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Big state and local changes for mental health treatment

New foundation planned for state & new program for Pueblo jail
Big state and local changes for mental health treatment
Posted at 12:09 AM, Sep 17, 2020
and last updated 2020-09-23 14:44:09-04

SOUTHERN COLORADO — Both the state and local level are about to see some big changes when it comes to treating mental health issues and substance use disorders.

Statewide

UPDATE:

The official blueprint for mental health reform across the state has been officially released, as of 12:30 on Wednesday September 23. CLICK HERE to read the full document.

PREVIOUS:

In April of 2019, Governor Jared Polis created the Behavioral Health Task Force, which is a team of 25 members and three subcommittees. The task force falls under the umbrella of the Colorado Department of Human Services.

One of the missions of the task force is creating Colorado's "Behavioral Health Blueprint," which is being finalized currently.
The finished blueprint will be presented to the state next Wednesday, September 23.

For the past 15 months, the task force has been examining the current infrastructure designed to treat mental health issues in the state. "We did a financial analysis and found that $1.4 billion in behavioral health services is available at our state, across 10 different agencies, and we have over 75 different programs... It's really convoluted, it's complex, and if I'm looking for services right now, it's my responsibility to figure out which provider has the funding for one of those 75 programs that can meet my needs, and that's not the system that we want to have in Colorado," said Summer Gathercole, the senior advisor for behavioral health transformation.

The task force originally had around 148 recommendations for the state on how they could better serve citizens, but they had to prioritize 19 because there is only so much that can be done at one time. While the official blueprint has not yet been released, here are those 19 recommendations, as provided by Gathercole:

"ACCESS: All Coloradans need access to a continuum of behavioral health services and to be connected to those services when they need them.

Recommended Actions:

  1. Develop a single point of entry (with “no wrong door”) to help individuals navigate the full continuum of behavioral health services.
  2. Expand and enhance the crisis services system including co-responder and explore alternatives to reduce reliance on police for non-threatening behavioral health emergencies.
  3. Address the bifurcation between mental health and substance use disorder.
  4. Have an adequate, equitable, and complete continuum of behavioral health services, and address current disparities.

AFFORDABILITY: Care can be affordable when people get the care they need to stay healthy, administrative efficiencies are captured, and payment models incentive positive outcomes.

Recommended Actions:

  1. Ensure adequate rates of payments and reimbursement, by all payers and payment sources, for the full continuum of services.
  2. Streamline and consolidate funding streams that include maximizing federal dollars.
  3. Prioritize the community investment funding available from not-for-profit hospitals to support implementation of the BHTF recommendations.

WORKFORCE & SUPPORT: A high-quality, trained, resourced, culturally responsive and diverse behavioral health professional workforce is needed in Colorado to deliver improved health and access.

Recommended Actions:

  1. Expand the capacity for a culturally competent licensed and unlicensed workforce.
  2. Support and fund the use of non-traditional workforce, especially peers.
  3. Reduce the administrative burden for providers.

ACCOUNTABILITY: Collaboration across stakeholders needs to take place to ensure that Coloradans are receiving the quality care they need.

Recommended Actions:

  1. Research, develop, and publish population-specific standards of care and reasonable outcomes to measure quality.
  2. Address high suicide incidences and disparities in care access, delivery, and outcomes for specific and marginalized populations.
  3. Designate a single fiscal management system to be used to account for all publicly funded services to improve allocations.

CONSUMER & LOCAL GUIDANCE: Engagement with community stakeholders is critical for feedback and guidance on how best to meet local behavioral health needs.

Recommended Actions:

  1. Collaboratively identify local, regional and systemic service gaps and solutions.
  2. Form and engage advisory groups to continuously provide input and guidance on system improvements.
  3. Identify and provide sustainable, flexible funding streams for local communities to prioritize primary prevention and invest in solutions to mental wellness disparities.

WHOLE PERSON CARE: Coloradans are best served when their social determinants of health are adequately addressed.

Recommended Actions:

  1. Offer and expand care coordination services to address social determinants of health.
  2. Expand high-intensity case management with treatment for individuals being discharged from a psychiatric hospital.
  3. Create planned and facilitated education opportunities on behavioral health and cognitive disabilities for law enforcement, first responders, judges and court officials and other partners."

The task force will execute these goals in phases, because there is lots of systemic work that needs to be accomplished. The first phase will focus on building an entirely new foundation for Colorado. "Create this infrastructure, so that we, for the first time ever, will have a statewide cohesive plan to really address the behavior health needs in Colorado," said Gathercole.

Also within the first phase, Gathercole said the task force would like to expand and enhance Telebehavioral Health. "We want to make sure that people have access to services both through Telebehavioral Health, and in-person as well," said Gathercole.

They also will need to identify new funding sources.

The second phase would tackle care coordination. Gathercole said it's about making sure a client does not have to go through the process alone. The recommendations suggest a more holistic approach to the patient, and helping them create a personalized plan. "The first question they're asked is what's your form of payment? What's your insurance? It's not, how can we help you? What do you need?" said Gathercole.

Gathercole also mentioned that when looking at other recommendations from the past decade, many themes are the same. However, she says this time is different. "We need to make this change and we need to make it now. And that is what's really exciting, is that we're no longer going to be talking about it, we're actually going to be implementing those changes and people are going to start to feel a difference, which is super exciting for Colorado," said Gathercole.

One of the local members of the Behavioral Health Task Force is Laura Teachout, who also sits on the board of NAMI Colorado Springs. Teachout said two of the biggest issues facing Colorado Springs when it comes to mental health are housing and the criminal justice system.

Teachout said the blueprint will address the criminal justice system concern very well, with a recommendation to implement Community Response Team (CRT) programs throughout the state. These are teams that typically include a social worker, who are sent on 911 calls with mental health concerns if it is considered safe enough to do so.

That model already exists in El Paso County as a pilot program with the sheriff's office. "It's worked beautifully. I mean, literally, 98% of the calls that folks have gone out from the CRT have not resulted in arrest...Similarly, the blueprint asks for an increase in the number of crisis drop-in centers, so that we can get people help when they need it," said Teachout.

Teachout said there are lots of passionate people who make up the Behavioral Health Task Force. She said they are committed to addressing the problems, and are willing to think creatively to solve them. "The system itself has blocked access, and so if we're able to change the structure and make it more usable or accessible, that would be a big improvement," said Teachout.

Teachout said the impact of COVID-19 on mental health is undeniable. Gathercole said before the pandemic, they estimated one million Coloradans were in need of behavioral health services, and they expect that number to increase.

Local

Meanwhile, Pueblo is embarking on a brand new program that hopes to help inmates look toward their future, rather than the past.

The Southern Colorado Harm Reduction Association received a grant from the Colorado Department of Public Health and Environment in July for $1.5 million over five years. With that money, they have teamed up with the Jail Based Behavioral Health Services to conduct classes with inmates. "A first of it's kind, as far as them coming into the jail to provide the services. And then a collaborative approach to help this population even after they've been released, for up to a year," said Marco Macaluso, the program manager for Jail Based Behavioral Services in Pueblo.

The two groups will work together to hold life skills classes for inmates. "It's going to help them shift, and start to have more of a future-oriented outlook. So, establishing goals, setting objectives to meet those goals and really starting to identify who they are and what it is they really want with their life," said Macaluso.

On Wednesday, around eight people were trained to be these teachers. Plus, the program will not have many restrictions as far as which inmates can enroll. But the person has to want to make a change in their life.

Macaluso also said the program will keep track of the data from these classes to see if they are helpful. Both entities will also help a person recently released from jail by providing them with resources. The goal is for little to no recidivism. "Just doesn't compare to other aspects around the state, other programs around the state," said Macaluso.

Right now, the program is being run as a pilot, but if the results prove it is sustainable and effective, it could become permanent.

Also at the training session in Pueblo on Wednesday was the Director of Opioid Response for the Colorado Attorney General's Office, Heidi Williams. Williams is currently traveling around the state to identify mental health issue or substance use disorder treatment gaps in local communities. "Policy decisions that were put in place many, many years ago, often have led to the criminalization of people often who are under the influence... We can't just treat the substance use disorder that they're experiencing, but we also have to look at the whole person and figure out what else is going on," said Williams.

Williams is essentially gathering information for settlement funds expected to come to Colorado. This money is from a lawsuit against Purdue Pharma, the manufacturer of OxyContin. Williams said the drug was advertised as non-addictive, when in fact it was. The settlements should be coming from a large manufacturer and three other large distributors, but will come over a long period of time, potentially 18 years. The exact amount of money could change as well.

Williams' work is determining how to best distribute that money when it does get to Colorado. "If the State of Colorado comes together collaboratively, as we often do, we'll get more money from these settlements, there's bonus money involved in that," said Williams.

If you or anyone you know needs help right now, call Colorado Crisis Services at 1-844-493-8255.