Behavioral Health Administration forming amid rising suicides, overdose deaths

Colorado spends more than a billion dollars a year on mental health and substance use care, but many of those who need help have a hard time navigating the system.

A bipartisan bill that Gov. Jared Polis signed into law Thursday lays the groundwork for a new government entity to manage the state’s myriad programs in one central place and streamline care. In September, Colorado’s Behavioral Health Task Force unanimously recommended the state establish such an agency as one of several strategies for reforming the state’s behavioral health care system.

This new entity, the Behavioral Health Administration, won’t appear right away. But House Bill 21-1097 — sponsored by Reps. Mary Young, D-Greeley, and Rod Pelton, R-Cheyenne Wells, along with Sens. Rhonda Fields, D-Aurora, and Bob Gardner, R-Colorado Springs — directs the Colorado Department of Human Services to establish the BHA by July of 2022. The BHA will be part of CDHS until November 2024, after which it may become a separate department in the state government.

“An estimated 1 million Coloradans live with a behavioral health condition, and we know the compounding traumas of the last year have only worsened mental health and substance use challenges for many,” Polis said in a statement from CDHS following the bill signing. “We need a system that can deliver timely, affordable and responsive services that truly put people first.”

By Nov. 1, the new law directs CDHS to come up with a plan to establish the BHA. The plan must include recommendations for funding and additional legislation to set up the new entity, which state programs should be managed by the BHA, how the BHA should be structured, and ways the BHA could collaborate with local governments.

The goal of HB-1097 is less government bureaucracy, not more, the bill’s sponsors say. Last year, an analysis found Colorado spends $1.4 billion on behavioral health services spread across across 10 state agencies and more than 75 programs.

“There’s 74 wrong doors until they figure out where they can get services,” said Robert Werthwein, director of DHS’s Office of Behavioral Health. “And our goal is just to get rid of those 74 different doors, have one entry into the behavioral health system, and for us to be smarter in government about how we approach the people of Colorado and putting them first.”

CDHS is working with a health care policy firm to “evaluate how the state could consolidate disparate programming and funding streams under the BHA,” according to a statement from the department. This summer, a task force comprising Lt. Gov. Dianne Primavera, Douglas County Deputy Manager Barbara Drake and several members of Polis’ cabinet will review and adopt an organization plan for the nascent agency.

The BHA’s duties will include:

• being the single state agency responsible for Colorado’s behavioral health programs
• receiving and distributing behavioral health funding
• reporting behavioral health data
• supporting a “whole-person approach” to behavioral health
• promoting culturally responsive and equitable care

HB-1097 passed the House on a vote of 52-8, with five lawmakers excused. In the Senate, it passed on a vote of 33-0, with two lawmakers excused.

“Today we celebrate the more than two years of work that has brought us to this historic milestone,” Michelle Barnes, the executive director of CDHS, said in a statement following the bill’s signing. “I want to thank all Coloradans who shared their stories with us, especially those who testified before the Task Force. Your input guided our vision for a more responsive, equitable and accessible system, and we are already working on BHA planning so we can continue our momentum.”

Challenges loom for new agency

In 2019 — the most recent year for which data is available — 1,287 people died by suicide in Colorado, according to the Colorado Department of Public Health and Environment. 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.

Meanwhile, overdose deaths are on the rise in Colorado as the powerful sedative fentanyl becomes more prevalent in illicit substances of all kinds. In 2019, 1,062 people died from a drug overdose in the state, representing a 9% increase from 2018 and a 4.9% increase from 2017.

Many Coloradans report challenges finding the mental health or substance use care they need close to where they live. In 2019, while developing its “blueprint” of recommendations for the state’s system, the Behavioral Health Task Force heard from hundreds of Coloradans. For 92% of those people, access to care was a top concern.

Amid the COVID-19 pandemic, there are early indicators that needs are growing.

People experiencing a mental health or substance use crisis can access free support through Colorado Crisis Services, the state’s behavioral health hotline, 24 hours a day, seven days a week. They can simply text “TALK” to 38255 or dial 1-844-493-8255 to be connected with a trained counselor.

The hotline has seen a more than 30% increase in total call and text volume during the pandemic, according to CDHS.

“We also know that 1 in 4 young people have reported being anxious or depressed or having a related feeling … during the pandemic,” Werthwein said, “so those are real impacts.”