​ Coloradan Rory Vaden is a bestselling author, keynote speaker and co-founder of Southwestern Consulting.

the Logical Long Term Consequences of our failure to provide Intensive Community MH Treatment

Corrected 4-9-2017 @ 5:36 p.m.     

          Most people with serious mental illness who are not being served by Medicaid community mental health services are:
  1. In the Criminal Justice System
  2. In Nursing Homes [Medicaid does provides mental health services in nursing homes -- our take is one really needs access to intensive community mental health services such as Assertive Community Treatment (ACT) -- and that is almost never available to nursing home residents in CO in our experience]
  3. Homeless
  4. In Mental Institutes
 5,700 for people with mental illness in DOC
and we are not sure how many thousand in Colorado Jails.

    So what is the point of all this?  Well, actually many:
  •   As a society we have just not come to terms with the fact that you CAN'T provide for INTENSIVE mental health needs on the cheap;
  • Well are people being relegated to the Mental Health Institutes -- well sometimes -- BUT not for the most part, because we don't want to pay for beds at the Institute -- they are very expensive -- and that's not where most people want to receive their services anyway.
  • We just bet people want to receive their services @ the nursing home because that's where more than 2,200 people with serious mental illness are residing in Colorado, according to the CMS Minimum Data Set.
  • On second thought, probably a lot of those people don't want to be in the nursing home but there aren't adequate Medicaid services in the community like Assertive Community Treatment for them to discharge to a community placement.
  • Well maybe the person is homeless, in prison, or in AdSeg (Solitary) in a Colorado Jail with mental illness-- that's the logical consequence when we decide we are not going to provide ESSENTIAL intensive community mental health services such as Assertive Community Treatment to those who need it.
2016 Point In Time (PIT) US Homeless Report (p. 77)
This is a very selected look, omitting families and youth.

Colorado

1,181 veterans
(Theoretically, the Feds are providing healthcare, but there has been a big push for communities & States to end Veteran homelessness by providing housing)

​1,642 chronically homeless individuals

  https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf
National Coalition for the Homeless: Housing Is Important But It Is Not Always Enough

CMS MDS (Minimum Data Set) for Nursing Homes
Frequency Report: First Quarter 2017
Level II Pre-admission Screening and Resident Review - Serious Mental Illness

CO has 2,219 people with serious mental illness in nursing homes.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Minimum-Data-Set-3-0-Public-Reports/Minimum-Data-Set-3-0-Frequency-Report.html#

To our knowledge people with mental illness in nursing homes have never had access to assertive community treatment or the reasonable but intensive community services they need to live in the community.

​Does that violate the Americans with Disabilities Act and the Olmstead Decision -- it sure does.
Colorado's Mental Health Institutes

451 In-Patient Beds (144 Civil Beds, 307 Forensic Beds) -- Pueblo
  • The Admissions Program: 104 Beds
  • The Restoration Program:  72 Beds
  • The Cognitive Behavioral Program: 116 Beds
  • The Psycho-Social Program 159 Beds

https://sites.google.com/a/state.co.us/cdhs-behavioral-health/home/mental-health-institutes/mental-health-institutes-at-pueblo/services
​
http://www.leg.state.co.us/clics/clics2013a/commsumm.nsf/b4a3962433b52fa787256e5
​f00670a71/869edea16f2eb25687257b360069cbd2/$FILE/13MICJS0322AttachE.pdf

94 Civil In-Patient Beds -- Ft. Logan
https://sites.google.com/a/state.co.us/cdhs-behavioral-health/home/mental-health-institutes/mental-health-institute-at-fort-logan

​
A Total of 238 Civil Beds thru Colorado's Mental Health Institutes


Where Are We?

Recently the Hickenlooper Administration has made valiant efforts to use marijuana tax money to fund affordable housing and other services and there's $2.7 million for housing and supportive housing for people with mental illness re-entering the community from jails & prisons.

And we are big supporters of all that.  BUT Colorado still has a long way to go to comply with the law -- for decades we've essentially just written off thousands of Coloradans with the most intensive community mental health needs because we thought they were too expensive.

This didn't happen overnight and it certainly didn't happen over one administration -- that's how we all got so acclimated to just accepting gross human rights violations of people with mental illness as the norm. 

The US and certainly Colorado are beginning to wake up -- but it may be to quite a hangover -- because the consequences of our decades failure to provide adequate housing & intensive community mental health treatment are now all the more expensive because we have grossly neglected it for so long.