencies O'Connor envisions having a presence at the crisis center already work together through the county's year-old Accountable Health Community action plan, which coordinates care and services among varying agencies and is one foundation on which the crisis center will be built.

Andres Mercado, an officer with the Fire Department's MIHO program that works to navigate frequent 911 callers toward social services, says he is supportive of the county's efforts at closer coordination.

"There's no place [in the county] for behavioral health issues when it's not an emergency but when a person needs a certain level of services on the spot," Mercado says, "and I think [the county's crisis center] will fill a big gap we have in that it also provides a physical hub for what the county is trying to do at the systems level."

Another one of the agencies involved in the Accountable Health Community program is the Interfaith Community Shelter at Pete's Place. Executive Director Joe Jordan-Berenis considers his shelter a "first step in a continuum of care" among agencies in the county. Folks can show up to Pete's Place as they are, Jordan-Berenis says, and the shelter's navigator keeps in contact with other shelters and social service providers to send a person elsewhere when their personal needs change.

The county is hoping that the crisis center will act like a bulldozer to raze such barriers. At a luncheon hosted by the county at the Hilton Santa Fe last month, county Health Services Division Director Patricia Boies told the room full of social and health workers that in the first quarter of fiscal year 2018, 65 women and 18 men received "navigation services" from seven different organizations, which were able to deliver on nearly half of the "unmet social needs that influence health" for those 83 people.

Boies said the approach is part of an institutional paradigm shift that sees a person's mental, physical and social health as inextricably linked.

"What I hope," says MIHO's Mercado, "is that in some years, we look back and see that we were insensitive and we were inefficient and wasted a bunch of time, money, energy and resources, and that we matured as a community."