There’s a new room in the Christus St. Vincent emergency department. Different from the other 36 exam rooms and away from the public waiting room, it has several black leather chairs that recline, gray walls that reflect purple in the sunlight, and a flat-screen TV hanging on the wall.
Not everybody is sure what the room is used for.
A few days after the hospital came under fire for releasing a schizophrenic man later shot to death by police last month, St. Vincent spokesman Arturo Delgado invited SFR to examine the space in the emergency department.
Advocates for people with mental illness had been told earlier that the room, part of a renovated ER, was meant to be a dedicated space for incoming patients in crisis to have their mental wellness assesed.
During SFR’s visit, however, Chief Nurse Debbi Honey describes the room’s purpose differently. It’s for patients, she says, but not those arriving. It’s for those leaving.
“This is the room we use for non-acute discharge patients,” Honey tells SFR. “Someone that may need a ride, someone who may need a referral to a service such as [Recovery Santa Fe] to come get them. … [It’s] just a more comfortable place for them to wait for their ride.”
When asked directly whether the room would be used at all to perform evaluative services for patients seeking psychiatric care, Honey reiterated that the room was for people who were on their way out, not in.
Delgado later tells SFR via email that the room was intended “to be a mulitpurpose area” that could be used for “intoxicated patients [to] decompress” and for patients awaiting further treatment or discharge.
“That’s not what we understood the room to be,” says Betty Sisneros Shover, president of the Santa Fe chapter of the National Alliance on Mental Illness. Instead, she says, “We had thought it was a way of separating those with psychiatric issues” while they waited to be evaluated by a crisis counselor.
Research cited by the American Psychiatric Association found that psychiatric patients visiting an emergency room can wait nearly two hours longer to receive care than non-psychiatric patients. Waiting that long in a sterile room could worsen the symptoms for somebody in the throes of a mental health crisis, according to Tom Starke, chair of the Santa Fe Behavioral Health Alliance and a co-founder of the nonprofit organization Recovery Santa Fe. The new room was supposed to be a solution to that problem.
The confusion indicates a deeper problem between the community that advocates on behalf of people living with mental illness and the largest provider of psychiatric services in Santa Fe.
The police shooting of 24-year-old Anthony Benavidez on July 22 amplified voices of dissatisfaction with the psychiatric care offered at St. Vincent and, more broadly, in Santa Fe County.
Following reports in the Santa Fe New Mexican that Benavidez had been released as a patient from St. Vincent a day before the fatal confrontation, “it just brought out a lot of the past experiences of our members taking people who they thought desperately needed care to Christus St. Vincent and having them sort of turned away, saying they’re not a harm to themselves or anyone else,” Starke says. “It hit a nerve in the community.”
The Saturday after the killing, the local NAMI chapter hosted a support meeting for people to come and discuss the event. Many were traumatized, Shover says, and feared that their loved ones living with mental illness could wind up dead at the hands of police. Some who attended, including Martha Cook, voiced their concern with how St. Vincent treats its psychiatric patients, particularly what advocates regard as improperly releasing people.
“A lot of people who were at that meeting were testifying about their own personal experiences that were similar to the one that Anthony experienced, where he’s [mentally] unstable but not admitted [to St. Vincent], and the person goes on to commit some other crime and eventually gets put in a detention center,” Cook tells SFR. “I’ve had that experience with my family member too.”
Hospital admission criteria lists attempted or desired suicide, recent “assaultive behavior” or the threat of it against oneself or others, and the inability to care for oneself (i.e., not eating) as some of the conditions that qualify a person for inpatient services.
Yet Shover says it’s ultimately supposed to be a judgement call by St. Vincent staff, who have discharged several patients who went on to do “some really bad things to people or themselves.” Both she and Starke tell SFR they’ve heard complaints from people that the hospital has released psychiatric patients in the middle of the night, potentially endangering their health.
Honey defended the hospital’s admission protocol. “If they’re cleared they can be discharged, [referred] back to their primary care or outpatient services, or they can be deemed eligible for inpatient services. But there is an evidence-based process that is gone through,” she says.
The miscommunication about the new room’s use may have happened because the advocates’ main line of communication into the hospital is gone. Earlier this year, Shover says she had been in contact with a registered crisis psychiatric nurse named Jacqueline Williams at St. Vincent about the new psychiatric evaluation room. But both Williams and her supervisor, behavioral health unit manager Susan Bodelson Kammerer, recently left their posts at the hospital. Shover says she was never offered an explanation for their departure.
A 2015 New Mexico Regional Health Report found that about 26 out of every 10,000 hospital discharges between 2009 and 2013 in Santa Fe County were for mood and depressive disorders. St. Vincent will continue to be the only facility in Santa Fe with inpatient psychiatric beds for the foreseeable future; a spokesperson for Presbyterian Healthcare Services tells SFR in an email that its new medical center opening next year in Santa Fe will not have inpatient psychiatric beds.
In the meantime, Santa Fe County has seized on the notion that it needs to establish more mental health services by seeking voter approval for money to build and staff a crisis center that could help 2,500 people with severe mental illness in Santa Fe. There’s no word yet of when the facility will open, but county Community Services Department Director Rachel O’Connor says the county will soon solicit proposals from health care providers who want to work with the center.