In November, a primary care physician prescribed Cameron Mozafari Lexapro, a medication used to treat depression and anxiety. He was living in Albuquerque and running the Queer Literacy Center at Corpus Arts. A few of Mozafari’s friends died by suicide around that time, and he was struggling with depression.
After he got the prescription, he registered with a University of New Mexico program to begin the long process of finding a mental health provider.
Two months later, his symptoms were worsening. He started having flashbacks to a time he’d tried to forget.
“I was getting fits of anger, and just like crippling depression, and like, I couldn’t get out of bed,” he said. After doing some research online, he had a hunch that he had Post Traumatic Stress Disorder.
He’d had a stalker over a decade ago, he said. He can’t remember a lot from those years when his stalker was after him — he’s repressed those memories in order to survive, he said. Since then, Mozafari mostly avoided dealing with the trauma he experienced in that time.
He still hadn’t found a mental health provider. “They would call me when they could, and I would follow up, and they said, ‘We still don’t have anybody,’ ” he said. He tried explaining that the problem was urgent and asked to be made a high priority because he was fearful about his own suicidality.
They never got back to him, Mozafari said.
“I was thrown into this maze of trying to advocate for myself, for trying to find anybody who would actually take me when, you know, the people whose job it was to connect me with health care professionals, they couldn’t find anybody,” he said. “And they were telling me to try to do it on my own.”
He only later got a formal PTSD diagnosis after moving back to his home state of Maryland. He said he moved, in part, because he wasn’t able to get mental health treatment in New Mexico, where he had been living for four years.
Once he returned to Maryland, he was able to find a provider in a matter of weeks, he said.
At the end of last year, there were 305 psychiatrists licensed to practice in New Mexico. The state needs at least 117 more psychiatrists to meet patient needs, according to research on the state’s health care workforce. Those numbers come from a report due out in October, though early findings were presented to state lawmakers on the Health and Human Services Committee on Aug. 19.
Mental health is just one part of the problem; New Mexico’s entire health care system is plagued by shortages, and nearly every county in the state does not have enough primary care physicians or nurses, researchers from the state’s Health Care Workforce Committee told lawmakers.
As things stand, New Mexico needs:
- 6,223 registered nurses or clinical nurses specialists
- 2,510 emergency medical technicians
- 524 physical therapists
- 521 pharmacists
- 328 primary care physicians
- 249 physician’s assistants
- 238 certified nurse practitioners
- 117 psychiatrists
- 108 occupational therapists
- 87 dentists
- 56 obstetrics and gynecology physicians
- 13 certified nurse midwives
- 10 general surgeons
- 5 licensed midwives
“There are massive shortages in every health care sector in the state,” said Dr. Richard Larson, executive vice chancellor of the UNM Health Sciences Center.
In 2020, only six of New Mexico’s 33 counties were at or above the national benchmark of 8.3 primary care physicians per 10,000 people: Bernalillo, Santa Fe, Los Alamos, Socorro, Colfax and De Baca. The counties with the worst rates were in the northwest and southeast parts of the state.
The researchers recommend lawmakers create incentives for existing primary care providers and community health centers to hire behavioral health providers. They recommend expanding the kinds of care provided at primary care facilities that can be paid for using Medicaid to include behavioral health.
To begin to address the staffing shortages, they say lawmakers should boost funding to student loan programs for medical students by $831,000 overall per year, along with an extra $12,000 for each student working to become a mental health provider.
If lawmakers can’t agree to that, they recommend the state instead add another $1 million to the State Loan Repayment Program, which helps practicing health care workers repay their student loans if they work for two years in a designated medical shortage area in New Mexico.
The committee is also asking lawmakers to fund at least one community location in each county for telemedicine video conferencing — a private, computer-equipped space inside one of the state’s 56 public health offices.
The use of telehealth more than doubled at the UNM Health Sciences Center last year with about 60,000 more appointments than in 2019. That trend is even more pronounced in 2021, almost tripling with about 176,000 more visits. This follows a huge national shift among health systems using telehealth to continue treating less urgent conditions while maintaining social distancing between providers and patients.
Looming effects of trauma
The pandemic has made the state’s existing problems worse, Eleanor Chavez said. She is the executive director for Local 1199, the state chapter of the National Union of Hospital and Health Care Employees. “The reality really is that we’ve had a nursing shortage in New Mexico for a very, very long time,” she said.
Jerry Harrison, executive director of New Mexico Health Resources, agrees. Just before the pandemic started, some health care facilities in Albuquerque had waiting times for first appointments as long as four months, he said. “But that’s been going on for years and years,” he said. “From my perspective, there’s absolutely nothing new about shortages.”
The state’s health care system cannot handle the amount of patients in need because of where physicians work and don’t work, and what kinds of insurance patients have or don’t, Harrison said. “We don’t have the policy infrastructure to deal with it, I can tell you that,” he said. “We don’t have a public health infrastructure that is working prospectively. It works reactively, because a lot of the employees are working what used to be three positions.”
Harrison also points to the defunding of the state Health Policy Commission in the first year of former Gov. Susana Martinez’ term and an understaffed state Health Department as exacerbating the problem.
But he does worry that the pandemic will lead to even more shortages in the future.
“I had a physician in training tell me, ‘I have seen more death in one year than I expected to see in my entire career,’” he said. “It’s beyond burnout that a lot of people have experienced in the last year. The potential for long-lasting Post Traumatic Stress Disorder is going to play out.”
In response to the extra stress for workers, many hospitals in the state are hiring more travel nurses, Chavez said. But those travel nurses often make double the amount that regular nurses do, she said, and that further damages morale.
“Some things that we’ve negotiated with the hospitals are extra-shift incentives where RNs and other health care positions will receive a bonus for having worked a certain number of shifts,” Chavez said. “And those shifts will also be paid at double time.”
But there’s still not enough staff in the state overall, she added, and “people can only work so much for so long.”
“That means every state is short,” Harrison said.
Mozafari said the health care coordinator who was assigned to him by his health insurance provider, Blue Cross Blue Shield, was trying to get him to have video appointments with people from a private company.
“It wasn’t clear if they’re even from New Mexico,” he said. “It didn’t even say, like, if they were trained professionals.” It was hard that the final thing his coordinator could do was to suggest a one-off, moment-of-crisis video chat with strangers “that I don’t know, don’t necessarily trust to tell my story to. And then to do that over and over again.” It was hard to fathom as PTSD treatment, he said.
Mozafari still teaches English and linguistics to undergraduate students at Central New Mexico Community College remotely, and he tries to stress to his students that mental health is an important part of overall health. He shows them statistics about rates of depression going up after the pandemic began.
“Nobody talks about it, and everybody’s suffering through it,” he said. “But, you know, the data is only part of the story. The other part of the story is the stigma attached to the fact that people aren’t talking about mental health, you know, what the actual statistics are. We don’t know because a lot of people are not seeking treatment, or treatment isn’t there.”
Where’s the info?
So far, the Health Sciences Center has not publicly released the full 2021 report by the New Mexico Healthcare Workforce Committee that was discussed by lawmakers on Aug. 19.
Larson presented some findings lifted from the report on Aug. 19, but did not distribute copies to everyone at the public meeting — only to lawmakers.
Source New Mexico asked to see the underlying report by filing two requests under the state’s Inspection of Public Records Act: one with the University of New Mexico Health Sciences Center where the research was done, the other with the legislative Health and Human Services Committee that saw the findings at the meeting..
Within two days, Legislative Council Service staffers provided all of the records they have that were responsive to the request, including a detailed breakdown of shortages in every health sector in every county in the state using data from the report.
The university, on the other hand, has not released any new information in response to the request.
UNM’s records custodian on Aug. 26 sent back the presentation that had already been publicly posted on the Legislature’s website.
“Records will be available at a later date, and you may submit a new request at that time,” the office wrote.
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