Report Type: Assessment Community Forum/Survey Data Profile
Community Health Needs Assessment
YEAR
2025
AUTHOR / ORGANIZATION
Presbyterian Medical Services
GEOGRAPHIC SCOPE
Multi-jurisdictional, Statewide (New Mexico)
What is this?
This is a Federally Qualified Health Center community health needs assessment conducted by Presbyterian Medical Services, a Joint Commission accredited 501(c)(3) organization serving 17 New Mexico counties. The assessment was completed in July 2025 with a re-evaluation scheduled for 2028. The methodology included engagement with community members, frontline staff, and regional guidance councils to identify health priorities, barriers, and needed resources. The report synthesizes primary data collection with secondary data from sources including the Youth Risk and Resiliency Survey, Census Bureau, New Mexico Department of Health IBIS system, and emergency department surveillance data to provide a comprehensive view of health needs across the service area.
Summary
This comprehensive assessment provides critical data for behavioral health systems change in New Mexico’s rural and frontier communities. The report documents that 32 of 33 New Mexico counties are federally designated shortage areas for behavioral health providers, with only 12.9% of mental health needs currently met statewide compared to 26.9% nationally. Among high school students, 77% who attempted suicide also used substances, demonstrating the urgent need for integrated behavioral health approaches. The assessment identifies children’s mental health services as a critical gap, with 32.2% of middle schoolers reporting anxiety symptoms and 11% having attempted suicide. PMS responds through integrated behavioral health delivery across 35 sites using evidence-based practices including EMDR, CBT, DBT, and culturally-specific approaches like the Navajo philosophy of Ke’. The organization operates innovative justice-involved programs, same-day suicide risk assessments for schools, and rapid-access appointments to reduce emergency department visits and law enforcement involvement. Key systems change opportunities include expanding telehealth infrastructure, addressing workforce shortages through training partnerships, and scaling successful models like the Joint Intervention Program and Sobering Center that break cycles of incarceration and emergency service overuse.
BH Systems Change Recommendations
How This Report Informs Systems Change The report does not contain explicit systems change recommendations but provides substantial data and programmatic models that directly inform behavioral health systems transformation: **Integrated Care Models to Scale:** - Justice-involved behavioral health programming in Santa Fe County demonstrates successful care coordination before, during, and after incarceration with Community Health Workers and Peer Support Specialists embedded in booking - Joint Intervention Program and Sobering Center models in San Juan County show effectiveness in breaking cycles of emergency service overuse, incarceration, and homelessness - Same-day suicide risk assessments for schools provide rapid-access crisis response model **Workforce Development Priorities:** - State needs 117 psychiatrists, 328 primary care providers, and thousands of behavioral health specialists - Half of DD waiver providers not accepting new clients due to workforce shortages - Telehealth expansion (from 11,403 visits in 2019 to 80,592 in 2024) demonstrates viable workforce extension strategy **Population-Specific Strategies:** - LGBTQIA+ youth require culturally competent, inclusive services (3x higher suicide attempt rates) - Gender nonconforming students need targeted interventions (21.6% attempted suicide and used substances) - Housing-unstable youth require integrated trauma-informed housing and behavioral health services - Veterans and justice-involved populations need specialized programming **Evidence-Based Practice Priorities:** - Trauma-informed care across all services - Co-occurring disorder treatment integration - Culturally responsive approaches including Native American traditional healing - Early intervention through Head Start and school-based services
How to Use for Systems Planning
**What this report IS useful for:** - Documenting behavioral health need across rural New Mexico counties with specific county-level data - Understanding social determinants of health impacting behavioral health access and outcomes - Identifying successful integrated care models (justice-involved programming, crisis response, school-based services) for potential replication - Justifying workforce development investments with provider shortage data - Supporting grant applications with comprehensive community health data - Understanding disparities among specific populations (youth, LGBTQIA+, Native American, Hispanic, veterans) **What this report DOES NOT provide:** - Specific systems change recommendations or implementation timelines - Cost estimates for service expansion - Detailed gap analysis specific to Bernalillo County (county not included in PMS service area) - Medicaid billing or reimbursement strategy guidance - Workforce pipeline development strategies - Regional coordination mechanisms across providers
Key Facts & Data Points
- PMS serves 80,567 unduplicated users across 48 clinics in 17 counties - Service area covers 87,097 square miles (approximately one-third of New Mexico) - 32 of 33 New Mexico counties are federally designated shortage areas for primary care, behavioral health, and oral health - Only 12.9% of mental health needs met in New Mexico vs. 26.9% nationally - 61.6% of adults with mild mental illness did not receive treatment - 43.7% of New Mexico adults reported anxiety/depression symptoms in fall 2020 - 77% of high school students who attempted suicide also used substances - 32.2% of middle schoolers reported anxiety symptoms; 11% attempted suicide - Rio Arriba County has highest overdose death rate in state (95.4 per 100,000) - 3,461 New Mexicans died of drug overdoses in 2024 (rate of 34.4 per 100,000) - 21.73% of target population lives at or below poverty level - 37.6% of service area residents lack high school diploma/GED - 54% of residents speak a language other than English at home - One primary care provider per 1,340 people vs. adequate ratio - PMS delivered 80,592 telehealth visits in 2024 (up from 11,403 in 2019) - 35 behavioral health service sites across 16 counties
Priority Services & Findings
**SUD Organizations** - Medication-assisted treatment (MAT) available across service area - Evidence-based practices: Community Reinforcement Approach (CRA), CRAFT, Matrix Model, Seeking Safety - Sobering Center in San Juan County addresses high-utilizers with harm reduction approaches - Joint Intervention Program (JIP) provides intensive case management for substance-involved individuals - Rio Arriba County has state's highest overdose death rate (95.4 per 100,000) - 58% of New Mexico adults used at least one substance (2020-2021) - Adults using marijuana, tobacco, and alcohol are 5x more likely to report suicidal thoughts - $39 billion estimated total cost of substance use to New Mexico **Mental Health / Crisis Care** - Crisis intervention and respite care services provided across 35 sites - Same-day suicide risk assessments for Santa Fe Public Schools - Rapid access appointments designed to reduce ED visits and law enforcement involvement - 25.1% of middle schoolers seriously considered suicide - LGBTQIA+ youth are 3x more likely to attempt suicide while using substances than peers - Emergency departments reported 1,166 youth mental health visits and 116 suicide attempts (Q1 2025) - 52% of adult male suicide-related ED visits included substance use diagnosis - Evidence-based trauma treatments: EMDR, reconsolidation of traumatic memories, CBT, DBT **Integrated Primary Care** - Behavioral health integrated into primary care medical homes - Infant mental health and child-parent psychotherapy services - Chronic disease management with behavioral health support - Care management and enabling services via telehealth - Multidisciplinary wraparound care addressing housing, employment, physical health, family supports - Totah Behavioral Health Authority integrates Navajo philosophy of Ke' (kinship, harmony, balance) **School-Based / Youth Services** - Mental health therapy on-site at 21 school locations - On-site dental screenings at 20+ elementary, junior high, and high schools - Head Start and Early Head Start Centers in four counties serving early childhood development - 32.2% of middle schoolers report anxiety; 31.4% report depression - Students using 4+ substances are 27x more likely to be injured in suicide attempt - Youth in unstable housing 7x more likely to be injured in suicide attempt while using substances - Early Head Start Home Visiting program in seven counties
Immediate Actions for Systems Planners
-Extract county-level behavioral health data from this assessment to compare with Bernalillo County metrics and identify relative need across the region -Review PMS's justice-involved behavioral health program model (Santa Fe County) for potential adaptation to Bernalillo County jail and reentry services -Analyze the Joint Intervention Program and Sobering Center models for high-utilizer populations as potential alternatives to emergency department and law enforcement response -Incorporate youth behavioral health statistics (32.2% anxiety, 11% suicide attempts among middle schoolers) into school-based services expansion planning -Use LGBTQIA+ youth disparity data to prioritize culturally competent training for behavioral health providers serving adolescents -Reference the 12.9% mental health needs met statistic when advocating for workforce development investments -Examine PMS's rapid-access appointment model for potential implementation to reduce avoidable hospitalizations -Consider PMS as a regional partner for telehealth expansion given their demonstrated capacity (80,592 visits annually)
Key Contacts
**/ - No Contacts Included in Report