'A big barrier'

Police officers, health care workers and rescue personnel in Albuquerque know Shawnna Boyd well.

The 37-year-old is what they call a "frequent flyer." She has been calling 911 for years – expressing thoughts of suicide and getting taken to the hospital.

Last July, she ran from her group home into the middle of Montgomery and caused a three-car crash. Other times, she has been arrested – charged with battery on a health care worker, assault for threatening another resident at a group home or criminal damage to property – although all cases against her end up getting dismissed when she is found incompetent.

Officers have had more than 150 contacts with her over the years.

"She knows she needs help and she's not getting it," said Shawnna's mother, Kathy Boyd. "I don't know what she needs, but I know she needs something that she is absolutely not getting. It's going to end up … she is going to kill herself."

For law enforcement and disability advocates alike, cases like Shawnna Boyd's highlight a lack of services to treat behavioral health issues in the state.

Advocates say jail is not a treatment facility and putting people with mental health issues into the criminal justice system won't help them. And officers tasked with responding to calls say they can take someone to a local hospital instead, but that is just a "Band-Aid fix."

"It's really difficult when there's not a whole lot for us to refer to," said Matt Dietzel, the acting commander of the Albuquerque Police Department's Crisis Intervention Division. "There's not a whole lot of intensive case management that we need so your police department's doing that."

Lack of coverage

Kathy Boyd said her youngest daughter has been diagnosed with bipolar disorder and schizoaffective disorder. She also has a traumatic brain injury.

She was living in a group home until she got kicked out last fall. Now she is living with her mother and sister in their Northeast Albuquerque home. She has a caretaker and takes daily medication but she continues to act out, hurt herself and run away.

So Shawnna Boyd's treatment team recommended she be sent to Nexus Health Systems neurorecovery center outside of Houston for a month.

"The services available within the state of New Mexico at this time are inadequate to provide ongoing support of Ms. Boyd's recovery and rehabilitation," her outpatient psychiatrist wrote in an affidavit provided to the Journal by Shawnna Boyd's attorney.

Stacey Adams, the senior national complex care liaison for Nexus, said the facility sits on 26 acres and is a "home-like environment" that can offer one-on-one care if needed but the goal is to help residents transition to being more independent. Residents participate in group and individual cognitive and "neurorehab" sessions to improve behavioral issues and increase their ability to function.

But Shawnna Boyd's insurance through Medicaid wouldn't cover the cost.

According to a denial letter, the Blue Cross Community Centennial medical director determined Shawnna Boyd is not able to do three hours of therapy each day and does not need skilled nursing care.

Attorney Max Kauffman, with Disability Rights New Mexico, disagrees, citing the psychiatrist's affidavit that said Shawnna Boyd can participate in three hours of therapy a day and does need ongoing skilled care.

"The reasons for the denial are not supported by the evidence that we see from the people working with her on a day to day basis – it's not supported by physicians who work with her," Kauffman said.

He has appealed the decision to an administrative law judge with the New Mexico Human Services Department, but a decision has not yet been made.

"We tend to look at the individual and point the finger at them to say, 'why can't you get your life together,'" Kauffman said. "But when they try they meet a big barrier such as this – where nothing in the community is working out so what's left is to try this one last thing – and then she's shot down because the (Managed Care Organization) doesn't want to pay for it."

Blue Cross Blue Shield wrote in a statement that in order to protect the privacy of its members it doesn't disclose personal or benefit information. It added that there is a process in place to protect the member and hear their concerns.

"Our members are at the center of all we do, and we are committed to providing them access to the right care, at the right place, at the right time," the company said. "Our care management tools and processes are designed with this in mind, considering among other factors state and federal regulations and medical necessity criteria set forth in our medical policies and backed by evidence-based medicine."

'Long-term fear'

When Dietzel joined APD's Crisis Intervention Division several years ago he began looking at reports to determine who were the "high utilizers" in terms of contacts with officers.

No matter how he looks at it, Shawnna Boyd is always No. 1.

"Her case is really difficult, because she calls police constantly," Dietzel said. "How this plays out is – in my mind – the care that she receives is not at a high enough level for the need that she has and so she has ways to get out of the system."

He said in one scenario, Shawnna Boyd calls 911, officers respond and she tells them she wants to hurt herself and they take her to the hospital.

"This happens extremely often, to the point where officers in that area command know her by name," Dietzel said. "The other scenario is, she'll get angry at the other people that she lives with and sometimes it becomes physical and there's occasional arrests as a result."

Dietzel said there are at least 155 cases involving Shawnna Boyd, although he expects there are more under incorrect spellings of her name or the wrong date of birth. Of those, 15 resulted in an arrest but the vast majority were reports for behavioral or mental health, several of which were transports to the hospital.

He expects responders with Albuquerque Community Safety – the city's newest department which responds to behavioral health calls – will soon know her by name as well.

Ultimately, Dietzel agreed that what's happening now isn't working.

He said the incident in July where Shawnna Boyd ran into traffic and caused a crash scares him because there are so many people his unit has tried to get help for who have ended up getting hit by a car and killed.

He said he worries what will happen if, in the future, Shawnna Boyd can no longer stay with her mother.

"What is the plan here?" Dietzel said. "She's living somewhere safe for now but my long-term fear is, that's not going to work out either and maybe this time there isn't a plan and she ends up completely homeless."

A call for care

Sitting in the living room of the house she shares with her mother and older sister one morning in mid January, Shawnna Boyd is outgoing and eager to contribute to the conversation. She shows off her nephew's puppy and a remote control WALL-E toy that lurches around the room, skirting the Christmas tree set up for a delayed family celebration.

Shawnna Boyd said she wants to go to Texas and she is hopeful that the center will help her feel better.

"I think it'll help me out," she said. "I'll be better and then I can live at home permanently with my family and not in the dang group home."

Kauffman and Dietzel are also optimistic that it could work, with Dietzel pointing out that if her calls to the police and for emergency transport get cut in half "it'd be a huge victory for everybody."

"If you want to look at this in terms of violent crime, that officer that's responding standing there with her, isn't responding to the person who just was involved in a shooting," Dietzel said.

As for Kathy Boyd, she remembers a time when spending time with her daughter was fun – they'd go to the park or the zoo, or ride horses training for the Special Olympics. Now there are a lot of fights and stress and she's always worried her daughter will get hurt.

"I just would like to have a quiet peaceful life," Kathy Boyd said. "I'd like to know she's taken care of. That's the main thing."