NOONAN | Mental health care is elusive for rural and poor Coloradans

Free market signals are flashing bright green in suburbs surrounding metro Denver, Boulder, El Paso County, and mountain resort towns. Multiple free-standing emergency rooms and urgent care facilities are popping up in areas where average income is $101,000, according to a Colorado Health Institute (CHI) report.

Russian hackers must be disrupting market signals when it comes to mental health and substance use care in many rural counties in Colorado.  They’ve apparently programmed all red lights even though there’s lots of need and not nearly enough service.

Up to 18% of individuals reporting behavioral mental health issues are unable to get access to care for their problems in southern Colorado.  “Nine of ten counties with the highest drug overdose rates have populations under 50,000,” states CHI in another report called Death by Drugs.  These counties also don’t have populations with average incomes of $100,000+.

Rural Coloradans living in non-resort communities will find one stand-alone emergency care facility along I-25 in Pueblo, one in the box canyon town, Telluride, and one in Crested Butte, up the rural highway from Gunnison.

The state is experiencing a steady rise in overdose deaths, from 912 in 2016 to 959 in 2017, as of latest data from CHI. The Robert Wood Johnson Foundation, in its 2018 County Health Rankings report, confirms CHI’s drug scourge analysis, showing that 13 rural counties in the state rank 45thand below in providing health services. Suburban metro counties, snow resort counties, and five traditional rural counties fill the top levels for adequacy.

Here’s a rundown of some bills still in play this legislative session that affect mental health and substance use disorder care:

HB18-1136, a bipartisan bill to provide residential and inpatient treatment for individuals with substance abuse disorders enrolled in Colorado’s medical assistance program, will “reprioritize the use of money allocated from the marijuana tax cash fund to assist… persons not otherwise covered by public or private insurance.” The bill was referred to House Appropriations on March 13 where it now sits.

SB18-024 will help mental health care professionals receive financial support for paying off loans used to gain their certifications if they work in rural communities for two to three years.  This bill will cost taxpayers $2.8 million.  The bill is not only bipartisan, its sponsors represent mostly suburban communities.  It passed the Senate Health and Human Services committee and will soon hit Senate Appropriations.

Both bills are supported widely by the medical community, Colorado Farm Bureau, the Colorado Order of Fraternal Police, county human services, and mental health and substance abuse organizations.

HB18-1263 is a bipartisan bill to allow medical marijuana use for autism and acute pain.  The bill will have minimal impact on the budget.  It’s receiving support from drug policy organizations and opposition from the medical community.

HB18-1357, recently introduced as a bipartisan effort and supported by Mental Health Colorado, will establish a mental health care ombudsman program designed to assist individuals who need mental health care find services.  The bill will also require annual reporting on mental health care parity to determine whether adequate resources are available for health care problems that occur above the eyebrows as compared to problems below the eyebrows.

It appears that free market signals in health care tend to follow the money. Health care providers, researchers, and organizations across the state understand this conundrum and are supporting bills to remediate this skew.  Access problems are deep and wide in rural Colorado, but access also affects those without deep pockets wherever they live.  It’s in circumstances such as these that the state needs to switch the red lights to green.