Crisis care is at the heart of community mental health centers’ service

By Kara Johnson-Hufford, CBHC CEO

Individuals with serious, persistent mental illness need a variety of care, supports and wrap around services to successfully manage their often-multiple challenges. Community mental health centers were built for just this purpose.

The initial community mental health center system was built to take care of the most seriously mentally ill in the community. In fact, it was not until 1974 that centers were allowed to treat children in need of care under federal guidelines. But filling this need wasn’t easy in many parts of the state.

Early interventions and services, particularly in more rural areas of the state, were creative. For a time, a “flychiatrist” used aviation to ensure psychiatric services reached every part of Colorado. Residents of Montrose took it upon themselves to make sure they had a crisis call center, staffing it with volunteers 24 hours a day. These early efforts gave way to a host of community collaborations that now form the backbone of behavioral health services at the centers. Often center staff will provide care in schools, jails, libraries, or other locations where people are in need of services. Centers rely on local partnerships with law enforcement, counties, child welfare departments and others to patch funding together to fill gaps that exist in patient coverage, or program availability.  

These partnerships in response to community need have expanded over the last 20 years to include more services to people involved in the criminal justice system as well. This support can include placing social workers in courtrooms across the state to help direct people with mental health needs to treatment services. Community mental health centers are often available to help juveniles and adults transition out of jail and prison by supporting treatment needs in addition to providing job skills and housing supports.

But in Colorado, crisis services aren’t limited to the traditional clinical definition of a crisis service. In fact, centers are embedded in every state and local emergency response effort, making Colorado unique in the nation.

In response to the 1974 Big Thompson Flood, the Greeley center was asked to provide mental health response. According to the National Council for Mental Wellbeing, this was the first natural disaster in which mental health was specifically asked to support the community response. Because no one knew how to best use the center as a resource, the clinical staff ended up serving in a social work role and even assisting families as they identified the deceased. This resulted in rapid burnout of many clinical staff after the recovery efforts concluded. However, the response generated state recognition for the center’s efforts, and built up a significant amount of support among the local community.

Later, the Columbine High School shooting in 1999 would cement the need for mental health support after a large-scale community tragedy. Columbine firmly rooted the centers in the core community disaster response teams. With the advent of the statewide crisis system in 2013 in response to the Aurora theater shooting, many more centers began to receive state funding to support people in crisis.  These services are often uncompensated by commercial insurance leaving programs without needed funding as state dollars are often not sufficient to serve the number of people seeking care. And when an emergency event calls for the mental health center to respond, depending on the size, scale and duration of these types of events, community mental health centers may deploy staff to provide care for years.

Outside these unpredictable disasters, community mental health centers are focused on serving the mental health needs in their communities year around. In 2022, 25 percent of the people served by community mental health centers were under 18 years old. And of the more than 200,000 unique clients served in the statewide system, the majority received individual therapy and case management for a range of needs including those with major depression, bipolar, anxiety and substance use disorder.