By Katie Kerwin McCrimmon
Colorado continues to lag far behind most states on mental health care, spending just one-third of the dollars that the top 10 states pay to help people with severe mental health needs, according to new national data in a study slated for release this spring.
An update of the sweeping 2003 Status of Mental Health Care in Colorado, the new report is expected to show that despite the state’s relatively low spending on mental health care, Colorado has innovators who are improving care with a variety of “medical home” models that blend behavioral health care with traditional medicine under the same roof.
Some of the best programs are emerging in the least likely places: clinics that care for the poor. (Click here to read about integrated mental health care at Salud Family Health Centers in northern Colorado.)
The medical home concept revolves around patients. Think of it as primary care on steroids. A true medical home should provide patients with a caring team that knows them well and provides integrated care — from dental, to medical to mental health care. The team takes responsibility to help patients achieve long-term health goals while providing immediate interventions in times of crisis. (Click here to read about Salud’s care for a couple coping with schizophrenia and diabetes.)
2011 update of The Status of Mental Health Care in Colorado
- Caring for Colorado Foundation
- The Colorado Health Foundation
- The Colorado Trust
- The Denver Foundation
Additional funders for 2003 mental health study
Reformers hope that significantly better primary care will save money while improving health outcomes. The medical home concept has been thriving through a variety of grassroots pilot programs in Colorado and across the country, according to data tracked by the Colorado Behavioral Health Council’s integrated care mapping project. Colorado has required medical homes for children through its Medicaid and Child Health Plan programs since 2007 under SB 07-130. Now, the Affordable Care Act provides financial incentives to expand the use of “health homes” under Medicaid and for people eligible to buy subsidized private insurance through online health exchanges.
Primary care is critical to patients with mental health challenges. Of people who receive mental health care, more than half get it in a primary care setting nationally. There simply are not enough behavioral health specialists to treat everyone who needs help.
While Colorado seems to be thriving in the push for health homes that may boost the quality of mental health care, the state has a poor history on funding this care.
In 2003, a coalition of foundations came together to study how Colorado stacked up on mental health care. The findings showed alarming trends and found a deeply fragmented system, similar to other systems nationwide. The study found that Colorado ranked 31st nationally for publicly funding mental health care. While one out of five people in Colorado needed mental health care services each year then, fewer than one-third of them received care.
Dr. Andy Keller, a partner with national consulting firm TriWest Group, led both the 2003 report and the 2011 update. He said the newest data show that Colorado remains stuck almost exactly where it was eight years ago in terms of funding.
But Colorado has made some notable progress through integrated medical homes and expansion of Medicaid mental health and substance abuse services. Former First Lady Jeannie Ritter made mental health improvements her primary goal, leading to increased awareness and cooperation among state agencies during former Gov. Bill Ritter’s term.
“We’re underfunding mental health care, but we’ve got a lot of progressive thinkers and innovators. And we’re leading in terms of grassroots promotion of integrated care,” said Keller, whose firm evaluates health care programs throughout the country.
Among the new findings expected to be reported this spring:
- Just under four percent of Coloradans are impoverished and have severe mental health needs.
- About 15 percent of people have either moderate or serious problems with mental health or substance abuse, now often referred to as “substance use disorders, according to the most recent epidemiological data.
- Colorado still ranks low among states for per capita spending on mental health care. The latest state-by-state data from the National Association of State Mental Health Program Directors (NASMHPD) in 2006 found Colorado stuck at 31st.
- Private data from Dale Jarvis and Associates, LLC, show Colorado’s public spending on mental health care per person with severe needs ranking 29th in 2008. Colorado spending is one-third of the average that the top 10 states spend.
- People with severe mental health needs have higher rates of death, and before they die, they cost the system huge sums for treatment of preventable health conditions, according to national and Colorado data to be cited in the report.
- People with psychiatric diagnoses are three to four times more likely to have chronic medical conditions such as diabetes and cardiovascular disease, according to national data.
- Mental health challenges often lead to poor health choices including higher rates of smoking and poor nutrition.
“Colorado is exactly in the same place in terms of rankings as we were in 2003,” Keller said. “(Former Gov. Bill) Ritter placed a priority on mental health. The funding has not improved, but it didn’t get any worse despite the worst recession in (recent) history…We’ve stayed the same.”
All of the top 10 states on mental health spending are in the northeast U.S., except for Alaska. Colorado is much more typical of western states, which tend to spend far fewer public dollars on mental health issues, Keller said.
“In the northeast, there’s a culture where counties will spend money on mental health,” Keller said.
In Colorado, counties spend money on jails, whose populations include high percentages of mentally ill inmates, but typically do not focus on mental health treatment.
Under the Affordable Care Act, states can apply for special initiatives to provide health homes for chronic conditions including mental health that offer up to a 90 percent match for federal dollars for the initial two years. Colorado is deciding this year on whether or not to pursue these kinds of programs.
“We have made progress thanks to a concerted effort over the last four years,” Keller said. “But addressing these complicated problems really requires a commitment over time.”
Keller says people often complain to him that the system is “broken,” like some watch that used to work and is now cracked. But, he points out that we’ve never had a well-oiled system that addressed complex mental health needs. In fact, Keller thinks we’re making dramatic improvements on many fronts.
“We’ve made tremendous improvements in awareness of child abuse, domestic violence, autism. We’re just beginning to address these issues,” he said.
Health providers are also beginning to understand the need to treat mental disorders in a different way.
“We used to treat these disorders like TB, where we came in with an intense treatment and we were going to kill off the virus. Now, we’re focusing on treating these issues as chronic illnesses, more like diabetes,” Keller said.
“Many of these conditions that emerge in adolescence often are long-term, multi-decade problems that a person has to learn how to manage and overcome. Our system isn’t set up to fund or provide them with accountable care over time.”
The newest challenges relate to finding long-term solutions for people with multiple needs at once, Keller said.
“We know how to treat it; we just haven’t figured out how to fund and coordinate it all yet. It’s really complicated.”