Attention 'kind of fades away'

Aug. 17--Ten years ago Tuesday, Albuquerque was rocked when mentally ill John Hyde went on a killing spree, shooting five people, including two veteran Albuquerque police officers.

With a longstanding diagnosis of paranoid schizophrenia, he had peacefully been managing his illness for years. But after a new psychiatrist changed his medication, he and his family had sought help for his escalating behavior.

The tragedy brought to the forefront the lapses in New Mexico's treatment and care of mental illness.

Today, the Journal looks at what has changed in the treatment of the state's mentally ill residents.

The John Hyde shootings launched regional leaders into a conversation about how to streamline the area's numerous, overlapping and underfunded behavioral health services.

The conversation following the Aug. 18, 2005, shootings started off strong with calls for new laws and more funding for services, but many say there wasn't much palpable change.

The number of counselors, psychiatrists, in-patient clinics and providers is still too few for the region's needs, mental health advocates say.

And fatal encounters between police and mentally ill people have not just continued since John Hyde but have increased to the point that it is one of the reasons the federal Department of Justice stepped in to monitor the police.

"Nobody talks about it (mental health) unless something bad happens. It's a hot button for a time period, there's this big push ... and then it kind of fades away," said Albuquerque police Lt. Glenn St. Onge, who heads the department's Crisis Intervention Section for mental health calls.

But since the March 2014 fatal Albuquerque police shooting of mentally ill man James Boyd, mental health advocates say substantial changes are closer now than ever in the last 10 years.

St. Onge and mental health advocates are hopeful the years of rhetoric about changes might finally be turning into reality.

Kendra's Law was the first reform on the lips of city and state leaders.

Kendra's Law is named after a woman who was pushed in front of a New York subway train by a man with a history of mental illness. Laws modeled after it, sometimes called assisted outpatient treatment laws, allow a judge, under strict guidelines, to force mentally ill people who have demonstrated they are a danger to themselves or the community to comply with a forced treatment plan with the possibility of involuntary commitment if the treatment plan isn't followed.

Albuquerque passed its own version of a Kendra's Law about six months after the Hyde shootings.

But the law was scrapped after a successful court challenge by the Disability Rights New Mexico group and four people who had been diagnosed with mental illnesses. They had the support of the American Civil Liberties Union.

The fight for a Kendra's law then went statewide.

Debbie King and Susan Smith, the wives of slain Albuquerque police officers Michael King and Richard Smith, lobbied alongside local advocates from the National Alliance on Mental Illness and APD.

But the effort has yet to succeed.

Though the two women have withdrawn from actively lobbying, others in the mental health community have continued, introducing or lobbying for a Kendra's Law each session since 2006.

An attempt in the 2015 session made it the farthest of all proposals. It passed through rounds of Senate and House committees but did not make it to the floor for concurrence and a vote, said bill sponsor Senate President Pro Tem Mary Kay Papen, D-Las Cruces.

She plans to introduce the bill again in 2016.

Meanwhile, the number of behavioral health providers in the state -- and in the country -- is below the level of demand, advocates, police and providers say.

In 2013 allegations of fraud led the state to freeze Medicaid funding for 15 clinics and providers across the state, effectively shuttering some of them. Providers were brought in from Arizona, but some of them are now leaving the state, too. The state says other local providers have stepped into that vacancy.

New state numbers show more people being treated now than before the shake-up. Human Services Department reports say the expansion of Medicaid coverage to more adults and the implementation of a state-level Medicaid system revamp called Centennial Care resulted in an increase in the number of people served of nearly 84 percent from the 2012-13 budget year to the 2014 calendar year.

At the same time as the fraud investigation, legislators passed a bill that would have set up "community engagement teams" in cities or counties that could intervene to provide help for the mentally ill before they reach a crisis point.

Gov. Susana Martinez vetoed the bill saying it was "well-intentioned" but was put under the wrong department. She said it should have been mandated to the Human Services Department instead of the state Department of Health.

The Human Services Department manages state and federal money that pays for behavioral health services.

It is in charge of the state's Behavioral Health Purchasing Collaborative, which is in charge of tracking and coordinating the state's mental health "delivery system" among various agencies. It handles state-funded payments. Its budget averages $57 million a year.

The department also administers Medicaid payments for behavioral health, which includes 70 percent federal funds and 30 percent state funds. Its budget since 2008 increased from $287 million to a projected 2016 budget of $482.5 million.

But for all the budget increases and state-level plans, the most changes are happening locally.

"You look at all these mental health task forces, memorials, committees and summits, they have identified this as a problem since the early 2000s and nothing's really changed," said St. Onge. "I mean nothing" at the state level.

Betty Whiton, a longtime volunteer with the city's National Alliance on Mental Illness chapter, shares St. Onge's frustration with the last decade but says the last two years have seen some movement.

"I'm not sure what happened after John Hyde for the next eight years, but for the last two years there has been a lot going on," she said.

Tom Gagliano, incoming president of NAMI-Albuquerque, agreed.

In the last two years, "we've gotten a lot done bringing all those services together. That's what really needs to happen. We need to assimilate all the resources and then get working on one direct hub where everything is directed."

And different entities within Bernalillo County appear to be trying to do just that.

Earlier this year, the Greater Albuquerque Chamber of Commerce organized a visit to Tucson by a group of business, health, judicial, political and law enforcement leaders to study its innovative approach to tackling mental illness and police response. Those attending included Mayor Richard Berry, County Commission Chairwoman Maggie Hart Stebbins and Chief District Judge Nan Nash. Tucson has overhauled its mental health response system in the wake of the 2010 deadly shooting spree by Jared Lee Loughner, also diagnosed with schizophrenia. That city has created a single contact crisis model that includes a hotline that triggers a crisis response team with officers trained in mental illness response and connects those in crisis with a caseworker who shepherds them to appropriate services.

Bernalillo County has contracted with the consulting agency that helped Tucson with its system and has plans to create a similar, but not identical, system here.

The county in July implemented new behavioral health tax expected to raise $20 million annually to fund services and programs.

The county, with a bit of help from the city, this summer launched a program that takes some homeless or near-homeless jail inmates with mental illness and gives them a home, a caseworker and a direct line to services and medication.

The Albuquerque Police Department has restructured its approach to calls for help involving people in mental health crises, in part because of the federal 2014 Department of Justice mandate triggered by high rates of officer-involved shootings in the city -- of which 43 percent were with people with mental illness.

St. Onge said that in previous years only 25 percent of officers had taken the voluntary mental health crisis training. Now, 88 percent have gone through the training, and the department has made it mandatory.

In the last 10 years, as the department has seen the number of officers dwindle, the unit dedicated to responding to mental health crisis calls has also had a reduction in numbers. But those numbers are up, St. Onge said, as mandated by the DOJ, which wants 12 detectives. The Crisis Intervention Section is set to hire its sixth detective next month.

Part of the unit, the COAST or Crisis Outreach and Support Team, was created in response to the Hyde shootings. It is a group of civilians who interact with people in a mental health crisis.

"I believe in this (police crisis intervention) program. But there is only so much a police department can do. Hospitals (providers). Laws. It's these systemic changes that need to happen," St. Onge said.

Of the local changes underway and the momentum from a decade of rhetoric, he said, "I hope they last."

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