El Pasoans in need of mental health care may soon have to wait to receive service. Strain on the local mental health care system has caused officials to consider implementing a waiting-list as one alternative to keep up with performance requirements recently issued by the state.

Gary Larcenaire, CEO of El Paso Mental Health and Mental Retardation, said the center has been running significantly over capacity for years. The center's Board of Trustees will have a meeting today at 6 p.m. to review some of the options to balance the 2009 budget and welcome the public to join the discussion.

“We've run the numbers on our budget and are no longer going to be able to over-serve. The state contracts with us for a certain number of people every month. I've been here five years now, and we've been exceeding that target considerably for the last five years.

"But changes in the performance contract requirements are making it impossible for us to continue doing that, and it's also putting well too much of a strain on the case workers that we have. There's just no way for us to maintain the quality of care that's expected,” said Larcenaire.

He said the Texas Department of State Health has been making incremental changes since last year which have increased the minimum number of hours of service which must be dedicated to each patient—an amount based on an assessment of the severity of each case.

Larcenaire said MHMR receives funding for about 587 children and 3,000 adults, but treats 1,190 and 4,000 respectively. The increase in the minimum average contact duration means a larger workload which will cause caseworkers to be spread thin.

“What you do is you end up diluting the soup down to the point where nobody is getting better. Everybody is starving. So we've reached a point over the last five years where we've kind of been making it work, trying to make it work, trying to hang on until the next legislative session, hoping for relief,” he said.

Larcenaire said he has been calling attention to the problem as far back as 2004.

Recently, he mentioned the issue of a waiting-list during a BRAC hearing last May in regard to the impending arrival of 70,000 soldiers and family members. He said the mental health care system would be unable to absorb the additional workload, and that a number of veterans with Post Traumatic Stress Disorder might be put on a waiting list.

Larcenaire said the center will make an effort to help the people who have to wait.

“Hopefully we'll be able to do some referrals to the [Federally Qualified Health Centers] in town like the Project Vida, La Fe and Centro San Vicente. We're not just going to kick them out. We're going to try to do as many referrals as we can. Mainly the FQHCs, though. My fear is that they'll end up in the jails and the emergency rooms,” he said.

El Paso MHMR anticipated the crisis and has made an effort to educate government officials, including health care providers and law enforcement agencies.

“We just got some crisis money, and that's a huge starting point for us,” said Larcenaire. “The crisis money is for acute stabilization, and we're using that money for people who are a danger to themselves or others to make sure that they get appropriate treatment. But the problem is after the crisis has been stabilized—the ongoing cost of treatment.

“Ultimately it's a state responsibility. It has been argued by prior judges that health is a county responsibility, and that mental health is health. But there's been some disagreement there, and an opinion went all the way up to the Attorney General's office and they said that mental health did not fall under that, so it remains a state responsibility,” said Larcenaire.

Larcenaire said he agrees with the new state-issued requirements. He said the reason for the change was probably due to research showing statistical benefit.

“We're certainly not being critical of the state in any way, shape, or form. They're doing everything that they can,” he said.

El Paso MHMR is a not-for-profit agency that serves as a "safety net" for people who need mental health and mental retardation services.

About three quarters of the around $16 million in government revenues for MHMR comes from the state, Larcenaire said.

He said that the administrative costs are “contractually monitored and it cannot exceed 10 percent. We have 450 employees.”

The proposal was news to at least one board member of the El Paso chapter of the National Alliance on Mental Health.

Jessie Zavala said she was against the idea of a waiting list, and said while she had not heard about the meeting tonight, would see about having NAMI attend and voice its opinion.