County cites proposed triage center operator's qualifications, while some call for bidding process

LAS CRUCES - The county commission took time Tuesday to address questions that arose from a recently unveiled business plan to run the long-unused Doña Ana County Crisis Triage Center.

Members of the public called on the county government to solicit bids for a provider to run the center, in the hopes of possibly contracting with a local entity, instead of the provider the county manager plans to negotiate with.

County Manager Fernando Macias had planned on beginning contract negotiations with Recovery Innovations International to operate the CTC. RII is a company that operates crisis services nationwide. The company also put together the business plan, which county commissioners discussed June 23.

At that same meeting, commissioners tabled a vote that would have allowed Macias to begin contract negotiations with RII, opting to allow for more public input first at a special meeting held June 30.

The purpose of the crisis triage center, which has sat unused since completion in 2013, will be to evaluate and stabilize people experiencing mental health crises and connect them with outpatient behavioral health services.

The county ideally wants the center to be available to people in protective law enforcement custody and open to walk-ins from the public. Those in custody could either be experiencing a mental health crisis, could be a mentally ill individual who has committed a nonviolent offense or could be someone suffering from substance abuse.

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One hurdle, which the county is trying to get the state to waive, is a state licensing rule that doesn't allow CTCs to admit people involuntarily.

Call for more proposals

Members of the public questioned why the county wouldn't solicit proposals from other providers before settling on RII.

Even though the county has invoked a health care exemption to the procurement code that doesn't require a bidding process for the CTC services, community members who spoke said the county should at least compare options.

Representatives from iNetMed, a a local for-profit psychiatric services clinic that vied to run the CTC in the past but wasn't chosen, claimed RII wasn't fit to run the facility under its business plan. 

iNetMed co-owner and operator Dr. Jo Velasquez called into question the plan's financial sustainability, plus the qualifications of its proposed staff of medical professionals and certified peer support workers — people certified by the state to help those in crisis who are themselves recovering from experiences with mental illness.

Macias said no local entity has experience running a crisis triage center. That's why RII was chosen.

"It'd be rare to find anyone in the entire state of New Mexico" with that experience, he told the Sun-News.

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There have been multiple plans for providers, some locally, to run the facility throughout the years, County Health and Human Services Director Jamie Michael said. Some providers weren't approved by commissioners; another left the state for financial reasons.

But opening the facility became more feasible only in the last few years since the state began licensing crisis triage centers. And, the state's Medicaid program now covers CTC services, which makes it more realistic to estimate costs, Michael said.

Chuck Browning, RII's chief medical officer, said RII is the industry standard in crisis care. RII operates a dozen crisis facilities nationwide and was a major contributor in developing national crisis response and care guidelines for SAMHSA, which published earlier this year.

"We have a strong tradition, and you can backtrack and check about all the different communities that we're in and what's our reputation," Browning said. "Do we cause problems, or do we come in and engage in the community?"

Crisis response continuum

Macias said contract negotiations will likely include proposing a joint community advisory body to evaluate CTC operations and results, along with overseeing the implementation of a larger crisis response continuum, which would include implementing a robust mental health crisis phone line system and creating mobile crisis units.

Macias says RII will try to hire locals to gauge an understanding of the local behavioral health environment, but will also hire out of state so as to not pilfer from the existing, scarce employee base.

"As a community we should be looking at increasing providers at every level, both professional and paraprofessional," Macias said. "This should be done to support the triage center and all other agencies so that it is a cooperative not competitive environment."

The CTC business plan stresses that the center functions best as part of a behavioral and mental health infrastructure within the community, called a "continuum of care," which includes mobile crisis response teams, a comprehensive system that handles mental health related phone calls and tracks cases and outpatient providers to connect people to.

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Some commissioners and community members called for greater coordination with the city of Las Cruces, which is reportedly putting together a plan to have iNetMed operate a mobile mental health response unit — which some said could siphon off patients who would have ended up at the CTC by stabilizing them on the spot, which would amount to lost revenue for the CTC.

But Macias said the city's proposal was factored into calculations included in the business plan.

"In other comprehensive systems a mobile crisis team is a referral source that directs people into the crisis triage center," Macias said. "However, the crisis triage center and a mobile crisis unit are two separate services that can function independently."

Commissioners Shannon Reynolds and Manuel Sanchez said they wanted to make sure the county has plans to build up local behavioral health resources in addition to opening the facility.

Sanchez proposed a mobile crisis unit manned out of the CTC. Commission Chair Lynn Ellins said that could be part of the negotiations with RII.

"I don't think this is out of scope or out of bounds," Reynolds said.

While that can be an option down the road, Michael said getting the facility licensed and opened is an important first step that needs to happen.

District 4 Commissioner Isabella Solis said she was in favor of moving forward on contract negotiations or "we'll be here next year doing the same thing." Solis said once the center opens, other elements will fall into place.

The county commission is expected to take up the contract negotiation authorization at its July 14 meeting.

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