League of Women Voters of Colorado

Behavioral Health Study 2015

STUDY GUIDE

Behavioral Health Study Guide

This guide accompanies the 2015 Behavioral Health Study materials and is provided by the Behavioral Health Study Committee.

Members of the Committee are available to present this Study Guide.

To schedule a presenter, please contact Barbara Mattison, Chair, LWVCO Behavioral Health Task

Force303/322-4878 or mattisonleague@gmail.com

Brain Disorders• Mental illness is a wide spectrum of brain

disorders, from mild to severe; those with mental illnesses/brain disorders should not be grouped into one category. For those reasons, say “people with mental illness”.

• In substance use disorder, addiction means a brain change – a brain disorder.

Access to Care

“Mental Health is the only physical illness where we wait until stage four to do anything.”

Moe Keller, Mental Health America of Colorado

Parity and Integrated Care

• People are more likely to start and complete behavioral health therapy offered in the same place as their primary physical health care.

• “Behavioral health stigma is real. Everybody in a small town recognizes your car or truck. When you’re parked in front of a clinic that provides integrated care, no one knows whether you are there for physical or behavioral health services.”Dorothy Perry, CEO, Spanish Peaks Behavioral Health System

Parity and Integrated Care

NEW Colorado SIM ProjectGoal: access to integrated primary care and

behavioral health services in coordinated community systems for 80% of state residents

by 2019

Federal Parity Act

• With ACA and federal Parity Act implementation, some health insurance plans will have the same benefits for physical and mental health – this is parity. Lifetime caps and exclusions for pre-existing conditions will be gone.

• However, health insurance plans are falling short in

coverage of mental health and substance abuse conditions according to a report issued April 1, 2015 by the National Alliance on Mental Illness (NAMI), based on a survey of 2,720 consumers and an analysis of 84 insurance plans in fifteen states.

Accessibilty• 17 Community Behavioral Health Centers

provide a range of core services at almost 200 locations

• Care beyond core services is dependent on local fund raising

• Behavioral health services are paid for through many sources of funding. With implementation of the Affordable Care Act (ACA), Colorado’s uninsured rate has fallen from 17% to 11%.

Accessibility: Colorado’s NEW Behavioral Health Crisis Centers

A community place to ensure that people are treated appropriately rather than being taken to

the Emergency Room or Jail

Accessibility in Colorado

• Colorado needs more behavioral health providers.

• Providers are concentrated in Front Range cities with some in mountain areas, Grand Junction and southwest communities.

• Residents of eastern and northwest Colorado have few, or no, provider options.

Accessibility in Colorado

• Colorado is 52nd (including U.S. territories) in the number of hospital beds available for mental health.

• Each state government department and division (Department of Corrections, Division of Child Welfare, etc.) and each educational institution, etc. has its own specific silos, i.e. how its specific funds will cover individuals; when an individual leaves that entity, his or her health benefits go away.

Children’s Behavioral Health

Over 50% of life-long mental health conditions are present by age 14

Early identification is an important part of a continuum of services

Children’s Behavioral Health

Challenges: • Families in Poverty have barriers to quality

care • Stigma influences whether parents will seek

and accept mental health care for their children

• Child data collection in Colorado is segmented with state departments, offices and agencies collecting different data; information is not uniform.

Children’s Behavioral Health

Challenges:Comprehensive early childhood services, home-

and school-based services, evidence-based and trauma-informed assessment and treatment, and integrated primary and behavioral health care in pediatric settings are not consistently

available across Colorado

Child and Adolescent Behavioral Health

Youth and young adults with mental health challenges between the ages of 14 to 25 have

unique needs and strengths that often transcend services provided in traditional youth and adult

service systems. These are ages when brain disorders may become apparent.

Services are not consistent.

Children’s Behavioral Health: Family and Community Support

• Family involvement is primary in a child’s treatment and recovery.

• Families face a complex, fragmented behavioral health system

• Office of Early Childhood focuses on adults in children’s lives and support for their behavioral health

• Colorado programs like Nurse Family Partnership focus on first-time moms

Case Management: Homelessness• People can’t work on their mental health

issues unless they have daily requirements covered (food, housing and other fundamental needs)

• MHCD’s High-Intensity Program: most clients have spent time homeless or in hospitals or in the criminal justice system

(typically for crimes relating to homelessness such as urinating publicly)

Case Management: Homelessness• CO Coalition for the Homeless:

“Residential instability increases risk for serious mental and physical health problems, exacerbates existing illness, and complicates treatment… preoccupation with securing food and shelter leaves little time for medical appointments. Pain and discomfort associated with illness and treatment side effects are compounded by lack of privacy, risk of abuse, and theft of medications. Clients frequently explain that they have ‘no place to lie down during the day’ to rest and heal.”

Case Management: Re-Entry

“It is critical to keep people with mental illness out of jail – the system can eat them alive. Jails are the new repository for people dealing with mental illness – there is hardly any place to take people other than the jail.” Nicky Marone, Executive Director, FOCUS Reentry

Case Management: Re-Entry“It is not known whether people who leave

prison homeless have a higher failure rate on parole, but it is known that people face enormous challenges, including finding housing, when they are released. Based on our own research and interviews with parolees, CCJRC believes that paroling or discharging from prison homeless is a barrier to successful re-entry and should be avoided to the greatest extent possible.”

Colorado Criminal Justice Reform Coalition

Case Management: Re-EntryPeople come to cities upon discharge from prison or jail

rather than going back to smaller communities where they would be known

Re-Entry Work: • Identify critical barriers to successful re-entry • Identify internal strengths/external resources

• Build a multi-faceted plan/carry it out• Focus Re-entry in Boulder provides a Mentor

Case Management: Problem Solving Courts

• Problem solving courts: “You can’t punish someone out of addiction”

• Problem Solving Courts work – money is saved; recidivism is reduced

• Non-adversarial model• Integrates treatment

and judicial systems

EducationEarly childhood mental health is the capacity of children from birth to five years to form close and secure adult and peer relationships, experience, manage, and express a full range of emotions, and explore the environment and learn—all in the context of family, community, and culture

Education

NAMI provides family education to help parents gain understanding, support, and access to resources as their children begin and continue to receive behavioral health services

Colorado Mental Wellness Networkworks in wellness and recovery education

CO Dept. of Public Health’s programs focus on education for healthysocial & emotional growth

Decreasing Stigma/Normalizing Behavioral Health Problems and Care

• Stigma is prejudice - society “candy-coats” it as stigma

• Treating people like “a diagnosis” is depersonalizing (“He’s Bipolar”)

• Individuals “self Stigmatize” and create ways to deal with mental illness including denial, not talking about it, isolating from others, and not making small talk

Decreasing Stigma/Normalizing Behavioral Health Problems and Care

Needed: • Education about mental illnesses

as brain disorders• Recognition in law and

insurance that mental illness & substance abuse are chronic illnesses

• “Coming out” by Persons in Recovery and their families, friends, and caregivers.