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City proposal would have social workers respond with police to mental health crisis calls

Las Cruces Sun-News - 7/23/2020

LAS CRUCES - The city may soon consider a plan to work with a local psychiatric services clinic to respond to mental health crises alongside police and fire teams.

That's part of a proposal initiated by District 1 Las Cruces City Councilor Kasandra Gandara, a licensed social worker who considers herself a behavioral health expert in the realm of child welfare.

Through talks she convened with city and county staff, people in the local behavioral health network and local law enforcement, Gandara said Las Cruces-based iNetMed Rx2 Inc. was chosen to submit a proposal for services to the city.

For the past five years, Gandara said she’s consistently recognized shortcomings in behavioral health care locally. She said she’s been aware of concerns from local law enforcement about having to respond to people in crisis.??????

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"I utilized the relationships that I had to bring (people) together, and then I let iNetMed and their team do what they do best and that is put together, based on their expertise, a proposal," Gandara said.

That proposal is still going through the procurement process and the selection isn't final, according to Interim City Manager David Maestas, so neither the full proposal nor the cost was available. But it would need to go before the city council for final approval.

In an executive summary of the proposal sent to the Sun-News by Gandara, iNetMed says it plans to roll out its services in three phases. iNetMed writes that the proposal was created with input from local behavioral health organizations and local law enforcement.

The program would first help those with mental health conditions who most frequently use the 911 system to access medical care, outpatient services and wraparound services -- such as housing, food assistance and transportation. Second, the program would establish a mobile crisis intervention team to assist law enforcement. Third, it would establish an outpatient treatment center to receive patients post-crisis.

The city’s proposal has surfaced as the Doña Ana County government moves toward finally opening its Crisis Triage Center. Some have worried the city's plan might siphon potential patients from the triage center; others say the two can work in tandem.

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The county will soon begin contract negotiations with a potential operator for the center, which County Manager Fernando Macias aims to get open this year.

The proposal also comes at a time when activists and some lawmakers have called to defund police department budgets and shift resources toward non-policing public safety programs, like social workers responding to mental health crises.

“This is an answer to police reform," Gandara said. “It’s a way by which to handle these kinds of situations so it doesn’t escalate."

Las Cruces and the county have had several incidents of law enforcement killing people with mental health conditions. Just this June, Las Cruces police officers shot and killed Michael Seltzer, a suicidal man who had fired a gun at police.

According to iNetMed, Las Cruces Police respond to about 1,500 mental health-related calls per year. The Doña Ana County Sheriff's Office responds to an additional 750 calls a year.

Gandara said officers aren't the best ones to handle certain situations related to mental health, despite the crisis intervention training they receive.

“I don’t mean any disrespect. I think our law enforcement officers are doing the best they can under the situation," Gandara said, before explaining “it’s one thing to get training on a certain thing. But it’s another thing (for it to be) your expertise.”

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The phased approach

The program is proposed to roll out in three phases, according to iNetMed. The third phase, iNetMed estimates, would occur in late 2020. No timeline is given for the other phases.

The first phase would address people who are frequent subjects of 911 calls about their mental health crises, so-called “super users.” These people have the most frequent contact with law enforcement, which puts them at risk of a situation becoming violent.

iNetMed says 915 super users have been identified by the Las Cruces Fire Department'sMobile Integrated Healthcare team. During phase one, iNetMed will reach out to them and offer access to medical and behavioral health care, wraparound services and referrals to hospitals .

The second phase would establish a mobile crisis response team. The on-call team would respond alongside police or fire crews to active crises in a van that's equipped with telehealth capabilities and is pathogen-controlled.

That way, a mental health professional or police officer could take the lead depending on the situation. Gandara said for some people, even seeing police can make them feel agitated or anxious and worsen the crisis.

But if a situation is dangerous upon arrival, an officer could secure the area first, the city councilor said.

The Mobile Crisis Intervention Team (MCIT) would include a licensed social worker or other provider, an EMT-Intermediate or paramedic, plus a prescribing psychologist would be available via telehealth. A licensed clinical professional would evaluate the individual on site and determine the best care.

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The final phase of the program would establish an “Ambulatory Psychiatric Care Center” to receive individuals who have been in crisis so they can receive outpatient treatment. Some services will include psycho-legal assessments, evaluations, psychological and neuropsychological assessments and competency examinations.

The center would accept referrals directly from the county crisis triage center, where stays are planned to be around 23 hours or fewer, and from emergency rooms, first responders and others who have come into contact with someone in crisis.

Caring for the whole person

Dr. Jo Velasquez, a prescribing psychologist and co-owner and operator of iNetMed, said iNetMed's proposal goes beyond triage, which she said results in the immediate, short-term deescalation of a crisis. But once the immediate crisis subsides, there's still work to do. That's where their services come in.

"My outpatient team … we may take another three months, six months, a year to stabilize (someone)," she said. "We're the long-term team."

Velasquez rejects the idea that triage is stabilization. She said while it's important to stop the bleeding in the moment, it doesn't address the bleeding.

And treatment goes beyond outpatient behavioral health care. It should address the whole person. If someone's basic needs aren't met, that will impede the treatment process.

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“This is about making sure the whole person has what they need to thrive in our community," Gandara said. "Right now, that's not happening."

Other circumstances can contribute to and exacerbate the problems that stem from mental health conditions, making them harder to overcome, the two say. That's why wraparound services are so crucial.

"All of that is embedded in a treatment plan," Velasquez said. "Even though I write the prescription for medication, what if that person doesn't have a way to get to the pharmacy?"

While a doctor can tell a patient to eat healthier or get more sleep, Gandara said, "all those things go out the door when you have an individual that's near-homeless or homeless."

Gandara hasn’t read the full proposal yet, she said, since she doesn’t want to view it or have input ahead of her city council colleagues. Any proposal to approve services with iNetMed to carry out such crisis services would require a council vote.

iNetMed proposed a plan in 2017 to run the county crisis triage center, but the county commission didn't approve it. Velasquez said the city proposal was submitted at the end of May, but Gandara said talks began informally about two years ago.

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iNetMed was chosen because Gandara and Velasquez have an established professional relationship, the city councilor said. Due to the COVID-19 pandemic, their telehealth capabilities stood out, Gandara said.

“I know what they can do," Gandara said. "I’ve seen the end result when they work with families and children, and they do excellent work.”

Velasquez said she and Gandara "are always talking shop."

In fact, the point of the program is to begin to plug gaps in the county's behavioral health care system. Gandara said this proposal would only be the first step toward creating a more connected system of behavioral health care within the county, also sometimes referred to as a continuum of care, which the area desperately lacks.

To Gandara, that continuum should also include wraparound services and a court system that's geared toward helping the mentally ill.

A recent gap assessment conducted by New Mexico State University's Southwest Outreach Academic Research Evaluation & Policy Center for LC3, the local behavioral health collaborative, showed the county lacks "specialized and experienced" providers, patients face significant barriers to accessing care and government accountability and funding is lacking.

In February, Mayor Ken Miyagishima announced he'd tasked the city councilor with spearheading the creation of a "behavioral health district."

“That’s been my marching orders,” Gandara said. “That’s what I’m envisioning. Developing this behavioral health district with all these municipalities, to include the county, working with the local collaborative to build a capacity, not only resources funding-wise but all the other things that are necessary to build up our behavioral health continuum of services.”

Michael McDevitt can be reached at 575-202-3205, mmcdevitt@lcsun-news.com or @MikeMcDTweets on Twitter.

This article originally appeared on Las Cruces Sun-News: City proposal would have social workers respond with police to mental health crisis calls

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