Crisis Triage Center’s future in question after provider withdraws

The future of the county’s Crisis Triage Center is in question after a private firm providing behavioral health treatment and crisis intervention said they’d vacate operations by Jan. 31.

The announcement followed the Doña Ana County Board of Commissioners’ vote Jan. 9, by 3-2, to deny RI International – the Arizona-based firm that operates the CTC and similar centers across the U.S. – a $561,902 grant from the New Mexico Behavioral Health Services Department.

The grant would have covered a gap between RI’s expenses and revenue and allowed the CTC to remain open through July 2024.

“As you know, we have worked to increase the number of guests we serve and have seen slow improvement over time; however, the volume of guests is not sufficient to sustain the operations of a 24/7 CTC,” RI’s letter to the county reads. “Additionally, with the outcome of the County Commissioners’ meeting on Jan. 9, 2024, there is not enough gap funding to continue CTC operations.”

While RI suggested that the Board’s rejection of the grant motivated their vacancy, a letter obtained by the Las Cruces Bulletin via public records request shows the company had contemplated leaving the CTC by Dec. 1. They sent the letter to the county on Sept. 29, 2023.

Some of the language in the September letter was identical to that of the January letter: “As you know, we have worked to increase the number of guests we serve and have seen slow improvement over time; however, the volume of guests is not sufficient to sustain the operations of a 24/7 CTC.”

The $561,902 grant from the New Mexico Behavioral Health Services Department was the county administration’s solution to prevent RI’s departure.

But conflict between the board and administration surfaced when the grant was brought up for approval at the Jan. 9 meeting. The ever-growing cost of operating the CTC alongside stagnating referrals stemming from lackluster police participation was the board’s significant concern.

“Unless there are some significant changes, we’re just going to be throwing money at the same thing with the same results, and we’re going to continue to put this down a money pit,” District 5 Commissioner Manuel Sanchez said.

Sanchez joined District 3’s Shannon Reynolds and District 1’s Christopher Schaljo-Hernandez in voting against the grant. District 2’s Diana Murillo and District 4’s Susana Chaparro voted to approve the grant. All five commissioners expressed support for the CTC conceptually, but differences occurred in how the CTC should be operated.

“We’re just not getting the results we need,” Reynolds said. “We’re not getting what we paid for.”

The potential closure comes after the CTC – built in 2013 but having no permanent provider until 2021 – saw 171 referrals in 2021, 1,150 referrals in 2022, and 1,267 referrals in 2023, according to data provided to commissioners.

Growing costs, stagnant referrals

When the CTC began operations in 2021, the county agreed to pay RI about $261,000 per year. The contract amendment proposed at the Jan. 9 meeting would have increased the yearly costs to $1,561,279.84, a nearly 500 percent increase. It would have been the eighth amendment to RI’s contract.

RI collects money on a per-person basis, meaning the more people who use the CTC, the more money RI receives. They do this by billing Medicaid when applicable. RI’s primary expense for CTC operation is personnel costs. Like an ambulance service, RI keeps the center staffed 24 hours to be capable of emergency crisis care. When fewer people use the CTC, RI goes to the county to cover the difference between expense and revenue.

Who uses the CTC, when they use CTC and why they use CTC has been a constant issue since the center’s opening in 2021.

According to statistics from the county’s Health and Human Services Department, the Las Cruces Police Department is the CTC’s biggest user.

LCPD officers brought an average of 15 people per month to the CTC in 2023. They stand alone as a police agency utilizing the CTC at a high rate. Other area police – New Mexico State Police, university police, the Mesilla Marshals, but most notably the Doña Ana County Sherriff’s office – use the CTC significantly less than LCPD.

That’s a problem for RI’s revenue since police dropping people off was meant to be a substantial source of referrals, according to RI’s business plan for the CTC.

“More than 80 percent of all admissions are referred by law enforcement,” RI’s business plan states, referring to similar centers in Arizona. “It’s estimated that Doña Ana County will come to experience similar rates.”

That hasn’t happened. Instead, data shows that just 20 percent of referrals come from law enforcement.

Referral issues

Since its inception, LCPD has utilized the center 397 times, according to the county.

Jeremy Story, the LCPD Chief, said the CTC had benefited the city and its officers but that changes to the CTC building and state laws regarding involuntary commitment prevented them from taking more people to the CTC. Story said that if those changes were made, LCPD would take more people to the CTC.

DASO – a department with about as many officers as LCPD – has used the CTC just 15 times, per county data.

Kim Stewart, the sheriff of Doña Ana County, told the Las Cruces Bulletin that bringing people to the CTC is easier for LCPD. Deputies don’t encounter people in public spaces as often as Las Cruces police officers do, Stewart said. Instead, deputies interface with people in homes located miles away from the CTC.

“They have to want to go voluntarily if we don’t have the probable cause to take them involuntarily. And a lot of times when we’re called to these, they are truly involuntary situations,” Stewart said.

Jamie Michael, the county Health and Human Services Department director, said she plans to address the county commission during a meeting on Jan. 23, as county administer search for a solution.

“The top priority is that we have access to crisis care in our communities. And then secondly, it’s trying to retain the staff there because they’ve been drained; they’ve been doing this good work for two and a half years. And so we don’t want to lose the traction and the momentum that we’ve built.”

If no immediate solution is found, the CTC will stop admitting people on Jan. 30.

“We’re trying to find some good solutions,” Michael said. “I do think the commissioners will support some good solutions because I think everybody knows that crisis services are needed. It’s just a question of how do we get there.”