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Colorado’s mental health system is “broken.” An audit could reveal why, and what to do about it.

While the state’s Behavioral Health Task Force decides how to spend $450 million, a battle waged in letters intensifies

Jefferson Center for Mental Health served about 28,000 people last year at its various offices, including in Wheat Ridge. (Kathryn Scott, Special to The Colorado Sun)
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As state policymakers and media outlets scrutinize Colorado’s mental health system, the head of a trade group representing 17 community mental health centers is calling for an audit. 

The CEO of the Colorado Behavioral Healthcare Council, which advocates for the community clinics across the state, wants an audit not just of those 17 centers but the entire behavioral health system. 

“We need to make the system much more accessible and we need to break down some of these barriers,” Doyle Forrestal said.

Her request comes as community mental health centers, the safety-net system for those with Medicaid or without insurance, are at the heart of an intense conversation about Colorado’s “broken mental health system.” 

They were the subject of an in-depth Colorado News Collaborative report that revealed the centers, which receive $437 million in tax dollars per year, are treating thousands fewer patients now than before the pandemic began and that some people in dire need of care are slipping through the cracks. And the centers were the subject of a subsequent letter to Gov. Jared Polis from statewide mental health advocates that asked the governor to “take action to address serious problems,” including a lack of transparency and the centers’ “failures to serve Coloradans with greatest needs.”

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The letter, signed by Mental Health Colorado president Vincent Atchity and National Alliance on Mental Illness Colorado executive director Ray Merenstein, among others – called for an overhaul of the community mental health centers. 

For starters, Colorado should create more transparency and accountability regarding the centers’ spending, including by requiring them to disclose to the state each time a client has to wait more than five days for an initial appointment, the advocates wrote. They also want the governor to create a standing group of policy and finance experts. And they made a related, and pointed, request: no more than one representative from the community mental health centers allowed on the panel. 

“The state should be bold and truly transformational in its efforts,” they wrote. “This means standing up to powerful trade associations and ending a long-standing sense of entitlement.”

Two days after that letter, Forrestal sent her own letter to the governor asking for an audit. 

What auditors would find if they look into community mental health centers, Forrestal said, is a system filled with redundant paperwork – so many reports and documents to justify public spending that time spent on actual program improvements suffers. 

The exterior of the Mental Health Center of Denver’s Galapagos Street location on March 26, 2019. (Eric Lubbers, The Colorado Sun)

The audit’s scope should extend to hospital systems, insurance companies, mental health therapists and psychiatrists in private practice, and beyond. The entire system needs review, from figuring out why medical offices and hospitals have been slow to incorporate mental health care to why therapists in private practice often don’t take insurance, she said. 

The scrutiny comes as more Coloradans than ever are seeking mental health services.

“We have a bunch of people who, prior to the pandemic, were starting to feel comfortable and wanting to reach out for services,” Forrestal said in an interview. “Now, it’s blown the doors off. People want access to care. They don’t know where to go. You have struggling family members that need help and resources and we just don’t have the people to provide that care.”

Meanwhile, there’s a third letter. 

A group representing mental health providers in private practice wrote its own letter, addressed to the legislature’s Joint Budget Committee, calling the current structure biased in favor of the community mental health clinics and against those in private practice. The state Medicaid department and the community mental health centers are a “clique that excludes the independent providers from representation and influence over policy,” including a recent 2% increase in staff wages that did not help private providers, said the group, called COMBINE.

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The battle waged in letters comes as a legislative task force gets closer to announcing how it will recommend spending $450 million in federal coronavirus aid tagged for Colorado’s mental health system. At the same time, Polis’ office is building a new Behavioral Health Administration, which will coordinate mental health care and substance abuse treatment at one state agency instead of the current system, which includes 75 programs at three state agencies.

The leaders of two state agencies — the Colorado Department of Health Care Policy and Financing, which includes the Medicaid division, and the Colorado Department of Human Services, which includes the state behavioral health office — released a statement Wednesday to make clear they welcome reform.

“Even before the pandemic increased the need for behavioral health services into a crisis, we recognized the need to make significant changes to our behavioral health system in Colorado,” said the statement from Kim Bimestefer and Michelle Barnes. “We are committed to addressing the problems and gaps in the behavioral health system and to making bold changes to ensure people the mental health and substance abuse treatment and services they deserve.”

The reimbursement rates the state Medicaid department pays to individual clinicians in private practice are far lower than those paid to mental health centers. Centers, however, say they need higher reimbursement rates than therapists in private practice in order to cover the costs of operating 24/7 crisis services, case management and community education courses. 

The statewide discussion on reform comes as Colorado is suffering from a mental health workforce crisis, with 1,092 job vacancies among the 17 regional mental health centers. 

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