Instead of trying to figure out how to pay for mental health care before seeking treatment, Coloradans will be able to get immediate assistance under a plan Gov. Jared Polis approved Wednesday while a yet-to-be-created Behavioral Health Administration works out the finances.
A one-stop shop concept with a single point of entry and regional care coordinators would help the 1 million Coloradans in need of mental health services and also tap into other support, such as food and housing, according to the Behavioral Health in Colorado: Putting People First blueprint.
“There is a real need for a comprehensive, coordinated behavioral health service,” Polis said in signing off on recommendations issued by the Colorado Behavioral Health Task Force.
“Reform is long overdue,” the governor said during a public ceremony at his Boettcher Mansion residence in Denver.
Polis created the 102-member task force in April 2019 under the Colorado Department of Human Services to propose ways to fix the state’s admittedly broken Byzantine system, which includes 75 programs across 10 state agencies.
“It’s easy to see how someone in need could get lost,” Polis said. “It means too many Coloradans are slipping through the cracks, when there are ways to help them.”
The behavioral health system is duplicative, inefficient and ineffective, Polis said, costing $1 billion annually. The report defines behavioral health as mental and emotional well-being, development and actions that affect overall wellness, including mental and substance use disorders.
The new system will be streamlined, patient-centered and ensure all Coloradans have timely access to affordable services regardless of their ethnicity, criminal history, location or situation, officials said.
“Too many Coloradans have lost loved ones to suicide or substance use because they could not get the life-saving care they needed,” said Lt. Gov. Dianne Primavera, a member of the task force's executive committee.
The plan calls for increasing the number of psychologists, social workers and other workers, and ethnically and racially diversifying the ranks.
One in five Coloradans has a mental health problem, and the aftermath of the coronavirus pandemic is increasing the need, said Michelle Barnes, executive director of the state’s Department of Human Services and chairwoman of the task force's executive committee.
Anxiety, depression, bipolarism, psychosis, suicidal tendencies and substance use are among the common mental disorders.
Colorado has the seventh highest suicide rate in the nation, recorded its highest death rate from drug overdoses in 2019, has excessive alcohol use, posts poorer outcomes than other states and ranks in the bottom half in the nation in accessibility of mental health care and magnitude of need, officials said.
Restructuring the system and implementing the recommendations will begin now and stretch over the next year, initially using existing funds, said Robert Werthwein, director of the Office of Behavioral Health, which is under the Department of Human Services.
“The first step is to establish the administration to supervise the functions,” he said in an interview.
The Behavioral Health Administration will take the form of a new state agency or entity within an agency that will consolidate all non-insurance based behavioral health funding and oversee behavioral health services, according to the plan.
Expanding telebehavioral health services, creating new legislation and identifying new funding sources also are in the first phase.
The proposal presents a vastly different model, said Lisa Zimprich, a member of a task force subcommitte on children's behavioral health who oversees mental health programs for Fountain-Fort Carson School District 8.
“It would help families access care right away, which is in stark contrast to our current system, in which families frequently end up waiting weeks or even months to receive care because of insurance issues, challenges navigating the system, a lack of providers or payment issues,” she said. “This blueprint is an attempt to get people the care they need right away and then figure out the back end.”
"Care coordinators" in communities would guide families through the entire process, according to the plan, although details of how that would work need to be set.
“There are no parameters yet,” Werthwein said, “but the blueprint is clear we want care coordination to be locally driven.”
Over the past year, the task force solicited public feedback on system reform through 14 statewide hearings and 16 community conversations.
After listening to residents speak about their bewilderment over how to get help for a loved one experiencing a mental illness or breakdown, a lack of therapists, payment problems, a dearth of services in rural counties, the stigma of mental illness, psychological implications among the homeless population and other challenges, the core task force of 27 members came up with suggested improvements.
Ensuring affordability, equity, access, proper assessment, adequate workforce and support services are among the goals.
The task force heard from people like Eagle County resident Vickie Zacher, whose daughter, Olivia, died by suicide three days after her 13th birthday in February 2018.
“I do feel my daughter could have been saved, but she was just a number being pushed through the system,” Zacher said at the event.
“Maybe if I could have afforded the $270 counselor visits or the school followed protocol, Olivia would be here today," she said. "I tried many times to get help for Olivia. A new system will mean families will have a different experience in the future, with timely access to services, so mothers won't have to go through what I went through.”
Forming a Behavioral Health Administration is the most important thing the state can do to improve funding and delivery of mental health and substance use services, said task force member Shannon Van Deman, vice president of the pediatric mental health institute for Children’s Hospital Colorado.
“It falls back on authority and who bears fundamental responsibility,” said Van Deman, who co-chairs the children’s behavioral health subcommittee and is a board member of Mental Health Colorado.
“There’s a lot of finger-pointing that creates this environment that’s so hard for families to navigate the system, and it’s hard to hold anybody accountable to make sure it’s working.”
A streamlined model also would enable the state to receive more federal funding, Van Deman said, by applying for matching grants, for example.
“We’re not fully capitalizing on federal dollars,” she said. “We could get more money and increase spending without using Colorado taxpayer money.”
In addition to children's behavioral health, other subcommittees studied ways to improve access to care and services for people in the criminal justice system who have been found mentally incompetent.
Polis added a COVID-19 subcommittee in May to analyze impacts of COVID-19 on the behavioral health system.