Colorado’s Mental Health Crisis
A Case Study on the Need for Oversight and Transparency in Mental Health
Lewis Carroll wrote a beautiful exchange in his classic book, Alice in Wonderland. It’s simple, but oh so important. For context, at this point in the book, Alice, lost in the woods, runs into the Cheshire Cat, where we see this conversation unfold:
“Would you tell me, please, which way I ought to go from here?”
“That depends a good deal on where you want to get to,” said the Cat.
“I don’t much care where–” said Alice.
“Then it doesn’t matter which way you go,” said the Cat.
“–so long as I get SOMEWHERE,” Alice added as an explanation.
“Oh, you’re sure to do that,” said the Cat, “if you only walk long enough.”
Recently, a powerful example of investigative journalism revealed the extent to which Colorado’s mental health care system is failing the residents who need it. And while the article added some new information that was previously unseen, it was just another example of the problems that people all over the country, and in this case in Colorado, have been facing for decades.
Like Alice and the Cat’s exchange above, it was a reminder that if we don’t know where we are going, any road will take us there.
A months-long investigation found that 17 community mental health centers aimed at providing mental health assistance to at-risk residents throughout the state, and which are financed by nearly half a billion dollars in taxpayer funds, failed to fulfill the needs of the Coloradans it was designed to act as a safety net for. I have written about the promise of an actual safety net system for mental health before - we know it’s going to be hard, take a lot of courage to challenge the dominant paradigm, and be difficult to achieve, but oh so important. The Denver Post article highlights how when there’s little to no substantive oversight and accountability, patients faced wait lists that worked against the patient’s mental health (and don’t forget about the challenges of our frontline staff being overworked and feeling burnout). Sure, this is as much about how we fragment care as anything else, but at some point we have to ask ourselves why we keep supporting something that doesn’t work.
Context
The Centennial State ranks near the bottom in terms of mental health and substance use disorder: 23.2% of adults have some form of mental illness, nearly 12% of adults have a substance use disorder, and over 5% of the adult population experience serious thoughts of suicide. Just this week a survey revealed that 33.6% of Colorado adults who suffer from anxiety and/or depressive disorders have been unable to receive the counseling or therapy necessary to treat their condition.
In light of this much needed attention on a major issue, it’s worth asking if we are bearing witness to repeated systemic failures in our mental health system or if we have intentionally designed entire systems to fail those who need care most.
In the mental health world, we have so many programs and policies that don’t work. We limit where a person can get access to care. We have different rules for mental health coverage, financing, delivery, and so much more. And yet, despite our poor outcomes, despite year after year of data showing people are not getting care, we don’t question enough or disband our approaches in large part because we keep perpetuating a system that’s dependent on them. We keep building programs on top of programs which all use these policies, creating a web of dysfunction that’s hard to deprescribe and difficult to untangle. It’s frustrating to say the least.
The chair of Well Being Trust’s National Advisory Council, and a member of the Well Being Trust Governing Board, Maureen Bisognano has always said that once we realize something is not working, it’s unethical to proceed as if it is.
In fact, you can see me talk much more about the above here in my keynote I gave to the Penn Leonard Davis Institute conference on mental health:
And while it’s easy to call out the shortcomings of others; it’s much harder to look inside and find flaws within ourselves. State leaders should use this opportunity to take a long hard look at how their own systems are serving - or failing to serve - residents. As I said above, we keep perpetuating a system that’s dependent on flawed approaches to care.
Movement
Colorado is taking some positive steps in the right direction after recognizing long standing issues within the state. Earlier this year, Governor Jared Polis signed a bill establishing a new Behavioral Health Administration (BHA), to streamline access to mental health and substance use services by coordinating all related programs and funding under a single entity. The bill also creates a cabinet level position at BHA in which a soon-to-be-appointed commissioner can spearhead a substantial overhaul of mental health systems by having a seat at the table. But as I wrote about recently in an op-ed, this position could lead to absolutely no change if the right person is not in place to courageously challenge the status quo and incrementalism that’s plagued advancing new strategies for helping people in Colorado.
The continuing crisis we see before us is perpetuated because too few leaders in positions of power and authority find it profitable to solve. This is an easy thing to write and a hard thing to change - it’s almost in our culture to want to preserve the status quo because it is easier despite it not being what’s best. Other states should take their lead what’s happening in Colorado and work to have leadership positions that can begin to speak into the process for change - to disrupt the inert systems.
State and local leaders at all levels should be actively examining what other states are doing to help their residents, and then implementing all methods shown to be effective. No ideas are too small or too radical when it means saving the lives of hundreds of thousands of Americans each year. At the same time, states need only look to Colorado to see the consequences of a health care system designed and operated for decades without a sense of transparency or accountability. More money into a dysfunctional system only leads to more dysfunction.
Where we go from here, as the Cheshire Cat said, depends on where we want to get to. If we - policymakers, care providers, fellow mental health advocates - decide, once and for all, to chart a path to give our neighbors, friends, and family members the help they so desperately need and deserve, I know we will get there. We must have the vision and push for change - no matter how hard it may be. If we remain indecisive, if we settle for hollow promises with no follow-through and no oversight, if we decide that we don’t much care where we end up…well then we’ll remain like Alice, just wandering. And wandering. And wandering…
Thank you Ben. This struck me twice. One was the need to assess, measure, plan, and make changes to improve. That's critical in any endeavor but especially when peoples mental health is at stake. Bravo. Second, this 'inside baseball' look is exposure a road map of a way to look, see, and understand. Simply pointing at change (i.e. change this) this you've shared the discrete elements of the problem and the solutions which lifts us all with knowledge to use.