[Editor's Note: This is part 2 of the county work session on March 23, 2021]

By Mary Alice Murphy

Tuesday, March 23, 2021's work session, the second of the month for the Grant County Commission, featured presentations and discussions.

The first presentation can be read at: https://www.grantcountybeat.com/news/news-articles/63903-grant-county-commissioners-hear-presentations-at-second-work-session-of-month-032321-part-1 .

Renee Despres, PhD, MPH, NM-EMT/I, a local health consultant, presented a proposal for commissioners to consider planning and budgeting for a Grant County Health and Human Services Department.

She said such an agency, managed by the county, would provide necessary infrastructure to support residents' wellbeing, build local health care, social services, and public health capacity, as well as coordinating existing resources in the county, using a data-driven approach. It would also advise county leadership on evidence-based policy decisions.

"I am not here as a COVID-19 Task Force representative, but because I feel a Health and Human Services Department would be important to the county to identify and address unmet needs of county residents," Despres said. "Part of the reason why I am proposing this is because of what I am seeing while working with the task force."

She noted that county personnel had responded with the resources they do have, but no coordinated effort exists to support residents' health and wellbeing.

Despres said that, like in other rural areas around the country, Grant County's population is sicker, poorer and older than its urban counterparts. Nearly one out of 3 or 29 percent of the county households have no access to the internet and many are not able to navigate the online environment.

"COVID-19 did not create these needs, it simply exacerbated them," she said. "We remain in an emergency. If we had had the agency, it would have helped. And the needs will continue. Social and environmental disparities have grown."

She noted that the high rate of poverty, food insecurity, the lack of broadband and the large distances to travel to needed health care, as well as the high rates of obesity, diabetes, heart issues, cancer, and the major issue of drug and domestic abuse, only adds to the problems and needs.

"Our economy requires a healthy workforce," Despres said. "But we don't have one. There is a lot of funding available to address many of these needs, but our capacity to pursue it is limited."

She explained that Grant County has a robust group of organizations that provide health care, public health and social services, including Hidalgo Medical Services, Gila Regional Medical Center, Silver Health Care, Cassie Health Care and more. Border Area Mental Health and multiple private providers offer mental health services. Social service organizations include El Refugio, Supporting People in Need, Kids in Need of Supportive Services, faith-based organizations and more.

"With few exceptions, there is little coordination among the services and organizations," Despres continued. "The Grant County Community Health Council is the advisory body to the county, but its capacity is extremely limited due to uneven funding and loss of membership over the past decade or more.

"By coordinating the resources through a county Health and Human Services Department, we can create one of the most thriving counties in the Southwest," Despres concluded.

Her presentation included a written document to the commissioners of the proposed structure and function, which would work closely with the County Community Development Department to assure health is considered in all development plans and activities.

District 3 Commissioner Alicia Edwards said this idea "is something I've had several conversations on over the past year. The driving forces for me are the concept for workforce development, which has stuttered over the years, but it feels like we're finally moving forward. And also we have a severe lack of resources for the poor in our community. One of my largest areas of concern I've addressed by working with pediatrician Dr. Brian Etheridge to build a pediatric consortium to work in groups in pediatrics. I'm in all the elementary schools and Montessori, with my Health Kids, Healthy Community job. As a commissioner, I'm involved in Stepping Up, in efforts relating to law enforcement, and as chair of the Gila Regional Governing Board, we've been talking a lot about reinstating the Behavioral Health Unit. I've been having these conversations on a call with a group of people I've never participated with before and we're having the same conversations."

She also noted the alarming number of mental health issues in children, including suicides. "We're talking about how we can partner with UNM neuropsychiatry to do an evaluation of children here. Dr. Etheridge has referred 47 children to UNM. Many don't have the transportation to get there and cannot afford to stay at a hotel. We have serious needs in this community. We need a realistic idea of what's bothering our kids. We expect them to grow up and be productive citizens, but if they are having suicidal iterations at age 7, that's not a likely outcome. With such an agency as Renee is proposing, we could access funding."

District 5 Commissioner Harry Browne said: "This is all new to me, but I appreciate the concreteness of this proposal, Renee. That said, I have two questions. Why a county department rather than bolstering the health council and have you seen an analysis or comparison of similar departments?"

Despres said she believed the health council and a county department would have separate roles. "The health council is a group of volunteers, with a half-time coordinator."

Browne asked what if the proposed $336,000 could go toward the health council instead of a department.

"We need the infrastructure and county resources to access the millions in funding that are out there," Despres replied. "On your second question, Doña Ana County, although much larger than Grant County, is probably the best example of a department not offering direct services but using other groups to do the work. Another piece of the puzzle is longevity and sustainability. Health councils are subject to political winds. Rio Arriba County also has such a department. Doña Ana County also runs a DWI program that reduces recidivism."

Edwards said she agreed. "Plus, the $336,000 in the third-year budget doesn't include other support of the county, such as human resources department, the county manager, the finance officer, the purchase officer that would not be supporting the health council. I highly value our community organizations. Our county has incredibly strong community organizations, but I think the partnership is critical. The weight comes with the county being a public health organization. Jamie in Doña Ana County is doing a great job and Rio Arriba County also chose to create a health and human services department."

District 1 Commissioner and Chair Chris Ponce noted that $336,000 is a lot of money, "when we already have these community organizations. My question is on the funding. I'd like to understand it a bit better."

Edwards said this was just the beginning of the conversation. "I think we have an opportunity with the federal funding that will come into the county to fund something like this. It feels like the timing is right. I think there are a lot of unanswered questions. I think it's an ask to invest in the health and wellness of the community going forward. I have no doubt in my mind that the return on investment would be high for a long time in our community."

Ponce also cautioned about starting such a department and then having to drop it when funding drops. "How will it affect Border Area, for instance? One of my biggest concerns is mental health. This brought up more questions for me. I've seen programs start up and then when funding drops, we leave them hanging."

Browne asked if the funding Edwards was talking about was the American Rescue Plan moneys. She replied that about $5 million is coming to the county.

To Webb, Browne asked if the county has requirements for the use of the funding, and Webb replied: "Not yet."

Despres said she would be happy to return to the commission and offer estimates of ROI. "If we kept three people out of the Detention Center, it would pay for the program."

Browne said he would like to hear from the health council on this proposal and how the council would work with such a department.

Despres said the health council had recently increased its steering committee membership.

"I was an early member of the health council," Browne said. "At that time, we had about 30 people representing 30 sectors of the community."

Edwards suggested having Despres, Jamie from Doña Ana County and representatives of the Grant County Community Health Council at the April second work session to discuss the proposal. "I will be happy to accommodate that."

Browne asked that any ROI be calculated not as an investment question, but whether it would be better to spend the funding in a department or put it into the groups and whether and how they would benefit.

The next discussion of the meeting centered on the county treasurer presenting the revised county investment policy.