As the 988 rollout looms, demands for improved mental health services go largely unanswered
In 2016, now living in New Mexico, the dam broke. Helberg, 40, attempted to take his life by drinking and driving, and was admitted to an Albuquerque hospital. When he was discharged, the staff gave him a 30-day supply of medications and told him to book follow-up appointments with a psychiatrist and counselor. But when he called them, he was told there was a two-month waiting list.
What saved him was something unexpected: a phone call. Tucked in a thick packet of documents from the hospital — his patient plan — he found a phone number for the National Alliance on Mental Illness (NAMI), the nation’s largest grassroots mental health organization. He decided to dial the number.
That one phone call turned his life around, Helberg said. NAMI connected him with peer-to-peer support groups and advocates who have served as a support system. He’s been clean and sober ever since and has become deeply involved in advocacy himself, to help people who would otherwise be neglected.
Mental health patients in New Mexico just get “sent out the door and wished good luck,” he said. In desperation, many people have gone to hospitals for psychiatric emergency services. “But all they did was either change their medications or send them on their way. And they weren’t getting their help.”
Leading in suicides
The shortages have only worsened during the pandemic, which has created unprecedented mental health crises, especially among the young, the U.S. Surgeon General recently warned. In 2020, suicide was the second leading cause of death for children aged 10 to 14 as well as for older teens and young adults. More than 12 million U.S. adults had serious thoughts of suicide, federal statistics show.
New Mexico, for its part, has long had one of the nation’s highest rates of suicide and substance abuse, amid a profound lack of mental health services. In 2020, the state had the fourth-highest suicide rate in the country.
In an effort to address the issue nationwide, Congress passed legislation in 2020 to create a three-digit suicide hotline number — 988 — to provide easier and better access to help. The 988 line, as envisioned, would be akin to a 911 for mental health emergencies, saving lives by instantly connecting people to the National Suicide Prevention Lifeline, which for years has required dialing 800-273-8255. But the 988 line is also supposed to do much more.
If all goes according to plan, the new 988 system would connect people to local crisis call centers where staffers provide emotional support — by phone, text or chat — and connect them to community-based services, including mental health crisis teams. The crisis teams, manned by counselors or other civilians, could help reduce deadly incidents at the hands of law enforcement.
In short, the 988 Lifeline would be akin to an air traffic control system: a single entity smoothly helping people to a safe landing. The line’s debut is set for July 16.
Unfortunately, New Mexico does not appear to be fully ready for the launch. Searchlight New Mexico spoke with experts, advocates, state and local stakeholders, and crisis responders about the upcoming rollout. They described the 988 system as an opportunity for innovation and improvement. But many also expressed concerns that the necessary community-based mental health services and crisis-response systems had not received adequate state funding and would not meet callers’ needs.
Patsy Romero, the CEO of Santa Maria El Mirador, in her Santa Fe office.
Photo by Nadav Soroker / Searchlight New Mexico
Vast needs, few providers
At its heart, the shift to 988 is supposed to connect people to local services. The trouble is, in New Mexico those services are profoundly lacking.
An estimated 83 percent of the need for mental health professionals goes unmet in the state, according to the Kaiser Family Foundation. New Mexico’s vast size and rural nature exacerbate the deficits: People must travel for hours to see providers, wait for extended periods or go without help. Nearly 60 percent of New Mexico adults with a mental illness do not receive treatment, the Office of Inspector General found.
Lives are at risk as a result. Between 2013 and 2017, Sierra, Hidalgo and Catron counties — some of the state’s most rural — had the highest suicide rates, health reports show.
Advocates trace much of the problem back to Gov. Susana Martinez, whose administration stripped the state of community services. Fifteen of the state’s behavioral health organizations — which provided about 85 percent of all behavioral health and substance abuse services to Medicaid enrollees — were forced to shut down in 2013 after they were falsely accused of fraud.
“That huge dismantling of the safety net of services in behavioral health in New Mexico in 2013 totally did away with the major providers of behavioral health, which was really a crisis in our state, especially for the severely mentally ill and children who have serious emotional issues,” said Patsy Romero, the chief executive officer at Santa Maria El Mirador, a nonprofit service provider for adults with intellectual disabilities. She has worked in the behavioral health field in New Mexico for over 35 years.
“It was really devastating, and we’re still crawling our way back to trying to implement a system of care.”
Photo by Nadav Soroker / Searchlight New Mexico
Two years to prepare
Since 2015, at least 22 people with signs of mental illness have died at the hands of law enforcement in New Mexico alone, a Washington Post database shows; other encounters have led to grievous injuries. Among the incidents: In 2020, 26-year-old Max Mitnik was shot in the head by an Albuquerque Police officer and gravely injured after his family called 911 to help get him to psychiatric care. More recently, on April 16, a Las Cruces Police officer fatally shot 75-year-old Amelia Baca, a grandmother with dementia, according to the ACLU. The family had also called 911 for help.
To help reduce such incidents, states have been advised to implement a Crisis Now model, in which crisis call centers link people to services in real time, book same-day or next-day outpatient appointments, or find in-patient beds. The goal is to ensure that people have someone to talk to, trained professionals to respond to them, and a place to go for safe and effective diagnosis and treatment.
But the glowing promise of the new system has been dimmed by fiscal reality. The transition to 988 requires significant planning, systemic changes and — especially — adequate funding. In Washington and New Mexico, the funding fell short, advocates say.
New Mexico recognized early on that it would not be able to implement mobile crisis teams and launch crisis triage centers for people across the state in time for the 988 rollout. Instead, it has focused on a “graduated implementation,” Neal Bowen, director of the state’s Behavioral Health Services Division, told Searchlight New Mexico.
“I’m old enough to remember when 911 came into effect. And it took years for it to be that kind of automatic system that we expect now,” Bowen said. “I think there’ll be a similar process with 988.”
But that’s not enough to pay for all the needed changes, which has left states scrambling to secure other piecemeal funding sources.
“It’s so important and so welcome that we’re getting this additional funding that’s coming from the federal government, but it’s just not enough to sustain states through the transition,” said Nicole Gibson, senior director of state policy and grassroots advocacy at the American Foundation for Suicide Prevention. “That’s why we’ve been really advocating a lot for the state investments.”
A few states have enacted legislation to boost funding for the 988 transition; others have imposed a monthly fee on phone bills, the way money is collected for 911. In 2020, for example, 911 fees in New Mexico raised more than $12 million by charging about $5.78 per person.
But in New Mexico, no phone fee or legislation was enacted to support 988.
The Behavioral Health Services Division will provide some money for the transition, but the agency doesn’t have a lot of surplus to offer. For fiscal year 2023, the division asked for $4.7 million in recurring general funds for 988; it received $1.5 million. It also received a $2.3 million special appropriation to expand the capacity of crisis call centers, but more is needed.
The agency will pursue other funding streams and will “try to flesh out the full Crisis Now system of care,” Bowen said. “We’ll certainly be going back to the legislature next year to ask for a different funding mechanism or more funds, because we need stable funding to support an ongoing crisis system.”
The decision to not pursue a phone fee was due to “no political appetite for adding any kind of fee to folks already struggling with COVID,” he added.
Romero, who is also a legislative lobbyist for NAMI, said mental health advocates across New Mexico pushed the state to enact legislation in support of 988 and will do so again in future sessions. The current funding, she said, is not enough for “a robust approach to a system of care that adequately and appropriately responds to those 988 costs.”
But more than anything, she worries about how the money that has been allocated will be spent.
“What I’ve experienced in these 35 years is a lack of a strategic, comprehensive plan by our administrations — it doesn’t matter what administration comes in — to make an intelligent decision or strategic plan about where do those dollars go,” she said.
“It’s the same thing we were talking about 20, 30 years ago. So I’m like, where’s the progress?”
When it comes to suicide, progress is especially hard to see. In 2020, 520 New Mexicans took their lives, a 23 percent increase from the 410 suicides a decade earlier. The problem is particularly devastating for Indigenous youths, whose suicide rates are the highest of all racial and ethnic groups — and in some years are as much as 242 percent higher than the rates among whites.
Dreams vs. reality
If further action is needed, they’ll be referred to resources. Hotline staff can also dispatch a mobile crisis team if needed, or escalate calls to 911 to get police or the fire department involved.
In New Mexico, this version of reality might not come true any time soon, advocates say. For one: If there isn’t enough staffing to answer calls within the state, they’ll be routed to national backup lines. And as call volume increases, this will happen more often, advocates fear.
Funding and staffing for the 988 shift has been an issue for other resources, such as the Agora Crisis Center at the University of New Mexico, which has long answered crisis calls from across the state. Agora’s new role in the 988 system “is up in the air,” said Molly McCoy Brack, the center’s director. Agora cannot likely fulfill the role of an official 988 crisis center under the new system, since facilities are being asked to provide many more services — and in Agora’s case, even space is limited.
The center is run by about 100 trained student volunteers as well as volunteers from the community. “Our entire crisis center is in what used to be a two-car garage,” McCoy Brack said.
Bowen, for his part, said the Behavioral Health Services Division aims to implement some of the recommended “air traffic controller” functions of the new 988 system. By July, he said the agency plans to implement mobile crisis teams in four counties, one of them in Sandoval County. He would not provide specifics about the others. When asked how many mobile crisis teams are presently operating, he said he didn’t know, adding, “That’s a good question.” In a subsequent email, he said 15 crisis teams were “in advanced preparation” or already operating.
Other mental health advocates clarified that there are mobile crisis teams in at least three locales: Albuquerque, Alamogordo and Santa Fe, where the Santa Fe Crisis Triage Center opened last year.
The center’s mobile crisis team is best thought of as “a service to public safety agencies,” said Kate Field, director of crisis services for New Mexico Solutions, which operates the facility. If weapons are present or a situation is considered dangerous, law enforcement will generally be sent out first; the team will only be allowed on the scene when it’s deemed safe.
Once 988 is implemented, how the mobile teams will be dispatched is still “an ongoing conversation,” Field said. “There’s so much to work out there.”
Safe places someday
Ideally, New Mexico will eventually have a triage center within 90 minutes of most residents, Bowen said. But that goal likely won’t be met for 10 years, he predicted. For now, he said the Behavioral Health Services Division aims to set up three new “safe place to go” centers within two years.
For Kenneth Helberg, that’s not fast enough. The 988 reforms seemed to have potential, he said. He’d hoped the new hotline system would answer some of the state’s most pressing mental health needs. But since there’s so little infrastructure, he doesn’t hold out much hope.
“We don’t have the services available,” he said. The lack of an adequate mental health system is a problem “throughout the whole United States.” But there are states that have taken steps “and tried to improve it and tried to make a difference, and made funding and put money in,” he added. New Mexico just wasn’t one of them.
Helberg said he’ll continue to offer support in his own way. He’s already a certified peer support worker and volunteers for the Psychiatric Rehabilitation Association, a group that provides education and training regarding mental health. He also volunteers for multiple NAMI programs, including one that involves making presentations to law enforcement agencies to share experiences with mental illness. Most recently he was the 2022 New Mexico Behavioral Health Star Winner, one of the state’s highest behavioral health honors.
By being an advocate he found his niche, he said. “I found that peers have a voice — that we can use our lived experience to help others, share a lived experience, help clinicians and move forward.”
Clarification: Due to erroneous information provided by the New Mexico Behavioral Health Services Division, a previous version of this story stated that the BHSD asked for a $4.2 million special appropriation. According to corrected information from BHSD, the agency asked for a $2.3 million special appropriation.
If you’re experiencing a mental health crisis or having thoughts of suicide — or if you’re worried about a loved one — help is available 24/7.
Call the National Suicide Prevention Lifeline, 800-273-8255, for free, confidential support. After July 16, you can also reach the Lifeline by dialing 988.
You can also contact:
New Mexico Crisis and Access Line, 855-662-7474
National Alliance of Mental Illness National Helpline, 800-950-6264
Agora Crisis Center, 505-277-3013