It’s a crisis on top of a crisis on top of a crisis.
In an investigative series last year, a team of Gazette journalists found that nearly 450,000 Coloradans aren’t being treated for mental illness, a singular crisis that lies at the root of so many others: homelessness, poverty, substance abuse and violence. In one study, Colorado ranked 48th out of 50 states in mental health services for children.
And now coronavirus has made it all worse.
“This is the worst mental health the country’s ever been in,” said Vincent Atchity, head of Mental Health Colorado. “We’re a state in distress.”
Shannon Van Deman, vice president of the Pediatric Mental Health Institute at Children's Hospital Colorado, told Gazette reporter Debbie Kelley that the financial crisis resulting from the pandemic is creating an even more acute behavioral health crisis in our state. The correlation between behavioral health and job stability, food availability and adequate housing is strong, she said.
On the front lines are children’s emergency departments. On one day in August, 100% of inpatient beds for children’s psychiatric evaluation and care were full, and 12 patients in emergency rooms across Children’s Hospital Colorado’s system had nowhere to go.
The same is true for adults.
There’s now a backlog in people seeking mental health treatment because they have been fearful of COVID-19 and have avoided hospitals. Now, adults and children are showing up in hospital emergency rooms with more severe mental health issues, Van Deman said.
More than half of Coloradans have experienced increased mental health strain during the pandemic, according to a new survey from the Colorado Health Foundation.
“They’re sicker. There are higher incidents of suicide attempts and deaths by suicide,” Van Deman said. “The stress is being felt.”
Anxiety, depression, fear, anxiousness about the pandemic, a lack of social connectedness and the basic sense of safety are being tested, she said.
In the midst of this cascade of crises, Gov. Jared Polis on Wednesday announced a brand new Behavioral Health Administration to reform mental health care from top to bottom.
His plan is a one-stop shop for the 1 million Coloradans in need of mental health services, according to the Behavioral Health in Colorado: Putting People First blueprint.
“Critics will say, ‘Oh great, another layer of government to screw things up,” remarked Atchity, who was a member of the governor’s task force that has been meeting for more than a year to write the blueprint.
“But the idea behind it is actually to eliminate layers of government by consolidating,” he said. Responsibility for behavioral health programming is currently distributed across a number of different agencies: the Department of Human Services, Department of Corrections, Department of Public Health, Department of Healthcare Policy and Financing. “This new agency will put them all in one place under one unified, single leadership,” said Atchity.
What that means is there will be accountability for delivering mental health care now.
“The current state of affairs is that individuals fall through cracks,” said Atchity. “We’ve got a safety net, but the mesh is so wide in our safety net that people just routinely plummet to their deaths.”
Van Deman welcomed the plan with open, grasping arms.
“Not only should we do this, but now is the time to make sure we have a robust system to support people,” she said.
The blueprint, however, is a “vision” that Polis signed off on, with no details of how the ideas might actually come to fruition.
Building the new agency “is going to take who knows how much time,” said Atchity.
“The world may come to an end before that. But I think it’s a step in the right direction.”
Polis said he wants Colorado’s reformed system to become a model for other states. But with Colorado enacting furloughs for state employees and facing additional potential budget cuts from COVID-19’s economic repercussions, is this the right time to launch a large-scale system overhaul?
The plan was mostly created before COVID-19 hit — how will that impact implementation?
“This may be the perfect time just because it is so urgent,” said Atchity. “It’s going to be such a laborious process that they may as well get it started now. It won’t have any impact on care in the short run.”
In theory and on paper it sounds great. But in practice can it work? Will Colorado’s glaring problems be addressed?
Unfortunately, it’s far too easy to get this wrong. Thomas Insel, the former head of the National Institute for Mental Health, made a remarkable concession recently.
“I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and, when I look back on that, I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs — I think $20 billion — I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”
Already, Colorado has taken backward steps. Behavioral health services as well as integrated community-based mental health services and substance use treatment and prevention services took a $20 million cut in funding last spring as state tax revenue plunged as coronavirus cases rose. Will the state find the will and the money for this massive effort given so many other emergency demands as the state’s economy recovers from coronavirus?
Or will mental health come second again?
Atchity points out that if the state and individual communities focus on fundamentals in the coming months, and address them well, mental health will follow.
“So much of our health is driven by the social determinants of health. If you want kids to be healthy … if you want adults to remain healthy and engaged in their communities in a meaningful way … then they need some basic things in place. They need stability of housing, they need access to food stability, they need employment, they need living wages. As long as those fundamental building blocks of quality of life are points of struggle for a fifth or more of our state population, those people are going to be at risk for crisis.”
On top of crisis. On top of crisis.