Despite financial investments in its behavioral health system, New Mexico lacks a “comprehensive grasp” of its finances and has done a poor job of providing services for consumers with mental health and substance abuse issues, according to a scathing report released Sept. 24 by the state’s Legislative Finance Committee.
The state does not know how it spends an estimated $209 million on adult behavioral health, whether it’s funding effective services, whether services are located in high-need areas or whether services are producing expected results, according to the new report. Estimates are that the state only spends 11 percent of its limited funding on proven and effective programs for adults, even though past studies have recommended greater spending on these services.
According to the report, “LFC Results First: Evidence-Based Behavioral Health Programs to Improve Outcomes for Adults,” New Mexico has been plagued with a number of problems regarding its behavioral health system.
Last June, state officials released an audit alleging that 15 of the state’s largest behavioral health organizations had engaged in mismanagement and widespread overbilling of federal and state government money (see MHW, July 15, Sept. 16, 2013). Five Arizona agencies were subsequently brought in to manage services for consumers with serious mental illness.
For adults, New Mexico leads the nation in alcohol-related death rates and is ranked among the worst in the nation in drug overdose–related death rates, suicide rates and serious mental illness rates. These persistent challenges in behavioral health outcomes, along with gaps in services, have substantial consequences in costs to consumers and taxpayers, including increased criminal activity, increased use of the health care system, property loss, decreased labor market earnings and preventable deaths, the report stated.
Behavioral health outcomes
Behavioral health outcomes in New Mexico continue to rank among the worst in the nation, the report stated. About two in 10 New Mexico adults suffer from mental illness and one in 10 suffers from mental illness. Serious negative outcomes include:
- The percentage of New Mexicans with a mental illness is higher than most states, and the percentage with a serious mental illness is among the highest in the nation.
- From 2008–2012, about 63,000 adults, or 4.3 percent of the adult population in New Mexico, had serious thoughts of suicide in the previous year.
- The suicide rate has consistently been among the highest in the nation.
- The alcohol-related death rate has been the highest in the country since 1997.
Adult mental health issues range from stress, anxiety and depression to more serious functional impairment and life-threatening situations such as serious mental illness and suicide, the report stated. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) reports 19.6 percent (300,000) of New Mexicans 18 or older have a mental illness.
This figure is above the national percentage of 18.2 percent. SAMHSA also reports 4.72 percent (72,000) of New Mexicans 18 or older have had a serious mental illness in the past year, up from 3.4 percent in 2008. This figure is well above the national percentage of 3.97 percent and ranks among the highest in the nation, according to the report.
The report noted that evidence-based practices (EBPs) for the treatment of mental illness and substance abuse disorder are limited and oversight of program fidelity is lax for many programs. Such programs as assertive community treatment, cognitive behavioral therapy and illness management and recovery are available.
Other EBPs, including collaborative care management for depression and depression with comorbid medical conditions, and primary care behavioral health co-located in community-based and integrated care settings, may be buried in generic individual therapy codes and specific treatment interventions and cannot be identified, the report stated.
The analysis also emphasized “the need for a system of care which is planned and designed coherently, managed and led effectively, and owned and guided by those who benefit from and contribute to the system’s existence and success.”
Additionally, the report recommended that the state:
- Develop and use common reporting system requirements;
- Develop a common set of core services across funding streams;
- Require or provide incentives for adherence to evidence-based practices; and
- Create statewide behavioral health research and development capacity.
“The Legislative Finance Committee report adds to the conversation about ways to improve behavioral health outcomes in New Mexico,” Matt Kennicott, spokesperson for the New Mexico Human Services Department, told MHW. “As has been the case over the past several years, we will continue to support the use of evidence-based practices in behavioral health. But this is only one part of the conversation.”
Kennicott added, “We also need to improve access to behavioral health services broadly by focusing on individuals in a holistic manner through integrated care in Centennial Care (our new Medicaid program), addressing behavioral health workforce shortages and streamlining the regulatory structure.”
He noted that HSD has taken important steps to improving access. “This is evident by the increase in the number of behavioral health consumers that were seen in FY14 — an increase of 30.8 percent over last fiscal year to more than 114,000 individuals served,” Kennicott said.
Meanwhile, HSD officials announced Oct. 1 that the department’s Behavioral Health Services Division has been awarded a suicide prevention grant from SAMHSA to help prevent suicide and suicide attempts among working-age adults from 25 to 64 years old, and to reduce the overall suicide rate and number of suicides in New Mexico. The grant totals $1.4 million over three years, with the state receiving $470,000 each year.
The state’s behavioral health system "has never been top notch," especially in light of the Medicaid fraud allegations in 2013, Rep. Elizabeth “Liz” Thomson (D), chair of the Behavioral Health Subcommittee, told MHW.
“It’s really disturbing and disheartening that only 11 percent of our behavioral dollars is being used on evidence-based treatment,” said Thomson. “We can’t say with one-hundred percent certainty that more funding isn’t being used [for these treatments]. We want to see better traction and more [emphasis] on evidence-based practices.”
Additionally, the way the state conducts its Medicaid billing, it’s impossible, she said, to determine whether evidence-based treatments are being used. “The billing codes need to be changed in order to dig down and see what therapies are being used,” she said.
The subcommittee, meanwhile, is working on recommendations for addressing challenges in the behavioral health system, including the lack of providers and homelessness, Thomson said. “The legislative council charged us with coming up with a plan,” Thomson said. “The problem is New Mexico is a poor state and a very rural state.” The subcommittee will take their recommendations to the full legislative subcommittee in late November or early December, she added. “We recognize that what we come up with will not [necessarily] fix the system,” said Thomson.
The state legislature’s Behavioral Health Subcommittee is preparing recommendations to release in another month on repairing New Mexico’s behavioral health system.