Category: CMHIP

Jill Marshall New Superintendent for CMHIP Beginning March 26

3/7/2018

The Pueblo Chieftain is reporting that the Colorado Department of Human Services has named Jill Marshall as the new Superintendent for the Colorado Mental Health Institute @ Pueblo. Marshall:

Is a Former Director of an Intermediate Care Facility for people with disabilities in New Mexico;
Before moving to New Mexico in 2011, she worked in the Texas Department of Assistive & Rehabilitative Services
Has More than a decade of experience in behavioral health, public administration, and human services

https://www.chieftain.com/news/pueblo/marshall-named-new-head-at-colorado-mental-health-institute-at/article_e68ec48b-0dc6-5b58-8ecb-a3603ab631fa.html

Orchid's Take:
HALLELUJAH!

Everyone brings something special & unique to a job that only they could bring.
It is great to see someone with a BROAD background in disability services in the top spot @ CMHIP
To us this is really an appointment looking to the FUTURE & a BROADER APPRECIATION of DISABILITY & NEURO-DISABILITY as they relate to some of our most difficult problems.
BUT beyond appreciation, it's someone who likely understands the breadth and range of what can really be done.

We Can't Wait to Meet Jill & We Know We Are Not the Only Ones

Jill Marshall, Colorado's new Superintendent for the Colorado Mental Health Institute @ Pueblo

Assertive Community Treatment: Mental Health Parity, Olmstead, Capitation, & CMS Quality of Care Requirements for States Contracting with Managed Care Organizations

2/12/2018

So here we have it: ALL kinds of reasons why people with mental illness should have access to the Mental Health Care at the the level that they need AND one of the BIG REASONS why they don't.
These challenges are NOT unique to Community Mental Health or in fact to Managed Care. We have had serious quality of healthcare problems:

in Nursing Homes,
Abuse problems in facilities for people with developmental disabilities
Serious Staffing Problems @ the Colorado Mental Health Institute @ Pueblo for DECADES -- maybe the State is finally trying to tackle that this legislative session. We would like to see more Emergency Action on this.
The Deaths and maiming of Colorado Inmates with mental illness in the shadow mental healthcare system of our prisons and jails.
This is true in public health and its true in private healthcare. It is very difficult for patients and their families to enforce quality of care standards.

We are struggling as a Society "To Do The Right Thing" and at the same time "CYAing" ourselves to the maximum extent possible.

IT IS NOT WORKING.

On paper -- in the Statute books, the US Supreme Court Reporters, Federal Reporters, Code of Federal Regulations, CMS [Centers for Medicare & Medicaid Services] Guidance, State Regulations --- WE SHOULD NOT HAVE A PROBLEM WITH ACCESS TO PERSON-CENTERED, INTENSIVE ASSERTIVE COMMUNITY TREATMENT, ETC.

BUT WE DO HAVE A PROBLEM WITH ADEQUATE ACCESS TO ASSERTIVE COMMUNITY TREATMENT & A LOT OF OTHER THINGS.

If one has low to medium needs with regard to mental health treatment -- Managed Care may work out pretty well.

BUT Colorado Medicaid Managed Care it is a FRICKIN' EPIC FAIL when it comes to people with the most intensive mental health needs and is just NOT UP TO SCALE.

The State of Colorado knows that it doesn't have adequate capacity, and it's one of many reasons they have so powerfully passively resisted Olmstead Compliance and Planning and bringing needed housing & services to scale.

They are not necessarily opposed to those things, BUT they don't want to be held ACCOUNTABLE for them either.

Which brings us back to our Society that "Wants To Do The Right Thing" and spends a whole lot of time "CYAing" itself.

People Tort Reform is NOT going to get us to the Solution to this problem, mainly because it doesn't get us to Solutions to the "Root Causes" of the original presenting problems.

A LOT of the FOUNDATION for Solutions to the Systemic Problems we find in Mental Health Managed Care has really already been LAID -- in Statute, Caselaw, Federal Agency Guidance and Requirements, State Regulations.

It's really analyzing what are the BARRIERS to realizing this in PRACTICE and NOT just THEORY.

CMS -- Overview of Quality of Care Information for Managed Care

CMS on State Responsibilties for Quality Assessment & Improvement in Managed Care

CMS on State Responsibilities to Conduct External Quality Review of Managed Care Organizations

With the Circle Program, the Hickenlooper Administration is Turning A Critical Corner in Honestly Addressing the Staffing Problems @ CMHIP -- That NO State Administration Has Ever Done Before

1/23/2018

State officials are proposing re-opening the "Circle Program" in the Community outside of the Colorado Mental Health Institute @ Pueblo (CMHIP):

to access Medicaid dollars; and
to avoid the severe staffing shortages @ CMHIP.

We couldn't be happier to hear this news, and even though we're only talking 20 beds -- it marks a HUGE CHANGE in Colorado State Mental Health Policy that has for DECADES been in DENIAL about the SERIOUS STAFFING PROBLEMS in Pueblo.
From the Neiberger Case spearheaded by Attorney Kathleen Mullin, finding insufficient staffing @ CMHIP almost 2 DECADES ago -- to the present time -- Staffing Problems have gone up and down --- BUT they have NEVER gone away.
This is particularly important with respect to the Circle Program because Pueblo is intending to turn it's Old County Jail into a Drug Treatment Facility --- and that is just going to put more pressure on finding competent staff in the Pueblo area.
We don't have a problem with CMHIP in principle -- BUT the number of beds have to be directly correlated to what the State can adequately staff.
Right now the State is still down 100 staff people and has been for months. The ability to staff CMHIP IS WHAT IT IS -- NOT WHAT WE WISH IT TO BE.
We and some of the professionals on the Orchid Facebook Page are already concerned about the proposal to loosen staffing standards by opening up some direct care positions to EMTs (emergency medical technicians) and paramedics. We are unclear where that stands based on the Jan. 8, 2018 Pueblo Chieftain report below.
https://www.chieftain.com/news/politics/pueblo-lawmaker-colorado-state-mental-hospital-will-be-hiring-paramedics/article_4937e2a8-0da8-530d-8303-530fe9533e4b.html

Having said that, the State's Circle Program Proposal marks a SEA CHANGE in DECADES OF COLORADO MENTAL HEALTH POLICY by placing HONESTY AND THE WELFARE OF PATIENTS FIRST.

Pueblo Chieftain

State officials want to move the highly respected Circle Program out of the Colorado Mental Health Institute at Pueblo, saying that would protect it from the chronic staffing shortages at the state hospital.

Colorado Department of Human Services officials will ask the Legislature's Joint Budget Committee to approve that idea Wednesday.

Where Circle would end up, or even reopen, is uncertain.

The 20-bed program treats people suffering from both mental issues and addiction. It was abruptly closed last June 5 so CMHIP could shift its nursing staff to help fill nearly 100 vacant direct-care staff positions.

The hospital had just failed a staffing inspection and was in danger of losing federal Medicare funds.

In its budget request, DHS argues that it wants to move Circle "into the community" -- meaning some other provider would operate the program.

The plan says there are two advantages for moving out of the state hospital. One is that patients could use Medicaid funds to pay for the 90-day treatment. Located at the state hospital, Circle patients can't use Medicaid funds to pay for care there.

Secondly, the specialized treatment program would no longer be vulnerable to chronic staff shortages at CMHIP. Although the hospital passed a staffing inspection in October, it still has more than 100 vacancies in patient-care staff.

State Sen. Leroy Garcia, D-Pueblo, said he has strong concerns about the DHS plan.

"We haven't seen this proposal until now and what happens if there aren't providers in our community able to operate the program?" he said Monday.

Circle has been popular enough with state lawmakers they have funded it by name in the state budget. The budget for next year was $2.2 million but DHS is asking to move much of that funding into the CMHIP budget. It notes the Circle staff was shifted into the hospital's direct-care staff to fill vacancies there.

The program is respected enough that Colorado judges refer defendants to it by name. When it was closed in June, The Pueblo Chieftain received several calls from distraught families around the state who had sons and daughters waiting in jail for an opening in the program.

https://www.chieftain.com/news/pueblo/colorado-officials-eye-moving-circle-program-out-of-pueblo-mental/article_fe600b92-c88e-57dd-abcb-bad3be3133df.html

The CO Mental Health Institute @ Pueblo & Political Courage: Mental Health Patients Should NOT Get the Short End of the Stick With A Location That is Over-Saturated with Facilities Given Its Size

11/22/2017

"One of the challenges is to get the Colorado Legislature's approval of Gov. John Hickenlooper's budget request for [CMHIP] salary increases of $13 million in 2018 and $26 million in 2019 for state-run patient-care facilities -- notably including CMHIP. Another challenge is to hire a strong, committed leader as CMHIP's next superintendent."
Pueblo Chieftain

We definitely agree with the Pueblo Chiefain that CMHIP and the State's other facilities are in desperate need of funding proposed in the Governor's budget.
BUT the reality is when Colorado has a Settlement Agreement or a Federal Agency breathing down their neck -- they generally comply.
The Filpside of that reality is that when they don't have that -- reasonable Staffing ratios, etc. tend to slip, and as we recently learned they can slip badly.
So the idea is NOT to keep re-filing the next Neiberger case coming out of CMHIP against the State or hope that Federal officials enforce their standards --it is to get to the ROOT CAUSE of these problems.
In my opinion and quite frankly the opinion of a number of advocates, staff and former CMHIP patients---- the problem is LOCATION.
The CMHIP article goes to great lengths to talk about the importance of "LEADERSHIP" in the superintendent role. We don't disagree with that. We would note that the Neiberger case did occur during the tenure of Supintendent Hawkins which the article seems to hold in great esteem.
Further, the article tends to support an idea to lower the standards of Staff @ CMHIP, recognizing the great difficulty of obtaining and retaining staff @ the facility.
Without more, we tend to think lowering staff standards is not such a great idea.
Right now Pueblo appears to have more health facilities than it can safely staff and the Pueblo Old County Jail is getting ready to be turned into a drug treatment facility.
PATIENT SAFETY AND BEST PRACTICE TREATMENT HAVE TO COME FIRST.
iF THERE IS SOME HORSE-TRADING TO BE DONE, WE WOULD RESPECTFULLY SUBMIT CONSIDERING PLACING SOME NON-HEALTH CARE RELATED STATE OPERATED OFFICE IN PUEBLO.

See below a brief description of the "Neiberger" case in the American Bar Association's Mental and Physical Disability Law Reporter from 2002.

Olmstead Talks In Terms of the State's Plan for Services for People with Disabilities in Both Institutions & the Community---Should Our Olmstead Planning Bill Consider Both As Well

10/22/2017

Generally, when we think of an "Olmstead Plan" we think of housing and community services for people with disabilities.
BUT the Supreme Court in Olmstead really talked about this "Comprehensive, Effectively Working Plan" as being thoroughly related to the State's Overall Plan for the Provision of Services for People with Disabilities, both in Institutions and in the Community.
So this is also very related to the idea of allocation of resources for disability services and that States can't necessarily be expected to change their programs overnight BUT they should have a "comprehensive, effectively working plan" to prevent the unnecessary institutionalization of people with disabilities or the great risk of institutionalization inherent in homelessness.
We are asking the question: Should we include "institutions" in our Olmstead Planning Bill because:

Institutions for people with disabilities have had a lot of problems this year in Colorado and there is currently not a lot of inclusion of people with disabilities with regard to the planning or oversight of these institutions.
Often people with disabilities in these institutions and their family members know what the barriers are to community living.
Staffing is a HUGE issue. We need people who are really motivated to solve those problems -- that includes staff and people with disabilities.
When we think about planning for institutions that is necessarily related to planning for Community Services AND we probably need to be doing that together.

Colorado Mental Health Institute @ Pueblo

El Pueblo, a mental health and substance abuse treatment center for children was shut down by state authorities late Sept. 2017 following complaints that children were abused and underfed. http://www.denverpost.com/2017/09/28/el-pueblo-boys-and-girls-ranch-closed/

The Oct 19th, 2017 CMHIP Public Meeting & the Need to Include the Mental Community Outside of Pueblo

10/14/2017

OCT. 19TH PUBLIC MEETING ON THE CO MENTAL HEALTH INSTITUTE @ PUEBLO (CMHIP)

"DHS Executive Director Reggie Bicha will host the meeting, along with state Rep. Daneya Esgar, D-Pueblo, and it will be in the Pueblo County Office of Emergency Services, 320 W. 10th St., starting at 5:30 p.m."

CMHIP MEETING

We think this is designed to address the concerns of the Pueblo Community -- which are legitimate.
It is NOT clear to us the extent to which the concerns of the mental health community are going to be addressed.
CMHIP is a STATE institution not just a Pueblo institution. A lot of the people @ CMHIP are NOT from Pueblo.
It is a considerable burden for a lot of mental health advocates from around State to trek to Pueblo and try to drive back to their homes @ night.
We (meaning the Mental Health/Disability Community) have been asking for inclusion on CMHIP for sometime.
We Need Systematic Inclusion on CMHIP issues, planning and oversight.

The Beginning of Our Olmstead State Pages: Arizona & California In Colorado, it is NOT just a lack of Leadership But of Integrity

10/8/2017

We have the Minnesota Olmstead Case in which a Federal Judge requires specific measurable goals for an Olmstead Plan.

In addition to that, specific measurable goals and real State accountability are common themes across the Country when it comes to Olmstead Compliance or lack of Compliance.

Our pages on Arizona and California are still in the draft stage -- but they make their points.

We hope to have most of the States covered by the end of the month, and we think they do give insight into the common issues in Olmstead Compliance.

Colorado government talks about Accountability BUT when it comes to OLMSTEAD they have wanted none of it.

Further, some might say Leadership is lacking. Maybe. Insofar as integrity and telling the truth are a part of leadership then yes.

BUT it has really been an integrity problem not just in Olmstead but:

Contracting for the Crisis Center Providers

"Crisis Access protested the cancellation, eventually appealing to the court that there had been “inappropriate political pressure from disappointed bidders.”

"[Judge] Stern agreed the process was “highly suspect.” He issued a preliminary injunction in February to stop the state from awarding new contracts to another group of mental health providers."

http://www.denverpost.com/2014/05/16/judge-advises-state-do-over-of-bungled-mental-health-contract/

Well, this little controversy had to do with the inappropriate (some advocates even said criminal) awarding of the Crisis Center Contracts to other than the initially chosen recipient -- That intially chosen recipient did NOT happen to be a current Mental Health Provider in Colorado -- AND that didn't go down well with the Mental Health power brokers in this State.

At the time it wasn't our issue, but we should have paid much more attention, because the lack of integrity it hinted at or as many believed evidenced was to be seen again and again.

the Jail Wait Case,

"The suit also alleged that the Colorado Department of Human Services had fabricated monthly data to make it appear as though detainees were receiving timely services.

"The agreement orders the department to hire an independent consultant to oversee continuing operations of the state’s mental health system for the remaining duration of a 10-year agreement made in 2012. The consultant is to ensure compliance and data reporting, and is to meet with DLC [Disability Law Colorado] and the state on a quarterly basis to provide updates."

http://www.coloradoindependent.com/160513/colorado-to-hire-consultant-agrees-to-independent-oversight-for-mental-health-system-in-lawsuit

CMHIP (Colorado Mental Health Institute @ Pueblo)

Long standing care and staffing problems going back decades. But under the Hickenlooper Administration:
*CMS "Immediate Jeopardy Designation"
*Failure to Inform Colorado Legislature of magnitude of staffing problems during the 2017 Legislative Session;
*Months of abusive overtime staffing practices, before Colorado finally asked for emergency increases in salaries in the range of 18-23 percent.
*According to the Pueblo Chieftain, CMHIP staff were advised to answer questions of CMS investigators, BUT don't volunteer anything.

lack of complete compliance with the ban on AdSeg for people with mental illness in CO Prisons.

People lie, don't exactly tell the truth, generally because they're afraid. Maybe people won't like them, they did something they might "get in trouble for," etc.

AND we do use "lying" as a BIG excuse to go off on people.

AND even just saying "integrity" is sort of moral grand-standing. Like anyone of us is perfect.

In the words of Meditation Guru Eknath Easwaran, "A deer never lied to me, and I like people better."

AND we need some integrity in our Olmstead discussions with the State.

AND we need some discussions, response to our inquiries regarding our Olmstead Planning Bill.

AND the State needs to comply with the LAW.

Arizona: How Far To Comply With Olmstead?

California: How Far To Comply with Olmstead?

More -- A LOT MORE -- Money in Housing & Intensive Mental Health Treatment is Needed in Colorado for People with Mental Illness -- It Could Be Along The Lines of A Billion Dollars

9/20/2017

A lot of people in the general disability community were pretty envious of the Mental Health Community -- an investment of $40 Million in mental health this year in the Legislative Session.

But that was before the Sh**
Hit the Fan on CMHIP (CO Mental Health Institute @ Pueblo) and the "immediate jeopardy" designation, persistent staffing problems, ad nauseam.

BUT -- WHAT IS IT GOING TO TAKE TO HOUSE and TREAT THOUSANDS OF PEOPLE WITH MENTAL ILLNESS IN CO JAILS & PRISONS --

WHEN WE CURRENTLY DON'T HAVE THE HOUSING & ASSERTIVE COMMUNITY TREATMENT (ACT) IS OFTEN NOT AVAILABILE.

ACT is NOT AVAILABLE to ALL WHERE REASONABLY MEDICALLY NECESSARY UNDER CO MEDICAID -- THAT'S DISCRIMINATION.

BTW -- ADULT & YOUTH ACT are available in Minnesota where reasonably medically necessary.

https://www.usgovernmentspending.com/colorado_state_spending_pie_chart

Colorado's gross domestic product is $334.7 billion.

As a lot of States, we have chosen to ignore the SCALE of the housing needs of people with disabilities regardless of Olmstead for years.

The cost shifting of people with intensive mental health needs to the Criminal Justice System and to the Homeless Shelter and the Streets is being called out and recognized in a way it hasn't been in the past.

The Chickens are coming home to roost -- AND WE WANT:

Inclusion
A Comprehensvely, Effectively Working Olmstead Plan with Measurable Goals that Bring Housing & Services to Scale to Meet the Need, and
Facilities for People with Disabilities that are ADEQUATELY FUNDED & STAFFED and NOT RIFE with ABUSE or BREEDING GROUNDS FOR SUICIDE.

D.J. Jaffe, CMHIP, Our Olmstead Planning Bill & TABOR: It Is Long Past Time To Have A Come To Jesus or More To The Point -- A Come To Reality

9/16/2017

Colorado Hasn't Allocated the Resources for the Inpatient Care or Community Care Colorado Citizens with the Most Intensive Mental Needs --- Need. That Has and Is Leading to in the words of Conservative Mental Health Advocate D.J. Jaffe "Insane Consequences." And that is true even in economically prosperous Colorado.

D.J. Jaffe is hardly a darling of the Left, in fact he is generally embraced by the Right, and we don't necessarily agree with all the prescriptions -- BUT he has pretty accurately described the problem in the US that people with the most intensive mental health needs have been written off as too expensive and cost shifted to the criminal justice system and the homeless shelter.

How can we have:

an evidenced based community mental health treatment such as Assertive Community Treatment that is the gold standard in intensive community mental health treatment
a major component of many MI US Dept. of Justice Olmstead Settlement Agreements, and
Yet not systematically required to be provided where reasonably medically necessary and desired --- politics? this is insane & life-destroying.

AND We Do Need More Beds & Sufficient Salaries for Staff.

We're asking the Hickenlooper Administration, Colorado Attorney General Coffman's Office, and the Colorado Legislature to look at the State's obligations under Federal Law as falling outside of TABOR restrictions based on the Supremacy Clause to the US Constitution.

Specifically, for our purposes that would mean:

State obligations to meet Federal Safety and Staffing requirements of facilities, etc.
Obligations under the federal Americans with Disabilities Act and the 1999 Olmstead decision and subsequent caselaw and federal guidance, etc.

National Review
By D.J. Jaffe
Price's War On Mental Illness
http://www.nationalreview.com/article/451039/mental-health-spending-serious-illnesses-should-get-bulk-spending

We Need Real Inclusion On CMHIP & Olmstead

9/11/2017

I don't have a problem with "empathizing" with state officials who are charged with the difficult duty of addressing the CMS initial "immediate jeopardy" determination and the larger long-standing staffing problems at the Colorado Mental Health Institute @ Pueblo.

   In fact, such empathy and understanding is no doubt essential.

   Having said that, it does not appear that Colorado State Government has the processes in place to successfully address the scope of this problem.

   The State does not appear to be empowered to do what it needs to do, or does not "think" it is empowered to do what it needs to do to address this crisis -- and large scale staffing problems at a large institute of vulnerable individuals is a crisis.

   No doubt in the midst of crisis it is hard to figure out how to include people -- but that lack of inclusion is part of the reason for the current crisis @ CMHIP.

   We don't know whether to laugh or cry or both when the Hickenhooper Administration sets up what come off as pretty bogus "listening sessions" around state -- and they can't talk about Olmstead or CMHIP with the diverse Mental Health Community that wants to talk them about those issues..

   BTW Olmstead Compliance is required by federal law and NOT subject to a poll taken by the State.

<<Previous

Val's Blog

Jill Marshall New Superintendent for CMHIP Beginning March 26

Orchid's Take:
HALLELUJAH!

Assertive Community Treatment: Mental Health Parity, Olmstead, Capitation, & CMS Quality of Care Requirements for States Contracting with Managed Care Organizations

With the Circle Program, the Hickenlooper Administration is Turning A Critical Corner in Honestly Addressing the Staffing Problems @ CMHIP -- That NO State Administration Has Ever Done Before

The CO Mental Health Institute @ Pueblo & Political Courage: Mental Health Patients Should NOT Get the Short End of the Stick With A Location That is Over-Saturated with Facilities Given Its Size

Olmstead Talks In Terms of the State's Plan for Services for People with Disabilities in Both Institutions & the Community---Should Our Olmstead Planning Bill Consider Both As Well

The Oct 19th, 2017 CMHIP Public Meeting & the Need to Include the Mental Community Outside of Pueblo

CMHIP MEETING

The Beginning of Our Olmstead State Pages: Arizona & California In Colorado, it is NOT just a lack of Leadership But of Integrity

More -- A LOT MORE -- Money in Housing & Intensive Mental Health Treatment is Needed in Colorado for People with Mental Illness -- It Could Be Along The Lines of A Billion Dollars

D.J. Jaffe, CMHIP, Our Olmstead Planning Bill & TABOR: It Is Long Past Time To Have A Come To Jesus or More To The Point -- A Come To Reality

We Need Real Inclusion On CMHIP & Olmstead

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Orchid's Take: ​HALLELUJAH!

CMHIP MEETING

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Orchid's Take:
HALLELUJAH!