Nearly every day in Colorado, someone having a mental health crisis tries to seek help at a hospital emergency room. There’s only one problem: ER doctors are able to diagnose and treat a broken foot, but they generally don’t have the training to fix a broken mind.
“Not to say anything against the professionals in the emergency room, but they often aren’t equipped to deal with it,” said Scott Glaser, the director of the Colorado chapter of the National Alliance on Mental Illness.
But, after decades of deep cuts to Colorado’s institutions and programs to help the mentally ill, the options are few. “We don’t have a place for someone who is in crisis to walk-in and have access to care and a way to deal with their crisis [immediately],” Glaser said. Many patients end up staying on a cot in the hospital ER for a day or two, until they are calmed down enough to be discharged, or until room can be found in a mental health treatment center.
“It is shocking,” said Moe Keller, of the organization Mental Health America of Colorado, “but this is a common, everyday practice.”
Some ER’s have psychiatrists on staff, but others do not, says the Colorado Hospital Association. Sometimes, this is due to a shortage of psychiatrists, particularly geriatric psychiatrists, said CHA spokesman Julian Kesner. Low pay from Medicare and Medicaid government insurance programs contributes to the shortages, he said.
"We don't have a place for someone who is in crisis to walk-in and have access to care and a way to deal with their crisis [immediately],"
A 2011 report estimates that fully 1.5 million Colorado residents – 1 in 3 people – are in need of mental health care or treatment for substance abuse. One in 12 – an estimated 450,000 Coloradans – are in severe need of mental health care.
The report, funded by a several foundations and authored by the group Advancing Colorado’s Mental Health Care, ranked Colorado 32nd in the nation for public mental health care funding.
The state ranks sixth in the nation for its rate of suicide. Yet, as Colorado Public News has reported, fewer hospital beds are available for children, adolescents and seniors with mental health illnesses than a decade ago. Currently more than 50 percent of care for mental health and substance abuse in Colorado is delivered via primary care physicians – of which there is also a shortage. And, many rural areas of Colorado have little or no accessible mental health providers.
Cuts to mental health services in Colorado and elsewhere have been a reality for decades. Keller, a former longtime Colorado legislator, noted that federal money to pay for mental health services began drying up in the 1980s, and states and counties began to defund programs. In 2009, the legislature opted to save millions by eliminating beds for children, adolescents and geriatric patients at the Fort Logan Mental Health Institute in Denver, one of Colorado’s two inpatient psychiatric hospitals.
“I regret that more than anything else, but we had to do what we had to do to balance the budget,” Keller said. “There was a theory that if we closed the beds in institutions, local communities would have to step up to the plate. They didn’t.”
In the months after James Holmes was alleged to have killed 12 people and injured 58 in a movie theater in Aurora, efforts have been launched to increase funding and rebuild infrastructure for mental health services. Holmes’ attorneys have claimed he is mentally ill. Many other violent episodes, including the mass shooting in Newtown, Conn., and smaller-scale incidents in Colorado, have raised consciousness for restoring funding for and access to mental health services.
In December, Colorado Gov. John Hickenlooper and Department of Human Services Director Reggie Bicha rolled out a proposal to inject $18.5 million in funds into mental health programs. The legislature is expected to begin debating several related bills in coming weeks.
Keller and Glaser are encouraged by the plan, which includes establishing a 24-hour statewide crisis hotline, and opening five walk-in facilities for people who need help. But, they say, there is much more to be done.
“In one perspective, $18.5 million sounds like a lot of money, but in some perspectives it is really just a drop in the bucket,” said Glaser.
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The governor’s proposed $18.5 million
- Create a statewide mental health hotline and establish five, 24/7 walk-in crisis centers allowing a stay of up to five days: $10.3 million
- Expand hospital capacity, particularly for jail inmates: $2.1 million
- Add community care, including two 15-bed residential facilities and more housing vouchers: $4.8 million
- Build a mental health/substance abuse data system, add de-escalation rooms and peer support at state mental hospitals: $1.4 million
Colorado Behavioral Healthcare Council proposal: an additional $1.27 million
- Expand from five crisis locations to 13, building on existing services.
Legislature’s Joint Budget Committee staff proposal: an additional $9.5 million
- Add mobile crisis unit, $5.9 million
- Add non-hospital respite facilities, $3.6 million
