State officials behind an ambitious, and daunting, plan to build a new government agency for behavioral health have selected a physician who directed crisis services in Washington, D.C., to lead the transformation.
Dr. Morgan Medlock, a public health expert who most recently was chief medical officer for the D.C. Department of Behavioral Health, spent the first two months on the job in Colorado touring the state’s mental hospitals, community mental health clinics and residential substance abuse treatment centers. As Colorado’s first commissioner of behavioral health, she reports to Gov. Jared Polis and is responsible for what’s been described as the state’s most monumental overhaul of mental health care in decades.
The Colorado Sun caught up with Medlock in the midst of legislative debate on how to spend $450 million in “once-in-a-generation” federal coronavirus aid to reform mental health care and substance abuse treatment in Colorado, as well as legislation that will set the rules for the new Behavioral Health Administration.
The new office will take over responsibility for more than 100 mental health and substance abuse programs that now are spread throughout at least four state agencies. By 2024, the office must create a statewide grievance system in which the public can report maltreatment or lack of access to care, and is expected to expand services, particularly in remote communities, according to the legislation.
Medlock, who is on the faculty at Massachusetts General Hospital Center for Law, Brain and Behavior and was a clinical psychiatry fellow at Harvard Medical School, talked to The Sun about her plans for restructuring the system, tackling the children’s mental health crisis, and helping Colorado find its way out of the fentanyl epidemic.
She has plans to hire an adviser for children and families, as well as a deputy commissioner for equity. In addition to a medical degree, Medlock has master’s degrees in divinity and public health.
Building the ideal mental health system
Medlock said her first priority is making sure people know where to go for treatment, which requires help from libraries, homeless shelters, doctor’s offices and more.
“We have got to have a strong front door to treatment, a single door of entry, and we’ve got to develop that through unique avenues. As we think about what this front door looks like, it will have a digital component where people can get help. You need to know that you can walk into certain places, whether it be shelters or libraries, schools, and receive help and guidance into accessing those resources. We need to combine the digital solutions with the human solutions.”
After focusing on the “front door” to care, particularly for those in crisis, Medlock said she will shift to improving long-term services for those in the system.
“We need to do the same analysis across the continuum of care, and think about that in terms of intensive services, outpatient support, etc, housing support. But as we build the continuum of care, we’re focusing on the front door.”
Building up the workforce is another key priority, as is setting up a grievance system so that people can seek help from the new Behavioral Health Administration when they can’t find treatment or when they receive inadequate care, she said.
“Any system has to be accountable in a public way. And when people are not experiencing the outcomes that they deserve, and are not satisfied with care, they ought to be able to rely on us as the BHA to help them resolve grievances and concerns.”
Opioid abuse research at Howard University
Before working for the behavioral health department in Washington, Medlock was the director of community engagement and new program development for the College of Medicine at Howard University, a private, historically Black university in the capital city.
“I was really responsible for being a strategy architect and opening new doors for opioid use disorder treatment to our community, and particularly, to marginalized communities,” she said. “It was my job to travel D.C., and particularly to Wards 7 and 8, where we have the highest opioid overdose rates, and meet with community members, faith leaders, those with lived experience, nonprofit directors, and talk about how do we have a comprehensive strategy for reducing opioid overdose deaths in those communities. That work also dovetailed into policy work I was doing on the mayor’s opioid fatality review board.”
The review board researched “root-cause analyses of opioid deaths, determining what policy solutions were needed to support individuals at risk of overdosing. We also analyzed the surge of fentanyl use in Washington, D.C., which has now, unfortunately, become a matter of national importance and crisis.”
Reducing arrests of those with mental illness
After joining the D.C. Department of Behavioral Health, Medlock focused on reducing arrests of people with mental illness and creating alternative ways to help people in crisis instead of charging them with crimes.
During her tenure, the city cut down on criminal charges against people in behavioral health crises, including by having mental health professionals — or co-responders — join police officers on certain calls, she said. Several law enforcement agencies in Colorado, but not all, use co-responders. She intends to use her background in helping people who’ve experienced trauma feel comfortable accessing care to help develop policies in Colorado.
“We took steps to work with national consultants on this issue to complete training and empowerment of our staff, to think about an individual in crisis as still a person and not a diagnosis. Not simply a charge.
“Even though individuals are in crisis, it doesn’t mean that they cannot contribute to a joint decision about next steps, and about what they do to heal. We also need to think about housing, we need to think about transportation needs, we need to think about the context of a person’s life, and especially the economic context of a person’s life. And for our work in D.C., that became extremely important as we thought about how populations were shifting as it relates to housing and economic policy.”
Responding to the fentanyl crisis
Overdoses from fentanyl, a powerful synthetic opioid, have skyrocketed in Colorado during the past two years. Most pills now sold on the streets that look like OxyContin or Xanax are counterfeit and contain fentanyl. Last week, a Colorado Springs woman was arrested for selling the little blue pills near a high school, where a student overdosed and died at her desk.
Medlock, who was on the D.C. Hospital Association’s opioid task force, said finding new ways to deal with the epidemic is among her top priorities. First up, she wants to build a system in which people who need mental health treatment or substance abuse treatment walk through the same doors to receive treatment at the same place, instead of the current, splintered setup.
“The Behavioral Health Administration does want to integrate those two parts of the system, and we’re doing that in an intentional way through our administrative structure. This issue is critically important. And when you add the lens of the pandemic and the hopelessness and the rise in anxiety and depression and suicidality that have all increased during the pandemic, and then you include the pre-existing opioid crisis, things are really at a dire level. The BHA is ready to step in and integrate our approach for individuals in substance-use crises.”
Hiring an adviser for children’s mental health
Medlock said she intends to hire a senior advisor for children, youth and families who will strategize about helping kids in mental health crises. To start, Colorado needs more psychiatric beds for children in order to spare them from traveling out of state for treatment, she said. The governor has plans to spend federal American Rescue Plan Act funds to create new neuropsychiatric beds for children.
“Many of our kids who are now being shifted out of state are those with neuropsychiatric needs, and with intellectual or developmental disabilities,” she said. “And so I really want to applaud Gov. Polis for prioritizing this issue so that we can bring more beds online for our kids, and so that their families and parents don’t have to deal with moving their kids out of state to receive vital care.”
“Equity cannot be overstated”
Medlock, who was vice chair of the American Psychiatric Association’s Council on Minority Mental Health and Health Disparities, said she’s received approval from the governor’s office to start a search for a deputy commissioner focused on equity and system effectiveness.
“I cannot say enough about equity. We want the work that we do to be effective across the continuum of care, and we want it to be equitable across the lifespan. Children and youth right now deserve more than what we’re providing, and we know we need to do better there. We know that racial inequities in behavioral health care need to be addressed, we know that we need a more just system of care for individuals with disabilities. And so equity cannot be overstated.”