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Psyched Out

Patients are being pushed aside because of profits and policies

May 25, 2011, 1:00 am

“If they spend all the money, they make no profit,” Judge Michael Vigil says of OptumHealth New Mexico, the state’s managed care organization. “So the fewer [hospital] beds they have to pay for, the more money might be left over.”
Credits: Wren Abbott

CSV serves the behavioral health needs of people living in seven counties in northern New Mexico, approximately 238,164 of whom suffer from mental illness, according to an April 2010 study commissioned by CSV. According to the study, by AE Consulting, 4,763 of those people are classified as suffering from serious mental illness, defined as “persons who often need psychiatric services provided through the hospital and the publicly-funded behavioral health system,” though that’s a low estimate, in the opinion of some members of the National Alliance on Mental Illness’ Santa Fe chapter. 

The study also found that CSV’s 11-bed IPU is usually less than half occupied, with an average occupancy of 4 patients. Yet according to the NAMI Santa Fe newsletter and Santa Fe County Sheriff’s Office staff, CSV often claims the IPU is full when prospective patients are turned away.

“We had a meeting with the hospital and they were saying [the IPU] is underutilized,” Deborah Tang, executive director of St. Elizabeth Shelter, says. “It’s like, ‘What do you mean it’s underutilized? You’re turning people away all the time!’”

Joe Hay is a case worker at St. Elizabeth Shelter who works with ED “frequent flyers”—patients who have a mental health diagnosis, a substance abuse problem or both, and seek repeated treatment at the emergency department. He tells SFR that, to be admitted to the IPU, patients need to be a clear threat to public safety or completely willing to get assistance, not a description often applied to those in the midst of a mental health crisis.

“It requires a lot of cooperation [from the patient] in order for [the IPU admission] process to start, or very severe threats like criminal activity before they will keep a very long psych hold on somebody,” Hay says. “Otherwise, they just get let out again…They need to say they want to get treatment, to agree to testing, to agree to an evaluation, to agree to stay in the psych ward or go to the Behavioral Health Institute [in Las Vegas] and without that cooperation…it needs to be very, very severe; otherwise, they get sent out again.”

First Judicial Court Judge Michael Vigil (no relation to Anthony Vigil) presides over the region’s Treatment Court program and gives a similar report on the care received by people he’s referred to the ED.

“We have had people who we have sent to the emergency room from our Treatment Court program, which is a program that works with mentally ill defendants, and who seem to be in a psychotic state. And we will have them taken to St Vincent’s, and they will usually give them some type of medication and release them back onto the street with very little follow-up,” Judge Vigil says. “It’s people who we feel need to be hospitalized until they’re stabilized.”

Unfortunately, the consequences for patients who don’t surmount these hurdles and gain entrance to the IPU can be dire. Judge Vigil points out that Santa Fe is lucky an incident like the 2005 murders perpetrated by schizophrenic John Hyde in Albuquerque hasn’t yet happened in Santa Fe. So far, the deadly events here that seemingly could have been prevented with more proactive hospital policies have mostly been suicides.

“We have had people who try to get treatment and end up killing themselves,” Vigil says. “They’re suicidal; [hospital staff] will talk to them for awhile; they won’t admit them; and they’ll end up taking their own life.”

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