Nearly every day in Colorado, someone having a mental-health crisis tries to seek help at a hospital emergency room. There’s only one problem: ER doctors are able to diagnose and treat a broken foot, but they generally don’t have the training to fix a broken mind.
“Not to say anything against the professionals in the emergency room, but they often aren’t equipped to deal with it,” said Scott Glaser, director of the Colorado chapter of the National Alliance on Mental Illness.
But after decades of deep cuts to Colorado’s institutions and programs to help the mentally ill, the options are few.
“We don’t have a place for someone who is in crisis to walk in and have access to care and a way to deal with their crisis (immediately),” Glaser said.
Many patients end up staying on a cot in the hospital ER for a day or two until they are calmed down enough to be discharged or until room can be found in a mental-health treatment center.
“It is shocking,” said Moe Keller, of the organization Mental Health America of Colorado, “but this is a common, everyday practice.”
Some ERs have psychiatrists on staff, but others do not, says the Colorado Hospital Association. Sometimes, this is because of a shortage of psychiatrists, particularly geriatric psychiatrists, said CHA spokesman Julian Kesner. Low pay from Medicare and Medicaid government insurance programs contributes to the shortages, he said.
A 2011 report estimates that 1.5 million Colorado residents – 1 in 3 people – need mental-health care or treatment for substance abuse. One in 12 – an estimated 450,000 Coloradans – are in severe need of mental-health care.
The report, funded by several foundations and authored by the group Advancing Colorado’s Mental Health Care, ranked Colorado 32nd in the nation for public mental-health-care funding.
The state ranks sixth in the nation for its rate of suicide. Yet fewer hospital beds are available for children, adolescents and senior citizens with mental-health illnesses than a decade ago. Currently, more than 50 percent of care for mental health and substance abuse in Colorado is delivered via primary-care physicians – of which there also is a shortage. And many rural areas of Colorado have little or no accessible mental-health providers.
Cuts to mental-health services in Colorado and elsewhere have been a reality for decades. Keller, a former longtime Colorado legislator, noted that federal money to pay for mental-health services began drying up in the 1980s, and states and counties began to defund programs. In 2009, the Legislature opted to save millions by eliminating beds for children, adolescents and geriatric patients at the Fort Logan Mental Health Institute in Denver, one of Colorado’s two inpatient psychiatric hospitals.
“I regret that more than anything else, but we had to do what we had to do to balance the budget,” Keller said. “There was a theory that if we closed the beds in institutions, local communities would have to step up to the plate. They didn’t.”
In the months after James Holmes was alleged to have killed 12 people and injured 58 in a movie theater in Aurora, efforts have been launched to increase funding and rebuild infrastructure for mental-health services. Holmes’ attorneys have claimed he is mentally ill. Many other violent episodes, including the mass shooting in Newtown, Conn., and smaller-scale incidents in Colorado, have raised consciousness for restoring funding for and access to mental-health services.
In December, Colorado Gov. John Hickenlooper and Department of Human Services Director Reggie Bicha rolled out a proposal to inject $18.5 million into mental-health programs. The Legislature is expected to begin debating several related bills in coming weeks.
Keller and Glaser are encouraged by the plan, which includes establishing a 24-hour statewide crisis hotline and opening five walk-in facilities for people who need help. But, they say, there is much more to be done.
“In one perspective, $18.5 million sounds like a lot of money, but in some perspectives, it is really just a drop in the bucket,” Glaser said.