Things are happening.
We journalists don’t report in a vacuum; we’re citizens of our community and state, too, and many of us have experience with the mentally ill. We report on problems and challenges always with the hope that attention will be paid, wrongs will be righted, consciousness raised.
So we’re extremely gratified to see action being taken on many mental health care fronts, because this problem will take a very large, dedicated village to fix.
Five laws have been passed to begin to repair our broken system. Gov. Jared Polis has signed measures to improve the state’s behavioral health system for kids, to address loopholes in behavioral health insurance coverage, and to help address youth suicide, mostly by lowering the age at which a person can independently seek mental health aid from 15 to 12.
He’s also signed into law legislation sponsored by Rep. Tony Exum Sr. of Colorado Springs and Senate President Leroy Garcia to create a peer-to-peer mental health assistance program for EMS paramedics. Another new law addresses opioid abuse in southern Colorado with an internet-based system to track available capacity at behavioral health treatment facilities.
And just last week, Polis and the Colorado Department of Human Services announced the members of the newly created Behavioral Health Task Force. After evaluating the gaps in the system, the task force will create a statewide, strategic blueprint to reform the system top to bottom.
“I am proud to lead this task force so we can urgently work to create a roadmap for behavioral health in our state,” said Executive Director Michelle Barnes. “The 100 citizens we have selected will make a critical difference for people dealing with issues related to mental health and substance abuse.”
Coloradans are showing they fully recognize the challenge and are up for it: CDHS received more than 470 applications for the 100 seats that make up the state Task Force and its three subcommittees.
The task force will focus on three areas: improving outcomes in children’s behavioral health, reforming how the criminal justice system and mental health intersect, and creating a state safety net to ensure that every Coloradan, regardless of ability to pay, can obtain appropriate behavioral health services.
In those three areas, what specifically can and needs to be done most urgently?
A reader of ours recently challenged us reporters and editors to lead the way in identifying and championing next steps — “from excellent coverage to picking a couple of actual improvements that it could fight for.”
We accept. Here are some of the best and biggest ideas suggested to our reporters by experts around the state:
More professionals. Now.
Increasing the number of psychiatrists, psychologists, therapists and addiction counselors across Colorado is a key step that several health experts said needs to happen to adequately address the region’s behavioral health needs. One estimate by the U.S. Department of Health and Human Services suggested the state needs at least 131 more practitioners, and many advocates say even more are needed. A greater use of psychiatric nurse practitioners is helping to fill the gap caused by a lack of psychiatrists.
We need generous scholarship money for young Coloradans willing to become mental health practitioners — perhaps with the proviso that they serve a year in a rural area, where the need is most acute. The vast majority of Colorado counties — 49 out of 64 — do not have inpatient psychiatric beds. None.
Urgent cares for mental health
We need neighborhood clinics that are as easy to use and access as urgent care clinics for physical health. When the country closed its big mental health institutions 50 years ago, the promised system of community-based care that was supposed to take its place was never realized. We need to realize it. This begins with creating small group homes where individuals with mental illness can live indefinitely for an affordable price. Unlike the institutions of the past, group homes should house only around a dozen people each and be staffed with social workers who run them like family homes, not hospitals, experts say. We also must ensure that there are a sufficient number of outpatient clinics that are geographically and financially accessible, so that patients who need emergency care can get it without having to check themselves in for a long stay.
Screen every student
Every time a student has to get a physical for a school, the student should get a mental health screening as well. Nevada has done this and seen its teen suicide rate drop, the only state in the country that can show a decrease. Routine screenings should also be required in pediatric clinics, the workplace, and primary care facilities. While Colorado requires doctors to do a mental health screening of children, the questions and process are not uniform.
More beds in hospitals
Experts tell us we need at least 50 psychiatric treatment beds per 100,000 people to provide individuals with severe mental illness with a minimal level of care. However, Colorado provides just 10 such beds per 100,000 people. In 2016, that meant just 543 psychiatric beds for the estimated 144,000 Coloradans with schizophrenia and bipolar disorder. Every emergency room in the state should be equipped with psychiatric beds. We’re thrilled to see just such dedicated beds in the new Children’s Hospital opening in Colorado Springs next month.
Change 72-hour hold law
If someone is mentally ill and an imminent danger to themselves or others, officers and in some cases mental health professionals have the right to place them in a facility for a 72-hour treatment evaluation. Professionals have told us 72 hours is not enough to make a meaningful difference in someone’s life — but data shows that seven days can make all the difference.
We need care coordinators
Finding a doctor, navigating insurance, figuring out how to pay for care, knowing which facilities are best for which ailments — it’s like navigating a labyrinth with locked doors. We need to create the job of care coordinator or peer-specialist who has experienced a patient’s hardships firsthand and can direct patients to the most effective methods of treatment, independent of insurance dictates. One family we talked to spent a year and a million dollars trying to find the right treatment, and ended up having to send their child to California.
Create one funding stream
Funding streams for mental health care cut across myriad different local, state and federal agencies. At the state level, for example, mental health funding sources include the Department of Human Services, the Department of Public Health and Environment and the Department of Health Care Policy and Financing. Several mental health advocates cited the balkanized nature of Colorado’s mental health system as a barrier to any possible reforms.
It’s everyone’s business
The principal of a local high school, speaking to us parents after the apparent suicide of one of my son’s friends at the school, ended the discussion with the statement, “In the end, we’re not a mental health care facility.”
Really? If not schools full of at-risk teens, then who is?
A certain clinical psychologist I know, who I happened to be married to, likes to remind me that mental health care is everyone’s business.
“What can be done to fix mental health care?” Dr. Kelsey French said to me. “We can treat all of our neighbors and people we come into contact with at the grocery store, at sports events, on the road, as people who are potentially hurting, angry and feeling lost and alone. So much of depression is associated with the feeling of being isolated. To potentially go through our days emanating compassion, looking people in the eye, smiling, being gracious. That’s what we can do.”
When I get too busy with work, too busy with my daily “business” to do much of anything for those hurting among us, Dr. French likes to remind me what Jacob Marley explained to Ebenezer Scrooge:
“Mankind was my business. The common welfare was my business; charity, mercy, forbearance, benevolence, were all my business. The dealings of my trade were but a drop of water in the comprehensive ocean of my business!”