When COVID-19 arrived in Colorado last spring, lawmakers scrambled to address what they expected would be a $3.3 billion shortfall in the state budget. The triaging at the Capitol included cutting more than $20 million for behavioral health programs, including some that were developed over years of work by a committee on opioid and other substance use disorders.
Now, state lawmakers want to make sure that next time there’s an economic downturn, the programs aimed at preventing and treating addiction and mental illness won’t fall by the wayside.
Senate Bill 21-137 — championed by Sen. Brittany Pettersen, a Lakewood Democrat — constitutes 20-plus pages of legislation that’s aimed at restoring permanent funding for various substance use and mental health initiatives, and making many of those programs more permanent.
“Every year, we have to come back and ask for the same money for the same programs,” Pettersen said before the Senate Health and Human Services Committee voted on the bill April 5. “That’s a problem because we don’t have predictability for these programs and sustainability.”
Some of the money in SB-137 would also go toward new programs, such as addiction recovery services for people with mental health disorders. The bill’s title: Behavioral Health Recovery Act of 2021.
“For a long time, Colorado has underfunded the mental health needs of our citizens, and so at this point in time it’s very critical that we invest every dollar that we can into the mental health of our constituents,” Sen. Faith Winter, a Westminster Democrat who worked closely with Pettersen on the bill, said in an interview.
SB-137 was approved on a 4-2 vote by the Senate Health and Human Services Committee on April 5 and referred to the Appropriations Committee. Republican Sens. Barbara Kirkmeyer of Brighton and Cleave Simpson of Alamosa were opposed.
“It’s going well beyond just restoring things,” Kirkmeyer said, questioning whether the bill’s millions of dollars in one-time and ongoing funding would be used to provide services in the most targeted manner possible.
Below are a few of the many funding streams that SB-137 would provide. The specific dollar amounts may change as the bill moves through the Legislature and as lawmakers determine how federal coronavirus relief money can be used for behavioral health programs, according to the sponsors.
• $4 million annually for temporary housing assistance to people with substance use disorders. The assistance program would be housed in the Department of Human Services and paid for with money from the state’s general fund, which is comprised mostly of revenue from income and sales taxes.
• $3.8 million for fiscal year 2021-2022, which begins July 1, for Colorado Crisis Services, housing assistance and treatment for rural communities. This would be one-time money appropriated to DHS from the state’s general fund.
• $3.5 million for fiscal year 2021-2022 for substance use disorder treatment and recovery. This one-time money would be designated for unanticipated costs related to the COVID-19 pandemic. It would be sent from DHS to the state’s four managed service organizations, or MSOs — Mental Health Partners, AspenPointe, Signal Behavioral Health Network and West Slope Casa — which contract with treatment providers across Colorado.
• $3.3 million for fiscal year 2021-2022 to the state’s 17 community mental health centers for unanticipated costs related to COVID-19. Like the money SB-137 would provide for MSOs, this would come from the state’s general fund.
• An additional $2 million to community mental health centers for fiscal year 2021-2022. This money would go toward school-based behavioral health services for children and their families.
• $2.5 million in fiscal year 2021-2022 for a pilot program aimed at improving the social and emotional health of elementary school students. The program would be housed within the Colorado Department of Education and would use marijuana tax cash fund dollars.
“Prior to COVID-19, children and youth were already facing a behavioral health crisis,” Zach Zaslow, director of government affairs for Children’s Hospital Colorado, said in emailed comments provided to Newsline. “The pandemic and its social isolation and grief has only made that terrible crisis even worse over the past year.”
Zaslow noted that Children’s Hospital Colorado has seen increases in emergency department visits for suicidal ideation as well as the severity of suicide attempts. The hospital system supports SB-137 as an “essential step toward addressing this growing crisis by restoring vital behavioral health funding,” he said.
• $3 million per year from the marijuana tax cash fund for the state’s medication-assisted treatment, or MAT, expansion pilot program. MAT involves using medications such as buprenorphine or methadone to help reduce cravings and normalize brain chemistry and physical health for people struggling with addictions.
The MAT pilot program, which is administered by the University of Colorado College of Nursing, was created through 2017 legislation to help improve access to MAT for Coloradans with opioid use disorders in Pueblo and Routt counties. In 2019, state legislators expanded the program to other regions, including the San Luis Valley. It received $2.5 million for the current budget year.
• $2 million a year for CDPHE to use on prevention and intervention for mental health and substance use disorders. Those efforts could include collaborating with local public health agencies. Colorado Department of Public Health and Environment would be able to use the money for data collection and analysis efforts, such as community health assessments.
• $2 million for fiscal year 2021-2022 to go toward behavioral health and substance use treatment for children and their families. This would be one-time funding for the Office of Behavioral Health.
• $1.6 million annually for the Recovery Support Services Grant Program within DHS. This would go toward targeted services for people in recovery from addiction who also suffer from a mental health disorder.
• $1.2 million in fiscal year 2021-2022 for the Opiate Antagonist Bulk Purchase Fund. This CDPHE fund allows local public health agencies and school districts to purchase overdose reversal drugs, such as naloxone or Narcan, in bulk. The fund was established through 2019 legislation, but would expire in September unless it’s renewed.
• $900,000 annual behavioral health funding for the Colorado AgrAbility Project coordinated by Colorado State University Extension and Goodwill Industries of Denver. The program helps farmers, ranchers and agricultural workers with disabilities to stay in the industry and get connected with resources.
Rebecca Edlund, associate director of technology and membership with the Colorado Farm Bureau, called the funding for AgrAbility a “phenomenal opportunity.”
“Agriculture is a physically very rigorous operation.” she explained, and when farmers and ranchers incur physical disabilities, those can jeopardize their ability to operate equipment and provide for their families — a responsibility they “don’t take lightly.”
AgrAbility can also help people with behavioral health disabilities, Edlund said. She recalled hearing about AgrAbility helping an Army service member who needed to work through some mental health issues before he could return to work in agriculture.
Mental illness, addiction take a grim toll
Comprehensive data on suicide and overdose deaths, the worst outcomes of unmet behavioral health needs, are not yet available for 2020. But even before the pandemic hit, Colorado was struggling.
In 2019 — the most recent year for which data is available — 1,287 people died by suicide in Colorado, according to the CDPHE. That’s a 9.5% increase from 2017, and it equates to an annual statewide rate of approximately 22 deaths per 100,000 people, the fifth-highest in the United States.
Rural counties have higher rates of suicide than do many of the state’s more densely populated areas, data shows. From 2017 through 2019, Park County, a rural mountain county west of Jefferson County in central Colorado, had an age-adjusted suicide rate of 54 deaths per 100,000 people. Just to the north, Clear Creek County did not fare much better, with a rate of 42 deaths per 100,000.
In the San Luis Valley, a key agricultural region, Conejos and Costilla counties each reported rates of 49 deaths per 100,000 people over the same time frame. Those two counties combined are home to just over 12,000 people, or one-sixtieth the population of Denver.
“For many of our farmers and ranchers, their nearest counselor might be two to three hours away,” Edlund said.
People living in rural areas often have limited access to mental health and substance use resources — which may contribute to higher suicide rates. Research shows there are a variety of risk factors for suicide besides mental illness, including physical health issues, job loss and grief over losing a loved one, according to the Colorado Health Institute.
Behavioral health issues loom large this year for farmers and ranchers, Edlund said, due to the combined factors of the pandemic, drought and federal policy changes that contribute to economic uncertainty.
There’s also stigma associated with seeking help for a mental health condition or substance use disorder in a rural community. That comes from neighbors seeing your car parked outside a provider’s office, Edlund said, coupled with a culture that’s taught generations of farmers and ranchers that to overcome difficulties, “you have to be stronger and you have to do it on your own.”
Some farmers also worry about business competitors knowing they have behavioral health needs. They’ve reported to the Farm Bureau that they fear this knowledge “might be something that (another farmer) tried to capitalize on in a land-based negotiation,” Edlund said. “That’s a terrifying proposition.”
Meanwhile, overdose deaths are on the rise in Colorado as fentanyl becomes more prevalent in illicit substances of all kinds. In 2019, 1,062 people died from a drug overdose in Colorado, according to data from CDPHE, representing a 9% increase from 2018 and a 4.9% increase from 2017.
The average, age-adjusted overdose death rate from 2017 through 2019 was 17 deaths per 100,000 people across the state. Rio Grande County in the San Luis Valley had a rate of 50 deaths per 100,000 over the same time period. To the east, Las Animas County reported a rate of 48 overdose deaths per 100,000 people.
The Colorado Farm Bureau supports SB-137 in part because of the resources it will provide for treating substance use disorders in rural areas, Edlund said. She believes the lack of resources coupled with depression and anxiety has contributed to higher overdose rates in less-populated areas of the state.
“This bill isn’t going to get us all the way there, but rural communities have very little access if their specific need is for substance use disorder care,” Edlund said. “Our rural communities are falling victim.”