To protect families’ privacy, parents have been identified by first names and children by an initial only.
Crystal G. has always known that New Mexico’s mental healthcare system is broken. Her aunt, who helped raise her, began showing schizophrenic tendencies at the age of 14. Her mother struggled with substance abuse and went into rehab when Crystal was six. The little girl was put in the care of her grandparents who, for the next two years, made a weekly four-hour round trip from Silver City to Las Cruces to get her to a therapist. It was the closest help they could find.
Since then, Crystal has seen 32 different therapists. “That’s almost a therapist for every year I’ve been alive,” she said, describing the revolving door of providers who suddenly closed their practices, stopped taking her insurance or made hasty diagnoses that would haunt her for years to come.
Today, she looks back on her childhood as an iteration of the pattern lived by thousands of families across New Mexico: “Just generations of hurt people raising hurt people.”
At 33, she is determined to do better by her own daughter. Crystal adopted M at age 5, after learning that the girl’s biological mother — Crystal’s aunt — had, during her own mental health crises, repeatedly endangered the child. M, now 8, worries that she too might end up with schizophrenia one day. It’s not an altogether irrational fear: Schizophrenia has a strong genetic component. But as Crystal often tells her, it’s possible to live well with a mental illness if you have the right support.
Two years ago, M was thriving under the care of an experienced and attentive therapist. She was in first grade, a social child with lots of friends. Then came the pandemic. Like millions of families across the country, COVID took a huge toll on the family, which runs a 24-hour towing business just outside of Silver City. Crystal was left to balance work, parenting and schooling. She set up a workspace for M’s schoolwork on one side of the kitchen table, right across from her own workstation, drew up chore charts and organized exercise and outdoor play time as part of their daily schedules. She spent hours researching and coordinating information between her daughter’s teacher and therapist.
But when school reopened in March 2021, so did the floodgates of stress.
M developed an eating disorder. “She would tear little pieces of paper off her book and start eating it,” Crystal said. “We went through her books and over 50 of them have been damaged — one was completely ruined.”
It was around the same time that Crystal discovered M’s beloved therapist was soon to retire. Crystal immediately began the search for a replacement, calling dozens of providers across Grant County. She felt like she was reliving her own childhood.
“There are no providers available for my daughter right now,” she said. “There’s like an eight, 10, 12-month waiting list for children. That’s terrifying as a parent.”
It’s a terrifying prospect throughout New Mexico, where families wrestle with endless waitlists, poor insurance coverage, limited and out-of-date information, and the fact that there simply aren’t enough providers to go around. For every school psychologist in the state there are 3,673 students; the National Association of School Psychologists recommends a ratio of 1:500. And just like Crystal 20 years ago, children across New Mexico are traveling hundreds of miles for a one-hour session with a therapist.
A parallel pandemic
The COVID-19 pandemic triggered a national emergency in children’s mental health, according to the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association. Suicidal thoughts, gestures and attempts have skyrocketed, as have rates of depression, anxiety, trauma and loneliness. Emergency departments across the country are overflowing with self-harming youth — many of whom are camping out in ERs for lack of inpatient and intensive outpatient treatment.
The problem is acute in New Mexico, which historically ranks among the worst in the nation for overall child well-being. Poverty, suicide, depression, substance abuse: These ills are widely known across the state. New Mexico’s long-standing dearth of mental health care for children and youth has reached a boiling point, according to providers, guardians and kids themselves. Help is harder than ever to come by, with many providers moving to telehealth — inaccessible to patients without internet service and to kids too young to engage via a screen. Other providers have left the field for good, thinning an already threadbare workforce.
According to the Hopeful Futures Campaign, a national alliance of 11 nonprofits working to improve mental health services, 58 percent of New Mexico children diagnosed with major depression — 18,000 out of 31,000 — never receive care. A large number of them are Hispanic; according to a 2021 study from Yale University, Hispanic youth are almost three times more likely to experience delays in care than white youth. Indigenous youth have disproportionately higher rates of mental health challenges linked to intergenerational trauma and ongoing discrimination, yet there are few mental health services for tribal communities and even fewer providers who are Indigenous or culturally competent.
Providers say they’re overwhelmed by the demand. Nikka Peralta, a clinical social worker and owner of Mending Hearts, a small trauma-informed practice in Albuquerque, said she turns away two or more people every day. “We are in a mental health crisis here,” she said. “Sometimes I get four calls in a day and I have to tell people that we have a super extensive waitlist. It’s unethical to put somebody on a waitlist for six months.”
“The amount of trauma we’re seeing is much higher than what we’d seen historically,” agreed Amanda Davison, clinical director and owner of The Family Connection, an outpatient center in Albuquerque. She reports a 500 percent rise in patient demand, from 3,000 sessions in 2019 to 21,000 in 2021. The number of referrals she receives has tripled in that period from 99 to 289, and nearly half are children with depression, anxiety, conduct and anger management issues, and trouble in school.
“We can’t work hard enough, fast enough,” said Angel Toyota-Sharpe, clinical director of the Family Counseling Center at Western New Mexico University. “The problem is, everybody’s full.”
The real crisis
Educators, economists and policymakers have deplored school closures, calling the loss of school-based learning the gravest loss kids have faced during the pandemic. Health authorities see it as a secondary issue to the real crisis.
New Mexico First, a nonprofit dedicated to leading policy change on critical issues, has also identified behavioral health as the most pressing concern. Next month, the organization will hold a statewide town hall to address the problem, bringing together providers, policymakers and citizens to work toward rebuilding the broken system from the ground up.
Danielle Gonzales, the group’s executive director, explained that kids are physiologically incapable of learning when they’re in fight or flight mode. She acknowledges that education took a big hit during the pandemic, but the most serious harm, she said, has been to kids’ mental well-being.
“We have to prioritize the learning environment, welcoming kids back in a safe and supportive way and acknowledging the pain and the loss, really focusing on healing.”
A shattered system
Whatever safety net once existed in New Mexico is long gone. In 2013, former Gov. Susana Martinez wrongfully accused 15 service providers of fraud, abruptly freezing their Medicaid payments and stranding approximately 30,000 New Mexicans without mental health care. And though Martinez’ allegations were eventually proven baseless, the damage was done — many providers closed their doors for good, merged with other agencies or drastically reduced their services. The system hasn’t recovered.
Providers still speak bitterly about the “shakeup” of 2013. Lisa Wooldridge, a counselor in Santa Fe, remembers the chaos and disruption it caused in the mental health community. Many of her adult clients had kids who were seeing a child psychiatrist at one of the agencies affected by the Medicaid freeze. “It put things into a tailspin,” Wooldridge said. Families were left scrambling to find care for their kids, and some never made it back into the system. Trust had been broken.
“There’s just no infrastructure,” said George Davis, a child psychiatrist and former director of psychiatry at New Mexico’s Children, Youth and Families Department. “You never really end up doing your job because you’re always punting. You’re recommending things that are not in the ultimate best interest of a child, like residential care or antipsychotics, because you’re always in emergency mode.”
An interactive mapping service from PullTogether.org shows the lack of services for youth in New Mexico, as well as the stark differences in the availability of services from county to county. Rural and frontier counties clearly suffer the most, a fact confirmed by the federal Health Resources and Services Administration, which reports that 65 percent of New Mexicans live in a mental health professional shortage area.
Families seeking services often can’t find what they need — even when it’s out there. There is no up-to-date clearinghouse for information: The New Mexico Network of Care, maintained by the state Human Services Division, lists providers who are no longer in practice and lacks basic information, including which providers are taking new clients, the length of their waitlists and insurance coverage. Even professionals in the field have trouble determining exactly what services are available. “It’s like asking someone to guess how many jellybeans are in a jar,” Davis said.
‘I’m sorry you’re so sick’
In the face of this weakened system, families are left with nowhere to turn. Trying to find decent care is “a second full-time job,” in Crystal’s words. She spends hours on the phone — researching, navigating intakes, getting on waitlists and following up with providers.
Candice, a single mother in Rio Rancho, has also been struggling to navigate the system for years. Her nine-year-old son D’s problems began in preschool. When he was 3, his daycare provider told Candice that “he’s just not like the other kids.” By age 7, he had been hospitalized seven times and Candice was told he had an abundance of disorders, from ADHD to disruptive mood dysregulation disorder, severe separation anxiety and borderline autism spectrum disorder. After his latest hospital discharge last summer, he was home for only two days before he had yet another episode at daycare — ripping a door off its hinges and hurting his daycare provider.
“What really killed me,” Candice said, “was when we went to leave and he was like, ‘I’m so sorry, Miss Shirley.’ And she says, ‘Honey, it’s not your fault. I’m sorry you’re so sick.”’
That was when Candice took him to Psychiatric Emergency Services at the University of New Mexico. There was no bed available. For the next three months, D was shuffled between UNM, Presbyterian Kaseman Hospital and the Children’s Treatment Center in Albuquerque. None of them could provide the support he needed.
Last September, a bed finally opened up at Texas NeuroRehab Center, a treatment facility in Austin. D spent five months there, and for a while the steady routine and reinforced coping skills seemed to help. But his stay did little to improve his ability to adapt to daily life in an outpatient setting, and when he returned home in February, nothing had changed. Candice is scrambling once again to find help for her son.
“This kid needs to know that I’m not giving up on him,” she said. “Everybody else has left him.”