Colorado’s behavioral health reform can’t leave the most seriously mentally ill behind  

Recently, the mayors of Colorado’s three largest cities made a public plea for help in three newspapers. Their point was simple: If we leave people with serious mentally illness (SMI) to fend for themselves in our communities and on our streets, we are endangering them and hurting our communities.  

The mayors of Denver, Aurora and Colorado Springs wrote eloquently of the need for more support for individuals with severe mental illness and co-occurring substance use disorder. As community leaders, they see the impact every day as they strive to meet the needs of the unhoused population, many of whom fall into this category. In particular, the mayors called on elected representatives to support expanding three types of bed-based care: inpatient hospitalization, residential care, and the RISE Program for jail-based competency restoration.  

While this call to action is part of the solution, it is only a part. Our vulnerable populations and the communities in which they live deserve a continuum of care with strong community-based services, ready access to outpatient mental health and addiction treatment, timely and safe crisis interventions, and a well-functioning civil commitment system.  

Community mental health centers—the safety net providers whose mission and charge is serving individuals with serious mental illness and substance use disorders—have watched with concern as well-intentioned behavioral health reforms to broaden the safety net to all Coloradans risk undercutting their ability to fulfill that mission. Indeed, they may worsen the problems the mayors highlighted. 

Here are three essential points we would offer to expand on the mayors’ pleas and help our state care for its most severely mentally ill individuals: 

  1. Colorado must continue to ensure stable funding for the full array of wrap-around services necessary to care for people with SMI in the community. Many services needed by this population—24-hour crisis support, housing, transportation, assertive community treatment, co-response between mental health and law enforcement professionals—cannot be funded through Medicaid alone. Many of these services require significant investments in infrastructure to sustain programs, regardless of volume, that have historically relied upon federal block grant dollars and thoughtful investment of general fund dollars by previous legislatures. There is no doubt that more providers are needed to meet the ever-growing demand for behavioral health services, but the programs required to support Colorado’s most vulnerable populations in the community should not be disrupted. We encourage elected officials to identify new funding sources to properly finance the system being put into place.  
  1. Colorado must continue the good work it has begun to help individuals with severe mental illness and co-occurring substance use disorder before they enter the criminal justice system, not after. While the mayors are right that Colorado needs more psychiatric beds to accommodate those who are so deeply ill that they need immediate, sustained intervention for their own safety and that of their community, we fail each one of these individuals if we don’t attempt to intervene before these beds are necessary and before these gravely ill individuals have cycled through the criminal justice system repeatedly. The mayors point to the RISE program of competency restoration offered in some jails. In addition, the legislature’s Interim Committee on Treatment of Individuals with Behavioral Health Disorders in the Criminal Justice System has developed proposals to streamline the competency restoration system. Further, a legislatively enabled task force has been looking at alternatives such as competency courts and wellness courts. Interventions like these are essential for addressing the problems the mayors cite. 
  1. Related to both the above points: safety net mental health providers need to be able to rely on all their community partners, including law enforcement and the courts, to compassionately care for individuals with severe mental illness. While it may seem counter-intuitive, treatment and recovery from serious mental illness sometimes require emergency and involuntary commitment and court orders for involuntary treatment and medications. And unfortunately, there are times when individuals with serious mental illness need to be placed in protective custody. Sometimes that involves transport that a behavioral health organization cannot safely provide. Those agencies, whether law enforcement or EMS, must feel confident in their ability to fulfill that role appropriately without fear of liability.  

As the Treatment Advocacy Center points out, most people with SMI are not violent; however, failure to offer treatment and early interventions can increase the risk of violence to self or others. Too often in recent years, Colorado has experienced high-profile breakdowns between our treatment and public safety systems where an individual who was clearly struggling fell through the cracks and injured or killed themselves or others. These cases are high-profile examples of the many others who suffer more quietly, but with no less trauma to themselves, their loved ones, and their communities. 

We must create a more balanced system that considers the needs of those individuals who have resolvable mental health challenges while also supporting those for whom mental illness is a more severe and long-term proposition. Our mayors were right to call the question. Now it is up to a larger group of us—families, communities, healthcare providers, law enforcement, courts, and advocates—to answer with a balanced solution.  

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Kara Johnson-Hufford is the Chief Executive Officer of the Colorado Behavioral Healthcare Council, an association of providers offering mental health and substance abuse treatment in communities across the state for every Coloradan who needs these supports.