Colorado must stop using jails for people in mental health crisis

Colorado is one of only six that still put people having a mental health episode behind bars.

By | jbrown@denverpost.com | The Denver Post
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Colorado should stop using jails to house people placed on involuntary mental health holds who haven’t been charged with a crime, says a task force created by Gov. John Hickenlooper.
The state is one of only six that still put people having a mental health episode behind bars.

The 30-member panel, ordered by Hickenlooper after he vetoed a bill in June that would have strengthened Colorado’s 72-hour mental health hold law, acknowledged rural communities without hospitals or mental health centers would have the toughest time adapting to new rules. Still, the practice should end now or, at the latest, by next January, the group said.

State law allows for detainment in a jail for up to 24 hours. Within a day, a person on a mental health hold must go to a health facility for evaluation and treatment, but in rural areas, the nearest mental health center is often hours away. The situation leaves sheriff’s departments with three options: driving the person to another town and leaving the community with one fewer law officer; holding the person in jail; or releasing the person back to the community.

“If a person has an epileptic seizure, you don’t put them in jail because there is not a hospital around — you get them transported to a therapeutic facility,” said task force member Moe Keller, vice president of public policy for Mental Health Colorado. “Individuals who haven’t committed a crime should never be locked in a jail. It can exacerbate the problem.”

Sheriffs sometimes detain someone who is suicidal or in grave danger because of their mental state, then release the person within 24 hours without filing a mental health hold, Keller said.

In Archuleta County, where the jail flooded two years ago, the sheriff has no space for anyone who because of mental illness is a danger to themselves or someone else. A deputy must drive all of them — more than 15 people per year — to Durango, where they are held for 24 hours in the La Plata County Jail. Archuleta County officers must then return to pick up the person and drive or fly them to an available mental health bed in Colorado Springs, Pueblo, Grand Junction or wherever they can find one.

“We are very, very challenged because we don’t like to hold people in a jail when there are no criminal charges but sometimes there aren’t other options,” said Archuleta County Undersheriff Tonya Hamilton in Pagosa Springs. “We’ve got 24 hours to find them a bed and figure it out and arrange transportation. It’s extremely challenging and it’s costly.”

The state task force, which was charged with examining the mental health hold law, said confining a person who has not been charged with a crime is a “massive curtailment of liberty.” Also, jails are “ill-equipped” to handle mental health crises, and a person’s condition could deteriorate in jail without psychiatric treatment.

“Law enforcement is in a position to charge individuals with a crime, often for behaviors associated with the symptoms of their illness, thus further contributing to the criminalization of mental illness,” said their report, released Tuesday night.
It took six months and about a dozen meetings for many on the task force to agree that “no one who has not committed a crime should go to jail,” said member Denise Maes, public policy director for American Civil Liberties Union of Colorado. Of the 22 people present at the final meeting, 19 supported that recommendation.

“It was really surprising to me,” Maes said. “Seriously, if 40-whatever other states can get to this and we are still beating our head against the wall?”

The first step, she said, was saying “no jails, period,” which will force counties to figure out new procedures. “Those are the devil in the details. Those are the hard decisions,” Maes said.

The task force released eight recommendations, including the creation of a “Mental Health Care Ombudsman Office” to serve as a watchdog. The office would ensure that people placed on mental health holds “receive proper care and protection” and would handle appeals and grievances from people with due-process concerns.

Other recommendations included making sure each region of Colorado has enough mental health providers, including crisis-response workers, and expanding the behavioral health workforce through loan repayment assistance programs, paid internships and “telehealth.”

Law enforcement should first contact the “crisis response system” in each region to determine the best place for evaluating a person on a mental health hold. The state, meanwhile, should consider adding or freeing up psychiatric beds at Fort Logan in Denver for people with traumatic brain injury, intellectual or developmental disabilities, dementia, or aggressive behaviors, the report said.

Panel members also discussed state policy and funding that would allow hospitals to open more psychiatric beds. For example, the six counties near Montrose could contract with the hospital in that town to double its psychiatric beds. The hospital in Durango could expand to serve sheriff’s departments throughout the region.

Eleven counties in Colorado have no hospital at all, let alone any mental health beds.

Expanding the crisis response system could mean placing a security officer in an emergency department or having a psychiatrist evaluate a person via computer, said Nancy VanDeMark, director of the Office of Behavioral Health at the state human services department. The panel has suggested a new subcommittee to look more deeply at crisis services in rural communities.

“We need to better understand the problem as it resides in rural communities,” VanDeMark said. “It’s not the same problem in Denver as it is in Delta as it is in Steamboat.”

Hickenlooper has tagged $4 million in his budget request to fund the task force’s recommendations.

The task force, finding that Colorado lacks data showing how many people on mental health holds are jailed and the reasons, recommended the state create a data monitoring system to track mental health holds.

Hickenlooper asked the state human services department to create the task force after he vetoed Senate Bill 169 in June. The legislation would have expanded the number of places a person could be housed during a mental health hold, and the length of time a person could be held in jail or an emergency room while waiting for a bed at a mental health facility.

At the time, Hickenlooper said he agreed that mental health facilities are not always available during a mental health crisis, but that the legislation did “not provide adequate due process” for people with mental illness. “Those experiencing mental health crises should get the treatment they need in the setting that is most appropriate for their care,” he said in a written statement this week.

A 2013 state law helped set up Colorado Crisis Services, a statewide mental health crisis response system. The system includes a 24-hour hotline, mobile crisis response, respite care and walk-in crisis centers. More than 5,000 people have visited walk-in centers and more than 6,000 have received mobile services since services opened in 2014.