The NM Mental Health Care Audit: Out of the Frying Pan

The state of NM has yanked Medicaid and Medicare funding from fifteen agencies that provide mental health care services all across New Mexico. This represents 30,000 patients, many of them children, some of them the very sickest of the population of people with psychiatric illness.

I don’t use the word “yanked” accidentally or lightly. There was no warning; not for patients, not for providers, and not even for the administration and management of these agencies. The NM state government announced in June that it would halt funding to the agencies and hand over their administration to five Arizona agencies.

We’re flying our flag upside down. We’re on our knees, begging someone in power to come and save us. Our newspapers and media outlets, from Albuquerque to Taos to tiny Quay, NM, are suing our government, trying to force them to offer some transparency, some little hint of what has happened and where we’re going, and they are silent. New Mexico, like every state in the US, has its own auditor, but NM contracted with a Boston company to conduct the audit at a cost of $3.2 million. Why? We’ve heard no reports of corruption in the auditor’s office, so why did they do that? Were we just in the mood to send a whole lot of our money to Boston and Arizona and we needed to find a way to do that? Because for all the information we’ve been given, that makes about as much sense as anything.

The line we have heard again and again from the NM Human Services Department (HSD) has been that there will be no disruption of services. Even as the stories have begun to circulate indicating that the transition of management has been anything but smooth (and in some communities and families it has been disastrous), HSD has continued to assure us that all is well. Everything is fine.

I was on a conference call last week that was advertised as a “listening call” so that HSD and representatives of the Arizona agencies could hear consumer concerns. My alarm bells sounded right away, because contrary to the commonly held conception of people with mental illness, many patients do have jobs, and the meeting was held from 1:30 pm to 3:00 pm on a weekday, so that cuts one significant population of consumers out immediately. Next, the call was conducted in English, with no plans to conduct another meeting in Spanish or Navajo or with translation services available for speakers of other languages, removing many more people from potential participation. The announcement about the meeting went out via email, cutting out the many people in our state who don’t have access to a computer, and the fact that a phone was required for participation again removed a large group of people. Finally, many people who are very seriously ill just can’t. To expect a person with severe thought or mood disorder that isn’t under control to participate in such a call is laughable.

But maybe that’s part of how such a terrible thing is happening: its victims are a population that is less able to advocate for itself than many others.

To be blunt: everything is not fine, and every word spoken on that “listening” conference call by anyone who isn’t paid by HSD made that clear. There are children who are not in school because agencies that provided behavioral management services to children so they could attend school (commonly known as 1:1 services, and provided via Medicaid instead of the public schools in NM) don’t have them. There are families whose children are in foster care who can’t do the items on their family action plans because there are no providers to oversee and provide for those plans. The overflow from the agencies that are part of the audit is creating profound pressure on other agencies that receive public funding, so that service is reduced for nearly everyone across the state.

For perspective: I wrote A Dislocation of Mind, about the many weeks it took to get my daughter some psychiatric care in this state, over three months before the audit started. It’s not like the situation in mental health care and addiction treatment was good before this started; we’ve gone from abysmal to catastrophic. What I have detailed here are just a few hints to the horror that the audit is for the people on the ground: the patients and providers who live with the reality of mental illness and addiction every day of the year.

And yet, with all this, we’re having a very hard time getting any attention to this crisis. My friends, I’m asking you, please, if you live in NM, write to the governor and all our legislators and to HSD and insist that they put patients first. If there is money missing, certainly we need to find out where it went and what happened, but not at the expense of people who are sick. (By the way, does it seem unlikely to you that there is vast wrongdoing in mental health care but all the agencies that deal with broken bones, skin cancer, and the flu are pure as the driven snow? Yeah, me too.) The NM congressional delegation has asked US HHS Secretary Kathleen Sebelius to set up a public forum, but no date for that has been announced.

If you’re not in NM, please send a note to anyone you know in national media. No one seems to be all that interested, and I am no cynic, but it’s hard not to think that few people care because people with mental illness are a little weird and scary and not always likable (Just like the rest of us, but don’t people with mental illness make the handiest scapegoats?). We need the federal government to pay some attention to us, and my fingers and those of my advocate friends are about raw with all the letter writing.

Watch this.

Read this.

Watch this space for links to a radio series on the audit, which will include part of an interview I did with Tristan Ahtone, the public health reporter at Fronteras. If you’re in NM, you can listen to it on KUNM tomorrow during Morning Edition in the am and All Things Considered in the pm, or you can stream it if you’re not in NM.

I Now Pronounce You MARRIED

Yesterday, New Mexico State District Judge Alan Malott issued the order: all clerks in Bernalillo and Santa Fe counties must begin issuing marriage licenses “without regard to the couples’ sexual orientation or gender” by today at 8 am, making them the second and third counties in which same-sex marriage is legal.  As of this moment, 6 pm on Tuesday, August 27, 2013, same-sex marriage is legal in a total of 6 New Mexico counties: Bernalillo, Santa Fe, Doña Ana, Valencia, San Miguel and Taos.

I promised myself years ago that when marriage equality came to my city, I wouldn’t miss the party. Equality New Mexico and the Democratic Party of New Mexico hosted a mass wedding celebration at Albuquerque Civic Plaza at noon, so I went there. Early.

Very, very early.

But it could not have been a prettier day if we’d ordered it up special, so I found a shady spot where I could see happy couples emerging from the county clerk’s office and settled in with my Kindle.

Soon, people began to arrive and prepare: flowers, a sound system, and excitement.

And media. Lots of media. Since I was there so early I’d staked out my spot. I think it may have been physically painful for the media people to see me, with my little Canon PowerShot, in the prime photographing spot while they jockeyed for position with their giant cameras.

There were lots of people on hand to perform weddings. The man on the right is Rabbi Harry Rosenfeld of Congregation Albert.

It’s always good to see bored cops at events. The opposition (Which is a funny way to put it; what do they oppose? LOVE???) was one man with a sign. He had three friends with him. They gave up and went home not long after they arrived.

Showing off the piece of paper that represents all that has been denied them for so long. It looks just like mine! Hooray equality! Hooray love!

Judge Jason Greenlee begins reading the vows, using spouse throughout. He declared everyone married and the crowd erupted with joyful shouting and whistling. After the mass wedding, some of the couples peeled off to request vows with clergy of their own faith tradition.

There were a lot of people shooting out flames of happiness.

I’m so proud of my city, and so happy that we have taken this giant step in the direction of real equality for all our people!

I’ve been waiting years for my own marriage to stop being a privilege that is vaguely tainted by others’ lack of access to it. Today, here in my city, my marriage feels cleaner and lighter because any two adults who want a marriage can have one. That doesn’t weaken my marriage; that strengthens it.

It’s a good good good day. Congratulations to all the newlyweds (though of course some of you have been married in all ways except this one for much longer than I have). May your lives together be filled with love and laughter and all the recognition that many of us take for granted. Congratulations New Mexico!

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