Bernalillo County is recruiting behavioral health advisers as new ordinance gets implemented

Aug. 3—In June, Bernalillo County passed a new behavioral health ordinance that restructures the bureaucracy around the county's behavioral health programs. It will take a while before the ordinance is fully implemented, but the county is looking to fill one requirement immediately: recruiting people to serve on a 14-person behavioral health advisory board.

The ordinance's passage faced opposition from staff at the county's detox facility, but Deputy County Manager for Behavioral Health Wayne Lindstrom said the ordinance demonstrates that county leadership is prioritizing behavioral health.

"I think the ordinance does a good job of calling for an evidence-based, trauma-informed, behavioral health continuum of care," Lindstrom said.

Big picture changes

The ordinance calls for a three-year strategic plan, due Nov. 30, that county staff have begun working on, said Lindstrom.

"In year one, we're basically going to be operating on what has been built thus far," Lindstrom said, whereas year three will likely have a much more aspirational plan.

The county fiscal year runs from July through June, so the budget for the current fiscal year was set before the ordinance passed.

"I see us as being between two realities," Lindstrom said. "One is we have this older airplane that we have to keep flying, which is the services out at the campus, as well as all the things that we contract for. While at the same time we're going to launch the building of a new airplane, or maybe even a fleet of aircraft."

The ordinance spells out that county behavioral health services will focus on a "no wrong door policy," which means warm hand-offs when trying to get people to the appropriate services, Lindstrom said.

"We want to be able to build a system where, if the door they come in can't help them, then they do appropriate warm handoff, if you will, whether that means driving somebody or calling a mobile crisis team to pick them up, or (Albuquerque Community Safety) or some other resource to get them to the right place at the right time, rather than shuffling people and recycling them through the system over and over again," Lindstrom said.

The ordinance also calls for increased transparency, including an online dashboard of information, which Lindstrom said could get launched more quickly.

The ordinance mandates a 14-person behavioral health advisory board, appointed by the county commission. Lindstrom said that he will present a list of recommended appointees to the commissioners in August.

The county is actively recruiting for the advisory board, looking for "diverse perspectives and experiences," Lindstrom said in a statement. Members will serve two-year terms in at-large positions.

The members will include a hospital or health system representative, someone from the behavioral health provider field, two public safety representatives, a disability rights representative, representatives from the courts, the city of Albuquerque, housing services, youth services and the New Mexico Department of Behavioral Health, a community health worker, a peer support worker, and people to represent the perspectives of Indigenous and LGBTQ+ people.

There are two other advisory boards, one focused on data and one focused on public awareness and education, that Lindstrom will appoint.

Objections

When the ordinance originally passed, at least 10 behavioral health staff members stood in solidarity as their coworkers voiced concerns about it. Among other objections, staff members from the county's CARES Campus said they were not asked for input on the ordinance beforehand, and several were concerned that the changes could lead to eliminating security at the county detox and addiction rehabilitation facility.

"I have a lot of ownership around the reaction that you saw around those issues," Lindstrom said.

He said that he spoke with some staff about a model developed over the past 30 years that demonstrated having armed security on the premises was not conducive to engaging people, which raised serious concerns with staff members, and about the idea of involuntary commitment.

"They have to deal with a lot of things, whether it's verbal abuse, or physical abuse, or somebody being actively psychotic. ... The reality is, they're not staffed appropriately to accept involuntary admissions. The facility is not designed for that purpose," Lindstrom said.

He said that he's focused on calming the waters with staff, and there are no immediate changes to the detox center. Jessica Jaramillo, who has been serving as interim director, was made permanent CARES Campus director in July, and interim Operations Manager Stephanie Avila was also made permanent.

County Commissioners Steven Michael Quezada and Walt Benson also voiced concerns about the ordinance. Benson said he was worried that the commission might use the ordinance to micromanage the department. Lindstrom said earlier versions of the ordinance worried him, because they did not seem flexible enough, but he is not concerned about the version that passed.

Filling gaps

The ordinance calls for a full continuum of care, which will require the county to fill in a lot of gaps in services, Lindstrom said. The county does not have enough group therapy, family therapy, intensive outpatient programs, or partial hospitalization programs, he said.

"Assuming that they put the money on the table that supports all of this, there's a lot we can accomplish," Lindstrom said.

He's hopeful the opioid settlement funds coming into the county could create a long-term source of revenue for behavioral health services. Lindstrom wants the county to form an endowment with a portion of the funds.

"That principal can stay and grow and be invested, and we can have investments and dividends paid off those investments, so that at the end of 10 to 18 years, we potentially can fund a lot of what's been built based off the dividend and not touching the principal, and potentially do that in perpetuity," Lindstrom said.