By most accounts, the state of mental health care in El Paso has improved dramatically in recent years, thanks to increased state funding and a groundbreaking collaboration involving the state’s Emergence Health Network.

Francis Fowler, a long-time critic of mental health services in El Paso, credits much of the change to Emergence CEO Kristi Daugherty, who was handed the reins in 2012 after the county fired and replaced the mental health agency’s board.

“When Kristi arrived, mental health was still pretty much a dirty word,” Fowler said. “Nobody wanted to talk about it, and nobody wanted to be open about it.

“We now have a community that’s looking at mental health as an important issue, not something to be shoved under the carpet or behind the door.”

Not long before Daugherty’s promotion in 2012, the state agency dropped its old name, the Department of Mental Health and Mental Retardation, in favor of the Emergence Health Network.

“The name change has allowed Emergence to take a place of importance in the community and be respected as the mental health authority,” Daugherty said. “I don’t think MHMR was respected before.

“I think it was a place to go out of desperation.”

Daugherty, who had been the agency’s chief clinical officer, is a licensed clinical social worker with a master’s degree in social work and an MBA.

She came with a lot of changes in mind for getting local government and nonprofits to share responsibility on mental health issues. But, she needed community support to make big changes at the troubled agency.

She got it from the Paso del Norte Health Foundation and other interests that helped back and organize the El Paso Behavioral Health Consortium.

Its members include executives from Las Palmas Del Sol Healthcare, The Hospitals of Providence, University Medical Center, University of Texas at El Paso, Texas Tech University Health Sciences Center and El Paso County.

The consortium, in turn, commissioned a study by a nationally known consulting firm, TriWest, to identify the problems and recommend solutions.

The collaborative’s ambitious goal is to establish “the finest behavioral health system in the country.”

But TriWest’s February 2014 report described a broken and fragmented system of care that was failing everyone – children and their parents, inmates in jail, homeless on the streets and everyday El Pasoans who suffer from mental illness.

The study found that 166,339 people, or 30 percent of El Paso County’s population, need care annually for mental health and substance use problems, and that more than 40,000 people have serious disorders.

The community, however, only had the resources and capacity to help about 13,500 people a year, according to TriWest.

Parents, school teachers and law enforcement officers lacked the training and education they needed to recognize and properly deal with mentally ill people they encountered, sometimes with tragic results.

But it wasn’t just an El Paso problem.

In 2011, Texas ranked 49th in per capita spending on mental health, but lawmakers began pushing for higher spending on improved mental health services.

By 2013, Texas inched up to 48th in mental health spending with increased legislative appropriations that amounted to $40.65 per capita.

That same year, the No. 5 state, Pennsylvania, appropriated the equivalent of $287 per person for mental health care and services.

Daugherty said there is no comparing the services available in states, communities and schools at the other end of the spending spectrum with those in Texas.

Still, the increased funding by the Texas Legislature in 2013 and 2015 made a difference, coming after years of stagnant budgets.

“We’re very low in per capita funding,” Daugherty said. “But the unfortunate incidents in the nation have funneled money into our crisis services.

“The enlightenment came from the tragedies that we’ve seen across the nation – the Columbines and the Sandy Hooks.”

In 2012, El Paso’s Emergence had a $32 million budget and about 420 employees. This year, the agency’s budget is $56 million and it has close to 600 employees.

The new people are primarily direct care providers, caseworkers and psycho-social rehabilitation workers.

That has helped tremendously, Daugherty said, but what has really helped has been the community buy-in.

Having the best system in the country may be a long way off, but El Paso’s progress hasn’t gone unnoticed.

“We’ve done some amazing things in four years,” Daugherty said. “I have colleagues running the larger centers in the state who looked at El Paso badly in 2012, but now they say, ‘Look what El Paso is doing.’”

Emergence has become the mental health provider at the county jails in Downtown and on East Montana, providing a higher level of care than ever before to a population badly in need of mental health screening and treatment.

“Sheriff Richard Wiles has been wonderful,” Daugherty said. “He’s an advocate of mental health treatment, not just for inmates but for the community.”

Law enforcement often took people who were clearly having mental issues to jail or University Medical Center’s emergency room, but Daugherty said Emergence now operates its own extended observation unit at its Montana office.

“It’s been open almost three years,” she said. “They can be here for up to 48 hours. They see a therapist, they get medication and they are actually provided psychiatric treatment for a psychiatric crisis.

“So, just because someone is acting kind of weird at the Howdy’s, instead of the officer immediately arresting them and taking them to jail, bring them here. We’re still working on that.”

A little over two years ago, Emergence introduced mental health first aid training for police and educators to help them recognize signs and symptoms of mental illness on the street and in the classroom.

President Obama’s Affordable Care Act not only established minimum standards for insured heath care, it also gave equal status to mental health coverage.

While the nation’s medical system is struggling to meet the additional demand for services, the availability of mental health services lags far behind.

“We don’t have the workforce to handle it,” Daugherty said.

But the consortium is working with UTEP to help social work graduates get licensed more quickly and find jobs.

And, Daugherty said, the El Paso Psychology Consortium is working with UTEP and Texas Tech, with funding from the Hogg Foundation and Paso del Norte Health Foundation, to increase the number of clinical Ph.D. graduates.

“There are a lot of people coming to the table who have never met before,” Daugherty said.

Email El Paso Inc. reporter David Crowder at or call (915) 534-4422, ext. 122 and (915) 630-6622.