But this article illustrates the Herculean tasks that states face in transitioning themselves from the traditional custodial role utilizing large massive hospitals and viewing treatment as often lifelong or at least so long that it may as well be lifelong, to a system aiming at re-integrating the chronically mentally ill safe enough to be returned to the communities and constructing complete new and entirely different systems of housing and care for literally thousands of persons within spans of a relatively few years. There are no simple answers in any quarter and the task which may have been viewed as achievable within approximate task-timer periods clearly is proving to be greater, harder, more coslty and complicated than likely almost anyone could have imagined.At the least, enforcement by the “feds,” may have to consist of extending time periods of effort to the states and partnerships that help with costs and perhaps even approaches not yet widely appreciated by any of us.
Colorado has had the practice of holding patients needing psychiatric evaluation in jail for many years. There are a number of states who utilize the local, county or municipal jails for such purposes around the country. Some observers of the long term history mental health services’ delivery, have chalked up this practice to the lack of hospitals and therefore emergency rooms, in large areas of states that have no psychiatric services. This practice has largely been dropped by most states. It seems to persist especially in western states where communities are far from such facilities and have to rely on the local jails to ‘hold’ prospective mental health patients who need emergency evaluations and there are no suitable mental health resources available locally.
The term mental health ‘hold’ is essentially another term for an “involuntary civil detention” of a person who has not committed a crime but is a danger to themselves or others. Usually, these kinds of orders in Colorado and other states such as Kansas, to permit holding persons against their will for up to 72 hours. Kansas, for the curious reader, is struggling at present with the issue of how to structure their involuntary holding process altogether.
Colorado now is moving legislatively to force the abandonment of this practice for once and all. In an article entitled, “Colorado would outlaw using jails for mental health holds, increase services under $9,5 million proposal,” written by reporter Jennifer Brown and published in the newspaper, the Denver Post yesterday, this attempt at modernizing and providing mental health intervention and referral services before persons in need have to parked in jails is detailed.
The main thrust and corrective action of this bill would be to establish “two-person teams” that would perform evaluations locally and refer persons felt to be having more mental health problems than legal ones, on to suitable treatment resources before they would be placed in a local jail. This bill would ban the use of jails as holding areas for such persons based on an initial judgment of their being a danger to themselves or others, such as persons who made suicidal threats and about whom an emergency phone call has been issued by families or spouses to the first responders who usually are the police.
The bill would further increase the availability of the on call assessment teams, increase local crisis response centers and transportation from rural areas to treatment centers. A “behavior health specialist” would work directly with police on such emergent service requests and in effect intervene to deflect the crisis-bound person in need to treatment rather than to a local jail.
Interestingly enough, the funding for this expansion of statewide largely rural emergency mental health services is envisioned to be funded by monies from the medical marijuana retail industry now legal and growing in Colorado.
Presently, Colorado law permits holding such a person deemed in mental health crisis in jails for up to 24 hours and then mandating disposition such as transportation to a distant behavioral health services center, such as a clinic or a large urban hospital ER, or the state hospital many miles away also. In practice, it appears that such persons in crisis were held for longer than the prescribed 24 hours and that counties found the volume of such patients to be higher than they were equipped to deal with. The article notes one example county had over one hundred persons in its jails in little over a year’s period of time. The article makes mention of the issues seen all over the country, that law enforcement agencies face day in, day out, namely the lack of resources to provide transportation for patients. It notes that counties would face the issue of removing a law enforcement officer from patrol service to the county when a patient would be driven to a far distant mental health service center. The article notes that this is a much bigger problem in the wide open spaces, sparsely populated of Colorado’s western counties. I lived in western Colorado for a few years as a young child in mountainous mining towns and my trips back later in life showed things and population densities had not changed. So I read the dilemmas that the agencies providing mental health or first responder services in the vast reaches of a western state and immediately sensed why.
The article notes that Colorado has the sixth highest suicide rate in the USA, yet is in the bottom half of the states in this country as far as providing adequate mental health/substance abuse services.
Observers of the mental health reform scene in this country may watch Colorado’s admirable restructuring of mental health service delivery efforts through the vehicle of this commendable legislation.
In a local publication, the Urban Milwaukee online newsletter reports on the beginnings of success in Milwaukee County’s difficult reform process addressing their overstressed mental health services delivery system. Milwaukee County had made the national news more than a few occasions in the last three years or so, as its deficiencies came to light. The reader is encouraged to use any search engine to see such accounts as this, to get a feel for what the advocates, patients, public mental health agencies and the local county government, were facing. It sounded even to this reader and observer, like another example of failure, governmental funding neglect, inadequate services, etc., that would take its place alongside numerous other instances of local and regional failure in mental health services delivery. It was also very much in doubt that adequate solutions would or could be organized, funded and put into place.
However, the local groups involved in Milwaukee County from county officials to agencies, advocacy groups, patients, and mental health providers, pledged to address the issues jointly, and they did so for over two years. Their efforts, I am sure, were extremely difficult and daunting to everyone involved. But they persevered under very stressful circumstances, and as the television commentators would say, ‘they pulled it off.’
In an article entitled “Milwaukee County’s Approach in Mental Health Reform is a National Success Story,” this unusual effort is detailed anyone interested in this national and local issue to read, take heart from, and to learn from.
One of the signal features of their effort was truly bringing all the “stakeholders” together to work in a very unified manner, encouraging novel ideas. Very different worlds, from police to clinicians and local governmental officials of all stripes formed working groups in a “multidisciplinary” way[another current buzzword that I often detest, but seems to apply in this effort]. One example is that early on in their work process, the reformers for lack of a better term overcame the usual city-county splits of governmental entities, clinical entities, and police law enforcement groups. Too often I have seen all kinds of efforts ranging from budgetary matters to who pays for the pro football team’s new stadium to where the next trash landfill will be located. In greater Milwaukee, the city-county entities worked together [gee, I wish Congress could do that…]
So, if you are interested in mental health reform and need an example of success to strengthen your own resolve, please read about Milwaukee’s efforts.
Western State (psychiatric) Hospital has been in operational distress for more than a year now and following the travails of this facility and its staff from the line ward workers and behavioral care technicians, nurses and professional staff has been quite sad and discouraging for anyone interested in mental health reform and service delivery policy.