Report Type: Assessment Recommendations
BernCo & CABQ Behavioral Health Systems Gap Analysis
YEAR
2021
AUTHOR / ORGANIZATION
Coalition for a Safer Albuquerque
GEOGRAPHIC SCOPE
Bernalillo County, City/County Joint
What is this?
This is a condensed and emphasized version of a comprehensive systems gap analysis commissioned to examine behavioral health services across the City of Albuquerque and Bernalillo County. The analysis was prepared in July 2021 and builds on the 2015 Behavioral Health Business Plan and at least six subsequent expert reports or community task forces. The methodology included key informant interviews with stakeholders including law enforcement, providers, community members, families, and consumers, as well as national expert consultations. The report synthesizes findings about system fragmentation, service gaps, and governance failures, then provides detailed recommendations for creating a unified system of care. Editorial commentary throughout the document (indicated by parenthetical notes) suggests this version was prepared to emphasize key points for decision-makers.
Summary
This gap analysis provides the clearest diagnosis of Bernalillo County’s behavioral health system failures and the most comprehensive blueprint for structural reform. The central finding is that despite substantial investment and seven prior planning efforts, the City of Albuquerque and Bernalillo County operate duplicative, uncoordinated services that are nearly impossible for community members to navigate. The report documents that people find “the process of getting help more painful than living with consequences of mental health or substance use disorders.” Key structural recommendations include: creating a formal intergovernmental collaborative body with an outside manager on a minimum 6-year contract; establishing a 24/7 Human Services Coordinating Center as both a community access point and provider hub; developing interim crisis triage services while awaiting the planned 2023 facility; implementing outcome-based contracting rather than output measures; and expanding the peer support workforce. The analysis emphasizes that any new system must be trauma-informed, include meaningful community engagement (not just surveys), and establish formal partnerships with Medicaid MCOs, schools, law enforcement, and community organizations. The report’s blunt assessment that contracted providers themselves “do not understand how the systems work” underscores the urgency for structural transformation.
BH Systems Change Recommendations
Explicit Recommendations from the Report: 1. Create a Structured Intergovernmental Collaborative Body with governing board and outside manager (minimum 6-year contract) to unify city/county behavioral health efforts 2. Develop One Comprehensive Strategic Plan including: - Joint SWOT Analysis - Combined mission, vision, and values statement - Facilitated strategic planning with broad community stakeholder involvement - Clear goals, objectives, and services focused on years 1-3 - Proforma budget of all behavioral health resources - Quarterly priorities, outcome measures, and meeting cadence 3. Create a Human Services Coordinating Center & Provider Relations Hub: - 24/7 telephonic access, extended in-person hours - Staffed by case managers, peer support workers, family peer support specialists, and community health workers - Continually updated database of all services using Open Beds software and Shatterproof's Atlas - Physical location accessible by public transportation 4. Establish Interim Crisis Triage Services at Westside Emergency Housing Center until 2023 facility opens: - Up to 72-hour stays - Staffed with behavioral health clinicians, medical personnel, and peer support workers - Accept walk-ins, family referrals, provider referrals, and law enforcement transports 5. Launch Comprehensive Public Education Campaign including billboards, bus shelter signage, direct mail, PSAs, social media, and community outreach 6. Expand Peer Support Workforce through additional contract funding for providers to hire CPSWs 7. Implement Outcome-Based Contracting with external evaluation rather than output measures 8. Establish Formal Partnerships with Centennial Care MCOs as required partners in intergovernmental collaboration 9. Adopt Trauma-Informed, Trauma-Responsive Management Practices across all system components 10. Unify Procurement and Contracting Processes between city and county with common definitions for services and eligibility
How to Use for Systems Planning
What this report IS useful for:** - Understanding the structural barriers to behavioral health system coordination in Bernalillo County - Identifying the specific governance and collaboration failures that have prevented progress despite funding - Accessing a detailed blueprint for creating intergovernmental collaborative infrastructure - Understanding why community members and providers cannot navigate existing services - Justifying investment in system coordination rather than additional siloed services - Informing design of a human services coordinating center and crisis triage services - Identifying workforce expansion opportunities through peer support workers **What this report DOES NOT provide:** - Current inventory of all behavioral health services and providers - Quantitative data on service utilization, outcomes, or unmet need - Budget analysis or cost estimates for recommended interventions - Implementation timeline or phased approach to recommendations - Specific contract language or governance documents for intergovernmental collaboration - Analysis of Medicaid billing opportunities or revenue projections - Evaluation of individual provider performance or quality
Key Facts & Data Points
- November 2014: 69% of Bernalillo County voters approved 1/8th percent GRT for behavioral health services - February 2015: County Commission officially approved the GRT increase - At least 7 expert reports or task forces have issued recommendations since 2014 without achieving system coordination - 6 Mobile Crisis Teams operate jointly with APD and BCSO - Only 16 beds exist at the Crisis Stabilization Unit on the CARE campus (adult-only, up to 2-week program with exclusionary criteria) - Law enforcement estimates thousands of 911 calls monthly are for behavioral health crises or public inebriation - Over 150 Certified Peer Support Workers (CPSWs) in Bernalillo County, many unemployed in the field - Planned Crisis Triage Center and Psychiatric Replacement Hospital with UNM targeted to open in 2023 - Recommended minimum 6-year contract for intergovernmental collaborative management - CPSWs require 40 hours of continuing education every two years for certification
Priority Services & Findings
**Mental Health / Crisis Care** - No effective crisis triage services currently exist in Bernalillo County - Current Crisis Stabilization Unit has only 16 beds, operates on social model with exclusionary criteria, and is not a walk-in facility - Individuals brought to ERs during crisis often wait long periods and receive no services unless suicidal - APD operates Crisis Intervention Team, Crisis Intervention Unit, and Crisis Outreach and Support Team (COAST) - 6 Mobile Crisis Teams deployed jointly with APD and BCSO - Officers report being turned away from hospitals during crisis transports - Interim crisis triage recommended at Westside Emergency Housing Center while awaiting 2023 facility - Crisis services should allow 72-hour stays with immediate assessment, food, referrals, and warm handoffs **SUD Organizations** - Medication Assisted Treatment (MAT) access needs improvement through Shatterproof's Atlas product - Substance use and mental health described as "epidemic" requiring coordinated response - Peer support workers identified as critical workforce expansion opportunity for SUD services - System lacks coordination with Medicaid MCOs who manage thousands of individuals with SUD **Integrated Primary Care** - No structured interaction exists between city/county and Centennial Care MCO care coordinators - Integration by referral and support to physical healthcare identified as needed service - Human Services Coordinating Center should include connections to health care providers - Quadruple Aim of Healthcare referenced as guiding framework for system redesign **School-Based / Youth Services** - Crisis Stabilization Unit is adult-only with no youth services mentioned - Albuquerque Public Schools identified as critical partner to engage in collaborative structure - School-based services information should be available through proposed Human Services Coordinating Center - No current structured engagement with school system on behavioral health
Immediate Actions for Systems Planners
-Convene City and County leadership to formally commit to developing a unified intergovernmental behavioral health collaborative with a single strategic plan and outside management -Issue RFP for independent manager/organization with population health, clinical, recovery, and behavioral health business expertise to lead collaborative development (minimum 6-year contract) -Establish formal partnership agreements with Centennial Care MCOs to participate in system coordination and share data on covered populations -Assess Westside Emergency Housing Center for interim crisis triage unit conversion while awaiting 2023 facility completion -Begin procurement for 24/7 Human Services Coordinating Center staffing and technology infrastructure including Open Beds and Shatterproof Atlas integration -Contract with external evaluator to develop outcome measurement framework and baseline data collection protocols -Engage CPSWs currently unemployed in the field to expand peer support workforce capacity immediately -Initiate planning for comprehensive public education campaign with communication firm experienced in health behavior change -Conduct inventory of all current city and county behavioral health contracts to identify unification opportunities and eliminate duplication -Schedule facilitated joint strategic planning session with broad community stakeholder representation, particularly individuals with lived experience
Key Contacts
**/ - Albuquerque BernCo Governing Commission (ABCGC) = - Albuquerque Police Dept (APD) = - Albuquerque Public Schools = **/ - BernCo Sheriff's Office (BCSO) = - CARE Campus = - Centennial Care Managed Care Organizations (MCOs) = **/ - NM Dept of Work Force Solutions = - NM Human Services Dept = - Project ECHO = - Westside Emergency Housing Center