"Why so glum?"

On March 2, the Colorado Legislature introduced House Bill 22-1278 (HB 1278) to create the Behavioral Health Administration (BHA). This cabinet-level state agency would take on issues at the center of Colorado’s torn and tattered mental health care system.

The bill outlines the duties and responsibilities of the BHA, some of which are to ensure the transparency of funds coming in and going out to mental health care providers and increase the efficiency and ease of access for behavioral health services in Colorado.

HB 1278 will also require the BHA to establish a statewide behavioral health grievance system and a behavioral health performance monitoring system to seek data access and quality of care issues.

Dr. Vincent Atchity, president and CEO of Mental Health Colorado (MHC), the state’s leading mental health advocacy group, said, “Many people have negative experiences accessing mental health care — where people feel judged, they don’t feel heard, there are all kinds of dissatisfaction that are greater than those experienced with physical health care services. In the world of mental health care, a single bad experience with a counselor or therapist can put you off from seeking care.”

Summer Gathercole, BHA Acting Deputy Commissioner, said the agency would be tasked with mending broken systems that haven’t met people’s mental health care needs. She shared, “We’ve heard from many Coloradans, during our public testimonies, who shared, ‘I tried to find a provider, and I couldn’t find someone who was from my community or could communicate with me and so I just stopped looking for services.’ That’s definitely not the system that we want to have in Colorado.”

Mental Health America’s annual “State of Mental Health Report” ranks all 50 states and the District of Columbia based on several mental health and access measures. Colorado ranked 51st, to which Atchity clarified that the state’s dismal numbers “go far back; we’ve always been way down there, but 51st is the new low, for sure,” he said.

Gathercole explained, “The BHA will take on several initiatives to ensure the fragmentation of services is addressed. It institutes a state-level entity that sets a shared vision and cohesive strategies for behavioral health.” She added that currently, services have “been very fragmented with different agencies and different providers doing different things. Now we need to make sure that we’re all working together as one.”

Task Force recommendations
In the spring of 2019, Colorado Governor Jared Polis established the Behavioral Health Transformational Task Force (BHTTF) to evaluate and overhaul our current behavioral health system. BHTTF made recommendations on how $450 million of American Rescue Plan Act (ARPA) funds could be used to improve mental health care and close gaps in the mental health system.

A BHTTF subpanel, consisting of behavioral health stakeholders from across Colorado, included Atchity, who served as vice-chair. Of the ARPA funds, he said, “The first realization of the recommendation process was, ‘Well, while it’s great to have $450 million, it’s not $4 billion.’ Our need for transformation is so extreme that nothing that we can do right now is going to solve all the problems that we have.” 

 He added that needs assessments should be spearheaded by local communities, saying, “What we are doing [at the state level] is showing a concerted bipartisan effort to do meaningful things and also acknowledging that local partners need to be the key players in changing the landscape of this state; that it can’t all be state-government driven. We have to depend on local communities identifying what their particular needs are and putting together the partnerships and then seeking access to the funds so that they can fill the local gaps.”

 Atchity prefers funds go into regional community grants, allowing each region to create its needs assessment. He said, “That would be meaningful for the state’s smaller population-sized counties. I’m hoping money can be used effectively in rural and frontier Colorado to meet some of the local needs.”

Severe workforce shortage
Gathercole said one looming issue is a worker shortage in the behavioral health care industry — a deficit already present pre-pandemic. 

When the BHTTF met last year with a behavioral health workforce development workgroup, they identified “not only the need to expand our workforce — with everything from peer support services to psychiatrists and everything in-between — but to ensure that we’re also increasing our workforce so that we have more persons of color and Spanish-speaking providers,” Atchity said.

He also explained differences, particularly in the mental health field. “Behavioral health care providers, similar to teachers, are poorly compensated, compared to people working in physical health care, and, in some ways, have a tough job because they don’t have the same satisfaction of seeing cures — you put somebody in a cast, you stitch them up, you gave them a course of antibiotics — like solving problems. People who work in behavioral health can see the same clients for months or years. There’s a high burnout factor,” Atchity explained.

The Latino community has an acute need for Spanish-speaking mental health practitioners. “We have negligible Spanish-speaking capacity for those seeking care. We are addressing that as urgent and dire, and it must be acknowledged among [legislative] leadership.” Atchity recognizes that the need to make more Spanish language services available takes a concerted effort. “You can’t just make that happen because you want it to happen.”

 Access to quality care
HB 1278 considers how BHA will hold providers accountable statewide, so there is access to high-quality service, regardless of where you live. Gathercole acknowledges that it’s labor-intensive work to build a statewide provider network database. “Not only do we want to expand the number of providers, but we also want to make sure that our providers are offering high-quality services. We are looking at identifying the outcomes that we can be tracking from BHA, again, to make sure that we’re looking at performance measurements, and not necessarily process measurements,” she expounded.

In 2021, Gathercole said the task force solicited stakeholder feedback. The two most frequent requests were: a system that’s accountable and transparent. Transparency includes, she said, “being able to share information with regions, like, ‘here are the dollars that were coming into your region and here’s how they’re being spent and the subsequent outcomes.’” 

Gathercole admitted, “And those are questions that we’re not able to answer very well right now.”

Positive experiences with the system
Frequently, Gathercole shared, they heard from many Coloradans who’ve had a negative experience with the mental health care system. However, she said, “We want to make sure, more than anything, that people have a positive experience when they’re interacting with the behavioral health system here in our state. I hope that people are hopeful that they will have a more positive experience because their lives should be more enriched because of their interactions with our system.”

“I’ve been feeling more transparent lately.”