Former clients of a Delta-based clinic that shut down early last month are still looking for mental and physical health care on the rural Western Slope.
Sixty people were referred to Axis Health System last month and one former client said she has found better health care options since Integrated Insight Community Care closed last month.
But some of the 1,400 other clients said they fear they’re facing a crisis, because there are too few mental and physical health care providers available in their area who take Medicaid, and can care for people with complex and specialized needs.
“It is unfortunate that the actions of Integrated Insight Community Care leadership led to the summary suspension of their license and contracts being terminated,” Stefany Busch, media manager for the state Behavioral Health Administration, wrote in a statement to the Colorado Sun.
While people search for new providers, lawmakers are working with an advocacy organization and other state health leaders to clarify a law around licensure of facilities similar to the ones operated by Integrated.
Integrated Insight Community Care closed after Rocky Mountain Health Plans pulled its contract with the clinic Jan. 18, citing concerns about patient safety and ongoing financial instability.
Rocky Mountain Health Plans is a UnitedHealthcare company and Medicaid insurance provider to many Coloradans with low incomes and disabilities.
The state Behavioral Health Administration also investigated allegations against the clinic that led to its closure, including claims it falsified treatment records and that its founder, Joel Watts, had an inappropriate romantic relationship with a client and gave center staff drugs and alcohol on the job.
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The Delta Police Department also launched an investigation into the clinic, said Becki Stevens, victim services coordinator for the Delta Police Department. “Because it is an active investigation it is not releasable,” she wrote in an email to the Colorado Sun on Monday afternoon.
Watts has denied any wrongdoing and said if he had a chance to work with the state and prove the allegations false, the clinic would still be operating.
Mental health experts said they understand state leaders needed to shut down the clinic to ensure patient safety. But the national behavioral health crisis is making it difficult for some former Integrated clients to find competent care, especially in rural areas, where mental health care options are scarce and the distance between medical offices is vast.
But when a clinic shutters in a small, rural community, that’s an emergency too, said Vincent Atchity, president and CEO of Mental Health Colorado.
Patients can lose access to their medications, they can face long wait times while trying to access new care and the closure can create distrust in the mental health care system and discourage patients from finding new doctors, he said.
A psychiatric emergency on the Western Slope
Notification letters were sent to Medicaid-covered patients of Integrated, prioritizing people with the highest care needs, a state Medicaid department spokesperson wrote in an email to The Colorado Sun.
Rocky Mountain Health Plans reached more than half of those former clients by phone to offer support, the spokesperson said.
Several community providers and organizations are helping support former Integrated clients during their transition to new care, said Haley Leonard-Saunders, director of communications at Axis Health System.
“If one organization doesn’t have the capacity to accept new clients, they could refer them to another partner stepping up to fill the gap,” she said.
Leaders at Axis Health System, a health care provider serving 11 counties in southwestern Colorado, have added more hours of group therapy throughout the month to support new patients and others transferring there, Leonard-Saunders said.
Sixty new clients were referred to Axis Health System’s Montrose and Delta offices in February for mental health and substance use disorder treatment, she said.
Although the uptick in new clients is significant, it was not unexpected, she said.
“We are doing what we can to be a part of the solution,” Leonard-Saunders added.
After the clinic closed, providers in western Colorado created job opportunities for former Integrated staff, according to the state Medicaid department spokesperson.
“Rocky Mountain Health Plans has contracted directly with affected behavioral health and primary care providers, in some cases, at their request,” the statement said.
But finding that help has required former Integrated clients to travel outside their communities for care.
A 12-year-old girl from Olathe who is deaf, has epilepsy, schizophrenia and a cognitive disability had a psychiatric crisis after her care abruptly ended at the clinic. She spent three weeks at West Springs Hospital in Grand Junction 45 miles from home before she stabilized on Feb. 17, her parents said.
Closing a loophole for patient safety
On Feb. 1, the Behavioral Health Administration served the Integrated Insight clinic a summary suspension, which required it to immediately stop providing substance use disorder treatment and community-based mental health services at its licensed clinical facilities.
However, the clinic was operating two Delta residences that stayed open for longer than a week, after Integrated ended licensed clinical services.
The Success House was a short-term transitional facility for women in child welfare cases and drug court and the Impact House was a residential facility for men in the criminal justice system who were deemed incompetent to continue with their court proceedings.
On Saturday, Watts said those two homes were recovery residences. But the state Behavioral Health Administration said they are not licensed by the Colorado Agency for Recovery Residences, which uses national standards to assess sober living homes and recovery residences and license them, said Marc Condojani, interim division director of statewide programs at the state Behavioral Health Administration.
But state law does not give either agency authority to require facilities marketing themselves as recovery residences to become certified, he said.
“That’s the hard part and that’s the particular situation with this provider,” Condojani said. “We often have no awareness or way of knowing when there’s a company out there that may have a housing unit and they’re marketing it as something like a recovery residence.”
When the state Behavioral Health Administration gave the clinic a summary suspension, it didn’t evaluate the Success House and the Impact House against Colorado Agency for Recovery Residences standards to see if some patients were supposed to receive a certain level of care, but didn’t, because the homes weren’t certified.
However, the administration said it did not identify any substance use treatment being offered in those homes that would have required the houses to be licensed under its licensing criteria, Condojani said.
On Monday, Watts clarified, and said there was peer support offered inside the houses and people received substance use and mental health treatment at the clinic’s medical offices. He called the homes transitional housing and said no therapy was offered inside the homes. The only people working inside the homes were peers under the direction of a therapist and Integrated’s clinical director.
Mental Health Colorado leaders are proposing that lawmakers amend Senate Bill 48, a bipartisan measure to aid in drug and alcohol recovery, to address what the advocacy organization calls a “gray zone” in how recovery residences and sober living homes are regulated statewide.
The proposed amendment would clarify which agency is responsible for ensuring recovery residences and sober living homes are certified if they are operating without a license from the Colorado Agency for Recovery Residences, said Lauren Snyder, vice president of government affairs for Mental Health Colorado.
“It says no more gray zone. If someone is operating without a certification from the Colorado Agency for Recovery Residences, it’s the Behavioral Health Administration’s responsibility to take steps to ensure they’re certified, or if they continue to operate without one, they can shut them down,” Snyder said.
Former Integrated staff who worked at the Success House and the Impact House made reports to Mental Health Colorado alleging that employees showed up to those facilities intoxicated and would start fights with certain residents, among other concerns, Snyder said.
“They had these homes where a lot of incidences of abuse that I heard of, at least, were happening,” she said. “They were getting a ton of state money to serve people in those homes but they never had those homes licensed or certified.”
After the two residences closed, Rocky Mountain Health Plans and other organizations began working to provide care coordination for clients who were staying there, Snyder said.
“I really wanted to make sure that if there were any outpatient competency restoration clients that the closure didn’t mean they had to go back to jail because that’s the reality,” Snyder said. “A lot of these folks are justice-involved and when a provider closes like this, they become homeless, and it’s harder for them to make appointments or show up for court.”
Watts said clinic leaders did try to find new housing and medical services for people living at the Success House and the Impact House.
“One person absconded, but we did let his attorney know that we would not recommend placement in the community. Before anything could be done, he left unaccounted for,” Watts wrote in an email to The Colorado Sun.
“Several others did receive a change in bond modification to allow them to return home or to the community,” he wrote in the email. “At least one was able to complete rehab. One, who was recommended by a community stakeholder later relapsed. Another who had her bond modified, relapsed as well.”
Inadequate care persists, even after hospitalization
When the clinic closed, Tiffany Garihan scrambled to find new providers who would take her Medicaid insurance.
Within a week of the clinic’s closure, Garihan moved back into a sober living facility in Grand Junction where she gets the substance use disorder treatment she sought at Integrated but says she did not receive.
She also found new psychiatric and therapeutic health care providers in Grand Junction.
When Garihan finds a new primary care doctor, she will have found all the new care providers she needs, since the clinic’s closure.
“I’m just glad that I’m out of that house and that I have people here at this new house that give me support and push me in the direction I need to be in,” Garihan said.
The parents of the 12-year-old girl who was hospitalized at West Springs said their daughter was placed on a 72-hour mental health hold at the Delta hospital emergency room two years ago when she lost touch with reality and tried to jump out of a moving car.
Soon after, she began receiving in-home therapy, at-home peer support, psychiatric medicine management and case management services at Integrated, the only resource the family had at the time.
The parents asked that their names not be used because one of them often works with the state Medicaid department and fears retaliation at work.
When the Integrated clinic closed down, there wasn’t enough time for the girl’s parents to put a new care plan in place, they said. The girl became paranoid, stopped taking her medication and began punching tables and banging her head against the wall.
“She was admitted into West Springs on one psych med and she’s coming out of West Springs on four psych meds,” her mother said. “They’re saying Integrated was shut down for patient safety, but when you close something like this, is it really about patient safety? Nobody asked us how that would be affected.”
There are few mental health providers near rural Olathe, where the family lives, and even fewer willing to take on the girl’s complex health care needs.
“I provide Medicaid services at my job and I can’t just pull out from a client’s home and have no plan. It’s against my regulations and I have to give a 30-day notice,” the girl’s father said. “I find it really frustrating that Rocky Mountain, as a payer source, is able to do that and there’s no repercussions for anyone except Integrated.”
The behavioral health crisis
The quality of care in America is such that if a person has health insurance, they can receive care for a physical health condition and leave with a reasonable treatment plan that is consistent with standards of care, said Atchity, CEO at Mental Health Colorado.
“When we’re seeking behavioral health care, that is just not true at all,” he said.
It’s not uncommon for people with behavioral health conditions to wait months to get access to care in rural areas only to find that their provider is young, inexperienced, middle class or wealthy and not able to understand the client’s needs in order to provide supportive care, Atchity said.
In rural counties, like the ones Integrated served, people know each other and it can be hard to protect a client’s privacy, which makes people more reluctant to seek needed care, he said.
On top of that, there’s a mental health workforce shortage and championed mental health providers often experience high burn out because they have full caseloads. And they feel frustrated when they see their patients cycling in and out of wellness, Atchity said.
When patients are able to access competent mental health providers, their struggles are not necessarily over. They’re often “dragged through” the time-consuming intake process when providers ask about their history with things like substance use, childhood trauma and sexual abuse, Atchity said.
Behavioral health care organizations also sometimes disparage people with substance use disorders, he said.
“It’s commonplace for people to walk out of those settings feeling dirty and not wanting to come back,” Atchity said. “You can end up spending a lot of money or time finding a mental health or substance use provider, and be worse off, or the same.”
That’s true for one former Integrated client who spoke on condition of anonymity because he was convicted of a felony sex offense and is afraid of retaliation for speaking poorly about former Integrated staff.
The primary care and counseling services he received at Integrated were good, he said, but now that Integrated is closed, he still needs DUI treatment, primary care and psychiatric services.
However, he will forgo the care because he fears being mistreated by doctors like he has been in the past and said he doesn’t want to spend time rebuilding trusting relationships with new providers.
“I hope I’m making the right decision,” he said. “In the past, it was more of a bumpy road trying to find medical help than it was doing it on my own.”
Forgoing treatment could mean life or death
But for some patients, especially those needing substance use disorder treatment, not receiving care can mean life or death, said Maggie Seldeen, founder and director of High Rockies Harm Reduction, a nonprofit working to reduce overdoses, death, disease and other negative consequences from drug use.
“It’s a serious, serious problem, and we’ve seen it happen in rural communities,” she said. “And there are other large risks associated with untreated mental health issues such as lost productivity, loss of wages, a decreased economy, suicide, crime, less involvement with family, higher divorce rates, anxiety, domestic violence and child abuse.”
In more conservative areas such as the rural Western Slope, people are often reluctant about discussing their mental health issues, making it harder for providers to offer them newer, more effective models for mental health treatment such as peer support, Seldeen said.
“A lot of people still think of rehab and Alcoholics Anonymous as the model, because that’s all we’ve really had for a long time, but we’ve realized that doesn’t always work,” she said.
“We even have communities that are still resistant to things like Narcan, which does nothing but save lives,” Seldeen said. “Folks just sometimes are not open to new ways of doing things and that makes it hard to implement new and better programs.”
The Integrated debacle has serious health implications for former clients, Seldeen said. But she encouraged people to never give up on finding care and know there are health care options for them.
MORE: Medicaid members can call 970-255-5660 or email RMHPCareManagementReferrals@uhc.com for help setting up services with a new provider, state leaders said.
The state Behavioral Health Administration has a dedicated call center and email set up to help other former Integrated clients at 720-947-5076 and bha_carecoordination@state.co.us.
Axis Health System, Delta Health, River Valley Family Health Centers, Hilltop, Vail Health Behavioral Health, MarillacHealth, Paragon Behavioral Health Connections and Collaborative Trauma Solutions are helping former Integrated clients find care at their facilities, according to the state Medicaid department.