GALLUP — The clinic didn’t look like much — yet.
A microwave and shelving unit were still sitting in boxes in the lobby of the new Certified Community Behavioral Health Clinic in Gallup, which opened Jan. 1 in a nondescript building on the city’s eastern side.
Dry-erase boards were awaiting installation in wide, flat boxes. A pink sticky note marked a spot on the wall where a sharps container would hang.
The facility, operated by the Santa Fe Recovery Center, is one of five new community behavioral health clinics in New Mexico certified by the state Health Care Authority and the Children, Youth and Families Department. They serve patients across seven counties, adhering to a federally designated model in which a comprehensive range of services are available through a single front door.
“A Certified Community Behavioral Health Clinic is meant to provide primary care for mental health conditions — so a one-stop shop,” said William Becker, director of the Gallup clinic, during a recent visit.
New Mexico — ranked among the top five states wrangling with the most severe shortages of mental health care, according to a legislative report — is one of 10 states selected to participate in a four-year “demonstration project” through the U.S. Department of Health and Human Services, the Centers for Medicare and Medicaid Services and the Substance Abuse and Mental Health Services Administration, said Nick Boukas, director of the state’s Behavioral Health Services Division.
The federal funding, Boukas said, will “not only make sure that this program works, but [inform] how can we expand it and give them additional resources.”
Behavioral health is shaping up to be key area of focus during the 2025 legislative session, which begins Jan. 21. Democratic lawmakers last week unveiled a package of legislation to help rebuild New Mexico’s system of care, with a proposed billion-dollar trust fund and potential allocations of $150 million to $200 million for infrastructure. Gov. Michelle Lujan Grisham set aside $100 million in her budget plan to expand behavioral health services, plus additional spending on initiatives like the 988 crisis line and substance abuse treatment.
For those dollars to count, Becker said, the state must do more to ensure clinics have enough trained personnel to succeed.
Across the U.S., nearly 1 in 4 adults live with mental illness. Becker estimated that equates to about 20,000 people in McKinley County who may be in need of the Gallup clinic’s services — and right now, that’s just not doable.
“I don’t think we have capacity to provide services to 20,000. ... There’s not enough clinicians. There’s not enough space,” Becker said.
‘Get those resources in one spot’
It often takes people experiencing mental health issues more than a decade to seek help. The median time between the onset of a disorder and an initial treatment contact is 11 years, according to one often-cited study.
Becker hopes the Gallup clinic will narrow the gap, in part by ensuring appointments are available shortly after a first call or visit.
“So, if you come and see us, for example, you show up, you say you’d like to receive services, we’re required to have you see a clinician within 10 days,” he said.
Certified clinics must provide a wide range of services, Boukas said, from basic behavioral health care to substance abuse treatment to primary care screenings.
“They’re going to be able to get those resources in one spot and be linked to services regardless of their age or ability to pay in that one location,” he said.
Another requirement: Clinics must be accessible to anyone, regardless of insurance status, he added.
The Santa Fe Recovery Center, at 2504 Camino Entrada on the city’s south side, will be tasked with providing the same range of services, said Kourtney Muñoz, the organization’s spokesperson.
“Essentially, it’s going to be the exact same thing that’s happening in Gallup. ... We’ll be slowly adding all of the services and making sure we’re staffed up,” Muñoz said.
‘This is a huge investment’
Along with the Santa Fe Recovery Center’s clinics in McKinley and Santa Fe counties, new certified clinics are serving patients in Bernalillo, Sandoval, Eddy, Doña Ana and San Juan counties.
Their funding is a mix of state and federal dollars. From fiscal years 2022 to 2024, New Mexico received nearly $9.3 million in grants from the federal Substance Abuse and Mental Health Services Administration to plan and establish them.
The state Legislature, meanwhile, has offered its own funds, including $1.5 million for fiscal year 2024 and $5 million for the current year.
Lujan Grisham’s budget recommendation for fiscal year 2026 includes another $3.4 million for the initiative.
In practice, providing service to anyone — insured or not — requires a complicated calculus with reliable predictions on the number of patients with insurance, including Medicaid, and those without any kind of insurance, Becker said.
Case managers will also be available to help patients sign up for Medicaid and other benefits.
“The hope is, at the end, it all balances out because I’ve told the state how many visits we’re going to have per year,” Becker said.
Community outreach efforts are underway to ensure partner organizations and local providers are aware of new certified clinics and the expanded mission at the Santa Fe Recovery Center, Muñoz said.
“The referral process won’t be that much different. It’s just going to be a matter of now they know they can refer people for more than just substance use,” she said.
Becker estimated it will take about a year to get all of the Gallup clinic’s services up and running.
“This is a huge investment from the state of New Mexico, but you don’t have the capital to turn on the lights on Day One and have everything available,” he said. “We have to build this out and start to establish these programs.”
Several days after opening, the pieces were starting to fall into place. The clinic’s two crisis stabilization rooms were already stocked with crayons, coloring books, fidget toys, games and notebooks, plus couches, pillows and beanbag chairs.
The crisis rooms are open 16 hours a day now, but Becker said he plans to expand that to 24/7 service as the clinic acquires more staff.
On average, he estimated the clinic provides crisis services for about two people per day. As the clinic ramps up, he expects it to serve about 27 clients daily.
Challenged by staffing
Asked how the recruiting and hiring process was going, Becker’s answer was immediate: “Badly,” he said.
To manage the 20,000 or so people in McKinley County who may need care each year, Becker said the area would need more than 250 clinicians, each of them carrying a caseload of 75 clients.
Right now, he said, there are only about 40 clinicians in town.
Behavioral health provider shortages are commonplace in New Mexico. The state has 19 geographic regions designated by the U.S. Department of Health and Human Services as mental health professional shortage areas. Those areas include parts of 28 of New Mexico’s 33 counties, according to a June 2024 report from the Legislative Finance Committee.
The Health Care Authority has made some moves to help with the provider shortage. On Jan. 1, enhanced Medicaid reimbursement rates for behavioral health went into effect, increasing those rates similar to “what we’re paying for physical health,” Boukas said.
And he said he’s hopeful the “exciting new opportunity” of certified community behavioral health clinics might lure more providers.
Becker, meanwhile, attributed the shortage of providers at the Gallup clinic to a variety of troubles, from a lack of housing in the city to a lack of graduates from New Mexico universities.
“I need child therapists. Where are these individuals? I don’t think that we graduate enough of them from our existing colleges,” Becker said.
And then there’s the matter of pay. It takes at least eight years of education to become an independent clinician and more to become a psychiatrist.
“For somebody that’s got a master’s degree, it’s not like we’re paying them a bunch of money,” Becker said.
The true answer to New Mexico’s behavioral health woes, Becker said, is wide-scale improvements to the behavioral health infrastructure and training systems.
“We’ve been negligent in thinking about that, right?” he said. “So we need to ramp up the number of professionals we have available, the number of spaces we have available to provide these supports, the number of crisis systems in the state of New Mexico.”
Becker added, “We need to essentially build out our behavioral health capacity in the state of New Mexico.”