State Mental Health System Still Underfunded but Slowly Getting Better

The Denver Post

Colorado's notoriously underfunded and fragmented mental-health-care system still has far to go, but it has improved substantially over the past decade, according to a year-long assessment.
"The Status of Behavioral Health Care in Colorado" commissioned by the Colorado Health Foundation, Caring for Colorado Foundation, The Colorado Trust and The Denver Foundation, was presented this morning before a crowd at the Denver Art Museum.
The report found much to be optimistic about. For example, funding here has grown, coordination of services has improved, and there are more mental health practitioners.
Colorado is a leader in integrating mental health care with primary care, which not only identifies mental illness sooner, it also saves money.
But in all those cases, the caveat is: it's better but not nearly good enough.
"People always say 'the system is broken,'" said study author Andrew Keller of TriWest Group. "The system is not broken, it's just really complicated and it's never really worked."
Clearly, Colorado still has work to do.
*Three in 10 Coloradans — about 1.5 million people — need mental health or substance abuse treatment.
*State spending on substance abuse treatment and prevention is one-third the national average.
*The state needs more mental health and substance abuse treatment providers, but the numbers have grown, from 10,564 in 2003 to 14,217 in 2010.
*The overwhelming majority of treatment providers — 82 percent of all psychiatrists, 86 percent of all child psychiatrists and essentially all psychiatrists specializing in substance abuse — are in the Denver and Colorado Springs metro areas. Many rural counties, especially on the Eastern Plains, have few if any treatment providers.
*The most recent data, from 2007, show Colorado ranks 32nd in the nation for funding mental health care, down a notch from its ranking of 31st in 2001. While Colorado has increased per capita spending, from $62 in 2001 to $84 in 2007, other states have made greater increases, Keller said.
And, Keller said, "If you are a youth or an adult of color, it is very likely that the first time you get services will be in jail."
That is not only a "travesty," he said, but it adds millions to treatment costs.
And while many insurance carriers are offering more coverage for mental health care, Keller said that for those with severe mental illness, Medicaid or other public programs often offer more comprehensive treatment.
Much of the reason for that, he said, results from public policy that dates to the days when the mentally ill were confined in state hospitals.
The current study is a follow-up to a blistering 2003 critique of the state's mental health system. That report, also done by TriWes, concluded that mental-health care in Colorado was woefully underfunded and that services were a "complicated array" so "confusing, redundant" and "outright unavailable," that the state barely had a mental health system at all.
The situation has improved, and the report highlighted ways to make it even better.
Doing a better job of integrating social services, health care and mental health treatment is one strategy that is effective and saves money, Keller said.
Dr. Chris Urbina, the state's chief medical officer, said at the end of the presentation that he intends to take very seriously the report's recommendations.
"I do know change is very slow, but we're committed to taking these recommendations and looking at them very seriously," Urbina said.
There likely won't be any more money, but "mental health and substance abuse are going to be one of our winnable battles," he said.
The full report is available at www.ColoradoMentalHealth.org.