Mental health

Colorado lawmakers on Wednesday heard from in-state and out-of-state experts about the need to disrupt the relationship between mental illness and the criminal justice system, with a message that jail-based services and police contacts are unhelpful interventions for those in severe crisis.

And, in particular, that existing treatment protocols are not working.

"While we all want our loved ones to be able to volunteer for services, we are trying to live in that untenable space because they simply cannot," said Sabah Muhammad with the Virginia-based Treatment Advocacy Center. "It stops being a medical issue when we wait for someone to deteriorate that far. Families are held responsible, communities are held responsible and the police are held responsible. These are not experts."

The hearing was intended to give background information to the three senators and three representatives of the Committee on the Treatment of Persons with Mental Health Disorders in the Criminal Justice System. At the center of the topic was the "27-65" statutes, which are the state laws pertaining to care and treatment of those with mental illnesses.

Included in the regulations is an emergency 72-hour hold that law enforcement or medical professionals can place on someone who is mentally ill and appears to be an imminent danger to themselves or others. Muhammad, who used to be a public defender in Georgia and has a mentally ill family member, advised that Colorado allow the families of people experiencing a crisis to place emergency holds, as well as lowering the legal standard.

"When they’re incapable of providing their own food clothing and shelter is when we’d like them to be considered a harm to themselves," she explained. "Not danger. Not criminal. We can have a lower threshold of care because that’s where the emergency starts for families."

There are approximately 30,000 mental health holds annually in Colorado. The average length of stay for someone committed to the Colorado Mental Health Institute in Pueblo is 120 days, but the state is also paying out $10 million annually pursuant to a settlement with disability advocates. The multimillion-dollar fine — calculated based on inmates per day — is due to an inability to quickly move people out of jail and into treatment.

Colorado Public Radio reported in 2018 that the average wait time for getting into a hospital for those sitting in jail after being found legally incompetent to stand trial more than tripled in just one year.

"We’ve got a team of 37 evaluators plus 20 we’ve contracted for," said Jagruti Shah, director of forensic services at the Colorado Department of Human Services. "I don’t know the issue at this point is a capacity for evaluations, but it really is the beds and the requests we’re getting for inpatient services. That’s really where we're stuck."

But multiple witnesses told the committee that the ideal solution is to address a person's crisis before police place them in jail to begin with. One program lauded as a success was Denver's Support Team Assisted Response (STAR), which pairs mental health professionals with medical first responders to address low-level, nonviolent calls in lieu of armed officers.

Since June 2020, there have been approximately 1,400 calls, none of which required police backup. Services offered included the provision of socks, water or snacks, and transportation to day shelters or service providers. Trained dispatchers, as well as officers' recognition that STAR personnel are more appropriate for a given situation, are a key factor in those outcomes, lawmakers heard.

"A lot of the police on the street will always take the easiest route that they can, which sometimes is over to the STAR program," said Cpt. Jamison Brown of the Denver Sheriff Department. "But once they have warrants and things that demand [police] arrest them, they really have no choice."

A phrase that came up repeatedly was the mentality of "treat 'em and street 'em." Emergency departments are not designated as providers of services under the 27-65 statutes, and a representative of the state's Office of Behavioral Health said many complaints pertain to middle-of-the-night discharges from emergency departments.

Lauren Snyder, the state policy director for the advocacy group Mental Health Colorado, acknowledged that some people have credited 72-hour mental health holds with getting them the treatment or medication needed to save their lives. But more commonly, they feel retraumatized.

"They don’t talk to you like you're human half the time," Snyder said, quoting complaints she has heard about the process. "They’re frustrated they have to deal with me ... It would have been nice if they’d offered me water or food ... You’re just playing with us. We don’t have time to play in the emergency department.”

In one extreme case, Snyder said medical personnel seemed to imply that if a suicidal patient wanted their attention, the next time she needed to cut herself deeper.

Rep. Judy Amabile, D-Boulder, said the various witnesses "make me want to cry" with their testimony. She wondered whether a patient's ability to pay correlated with the length of a mental health hold.

"I suspect there’s something there as a practitioner," said David Iverson, the director of psychiatry for the Colorado Coalition for the Homeless. Iverson acknowledged that he could not defend some of the treatment his colleagues provide, and he reportedly signs the death notices of four to five homeless individuals every week.

"There are no mental illnesses cured in 72 hours," he said. Instead of being a gateway for treatment, the mental health hold "is now often a dead end." He suggested there be more peer support, meaning that patients can hear from someone who has shared their lived experience and recovered from it.

The state announced in 2019 that it would add 128 beds through December 2021 at the state mental health hospital. Currently, there are 94 beds for non-criminal patients. Iverson said that peak psychiatric capacity in the 1950s was 5,500 beds.

An estimated 35% of the population involved in Colorado's justice system have mental health concerns, and a key recommendation the committee heard was to interrupt individuals' involvement with criminal courts in the first place due to unmet mental health needs.

Muhammad, with the Treatment Advocacy Center, emphasized that punishing someone for their behavior will achieve nothing if a person cannot manage the behavior in the first place because of their illness.

"I had a former client when I was a public defender who was charged with trespassing. Couldn’t give his name. Didn’t know he was in the state of Georgia. There was no crime there," she described.

"Everybody in that courtroom, when we know we’re facing something like that, need to become an advocate," Muhammad added. "We can’t just say, 'Let’s bring more resources to the jail.' That is criminalizing and we’re allowing it, and we do not serve our community when that happens."

The oversight committee will hold additional hearings next week.

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