NEW IN-PATIENT CARE, ROUTINE TELE-HEALTH, AND MORE OPPORTUNITIES FOR MENTAL HEALTH TREATMENT IN COLORADO ACCORDING TO MENTAL HEALTH COLORADO’S MOE KELLER

Originally appeared in thecoloradohealthreport.com

…our accommodations to the coronavirus, combined with a re-evaluation of the mental healthcare system in Colorado, are leading to new strategies to treat people with mental illness.

As we continue to find our way through the COVID19 pandemic; our accommodations to the coronavirus, combined with a re-evaluation of the mental healthcare system in Colorado, are leading to new strategies to treat people with mental illness. That’s according to Mental Health Colorado’s (MHC’s) Director of Advocacy Moe Keller. MHC is an advocacy non-profit that promotes wellness for those with mental health conditions and substance use disorders through policy initiatives aimed at lawmakers, healthcare providers, and the general public. Keller says developments, like the end of an historic legislative session and the advent of virtual communication at public agencies, forced to close buildings because of the virus, are steering us in new and sometimes more effective directions.

Keller’s perspective on new strategies in the mental health world come from a life in healthcare advocacy. Like a lot of advocates, Keller’s experience as the family member of a person with a psychiatric disorder is one of her motivations for trying to make the mental healthcare system more effective and responsive to patients and their families. For 25 years she worked as a special education teacher. She went on to represent Coloradans as both a state senator and a representative in the Colorado House. And she wrote and sponsored landmark legislation including: mental health parity bills, measures restricting the use of seclusion and restraint for people with mental illness, and a law that reformed the treatment of children with mental illness in Colorado.

Keller says Colorado lawmakers have become more sympathetic to the needs of state residents with mental illness. The pandemic, she agrees, may have financially gutted important initiatives for Coloradans, like the “Social Security Disability Application Assistance” statute, but lawmakers preserved them, along with a mental health taskforce that advises them. They also repeatedly expressed their commitment to mental health services. It’s been a long time coming, but there are some real reasons to hope that we’re going to be improving our care of Coloradans with mental illness.

…tele-health has worked so well that… public mental health centers plan to continue to schedule virtual visits.

It turns out that tele-health has worked so well that after the pandemic, public mental health centers plan to continue to schedule virtual visits. “People will be able to get services,” says Keller, “especially the people who have mild to moderate anxiety, mild to moderate depression, panic attacks, OCD,… they could be reached a lot easier, and they don’t necessarily need to come into an office.”

Besides the success of tele-health, it has become apparent to administrators of public mental health centers that some buildings may be superfluous. Keller says one mental health center is considering repurposing one of their buildings for low income housing, for example. This is good news for people in the mental health community, who have sometimes complained that public mental health centers weren’t adequately treating Coloradans with severe mental illness.

“…when people had serious mental illness… the mental health centers weren’t taking them.”

“What we have found,” says Keller, ” is that when people [had] a serious mental illness and they’re aggressive, they’ve been in and out of psychosis, …the mental health centers weren’t taking them. We said, ‘you have a contract with the State of Colorado to provide services for the severe and persistent population with mental illness, and you’re not doing it.’ You’re denying care to this segment.” Keller says she understands that people with severe mental illness, who are aggressive, should probably not be waiting in an office, but there are things that public mental health centers can and should do in communities: “Assertive Community Treatment.”

Keller says mental health centers are doing good things in the community. Some have partnered with the Colorado Coalition for the Homeless to find temporary housing for severely mentally ill people. Some are also working with the first responder network that sends mental health professionals along with police officers to calls involving people with mental illness. At the end of the 2019 legislative session, mental health centers worked with MHC to pass SB19-222. This bill requires community mental health services for individuals who are aggressive or difficult to treat. It might take some time to get partnerships up and running; but Keller maintains that by state law, community centers, including mental health centers, have a state-required mandate to serve the population of people with severe mental illness in Colorado, aggressive or not. You can review SB19-222 here: https://leg.colorado.gov/sites/default/files/2019a_222_signed.pdf.

Another problem for family members of people with severe mental illness, as regards public mental health centers, is access to information. Staff members at public mental health centers cite the Health Insurance Portability and Accountability Act (HIPAA) for not communicating with family members of adults with mental illness. Keller recommends in an ideal situation that when the person with mental health challenges is in good health, family members should get something in writing (a HIPAA release) indicating that parents or a trusted adult can act in the interest of the person with mental illness when they’re having a hard time doing it for themselves. Family situations involving people with severe mental illness can often be less than ideal. Guardianship and psychiatric advance directives might work for some families. Keller says while family members can be left out of conversations with mental health professionals, relatives CAN talk to mental health care providers. “I don’t think this is healthy,” is something a parent or relative can say about their loved one… often, if need be.

Something that public mental health centers CAN do that can’t be done in some other treatment settings is offer peer counseling.

Something that public mental health centers CAN do that can’t be done in some other treatment settings is offer peer counseling. Like other mental health advocates working to map out options for the future of mental healthcare in Colorado, Keller has high hopes for this work. As she and others analyze parity for mental healthcare compared to medical care in Colorado and in other states, they’ve found that while there are challenges with the managed care payment structure of public mental health centers, there is also flexibility: They can offer transportation and hire peer support specialists for example, under this payment model. Mental healthcare workers can meet with people where they live or wherever they are.

Hospital administrators are apparently rethinking their care of patients with mental illness, too. Typically, if a person is brought into a hospital emergency room on an involuntary hold because of mental illness, says Keller, physicians in that setting make determinations about the best course of treatment for the patients. They often only stabilize the patient, though, and release him/her as soon as they determine that the patient is not a danger to him/herself or others. Required discharge plans, under these conditions, says Keller, are largely non-existent. She notes, often the staff in the emergency room will simply give the patient a card with the name and number of the nearest mental health center and send them out. But they come back, and they come back sicker–mentally and physically. They get to the point where they can no longer take care of themselves, and no one will take them–not assisted living facilities, nor nursing homes.

Keller says the University of Colorado Hospital… is constructing a stand-alone building… for psychiatric treatment and long-term care.

Keller says the University of Colorado Hospital in Aurora is constructing a stand-alone building on the Anschutz campus for psychiatric treatment and long-term care. In fact, says Keller, CU is integrating mental health into all departments, starting with Maternity and Pediatrics.

In addition to new projects in the works to support people with chronic mental illness, Keller says on-going programs, like the Circle Program in Pueblo that cares for court-ordered patients with co-occurring mental illness and other diseases like substance abuse, have been preserved by state legislators despite COVID cuts. There are also plans to set up two more Circle Programs: one on the western slope in the Montrose-Delta area, and one in Ft. Collins.

The urgent need for mental health treatment programs, housing opportunities… are the focus of new initiatives.

The urgent need for mental health treatment programs, housing opportunities, and basic healthcare are conditions that are not only increasingly apparent to policy-makers in Keller’s view, more and more they are the focus of new initiatives. “Every legislator has had a call, maybe more than one, from a constituent who… says I’m in trouble. Help me. We find, for the most part, that the legislation and the interest in mental health is bi-partisan. …They get it. …It takes money and effort. And I think we have reached the point especially at the local levels where… county commissioners and city councils are talking about it.” Keller says five counties in the last two years have gone to voters and asked for a sales tax or mill levy, specifically for mental health. “And each one of them passed, and passed big,” she notes.

It’s not only Colorado lawmakers who currently have a clearer picture of the needs of people with mental illness, Keller muses. With the pandemic, everyone better understands isolation, financial uncertainty, and worry about meeting everyday needs. Keller continues her work with MHC to research, compile and weigh-in on mental health opportunities for the non-profit; and in her advocacy work aimed at state lawmakers. We hope to see more of the new initiatives she’s been following in operation!