Q&A: Colorado’s new behavioral health leader wants ‘people-first’ system

Next month, the state will roll out a provider directory that any Coloradan — insured or not — can use to find care

By: - June 13, 2022 5:05 am
Morgan Medlock

Dr. Morgan Medlock was appointed as the state’s first behavioral health commissioner in January. (Courtesy of Colorado Behavioral Health Administration)

When Gov. Jared Polis appointed her in January as the state’s first ever behavioral health commissioner, Dr. Morgan Medlock knew she had a difficult task ahead of her.

Mental Health America had ranked Colorado 51st in the nation for adult mental health, and media reports revealed cracks in the status-quo system of care that included a lack of accountability for state-contracted providers.

But Medlock maintains she’s up for the challenge, telling Newsline that the desire to make a “generational impact” keeps her going. Before coming to Colorado, Medlock served as chief medical officer and director of crisis and emergency services for the Washington, D.C., Department of Behavioral Health, and she previously held an appointment as a clinical psychiatry fellow at Harvard Medical School. She serves on the faculty of the Massachusetts General Hospital Center for Law, Brain, and Behavior and of the Howard University College of Medicine.

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Medlock spoke with Newsline on Friday about the next steps for the state’s Behavioral Health Administration, or BHA — a new state agency that will centralize mental health and substance use programs while streamlining and improving patient care. As behavioral health commissioner, Medlock will oversee the agency and shepherd the state through a new era, in which millions of dollars in one-time federal funding and state reforms could permanently reconfigure how Coloradans access treatment.

The below interview has been lightly edited and condensed for clarity.

Since being appointed in January, what has your work as the new behavioral health commissioner mainly involved?

Relationship building. It’s been at multiple levels. You know, we started by launching a statewide tour. We’ve been to over 40 locations across the state, just building relationships, being with community, showing up with community, … letting people know that we will be doing this work from a framework of community empowerment, uplifting lived expertise. And also working with those who provide care, to collaborate with them to improve practice, and to elevate the work that we do for the people of Colorado.

It’s been a real joy to appreciate the diverse communities across our state. It’s been a joy to meet leaders that are passionate about putting people first, and it’s been a joy to collaborate with my peers on the cabinet who are eager to form our new interagency council, which will be the first time that the state of Colorado has all cabinet agencies at the table to reimagine what behavioral health care looks like in our state. So I would say building relationships at the levels of community, at the levels of providers and also within state government has been my main role so far.

What were some of the major themes you heard from people on the statewide tour, and how do you expect to apply those to your new role and to the Behavioral Health Administration?

I think that if I could just summarize what people want within the BHA, they want a trusted partner. They want equity in all aspects of what we do, and they desire to be heard. And as we have processed those three main outcomes from the state tour we have come to a vision statement of really developing a system where behavioral health services are achieving three outcomes: where they are accessible to the people of Colorado, where they’re meaningful in how services are delivered and where they’re trusted.

If we can achieve that — it sounds simple, but it’s quite complex to get there for all communities and all people of Colorado — I think that would be a great achievement. I think that would be a historic achievement, and I think that in my mind would be a people-first behavioral health system.

Could you go into a little more detail about what “meaningful” means, and how that’s different from what we have now?

Sure. A behavioral health system that provides meaningful services, according to the people of Colorado, (means) services that do not require an encounter with law enforcement to access them. It means services that are delivered in ways that are culturally responsive and appropriate, services that are attuned to the unique needs of communities across this state. Services that are timely — we know that being on time in terms of service delivery, delivering the services when people need it and also how they need it is important. And I think that meaningful services ought to make a difference in people’s lives.

Ultimately we want a Behavioral Health Administration that demonstrates in a powerful way that at every touchpoint of our system, we desire for people to succeed, that we have an approach to thinking about them that is informed by their strengths, by their resilience, by their history, and we want to uplift that as we build a people-first system. So that’s how I define that.

(People) have survived trauma, survived various events in their lives to even present and say, 'I need help in this area.' That takes profound strength.

– Dr. Morgan Medlock

You were the chief medical officer and director of crisis and emergency services in Washington, D.C., before coming here. Could you talk about that role and how some of your experience there or things you learned may apply as the behavioral health commissioner?

I’m a crisis psychiatrist, so that role was really a role where I got a keen view of the challenges that can occur within any crisis system that is attempting to be effective. In my prior role, we were mainly focused on bringing a trauma-informed and resilience-informed lens to how we deliver crisis services, and I think that, although it’s on a much greater scale in Colorado, I think that’s the same calling, you know, here in our state — that people want to be seen as people. When we say we’re a people-first system, that means that we see who they are first, not their challenges, not their diagnoses, not their needs first, but first they are treated with dignity and respect as human beings, and we want that empathy and that compassion to be felt at every door in our system.

In D.C. we were mainly embracing a trauma-informed approach to how we deliver care, paying close attention to thinking about what people have experienced, not just what was “wrong,” and also thinking about their strengths as they have survived trauma, survived various events in their lives to even present and say, ‘I need help in this area.’ That takes profound strength. And so I think for me, “people-first” would mean that’s what we see first: not the challenges, but the person.

How will you make sure that providers at every level of this new system are keeping those values in mind — being trauma-informed and people-first? Do you imagine that’ll be some kind of a statewide training, or how does that sort of trickle down everywhere?

We’ve got to be really effective in the area of workforce development, building learning opportunities and training opportunities to these approaches, which are all evidence-based in terms of trauma-informed care, culturally appropriate care. We’re going to be launching something called a learning management system over the next year that will have modules on the various values that I’ve spoken about: people-first, culturally appropriate, trauma-responsive, equitable care.

There’s a real piece of this that is not just about training. As we advance equity in behavioral health, we also have to be sure that we’re recruiting leaders to the behavioral health system that have these values. The other aspect of our workforce development is also increasing capacity for leaders from diverse backgrounds to be recruited and excited about working in the behavioral health system. So we have hired our workforce development policy officer, who starts next week, who has 18 years’ experience in higher education and will be advising me on how we pursue unique avenues such as loan repayment, apprenticeships and other opportunities to really promote a diverse workforce that is excited about the values that we just mentioned. And so it’s both training but it’s also increasing capacity.

Gov. Jared Polis talks about Colorado’s Behavioral Health Task force during a press conference on Sept. 23, 2020. (Moe Clark, Colorado Newsline)

It does seem like just having enough people has been a real challenge, especially in places like the Colorado Mental Health Institute at Pueblo. Do you feel like this system of recruitment will help get more people? How worried are you about the workforce gaps, especially for residential care, and how do you expect to address those?

Well, I want to first put this in the context of just the national landscape. You know, workforce issues are not unique to Colorado. This is a crisis nationally, in terms of the shortage of professional and paraprofessional behavioral health supports. And so I do want to just acknowledge that, that this is a point of national crisis. I think in Colorado we are ready to take unique and urgent steps to support and recruit a competent workforce. We’re going to be leveraging such tools as telehealth and other mechanisms to ensure all the people in Colorado get the care that they deserve.

You’re right to point out that especially in inpatient settings, hospital settings, that the challenges are even more extreme — because since the COVID-19 pandemic, some providers have preferred to work outside of institutional settings, and so it is often harder to recruit to jobs that do not have that flexibility, that are 24/7 direct-care jobs, and we acknowledge that. Within (the Department of) Human Services, we are looking at our pay scale and other improvements that we can make in terms of increasing excitement and incentives for working in 24/7 direct care settings. But you’re right to point out that particularly recruiting folks to those types of jobs where the remote flexibility is not necessarily present, there’s a unique challenge that we have to address.

Do you have specifics that you could elaborate on as far as pay scale at this point?

Our executive leadership team has already issued a pay incentive for those who are providing direct care, and that will take effect this year. Across government, we are looking at pay equity and reassessing also skills-based hiring and thinking about … How do we engage in a new way of hiring that does not exclude people who could do excellent work for this state but maybe in the past have been excluded based on irrelevant degree requirements or other things that may not necessarily best serve the people of this state? So our governor has asked us as executive directors and cabinet members to think about how each of our agencies can also support skills-based hiring that will be the most meaningful to the people of Colorado.

I’m sure you’re well aware of some of the reporting done recently on the community mental health centers and the behavioral health system that has been in place, where maybe there wasn’t as much accountability as there should have been in these community mental health centers. How are you planning to address those issues and bring those community health centers into the fold of this new system — or not?

We don’t want to see any doors closed. We do know that we have make improvements, and that Coloradans don’t just deserve an open door. They deserve an open door to quality care, and that’s where we’re trying to go as the BHA. I will say that I’ve been floating this idea with providers of launching a BHA provider academy, where we can create a space where as we are making the key reforms that the people of this state have demanded, that we also are transparent and truthful with all stakeholders as those changes are being implemented.

We want to be sure that those with lived expertise, providers, those who are care coordinators, navigators, across this state are all at the table to inform these changes and reform efforts, so the same principles that we’ve utilized in engaging our community are the same we would utilize in engaging our providers. We want all voices at the table so that this work can be successful.

I think what it’s really about is, you know, we do value truth. We do value the Behavioral Health Administration being a source of change and not conflict. We do value authentic partnership, and we know that as I think you’ve heard me say, that the trust has been broken. And so we’re committed to rebuilding trust by taking meaningful action, and so that’s why we are coming out of the gate in July announcing several key reforms, including launching the advisory council and also launching our new care directory. So a lot of things will be happening in our first few months, because we know that at this point Coloradans have heard enough said, and now it’s time to do it.

Could you talk about what the care directory is?

Yeah, I’d love to. Really exciting. The care directory will have a soft launch on July 5, but it’s a collaborative, it’s the outcome of a collaborative effort between Human Services, the Behavioral Health Administration and the Department of (Public Health and Environment) to for the first time have a care directory that is a one-stop location digitally for the people of Colorado to go on this application and find a provider closest to them. It also asks a really powerful question — “What are you experiencing today?” — rather than asking someone to identify, “Do you need this kind of treatment?” I think starting from a person-centered place of just, “What are you experiencing right now?” and then having a response that’s appropriate and timely and effective is where we’re going. Eventually this application will be further developed to where Coloradans will be able to initiate telehealth and other options through that same application, so really excited about where this is going.

Is it just like, “No matter what kind of insurance you have, these are the people you can see”?

This application will actually be irrespective of payer, so for those who are covered under public plans, those options will be there, but it will also include commercial options. (That’s) the difference between care directories that have existed in our state, which have kind of separated those who may have commercial insurance versus Medicaid, etc. This application is for all people.

I believe that we will make history together. I believe that we will go from the 51st ranking to being a top-10 state in mental health care.

– Dr. Morgan Medlock

You obviously have a huge task ahead of you leading this new Behavioral Health Administration and overseeing this complete overhaul, basically, of the state’s behavioral health system, which was ranked last in the nation by Mental Health America. What motivates you to face this challenge and what keeps you hopeful?

As I shared in my op-ed, I come from a family that has been deeply committed to mental health care and services for most of my life. My dad actually still operates crisis centers in the neighborhood I grew up in, and so I come from a family that takes on challenges, and so I do want to just point to my own experience growing up with that culture around me. I bring that same intensity and passion to this job. I believe that with the people of Colorado, we will do something that has never been done. I believe that we will make history together. I believe that we will go from the 51st ranking to being a top-10 state in mental health care. I’m looking forward to our transformation, and it’s that desire to contribute to something that has a generational impact that excites me and motivates me. I believe that three generations from now, we will truly see a new legacy in this state, and I believe that as we look back on that it would have started in this moment. So that is what excites me — making a generational impact.

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Faith Miller
Faith Miller

Reporter Faith Miller covers the Colorado Legislature, immigration and other stories for Colorado Newsline.

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