COVER STORY Colorado Governor-elect Polis

Logan County Commissioner Byron Pelton, right,  presents then-Gov.-elect Jared Polis with information about the need for adequate mental health and substance abuse services for northeastern Colorado, at a Colorado Counties Inc. conference in Colorado Springs on Nov. 26, 2018. (Jerilee Bennett/The Gazette)

After steering numerous pieces of landmark legislation into law in the 2019 session, Colorado’s mental health care advocates are looking to close gaps in coverage and address issues one lawmaker calls the missing pieces in the puzzle with a focused set of proposals set to be introduced in the General Assembly’s upcoming session.

Bills in the works include measures to set a minimum standard for mental health training for educators, allow some caregivers to work in more situations than they can currently, and establish an alternative transportation system for individuals experiencing crises.

“We have a long way to go to improve the mental wellness of our state,” said Vincent Atchity, president and CEO of Mental Health Colorado, in a statement. “Suicide rates continue to rise, quality, affordable mental health and substance use care is still not accessible to all Coloradans, and many of us continue to feel shame for our mental health or substance use conditions.”

Moe Keller, Mental Health Colorado’s director of advocacy and a former state lawmaker, said the organization has been busy helping implement sweeping changes to the state’s mental health system signed into law earlier this year by Gov. Jared Polis.

With Democrats in control of both chambers of the Legislature — for the first time since 2014 — leaders in the mental health field were able to pass eight bills in a flurry of legislative activity, checking off major items on their agenda.

“We’d never done that many before, and I don’t think we want to do that many again,” Keller said with a chuckle.

In addition to helping prepare bills for the 2020 session, she said the community has been occupied with breathing life into this year’s laws, including the establishment of psychiatric advanced directives, the mental health equivalent of medical advanced directives; requiring parity from insurance companies when it comes to covering behavioral health and related matters; and putting in place an independent ombudsman office to monitor parity compliance by private sector insurers and Medicaid.

Among the bills slated to be introduced when lawmakers convene in January is one to require that licensed educators — teachers and principals — have to take at least one class involving mental health aspects as part of their regular recertification process.

“Every five years, if you’re in a school setting, you have to renew your license, and to do that you need to have a certain number of credits,” Keller said. “We’re asking that some of those credits be mental health-related for kids.”

The bill, formulated with the assistance of the American Foundation for Suicide Prevention and the Colorado Behavioral Healthcare Council, is an attempt to “go upstream,” its backers say, and could include training in mental health first aid, the Zero Suicide framework and social factors involved in mental health.

“We have come to the point where teachers are desperate for this stuff,” Keller said, recalling a recent conversation with a teacher who described an alarming level of mental health trauma in the classroom.

Another bill on deck would boost the Peer Support Specialist program in an effort to help increase the number of available mental health care providers — a particular concern as parity requirements kick in, potentially creating a need for many more qualified professionals.

Peers — individuals who have been through various mental health situations — are considered a vital component in the mental health care system but are currently only able to provide services in limited settings, Keller explained.

The proposed legislation would change how peer services can be billed under Medicaid and establish financial incentives to help peer access continuing education, removing what’s effectively a professional ceiling that discourages some from staying in the field.

“Some peers work in mental health centers and detox centers, but they cannot work in jails, they cannot work in emergency rooms,” Keller said. “We’re trying to work this up so peers can run clubhouse, do mentoring, provide help with writing psychiatric advance directives.”

If it’s successful, she added, that would free up some of the behavioral health professionals currently working in those settings to meet an anticipated higher demand elsewhere.

A bill that will be sponsored by state Rep. Tracy Kraft-Tharp, D-Arvada, would create an alternative transportation system for individuals in crisis or who need transportation from one facility to another — from an emergency room to a treatment center, or a county jail to a hospital that could be hours away, for instance.

The proposal is aimed at resolving two problems, its supporters say.

Going back several years, Kraft-Tharp said, lawmakers and other officials convened a task force to figure out how to keep people with mental health issues from being confined indefinitely to jails rather than receiving treatment.

She noted that a bill that resulted tackled much of the problem but left out a crucial factor. It’s one thing to require that sheriffs and other authorities stop warehousing people with mental health issues, but if there isn’t a suitable facility nearby, under-staffed law enforcement offices can be stretched even thinner having to ferry individuals to their destination.

Her bill would create a regulatory and payment framework for an inexpensive alternative to ambulances and patrol cars.

“We never took care of the transport issue,” Kraft-Tharp said. “Down in those rural areas, driving someone three or four hours away, that’s an eight-hour day. This is the missing piece in that puzzle, how we can provide support to the sheriffs and law enforcement.”

Keller said the bill can also help attack another problem with the current transport system, which can heighten an individual’s mental health crisis when faced with being handcuffed in the back of a patrol vehicle or strapped down in an ambulance.

“Now, a person in crisis, on the streets or in their home, a police car or an ambulance are the only two alternatives,” she said.

“Ambulances are financially prohibitive, and a police car will often exacerbate the situation. What about establishing a private sector, secure transport, like a van, designed to have a driver separated from back, perhaps with a peer or clinician in the back?”

Inspired by systems in place in Virginia and Minnesota, she added, advocates are considering running pilot programs in a couple parts of the state.

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