Colorado's need for mental health care has never been greater, after a year of living under the dark clouds of COVID-19, economic disruption, social unrest, record wildfires and another mass shooting.
Government money has never been easier to come by. Peanut butter, meet jelly.
The problem for the General Assembly, with billions to divvy up, is priorities and followthrough, more than politics or money, according to advocates and lawmakers engaged in figuring it out.
They sure don't lack legislation to get there: more than a dozen significant bills that take direct aim at shortcomings in Colorado that span years, if not decades, to address the growing awareness of the mental well-being that touch the tar-papered barns of the Eastern Plains as much as mountaintop mansions of Telluride.
With billions coming from the federal government, lawmakers also are flush with budget cash left over from cuts that were too deep a year ago and the prospects of a robust economy returning faster than once expected. Sen. Brittany Pettersen contends there's never been a more important time to rebuild the state's emotional well-being alongside its infrastructure and economy.
For years, Pettersen, a Democrat from Lakewood, has invested her political capital on Sisyphean fights to fund substance abuse programs, as well as other mental and behavioral health care.
She is sponsoring the most important piece of legislation this session: the Behavioral Health Care Recovery Act, Senate Bill 137, a $34 million omnibus that covers a rainbow of old and new programs with ongoing state funding and a fair share of one-time federal recovery money.
“It's really important that as we look at economic recovery, we're also looking at the health and well-being of Colorado and of Coloradans,” Pettersen told the Senate Health and Human Services Committee as she unveiled her master plan on March 31.
Legislators, however, will have to bear in mind that state and federal stimulus money, by definition, is temporary. That means that initiatives started with it will have to be funded by taxpayers or cut later on. That's the balance forward-thinking lawmakers will have to consider.
Moreover, the Colorado Constitution's Taxpayer’s Bill of Rights will force cuts in all government spending, if the new programs push the state past its constitutional spending cap triggered by, ironically, a growing economy.
Besides restoring cuts from a year ago, Pettersen's bill expands funding for rural mental health partnerships, wipes away expiration dates on existing pilot programs also invests on the law enforcement side of the equation to slow meth, fentanyl and other illegal opioid distribution in the state.
“The bill is very big,” Pettersen said. “We're doing a lot in this, but it's going to be critical to not only adults' mental well-being, but also for our kids.”
Big problems demand big solutions, she contends.
As the federal dollars materialize, Pettersen said, expect some “significant amendments” as her bill makes its way to the governor's desk through the Democrat-led legislature.
She advised “going bigger to put money where it needs to be.”
Of 12 bills that specifically address mental health, only two lack bipartisan sponsors. One is Pettersen’s comprehensive package. The other would require insurers to cover a one-hour mental health wellness exam annually.
Lawmakers seem likely to create a state Behavioral Health Administration to reallocate funding and house efforts under one administrative roof, the recommendation of a statewide task force that looked at improving how Colorado provides services and spends money.
Other bipartisan legislation would, respectively:
- Allow the Public Utilities Commission to set a telephone surcharge to pay for the state's 9-8-8 suicide prevention hotline.
- Strengthen peer counseling services.
- Fund mental health programs for police officers.
- Expand suicide prevention training.
- Train court officials who deal with domestic violence and child abuse cases.
What the pandemic gives Colorado in stimulus dollars, however, it has already taken away in terms of emotional and financial stability across every demographic, especially for the unemployed, struggling families and children across the economic spectrum, according to researchers.
Mental Health America calculated that 9.7% of youth in the U.S. have severe major depression, up from 9.2% the year before. In children who identify as more than one race, the rate is 12.4%.
The rate also soars for gay teens. In September, more than half of LGBTQ children ages 11 to 17 said they had had thoughts of suicide or self-harm in the previous 14 days, according to the survey.
In 2019, before lockdowns and layoffs, 1,312 Coloradans took their life — the highest number of suicides on record, according to the U.S. Centers for Disease Control and Prevention.
Colorado ranked fifth in the country in the country then with 22.1 suicides per 100,000 residents, or more than four times the suicide rate of Brooklyn.
Freshman Rep. Lindsey Daugherty, D-Arvada, passed a key suicide prevention out of the House, 57-6, on March 31.
She called House Bill 1119 a comprehensive approach, providing more access for students and teachers to get the guidance they need to help others.
She worries about dark thoughts being contagious, pointing to research that indicates people who knew someone who committed suicide were 1.6 times more likely to have suicidal thoughts about themselves, and 3.7 times more likely to attempt suicide. Children or adolescents who know about a friend’s suicide attempt are nearly twice as likely to attempt suicide.
“Far too many Coloradans have felt the gut-wrenching sadness and heartbreak of a suicide attempt,” she said.
Overdoses also spiked in 2020. The 443 recorded overdose deaths from January to April 2020 represented a 35% increase over the same period in 2019, according to the Colorado Health Institute.
Another sponsor on the omnibus bill, Sen. Faith Winter, D-Westminster, called drug abuse an “epidemic in a pandemic.”
“Even with these advancements, there’s still so much work that needs to be done,” Winter said, “and more work can be done with the support of the General Assembly.”
Mental Health America found a five-fold increase in mental health screenings for stress over the last year, and a 600% spike in screenings for depression.
Meanwhile, Colorado ranked 47th when Mental Health America measured the prevalence of mental illness against access to care.
Urgency of violence
In years past, mental health has had to get in where it would fit into the state budget, but after 10 people were killed at a Boulder grocery store on March 22, those who don’t want to talk about regulating guns are more eager to focus on mental health.
Senate Majority Leader Steve Fenberg, a Democrat from Boulder, told reporters that mental health is part of the conversation on how to respond to Colorado's latest mass shooting.
“It's an area that we absolutely have to do a better job on, and I think there will be bipartisan support to do so,” he said.
In 2019 Democratic majorities in the House and Senate overpowered Republicans to pass a red flag gun law to temporarily seize guns from those who are a danger to themselves or others. The family of the accused killer in Boulder had concerns about his weaponry, but they never contacted authorities, so the precaution was of no use.
“I don't know if the law needs to change, but I do think we need to make sure that people know about it,” Fenberg said.
A Columbia University study published in the journal Psychological Medicine in February looked at 1,315 mass murders worldwide and found that only about 11% of the perpetrators had a diagnosable mental illness, such as schizophrenia or mood disorders, and fewer than 1 in 5 involved a weapon other than a gun.
Instead, researchers found mass shooters typically already faced legal issues, used recreational drugs, abused alcohol or exhibited anti-social but non-psychotic symptoms.
Those are exactly the types of mental health programs, however, covered by legislation currently on the table.
Rep. Sen. Jim Smallwood from Parker added three amendments to the Senate version of the state budget on April 9.
The School Bullying Prevention and Education Program grew by $2 million, the same amount added school-based health centers. He also landed another $500,000 for the suicide prevention program.
“Proper mental health screening of our students, combined with the sustained resources provided under both suicide prevention programs which include crisis hotlines is critical in helping solve problems like school violence and teen suicide,” Smallwood said.
Children have lost what they can never recoup, time. High school students have missed school activities, social development, proms, graduations, the snapshots of life those before and after will share.
Logan County Commissioner Byron Pelton said that he knew of 10 suicides in northeast Colorado since last fall; eight were school-age children, he said.
Summit County Commissioner Tamara Pogue worked in behavioral health for 10 years before she became an elected official.
“I have held a parent’s hand when their 13-year-old committed suicide. I’ve seen families torn apart because of their inability to access behavioral health care,” she said. “Quite simply, no matter where you look, the system is underfunded and it is a crisis.”
Moe Keller has seen both sides of this equation from her front-row seat at the Colorado Capitol for two decades.
She has advocated for Mental Health Colorado for 10 years, after she spent eight years in the legislature fighting for mental health issues to have a place at the negotiating table.
“This is aggressive,” Keller said of this year’s slate of legislation.
If Democrats and Republicans around at the table under the gold dome in Denver, they're following an example of local leaders across Colorado, who see the impact of failing to take mental health seriously: homelessness, drug abuse, alcoholism, disrupted classrooms and broken families, she said.
The pandemic brought those issues into sharper focus.
“Our state is undergoing a collective trauma," said Frank Cornelia, deputy director of the Colorado Behavioral Healthcare Council, which represents the state’s 17 mental health centers, service organizations and clinics.
He vowed, “This funding would change and save lives in so many ways.”
Gov. Jared Polis spoke of the tough times during the kickoff of National Child Abuse Prevention Month online and promised hope over the horizon.
“This crisis is cause for us to reinvest in the things we once took for granted, like safe, nurturing places where our kids could learn and thrive and play and grow. There’s a lot of work ahead.”
If you or someone you know is having mental health struggles, including thoughts of suicide, Colorado has a free 24-hour help line. Colorado Crisis Services offers free, confidential, professional support. Call 1-844-493-8255 or text “TALK” to 38255.
13 Mental Health Bills To Watch
1. SB21-137 Behavioral Health Recovery Act
Extends, modifies and increases funding for behavioral health programs.
Cost: $33.9 million the first year and $12.3 million in out years from the General Fund, Marijuana Tax Cash Fund and federal money.
Sponsors: Sen. Brittany Pettersen; Reps. Michaelson Jenet and Chris Kennedy
Status: Passed the Senate Health and Human Services Committee to the Appropriations Committee on April 5.
2. HB21-1097 Establish Behavioral Health Administration
Creates the state Behavioral Health Administration, based on the recommendations of a 2019 task force.
Cost: Reallocation of existing funds
Sponsors: Reps. Mary Young and Rod Pelton; Sen. Rhonda Fields
Status: Passed the Senate Health and Human Services Committee to the Senate floor on April 5.
3. HB21-1068 Insurance Coverage Mental Health Wellness Exam
Requires insurance coverage for an annual mental health wellness examination of up to 60 minutes.
Sponsors: Rep. Dafna Michaelson Jenet and Brianna Titone; Sen. Dominick Moreno
Status: Introduced In House on Feb. 16, no committee hearing scheduled yet.
4. SB21-154 9-8-8 Suicide Prevention Lifeline Network
Enacts federal legislation establishing the 9-8-8 crisis response line and creates sustainable funding.
Cost: A surcharge to be set by the Public Utilities Commission
Sponsors: Sens. Chris Kulker and Cleave Simpson; Reps. Lisa Cutter and Matt Soper
Status: Passed the Senate Health and Human Services Committee to the the Finance Committee on April 7.
5. HB21-1021 Peer Support Professionals Behavioral Health
Broadens peer support services billing under Medicaid, clarifies that peer support services ro include telehealth and other advances.
Cost: $109,294 paid for by fees on support service providers
Sponsors: Reps. Rod Pelton and Yadira Caraveo
Status: Passed the House Finance Commitee to the Appropriations Committee on March 29.
6. HB21-1030 Expanding Peace Officers Mental Health Grant Program
Allows additional public safety agencies to apply to the renamed Peace Officers Mental Health Support and Community Partnerships Grant Program, adding 330 to join the 335 agencies eligible now.
Cost: existing resources
Sponsors: Reps. Julie McCluskie and Hugh McKean, Sens. Janet Buckner and John Cooke
Status: Passed the House Public and Behavioral Health and Human Services Committee to the Appropriations Committee on April 5.
7. HB21-1119 Expanding the Crisis and Suicide Prevention Training Grant Program
Updates the role of the Suicide Prevention Commission and Colorado Department of Public Health and Environment to include prevention, intervention and “postvention.”
Cost: existing resources
Sponsors: Reps. Janice Rich and Lindsey Dougherty, Sens. Kerry Donovan and Don Coram
Status: Passed the Senate State, Veterans and Military Affairs Commitee to the Consent Calendar on the Senate floor.
8. HB21-1228 Domestic Violence Training Court Personnel
Requires additional training in domestic violence and child abuse for respective court personnel.
Cost: not specified
Sponsors: Rep. Meg Froelich, Sen. Jim Smallwood
Status: Passed the House Public and Behavioral Health and Human Services Committee to the Appropriations Committee on April 6.
9. HB21-1085 Secure Transportation Behavioral Health Crisis
Provides secure transportation other than a traditional ambulance service for individuals experiencing a behavioral health crisis.
Cost: $529,764 in gifts, grants and donations.
Sponsors: Reps. Julie McCluskie and Colin Larsen; Sens. Jeff Bridges and Jim Smallwood
Status: Passed the House Public and Behavioral Health and Human Services Committee to the Appropriations Committee on March 23.
10. HB21-1166 Behavioral Health Crisis Response Training
Trains cross-system behavioral health crisis responders to help people with intellectual and developmental disabilities.
Sponsors: Reps. Mary Young and Perry Will; Sen. Joann Ginal
Status: Passed the House Public and Behavioral Health and Human Services Committee to the Appropriations Committee on March 30.
11. HB21-1130 Expand the Transition Specialist Program
Redefines “high risk” to allow more patients to access recovery services.
Cost: Existing resources
Sponsors: Reps. Dafna Michaelson Jenet and Mary Bradfield; Sens. Chris Kolker and Bob Gardner
Status: Passed out of the Senate with no amendments to the governor on April 7.
12. HB21-1146 Auricular Acudetox Professional Practice
Repeals the requirement in the Mental Health Practice Act that a licensed mental health professional practice auricular acudetox, a form of acupuncture that helps with substance use disorders, mental health conditions and pain.
Sponsors: Reps. Andres Pico and Donald Valdez; Sens. Rachel Zenzinger and Rob Woodword
Status: Passed out of the Senate with no amendments to the governor on April 7.
13. HB21-1258: Mental Health Sessions for Youth
Creates a program to reimburse providers for up to three mental health sessions with a young person.Cost:
Sponsors: Reps. Dafna Michaelson Jenet and Kevin Van Winkle; Sens. Janet Buckner and Rob Woodward
Status: Introduced in the House on April 6, assigned to the House Public and Behavioral Health and Human Services Committee.