Grading the States 2006: Colorado - Narrative
Colorado was one of only two states that declined to provide specific information in response to the survey used in preparing this report. It therefore has been graded "U" for "Unresponsive."
The state's Division of Behavioral Health & Housing (DBHH), located in the Department of Health & Human Services, said that the agency "did not have time to take part in non-mandated activities at this time, as we have had significant staffing reductions in the past few years." Requests for information on expenditures related to evidence-based practice (EBP) initiatives also were met with repeated responses of "data not available."
Those statements speak volumes about the degree to which Colorado's state budget battles have hog-tied the state's mental healthcare system, impairing initiativeand hampering responsiveness and accountability to consumers and families.
Drawing on generally available public information alone, the picture in Colorado is not pretty. In recent years, a national recession, declining tourism revenue, and the impact of a Taxpayers Bill of Rights (TABOR), along with other legislative measures, combined to severely restrict public services. TABOR forced the state to limit growth in government services through strict constitutional controls—and stretched an already troubled human services system even thinner. Deep spending cuts in education and healthcare hurt middle and low income residents the worst.
- Emergency department admission rates for Medicaid and uninsured clients with mental health and/or substance abuse needs grew 83 percent over three years.
- In FY 2004, the state helped approximately 14,000 fewer consumers than it did three years before.
- The state reduced the number of beds in the state hospitals at a time when community services were being cut. Capacity decreased and squeezed people who were sick even more. In such cases, costs inevitably shift to emergency rooms, police, and the criminal justice system.
The good news is that as a result of the fiscal carnage, the state has suspended TABOR for five years. The increased availability of tax dollars has made it possible for the restoration process to begin. The governor's budget provides for some increases in proposed funding for mental health services; the legislature is considering additional increases. The bad news is that for many people living with serious mental illnesses, damage already has been done.
Despite the state's fiscal woes and shrinkage in services, Governor Bill Owens held the line in one critical area - vetoing a legislative attempt in 2005 to restrict access to medications under Medicaid through "preferred drug" lists (PDLs). In a strategy to circumvent a veto this legislative session, legislators have now introduced a bill to bypass the governor and put the issue directly to Colorado citizens for a vote by referendum. Several points are relevant:
NAMI applauds the Governor's stand in 2005. Doing the right thing is not always popular or easily understood.
When it comes to psychiatric medicines, one size does not fit all, especially for the fragile Medicaid population. Side effects vary among different individuals. Some medications require weeks or months to take effect; restriction of physician-patient choices at the outset often can lead to greater suffering and costs over time.
The cost of one emergency room visit or hospitalization from one relapse can be expected to exceed significantly any per-person PDL savings. That also assumes that a person in psychiatric crisis gets help in time. The costs of suicide, homelessness, or prison are even greater.
Better, cost-effective alternatives exist. For example, the federal Center for Medicaid and Medicare Services has identified Missouri's Mental Health Medicaid Pharmacy Partnership (MHMPP) as a national model for oversight of clinical prescription processes. The innovation saved that state approximately $8 million in 2004. Equally important, MHMPP is grounded in sound clinical practice, rather than indiscriminate, restrictive formulary approaches.
In response to the budget crisis, the legislature has authorized municipalities to create special tax districts to fund mental health services. The Aurora City Council recently approved holding a public vote to create a district to raise $10 million annually. NAMI encourages communities to consider such initiatives, although it's uncertain how effective they will be in meeting the state's overall needs.
For cost-effectiveness, EBPs are essential. Unfortunately, DMH did not respond to requests for information in this area, but advocates report that DMH convened a working group in 2004 to develop a plan to generate provider support for EBPs. The state should insist on EBPs in its contracts with providers.
Lack of financial support for community-based mental health services continues to have devastating impacts on other systems that pick up the slack for underfunded services. Unless the state begins to make a financial investment in a mental health system to help people with serious mental illnesses move toward recovery, they will merely continue to shift the costs to taxpayers through other sectors, including the criminal justice system. In approximately 10 years, the number of people with mental illnesses incarcerated in Colorado's state prisons increased by a factor of 10 - to approximately 2,400 in 2002.
The short-sightedness of failing to invest in an effective mental healthcare system is not only cruel, but sadly at odds with the pioneering vistas of the Rocky Mountain State. Advocates report optimism over recent developments and attention by key legislators; time will tell if the state can claim national leadership in developing a sound mental health system.
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