Kristi Daugherty has come a long way, from a social worker in the field to a rising star as Emergence Health Network’s CEO, and she has brought El Paso’s non-profit mental health authority a long way, too.
With a bachelor’s degree in social work from NMSU, she began her career in Alamogordo as a child protective services worker for children who were taken from their families.
It was a tough job that gave her the chance to see how undiagnosed and untreated mental illness afflicted the lives of children and their parents.
“That really drew me,” she said.
Fast forward a few years and Daugherty had a master’s in social work along with valuable experience in the private sector where success hinges on organization and the bottom line.
Coming to El Paso, she started on an MBA and a consulting job working with El Paso Mental Health Mental Retardation in 2008.
The head of MHMR, Gary Larcenaire, recognized her organizational skills and hired her a year later. He made her the agency’s chief clinical officer in 2010 at a time when both he and the non-profit were in hot water.
By the end of 2011, Larcenaire was gone and a reconstituted board named Daugherty interim CEO about the same time that El Paso MHMR’s name changed to Emergence Health Network.
She calls the next eight months “the longest job interview of my life.”
After conducting a national search for a permanent chief executive officer, the Emergence board gave the job to the woman who was already doing the job.
At the time, the agency responsible for public mental health care services in El Paso was, Daugherty herself says, broken in the eyes of local officials, the public, the people it was supposed to serve and their families.
“There was a really unfortunate climate and culture here,” she said. “The attitude was, ‘These are very sick and poor people. Where else are they going to go?’”
Daugherty recognized that attitude had to change if Emergence was ever going to do its job.
So did the community’s attitude that one underfunded non-profit was solely responsible for the tens of thousands of children and adults in need of mental health services in El Paso.
“We’ve come a long way since then,” she said.
A meeting of CEOs from area hospitals, the Paso del Norte Health Foundation and Emergence about the fate of the state psychiatric hospital led to a much larger discussion and a critical study of mental health services in El Paso.
And that led to an unprecedented alliance, the El Paso Behavioral Health Consortium, made up of public officials, CEOs and agencies who are working with Emergence to bring mental health out of the shadows.
Daugherty sat down with El Paso Inc. for a long conversation about mental health at the family level, how the turnaround at Emergence has gotten the state’s attention, Obamacare, talking to your kids and her thoughts on marijuana.
Q: People have always had a lot of strange ideas about mental problems, probably because we just don’t understand them. This is a big question, but what causes mental health problems? Are people born with them or are they the result of bad experiences growing up?
There’s many different interpretations of that in my opinion. You could be predisposed to mental illness. There is a lot of research going on now regarding predisposition to mental illness. We could all be carrying around a gene that never goes active. You’re born with it. A lot of times, it’s triggered by trauma. If you have an adverse childhood experience or some sort of traumatic event in your life, it could trigger that gene.
That’s the research going on now. It’s a chemical imbalance. So you have to think about diabetes and things like that being a chemical imbalance and some of those kinds of things are predisposed, too.
Mental illness has been around for a long, long time, but I think the attention to the root cause of it is fairly new in the research. We’re not just putting people in institutions anymore and letting them sit there until they pass away. I think we’re now looking at what are the root causes of mental illness.
Q: How important is it to recognize these issues early? What difference can it make?
It makes a huge difference. The first episode of a mental illness, whether it is depression or psychosis, is so much more manageable than something that had decompensated or deteriorated to a point of delusions or when paranoia has set in. They’re more likely to be receptive to some sort of help.
That’s where we as an industry have failed, but it’s being recognized now. When it comes to early adverse experiences, they’re looking at young kids that were abused or neglected and how that has affected them later in life. We see a traumatic event as a cause of mental illness or something that will have an effect later in life.
We all say you’ve just got to toughen up and deal with it. But some people deal with things differently, and I think we have to look at it not only from a perspective of recognizing signs and symptoms but also recognizing events in individuals’ lives that could cause affects down the road and address them.
Q: What should parents look for and when should they seek professional help for a child or a student in class?
In children, you’ve got to look at immediate changes in behavior, in friends, grades or interests. If you have a kid who’s very social and then all of a sudden, they’re not interested in things, that’s a huge sign.
You’ve got to talk to your kids. I have a son who’s 9, and one of the things that we do every night, if it’s possible, is the TV goes off, phones go off and we sit down and have dinner every night, and we talk about what’s going on. He asks me questions, too. We have that exchange and it’s gotten to where he’s very comfortable talking to me. If he’s got a kid at school who’s being mean to him or whatever. Bullying is an unfortunate thing. Kids can be kind of cruel.
We talk about how he’s going to deal with it tomorrow. Then we talk about it tomorrow, about how it went. You’ve got to talk to your kids. You’d be amazed what your kids want to tell you, and it’s critical that you listen.
Q: This is a little off track, but what are your thoughts on marijuana use and legalization? Do you have concerns from a mental health standpoint?
I do. The problem with marijuana is it’s not just marijuana. It’s laced with something sometimes and you just don’t know what you’re getting. I don’t know if you want to compare it to cigarettes, but it’s a stage-one addiction to me, and that’s just my opinion. You start with something that they say is not that big a deal, but they get addicted and then what’s next? What’s next?
Q: The Affordable Care Act, also known as Obamacare, puts mental health on the same level as physical health and requires insurers to cover mental health care. How is that working?
It’s sort of working. Affordable care is not necessarily working. If that’s not working, then the parity may not be working. The thing about parity is, in concept, it’s an amazing idea. In practical terms, it’s difficult because it’s very hard for the mental health industry to meet the need.
We don’t have the providers. We don’t have the funding. We don’t really have the ability to meet all of the needs. But I think in concept, it’s a great idea. We need to work harder and figure out how to get more folks coming out of school with psychiatry degrees.
Mental health parity keeps me up at night because we don’t have the workforce to meet that need.
Q: You mean the industry as a whole, public and private?
The industry as a whole. The public is competing with the private for the same body as far as the workforce is concerned. But I can’t compete on the salaries with the VA and Beaumont and some of those larger providers.
Q: Are we seeing a significant new demand, a surge of people looking for mental health services? Or is this something people are really not aware of?
There has not been a surge. I still think the stigma attached to mental health stands in the way of people seeking services.
I was talking with someone recently who said we shouldn’t be saying let’s reduce the stigma of mental illness because you’re saying there’s something wrong with being mentally ill. I completely agree with that. There is nothing wrong with seeking treatment. It is an illness, just like any other illness. There are very successful treatments, whether it’s a medication or therapy, and there are so many successful people living life every day with a mental illness.
Q: I have a friend who is bipolar and has had terrible episodes in her life, but she says, “When I’ve got my meds right, everything is just perfect.” She is doing wonderfully now and is very successful.
When I do different speaking and even when I talk to our new employees, I say you have to constantly remind yourself that mental illness is the only illness that when you don’t take your medication, you’re at risk of going to jail. There’s something wrong with that.
Q: What brought you to El Paso?
I was recruited by the previous CEO, Gary Larcenaire, to work with a subsidiary that this company owns that’s not really involved in the state dollars. I came in as a contract consultant. I was doing some other things and this sounded interesting because it was a big mess. It was a subsidiary that needed accredited work and that was very interesting to me because that’s what I do very well.
Q: El Paso MHMR was in financial trouble when you came. What was the problem?
Back then the center was kind of shaky because they were not maximizing their billing capabilities. But we’re very good at that now. I brought that from the private sector where you don’t leave dollars on the table.
Q: Did you see yourself working at this level when you were doing social work in the field?
No, I always knew my forte was program development and fixing things that were broken and giving it to someone else to deliver the service. So when Gary Larcenaire brought me over to do that, it was a challenge and I was interested.
I was deciding what I really wanted to do with my career at the time. I was looking at leaving El Paso, and then things progressed and all of a sudden, I’m sitting in a CEO seat in El Paso and glad to be here.
Q: People are probably wondering how long you’ll be here before another agency in another city or state lures you away.
I have work to do here.
Q: In a 2013 comparison of spending on mental health by states, Texas was No. 47. How much has Emergence’s funding increased since then and what difference has that made in El Paso?
We’ve increased our budget quite a bit, but it’s not all state money. Over a five-year period, we were able to bring $23 million in new federal money into the system. That has been huge and has had a major impact on what we’ve been able to do.
The state has also increased our funding so we wouldn’t have a wait list for services. They’ve infused some money so we can expand manpower in a crisis to be available. They’ve also given us money because our psych hospital tends to not have beds available. They’ve given us money to purchase beds at El Paso Behavioral Health.
Q: What new services is Emergence offering?
We’re offering the same services. On our outpatient clinics, we have a set standard of services the state expects us to offer. We’re offering the same services – we’re just doing a better job of it. People aren’t waiting four hours to see their doctor, they’re waiting 30 minutes, or they’re getting in and out in 30 minutes.
I’m not exaggerating – it was bad, because of capacity. Caseworkers were carrying 60 clients. Now they’re carrying 25 because we’ve gotten better at billing and collecting, and I can afford more caseworkers.
We’ve been able to increase our ability to operate as a business from billing, collecting and authorization to where I’m pulling in money, so I can spend money.
Q: But you do have services that weren’t offered when you got here, right?
The extended observation unit is a new service. It’s 11 beds over at 1600 Montana and it’s a 48-hour observation unit for people who are in a psychiatric crisis. They can stay there on an emergency detention or voluntarily. They’re seen within 15 minutes by a psychiatrist, usually by tele-med.
There are nurses there, qualified mental health professionals, licensed professional counselors, and they get served. They get their medications. They’re stabilized with the hope that they don’t go to the hospital.
Q: How far has Emergence come?
I can honestly say the support that Emergence gets from the community has come leaps and bounds. We really appreciate the type of support we get now from the community and from the elected officials. When I took over, we didn’t have that.
It allows me to do my job and maybe push the envelope a little and try to get things moving at the state or federal level. We’ve put El Paso back on the map. El Paso really wasn’t a player in Austin, and we are now.
We are being recognized for the things we do and are able to draw money in from grants because El Paso is considered a place to watch and see what’s happening in the mental health system.
Emergence has gained respect in the community. People look to us for guidance and advice on mental health services. It really makes a difference in where we’re going.
I believe we’re getting to the point where people are talking the same language and are on the same page. Before, we weren’t even in the same book.
Email El Paso Inc. reporter David Crowder at email@example.com or call (915) 534-4422, ext. 122 and (915) 630-6622.