DBSA Albuquerque sits on the board of the Bernalillo County Forensic Intervention Consortium (BC FIC) chaired by Barri Roberts. The purpose of FIC is jail diversion. This means getting peers to mental health services rather than criminal incarceration. It is with pride and honor that we assist with peer advisement for FIC.

On August 30, Dr. Bryan Lance Hurt, Mental Health Director of the Bernalillo County Metropolitan Detention Center (BC MDC) shared with FIC members that CCS (Correct Care Solutions):

“Effectively immediately, CCS will now be providing a prescription for a free 14 day supply of medication to released inmates instead of the 3 day supply that was provided previously. CCS continues to provide a 30 day prescription which at the patient’s expense.”

This is incredible news and a huge step in the right direction. There have been many replies to Dr. Hurt’s email notification from FIC members, and DBSA Albuquerque is republishing a contribution to the email thread from Michele Franowsky, retired mental health social worker for the Mental Health Division of the Public Defender Department. This email is republished, in full, with permission of the author.

Hello All,

I am writing this e-mail based on my experience of being the mental health social worker for the Mental Health Division of the Public Defender Department for 14 years. As I retired one year ago, the information provided below may have changed.

During my employment with the Public Defender, I have picked up clients from MDC upon their release and transported them to obtain their specific social service needs. Sometimes, when I did not have access to a state car, I took the bus with a client.

One of the problems is that it is very difficult to navigate the system. It was difficult for me to navigate the system and I know the system very, very well. One must keep in mind that the individual has a severe mental disorder and has just been released from jail. Most often the client is dropped off downtown and has no money.

It is the client’s responsibility to check in with his/her Pre-Trial Services Officer or Probation Officer upon his/her release. To go to Probation and Parole, this meant getting from downtown to the Monte Vista/University Area where the Community Corrections Unit Probation Officer was located. (The Community Corrections Unit is the unit that is trained to deal with individuals who have mental health issues). That interview, itself, can take 3 or 4 hours. (Or at least that is what I was told when I took a client to Probation and Parole in 2013).

When it becomes somewhat of a challenge to pick up medication, clients’ motivation decreases significantly. The individual must be able to get to the closest pharmacy, usually by walking. Frequently, they don’t have the money for a bus ticket. If they do have the money for a bus ticket, they need to be well versed in taking the bus or have access to a phone or a computer to obtain the bus route.

If clients are able to obtain their two-week supply of medication (previously 3 days), the next hurdle is to get the month’s prescription filled. This means they must have Medicaid. If they do not, then the individual has to go to UNM or Healthcare for the Homeless at the prescribed times. At UNM, they may not be seen for the first three times. They are guaranteed to be seen on the fourth visit, however. Transportation to UNM is an issue just like getting to the pharmacy, except that it is a really long walk from downtown.

Another problem I frequently experienced (I dealt with the Walgreen’s on Sequoia and Coors) had to do with the medication being called in. Both PSU and most Walgreen pharmacies are always very busy. After going to Walgreen’s with no successful outcome, I learned to call them first to ascertain whether the prescription was called in. If not, then I contacted PSU and asked them to call it in. Then I would call Walgreen’s to verify that it had been called in. I was told by a pharmacist at Walgreen’s that they often had to check their voice mail to see if the prescription had been called in. Not only that, but I was told that the Walgreen’s (on Sequoia) had a second voice mail that needed to be checked as well. So when I called Walgreen’s, I had to ask the staff if they had checked both voice mails.

On one occasion, I went directly to Walgreen’s from MDC with the client at 11:00. After multiple phone calls to PSU and Walgreens, I was able to pick up the medication at 6:30 p.m. and take it to my client by 7:00 p.m. On that particular day, PSU/MDC had a crisis and my calls regarding meds for my client were simply not a priority (and nor should they have been).

I want to be clear that I am not being critical of either PSU or Walgreen’s. As I previously noted, both are extremely busy. Both endeavor to make things work. And I do not think that the solution lies in working with either entity to solve this particular problem. What is really needed is an individual to help the client navigate the system: Someone to follow up to ensure the medication has been filled; someone to pick up the medication; someone to ensure that the one-month prescription gets filled and picked up; and someone who ensures that the client gets into the system for medication management, i.e. a case manager. However, Medicaid doesn’t pay for transportation nor does it pay for case managers.

In my opinion, the real solution is expanded mental health services. Why not try to obtain funding to expand St. Martin’s, Healthcare for the Homeless, NM Solutions, or UNM to provide a one stop shop, so to speak. It would be a place where the individual could be seen by a prescribing provider and have easy access to a pharmacy. Ideally, the location would be downtown since that is where individuals are released when not picked up by family, friends, etc. upon their release from MDC.

One might expand this facility to include staff who could do psychiatric assessments for crisis situations and provide appropriate referrals. It could also include staff who consist of social workers and counselors who could provide case management services and counseling. The facility could develop a volunteer program to include peers to provide case management services.

Perhaps we could look at ways of developing such a treatment center as an alternative to AOT. One of the problems I have with AOT is that it involves the courts. Once the courts are involved, the unintended consequences would probably be increased incarceration for non-compliance. That is the only leverage the courts have. We already use the jails for non-compliance with medication management.

The other problem I have with AOT is that for it to be effective, there will be a need for expanded mental health services. Why not avoid the courts and the legislative process and deal with the solution to the problem directly?

In addition to the difficulty of navigating the system, many clients don’t want to be on medication for various and legitimate reasons. If there were a one stop shop where clients could be assessed in a crisis situation and/or receive counseling without having to be on medication (at UNM Psychiatric Center, it is not possible to be seen for counseling unless one is on medication), providers could develop long term relationships with clients. Over time and with supportive psychotherapy, clients could be engaged in treatment.

These are just a few of my thoughts. If anyone has any questions regarding the above, please let me know. Thank you.