By Mary Alice Murphy

Several members of the Grant County community, who have been working on a continuum of care to address substance abuse, spoke before the Interim Legislative Behavioral Health Committee on Wednesday at Western New Mexico University.

Those speaking included Susie Trujillo of Gila Regional Medical Center Project Development; Michael Carillo, Grant County Detention Center administrator; Ron Hall, District 3 county commissioner; Chris DeBolt, Grant County Community Health Council coordinator; and Jim Helgert, WNMU professor of chemical dependency studies.

Trujillo praised Hall's hard efforts. "We are here before you because Ron is so passionate and committed that he has moved us forward."

"We are not asking for anything from you," Trujillo continued. "We are doing it ourselves. The history of our community around substance abuse is that for 10 or more years we have been working to address the issue. We get what I call 'flavor of the month' funding, so funding goes up and goes down. A program is funded, and then it goes away. The substance abuse continuum of care idea has had a four-county committee, but Ron said he would like to do something different.

"We split into a smaller group," she continued. "Gila Regional offered Ashleigh Garcia to facilitate the meetings. We've been meeting at least weekly. I have given each of you a packet with six items of data and articles."

"I'm just a cog," Hall said. "You see here the full wheel. I was a police officer for 25 years, and, then as magistrate judge for about 20 years, we shoestringed to develop programs. After I retired, I ran for county commissioner, with this idea in the back of my head. We, as a commission, decided to develop a substance abuse continuum of care center for just Grant County. We are doing it in phases, with feasibility and needs assessment being the first phase. We came together with the stakeholders. We brought in district, magistrate and municipal judges. We talked to law enforcement and heard horror stories from the Sheriff's Office and the same thing with first responders. We did surveys to get a handle on the needs assessment. Mike came on board. We knew we wanted to find independent funding, so we sat with our architect. Yucca Lodge is a great asset in the community for substance abuse, so we talked to them. We talked to Human Services Department, the Department of Health, and other agencies. The message was always that Grant County has a substance abuse problem. We didn't realize how large.

"Services weren't coordinated," Hall continued. "We developed a program to meet our needs. We brought in ideas from Turquoise Lodge; we determined best practices, and have done site search. We are close to resolving the site. Through the county, we secured funding. We are at the request for proposal process. Phase 2 will be planning, site selection, architectural drawings, and an RFP for a provider of services. Phase 3 will be the build of the facility, and Phase 4, occupancy with providers."

"We are not looking at anything particularly different," Trujillo noted. "We figure if we have services in one place, it reduces fragmentation. We are doing the work differently. We looked at whether the service is reimbursable, how the provider is licensed and certified."

Carillo said the group's reasoning behind the process is "the need for services and a facility. I came to the Detention Center from law enforcement. Law enforcement to corrections is an eye-opener. We have needs and issues for an inmate support system. We have alcohol abuse, substance abuse, mental health issues and recidivism. Seventy-five percent of our inmates are recidivists. The rest have alcohol, substance abuse, or mental health problems. We are just putting a Band-Aid® on a bigger problem. They don't belong in jail. We are losing family members, kids, grandparents. When they get out society has labeled them. We don't have the resources to address the problem. When they are let out, they go back to the same people and same behavior."

He said an intern from Western is providing them with resources for help. "If we don't help them, we have to build more jails. When I came back to Silver City, I walked into the jail and saw the same individuals I had arrested in the 1970s. The younger people told me: 'My dad and grandpa told me I would meet you.' It's generational. Then it was socially acceptable to put alcohol in a baby bottle. Now it's doing meth around their kids. We need to do something different, because what we're doing isn't working."

Carillo said he had an inmate who was dying. "We sent him to the state hospital, where he stayed for 30 days. The release date came and they sent him to Las Cruces where he didn't know anyone. He stayed in a halfway house and they bought him a bus ticket to Silver City. His family didn't even know he was here."

"Right now, the same practices have to change," Carillo said. "What we're doing is morally wrong. It's wrong. We cannot lose perspective of who they are in spite of what they did. We have to provide them with resources."

Trujillo noted that the group has received information from the Department of Health epidemiology section. She also pointed out that in the packet given to the legislators are a jump drive on which are the epidemiology report, fact sheets, and the Grant County Community Health Council plan and profile.

"Grant County is first in the state for binge drinking and third for heavy drinking," Trujillo said. "Concerning controlled substances, the county has high levels of opioids use, is fourth highest in opioid prescription use. We had 306 hospitalizations due to substance abuse. We serve a 1,700-mile area. Our alcohol mortality rate is similar to the state's rate, but is twice as large at the national rate. We recommend access to effective treatment. We want to prove we have done our homework."

DeBolt talked about the survey sheet. "I was a member of the health council, and now I'm the coordinator. Much more information is on the jump drive. On the assessment, substance abuse was ranking second among residents' concerns. For every group surveyed, alcohol and substance abuse was first, second or third, most often first or second."

She also showed the legislators a copy of the resource directory, which could also be found on the jump drive. "It lists every resource that is free to the residents. We encourage you to use your health councils to do work like this."

Trujillo noted there is a crisis in the New Mexico Access Line. "The highest number of calls was 716 in Bernalillo County, but in Grant County, which is much smaller, there were 351 calls. We are going to challenge you guys on the Medicaid waiver. There is a whole grid that Medicaid would like to cover. We hope you look at behavioral health on the grid, Information is hard to come by."

Rep. Elizabeth "Liz" Thomson of Bernalillo County, who serves as chairwoman of the interim committee asked for waiver information.

Trujillo said she would give copies to them. She also pointed that work force is a huge problem, because of substance abuse. "We are lucky to have Western New Mexico University to address it," as she introduced Helgert.

Helgert, who teaches chemical dependency studies at Western, said the program is in the College of Professional Studies, along with counseling, behavioral health, psychology, criminal justice and social work. He described the degrees to which his course can lead. "At Western, we have the only four-year chemical dependency degree in the state." He then listed the classes that can lead to the degree. "It is the only clinical degree from Western that you can get licensed from a bachelor's degree." He listed the jobs that fit the degree. "Chemical dependency ranks in the top three of work force issues for lost productivity in the country. Most child abuse, divorces, homelessness and suicides are a result of substance abuse. It is slated to grow by 30 percent by 2022, it is estimated. We teach evidence-based practices, because we want the students to have confidence in a job when they graduate."

Trujillo began the sentence: "One of our issues...," which Helgert finished: "is when we produce the students. If they are not employed by a community mental health center, they may not be reimbursed for their work. It's killing us, especially us in the middle of nowhere. We have seven licensed graduates, but after the implosion of the behavioral health system, they are not able to be reimbursed."

Sen. Cisco McSorley of Bernalillo County commented: "What a great presentation. I don't know what's in the water down here, but you have led the way in so many things, and this is just the latest."

He noted that the Pugh Foundation is helping to rebuild the criminal code. "We would like you, Mr. Carillo, to talk to several committees—the judicial, corrections and the rewrite committee. Could you get this idea into the school-based clinics?" to which Helgert shook his head no and said: "because it can't be reimbursed."

McSorley did not see the shake of the head nor hear the words, and kept talking. "Having the graduates in the schools would kill two birds with one stone. Expanding the programs to adolescents can nip the problem in the bud."

McSorley pointed out that in the 1960s, "they dismantled the behavioral health warehouses for those with mental illness, which was the right thing to do, but did not provide a comprehensive alternative. Jails are not appropriate places for them. We need to solve the mental health issues with a public health solution, not through corrections. We need to reinvigorate our public health system. I challenge you to free up $42 million for public health," he said to those legislators who also serve on the appropriations and finance committees. "Over half of Bernalillo County goes into the Detention Center. It costs $100 a day for incarceration, and $22 a day for treatment. We are last in the nation in providing alternative services to incarceration."

"Now I have statistics and can say you are doing this in Grant County," he continued. "I constantly sing your praises for your restorative justice system."

Sen. Gerald Ortiz y Pino of Bernalillo County said the group gave an "inspiring presentation. Have you looked at Oxford House?" Trujillo replied that the group had toured one of the homes.

"It's a simple and elegant way to maintain sobriety," Ortiz y Pino said. "A local option liquor excise tax could be a financial resource for you."

"We are always supportive of funding," Trujillo said.

"Increase the tax on alcohol, and it would fund treatment," Oriz y Pino said.

"Most of what we are proposing is doing the same thing as Oxford House, but a little bit differently," Trujillo said.

"This article you included (in the packet) is excellent," Ortiz y Pino said. "It captures the frustration of Medicaid. The entire state behavioral health system converted to Medicaid. At the state level, we have to put in some restrictions. The silly circular non-productive hospital jumping was put on the local communities. The 50 million of non-Medicaid behavioral health patients were given to Optum, which uses the same hospital jumping. They try to take non-Medicaid money out of managed care."

Sen. Howie Morales, representing Catron, Grant and Socorro counties, thanked the group. "I have incredible respect for what you presenters do. I give you and the County Commission credit for finding the funding. You have the steps in place. I think this is unique and could be used as a pilot for other areas. I think DOH can use some of its funds. I ask you to see if you can form a partnership with Yucca Lodge, and how this can tie into this initiative."

Jeremy Averella, Fort Bayard Medical Center chief facilities officer, said he, Brad McGrath and the Fort Bayard team were looking at how to logistically form the partnership. "Yucca Lodge is kind of a sister facility to the main Fort Bayard hospital. Maybe we can parse it out and get funding with the partnership."

Morales asked: "What is the operating budget for Yucca Lodge?"

Averella said: "$1 million, but that does not include the food and maintenance costs, which are included in the whole facility's operating budget."

"Would it be possible to move the funds to the continuum of care and open up space at Fort Bayard Medical Center?" Morales asked.

"That has been discussed," Averella said. "Anything can be done with the right funding sources, but we don't have the funding separated. In detail, when we have the new facility, we will need security, dietary, housekeeping, maintenance and other costs. We, right now, don't take people from corrections. We will have our own entity at the continuum of care."

"Can those services be in the new facility?" Morales asked.

Hall replied that the group is talking about that and "we continue to talk about that issue. We will put out a request for proposal to provide services. We will provide the facility."

"I want to maximize the resources," Morales said. "I have asked local governments to put in funding you, and you have. Now the state has to step up."

The session went onto a different topic with different speakers.