After mental health crisis ends, a patient's wait begins

Apr. 7—Holly Lovejoy thought things were looking up for her daughter.

After years of addiction and off-and-on homelessness, Kudra Hernandez had been through detox and two 30-day programs at the Santa Fe Recovery Center. She had started the center's 90-day program but left partway through.

Lovejoy said her 22-year-old daughter, who "had been through a lot," was struggling with group therapy at the center and hoped to start getting one-on-one, trauma-based therapy.

Hernandez moved back into her mother's home in Santa Fe and got on a waitlist.

It took about four months for her to finally be assigned a therapist last fall, Lovejoy said. By then it was four days too late.

Hernandez — who loved dancing, makeup, punk music and the rock band Black Veil Brides — died Oct. 6 after overdosing on methamphetamine and fentanyl in her mother's house.

Now Lovejoy — who is 47 and a mother to three other children, including Hernandez's twin brother and a younger son and daughter — is left with an altar in her living room stacked with pictures, gifts and mementos, as well as the gnawing, aching question of whether somebody could have done something to save her daughter.

"I think that if there were just more resources, and I think if we had a culture here that was a little bit more about prevention, then we would be in a different space," she said.

Hernandez is one of countless New Mexico residents who have fallen into a dreaded gap in services behavioral health professionals describe as a common scenario in an overwhelmed system with too few resources: a sort of post-crisis waitlist purgatory. State leaders and providers say progress in behavioral health has focused mainly on developing crisis care and on trying to increase the number of providers. But the lack of transitional resources remains a major problem.

"People finish one program and they're on a waiting list for the follow up, and they don't get it," said state Sen. Jerry Ortiz y Pino, an Albuquerque Democrat who has advocated for behavioral health system reforms. "We're just playing Whac-A-Mole."

Lovejoy said she doesn't know if getting into therapy sooner would have saved her daughter. After all, she'd been trying to get help for Hernandez for nearly a decade as her addiction and mental health issues snowballed.

Last year, Lovejoy said, Hernandez seemed ready to change.

Lupe Sanchez, a residential services manager at the Santa Fe Recovery Center, said she sees the gap in services affect many clients who come in for detox or shorter-term residential programs.

"That's 1,000% real," she said. "We deal with people who have a lot of behavioral health issues. ... As soon as they leave, it's like, 'Where are they going to go?' "

Betty Sisneros Shover, board president of the National Alliance on Mental Illness in Santa Fe, said the lack of providers in New Mexico often becomes apparent to patients the first time they try to get an appointment with a therapist.

"Many people tell me that they wait weeks to get in for an evaluation," Sisneros Shover said. "That's where our system kind of breaks down, is the follow-on care that's necessary to keep people stable."

'I felt pretty helpless'

Hernandez's path through New Mexico's behavioral health system seemed haphazard to Lovejoy because of both gaps in service and her daughter's own mental state and choices.

Her daughter started using drugs in high school, Lovejoy said. First marijuana, then harder drugs. As a student at New Mexico School for the Arts, Hernandez struggled with anxiety, depression, body dysmorphia and a condition known as disordered eating.

Her mental health issues "just seemed to make it harder and harder for her to enjoy what she had liked to do," Lovejoy said.

Hernandez saw two counselors at school before she left at the end of her junior year. She had a psychiatrist for a time, but the provider changed jobs.

"So we lost that care," Lovejoy said. "She just decided not to pursue with another psychiatrist. ... She was kind of left in a lurch."

Sisneros Shover said she hears regularly that losing access to a therapist knocks people off a stable path.

"Once [patients] feel safe and they trust a provider, it's very hard for them to move on to another," she said. "You've got to tell your whole story again, and that's very traumatic to some people."

Lovejoy was a single working mother on Medicaid at the time, and navigating the system was a major headache, she said. Later, when her other children started counseling, the copays started to add up.

When Hernandez was 16 or 17, Lovejoy said, she planned to take her to a rehabilitation program in Pennsylvania, where Lovejoy is originally from. When Hernandez found out about the plan, she ran away from home and started staying on friends' couches.

"I felt pretty helpless," Lovejoy said. "Especially in the high school period ... finding out that you can't, like, get your kid into recovery if they don't want to go, when they don't even know who they are or what they want."

In the years that followed, Hernandez sometimes stayed with friends, sometimes with her mother. She spent time in a transitional living program and was doing well and working. But in February 2021, a recent ex-boyfriend died by suicide, a devastating blow, Lovejoy said.

Hernandez reconnected with another ex, and things started to go downhill again.

At one point, she went to her mother and twin brother and told them she had been using fentanyl and wanted to get Suboxone treatment. One clinic required patients to arrive early in the morning, and sometimes Hernandez didn't have enough gas in her car to make it. Another clinic had only small windows of time when Suboxone was available.

By January 2023, Hernandez and her boyfriend were living on the streets, sleeping in a car. She was arrested twice last year, once in Santa Fe and once in Albuquerque.

It seemed like a turning point, Lovejoy said.

"I think she was kind of tired of living the life she was living," she said.

Hernandez entered a 30-day program at the Santa Fe Recovery Center. She relapsed a few days after leaving and then put herself back in for a second 30-day stint. She was accepted into the center's 90-day program and got through about two-thirds of it before leaving.

She was sober by then, Lovejoy said, but had yet to tackle the "root trauma" and mental illness her mother believed was a driving factor for the addiction. Along with her other mental health conditions, Hernandez thought she might have an undiagnosed mood disorder, Lovejoy said.

During her time at the Santa Fe Recovery Center, Hernandez wrote down triggers and signs she might be in danger of relapsing, Lovejoy said.

"She was supposed to review these with her brother and I," Lovejoy said, adding she thinks Hernandez would have gone over the list with them if she had finished the final recovery program. "We never had those conversations."

Need for a comprehensive system

The only alternative to a therapy waitlist for many mental health and behavioral health patients in New Mexico is turning back to crisis providers, whose roles in some cases are stretching to include transitional services.

Kate Field, crisis services director for the Santa Fe Crisis Triage Center at Santa Fe County's La Sala Center, said therapists there regularly see patients multiple times to avoid allowing them to languish on waitlists that can stretch on for months.

"The problem with the philosophy of a crisis continuum being 'one and done' is these individuals have not had services for years," Field said. "It's not a simple process to say, 'Now we have this contact and they're fixed.' ... If they're not stable, we're not going to discharge them."

Navigating waitlists along with the maze of available resources and eligibility rules can be bewildering.

In addition to more mental health providers, Ortiz y Pino said, the state needs to develop ways to help patients find their way through the network of care.

"What we really need is a comprehensive system that would provide really good care for people going into residential treatment, after they get out, [through] follow-up 12-step programs, opportunities for counseling, support services, navigators to help hook them up with the right resources," he said. "All of that is so desperately needed."

Housing is often cited as another missing piece of the puzzle.

NAMI regularly gets calls from families looking for a place where a loved can go when they're released from a hospital or jail, Sisneros Shover said. Sometimes after a person has a mental breakdown or crisis, they aren't welcome back into their own home because of their behavior.

Other times, she said, a person might realize after a crisis their home environment isn't healthy and will lead them right back into crisis.

"We have no homes to transition people from ... discharge from a hospital or a jail into some safe place they can be until they can get permanent housing," Sisneros Shover said. "That's really lacking in our state."

Painful reminders of problems

Today, Lovejoy is trying to move forward, caring for herself and her other children.

Getting the text message notifying her Hernandez had been assigned a therapist a few days after her death stopped the mother short — but so do all the texts and calls she still receives regarding her daughter. A recent call came from the District Attorney's Office in Albuquerque, which was unaware of Hernandez's death.

"Stuff like that guts you, especially for me having an understanding that my daughter was probably struggling and not telling anyone," Lovejoy said.

She also wonders whether it would have been easier for Hernandez to stay sober if drugs weren't so easy to find.

"I feel like we're genuinely not doing enough to curb what feels like an over-rampant substance-abuse culture," Lovejoy said.

Reflecting on her daughter's death, she said, "I just don't feel like maybe it needed to happen."