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NAMI Boulder County Input to the Colorado Task Force on Behavioral Health

NAMI Boulder County Input to the Colorado Task Force on Behavioral Health, October, 2019 

Behavioral Health System Issues and Needs 

In Colorado, services for children, adolescents and adults with serious behavioral health illness, have become increasingly fragmented under Regional Accountability Entities administered by commercial insurance companies such as Anthem and United Health. In addition the funding streams from federal and state sources are fragmented and costly to administer. 

The behavioral health core safety net providers need to be able to provide person-centered, recovery-oriented, flexible, “wrap around services” to children and adults with more serious mental illness that go beyond services provided in the commercial insurance model. A capitated funding system for local public providers works better, decreases administrative costs and allows the flexibility to serve high risk populations such as the homeless, pre-school “kick outs”, and even infants with depression and failure to thrive. 

Services that are centralized for the State such as crisis services and crisis beds do not work well for areas outside Denver. They need to be more immediately accessible and integrated with other local, first responders. 

As our survey of NAMI members in Boulder and Broomfield Counties highlights, we need a public integrated continuum of care in local communities for people with serious behavioral health illness and children with serious emotional disorders that is provided in partnership with: 

  • Other local, first responders such as law enforcement and hospital emergency departments for crisis intervention and diversion from arrest or incarceration whenever possible; 
  • Child Welfare, pre-schools and public schools for early intervention
  • Public Health Departments for prevention
  • The Juvenile and Adult Criminal Justice system for alternatives to incarceration; 
  • Primary health care providers and health clinics; 
  • Shelters for the homeless and housing agencies; 
  • The Division of Vocational Rehabilitation. 

Proposed Solutions 

Successful models for integrated behavioral health programs in Colorado that prevent incarceration and out-of-home placements do exist in several areas of Colorado, especially in those areas where the public behavioral health provider agencies coincide geographically with the local Judicial District and Social Services. 

Therefore we propose that Colorado: 

  1. Create Behavioral Health Districts that geographically match the Judicial Districts but are a separate system from the judicial system. The Behavioral Health Districts will be administered and jointly funded by Capitated State Medicaid Funds, by combined state funding streams, by increased General Funds and other sources of funding including federal and local grants.* The purpose is to provide person-centered, recovery-oriented services to adults, adolescents and children with serious behavioral health disorders to help them thrive in their own families and communities and prevent arrests, incarceration, institutionalization and out-of-home placements. Aligning the judicial system with mental health districts, as has been the case in the past, allows for blended funding and collaborative program development. Such alignment will also promote local solutions to local problems and allow solutions that are consistent with the culture of the area. Salaries and benefits for both State and County employees are generally higher than those of behavioral health workers employed by private-non-profit agencies that are not funded well enough to pay more. Community Mental Health Centers are currently overwhelmed with needs for services, complicated funding sources, complex accountability requirements, and  restrictive service regulations that impede their responsiveness to individual and public needs. Nevertheless, our Community Mental Health Centers remain the primary providers of services to individuals and families with the most serious behavioral health needs. They need to be included in problem solving by the Behavioral Health Districts.
  1. Create savings at the administrative level by funding services more directly without a commercial insurance administrative layer motivated by profit. There should be no profit in public behavioral health services for the most seriously ill children and adults. 

Promote local control, responsibility, engagement and creativity. 

  1. Open more State public hospital beds to accommodate both the civil and “competency to proceed” admissions and allow for optimal lengths of stay. Allocate the civil beds to local districts so that there is careful management of the usage and ensured continuity of care and close coordination between inpatient providers and continuing care providers in the community.
  1. Fund, maintain and replicate successful behavioral health program models throughout Colorado that are integrated with other local systems and tailored to local needs. 
  1. Create an integrated, accountability system that allows for flexible “wrap around” services and focuses on carefully selected Outcomes in addition to numbers of people served and numbers of services provided. Eliminate unnecessary and/or duplicative requirements. Too many reporting requirements coupled with case loads that are too high lead to burn out and the loss of dedicated, highly skilled behavioral health professionals.
  1. Within laws such as Psychiatric Advanced Directives, HIPPA and the CARE Act, encourage behavioral health providers to include primary care providers, whenever beneficial, as part of the treatment team with the person suffering from behavioral health illness especially when the person is living with the primary care givers.
  1. Enforce Parity laws for people wanting to use commercial insurance. 

* (Private providers could continue to bill State Medicaid on a “fee for service” basis for those with less serious issues that do well with outpatient services and do not need more intensive services.) 

Submitted by: 

Phoebe Norton, MSW, Past Director of the Mental Health Center of Boulder County, Inc. Current Board Member with The National Alliance on Mental Illness, Boulder County 

Roxanne Bailin, J.D., Past Chief Judge of the Twentieth Judicial District 

Joe Pelle, Boulder County Sheriff 

Endorsed by: The National Alliance on Mental Illness of Boulder County 

References: 

Bedlam, An Intimate Journey Into America’s Mental Health Crisis by Kenneth Paul Rosenberg, M.D. with Jessica DuLong, Random House, New York, 2019 

Colorado Office of State Planning and Budgeting, Behavioral Health Funding Study by the Western Interstate Commission for Higher Education, Mental Health Program, November 2016 

National Association of State Mental Health Program Directors, Fact Sheet on Harmonizing Funding Streams: The States Behavioral Health Authority Role, June 2012 

Attachment: 

Brief History of Mental Health Funding in Colorado 

See survey results here

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