It took Aretha Amundson five years to become a fully-licensed professional clinical counselor. Her journey began with a master’s degree from Western New Mexico University, followed by 3,000 hours of supervised work at the Child Development Center and Hidalgo Medical Services in Silver City.
“It’s a horrendous process,” Amundson said, describing the expensive education, unpaid internships and arcane credentialing protocols required for mental health counselors. But it’s a trial she was willing to undergo because of the vital need to expand mental health services in her community.
Today, she works with children and youth in Silver City where she’s building a new branch of Winborn Wellness and Counseling — based in Deming, 52 miles away — from the ground up, setting up playrooms, painting the walls in bright colors and working with trainees. Now, finally, she is able to bill insurance companies and Medicaid for the work she does.
Building the practice has been grueling.
“There just aren’t enough therapists, and many of them are retired or burnt out,” Amundson said.
Like many small communities in New Mexico and throughout the country, Silver City suffers from a dire shortage of mental health care providers.
“The biggest threat to changing any behavioral health system is the workforce,” said Neal Bowen, director of New Mexico’s Behavioral Health Services Division. “And it is certainly not just New Mexico — every state in the union has a workforce shortage.”
What is unique to New Mexico, he said, is the intensity of the need.
“It’s a different level of trauma. We have such a high tax of adverse childhood experiences, and that’s predictive of a great number of social and health care difficulties going forward through life.”
An adverse childhood experience — or ACE — is defined as one of 10 kinds of childhood trauma, including abuse, neglect, mental illness, substance abuse, domestic violence, and an absent parent or incarcerated household member. New Mexico has one of the highest rates of ACEs in the nation, which means the state has an acute need for behavioral health services. And this also puts large demands on providers. Working with clients who have severe trauma is linked to high rates of provider burnout due to emotional exhaustion, the American Psychological Association reports.
Another part of the problem is low wages: Behavioral health professionals with master’s degrees — like counselors and mental health social workers — earn 33 percent to 45 percent less than other health professionals with a comparable education, including physician assistants and registered nurses, the Bureau of Labor Statistics reports.
The average annual salary for counselors is $51,420, making it hard to recruit professionals from out of state. Bowen recalled a former patient who worked as an assistant manager at a truck stop and was inspired to go back to school and become a social worker, but had second thoughts after researching the field.
“Why would I go get a master’s degree to get paid less than I get paid as assistant manager at a truck stop?” the patient told Bowen.
“You pretty much have to come from money to access the level of education to be a therapist,” said Marshall Martinez, executive director of Equality New Mexico, an advocacy organization for LGBTQ people. That limits the workforce in terms of race and ethnicity, class, and gender identity, he said.
That’s a problem in a state where 48 percent of the population is Hispanic and 11 percent is Indigenous. When providers don’t reflect the cultures and languages of the people they serve, it’s nearly impossible to help them.
Most New Mexico providers are based in Albuquerque or Santa Fe. Only 29 percent work in rural counties, relegating 65 percent of New Mexican residents to a “mental health professional shortage area,” according to the federal Health Resources and Services Administration.
A lasting ‘shakeup’
New Mexico’s behavioral health workforce took a huge hit in 2013 when former Gov. Susana Martinez wrongfully accused 15 service providers of fraud, abruptly freezing their Medicaid payments. Though her accusations didn’t bear out, her actions left 30,000 New Mexicans without mental health care and threw hundreds of providers out of work.
This event — known today as the “shakeup” — continues to cast a long shadow over the state’s behavioral health workforce.
Nikka Peralta remembers it well. She had just completed her internship at TeamBuilders, one of the agencies forced to close temporarily as a result. “I got out just before everything went up in flames,” she said.
Today, Peralta owns a small group practice in Albuquerque called Mending Hearts, where calls for help often number four per day and a six-month waitlist has become the norm. She has plans to expand her practice, transforming it into a trauma-responsive wraparound service for people experiencing homelessness, addiction and other social harms.
It hasn’t been easy. In 2020, Peralta started the process of designating her practice as an agency with Medicaid. Once that’s in place, she’ll be able to apply for certification from the state to hire and bill for less-experienced counselors – a crucial step in building a workforce practically from scratch.
“We’re building a system,” Peralta said. “I want to be the foundation.”
Almost two years later, she’s still cutting through red tape.