Almost a quarter of the residents of Routt and Moffat counties use the local community health center, which is why it has tried to incorporate mental health screenings for anyone who comes in for a checkup — or even a toothache.
Northwest Colorado Health, with offices in Steamboat Springs and Craig, began integrating mental health care a decade ago, trying to catch early signs of depression and send patients to therapy appointments, either on site or to the region’s community mental health center. It added mental health screenings to dental appointments in 2017.
Yet, like many of Colorado’s 20 community health centers spread statewide, Northwest can’t hire enough counselors and social workers to keep a full staff and is constantly scrambling to keep up with its behavioral health goals. Patients who can’t get an in-person appointment are linked via telehealth to a therapist who doesn’t live in northwest Colorado.
“The asterisk is that when we are fully staffed, we are fully integrated,” said Stephanie Einfeld, CEO of Northwest Colorado Health. “That’s truly been a big barrier of ours.”
Colorado has been talking about true integration of mental and physical health care for years, if not decades, in what many experts see as the key to addressing the state’s suicide and mental health crisis. Now, an influx of federal coronavirus relief funds will supercharge the work.
One piece of legislation passed by Colorado lawmakers this year provides $35 million for community health centers, doctors’ offices and clinics to add mental health offerings — whether they’re starting from none or have ambitious plans to ramp up services. Another new law designates $11 million to add more mental health care to school-based health clinics and pediatricians’ offices. Two other bills focus on recruitment and retention of therapists, psychologists and substance abuse counselors.
“We will never see this kind of funding again,” said Sen. Sonya Jaquez Lewis, who was a prime sponsor of House Bill 1302 that put $35 million into “whole-person care.”
What many clinics need are technology boosts to improve telehealth options, as well as funding to hire more therapists, she said. Colorado lost too many behavioral health providers to retirement and burnout in recent years, and then the coronavirus pandemic sent rates of depression and anxiety to new heights. “It’s always a balancing act with whole-person care, that you have to have the providers accessible and on hand,” said the senator, a Boulder Democrat and a pharmacist.
Clinics can apply for the grant dollars to expand hours to offer night and weekend behavioral health care for working parents who are struggling. They could use it to put employees through advanced training so they can screen for mental health issues or provide therapy.
Under a companion bill aimed at increasing the workforce, community colleges can seek funds to expand night and weekend programs for health care workers who want to go into mental health or advance their careers but don’t want to leave their jobs. Also included: funding to expand a program in which robots are dispatched to remote parts of the state to teach health care professionals how to perform certain procedures. In the training courses, the robot is the patient.
In the next five years or so, Jaquez Lewis envisions that colleges will offer free tuition to those interested in working in health care and mental health. And patients — no matter where they go for health care — will get preventative behavioral health care without hardly noticing.
“It’s done so seamlessly as part of the regular questions that the patient doesn’t even know what’s going on,” the senator said. “It’s not like, ‘Now we are going to screen you to see if you have mental health issues.’”
“We’re trying to finally gear things for reality.”
The $35 million bill is a continuation of a now-dead federal grant program, called the state innovation model. Under the program, from 2015-19, 344 primary care practices received funding to integrate mental health care. A federal evaluation showed the program resulted in fewer behavioral health-related visits to hospital emergency departments, but then the funds stopped.
The efforts to better incorporate mental health care into medical offices come at the same time Colorado is attempting to revamp the state’s community mental health system, which includes 17 centers across the state. New rules will open the centers, which have operated under no-bid contracts to take care of patients with Medicaid or no insurance, up to competition — including potentially from some of the state’s 20 community health clinics that offer medical and dental care.
Community health clinics, ranging from Tepeyac and STRIDE centers in the Denver metro area to Uncompahgre Medical Center in Norwood, began offering mental health care as far back as 2006 or 2007, according to the Colorado Community Health Network. But those services have expanded to the point that today, the centers often have a mental health professional sit in on medical appointments or, at the least, have a medical employee ask screening questions about whether a person feels depressed or has thoughts of wanting to die.
The reason community health centers must incorporate mental health care is that 1 in 7 Coloradans get primary care from a local community clinic, said Taylor Miranda Thompson, the senior quality initiatives manager for the network. That’s 847,000 patients at 230 clinics in 45 of Colorado’s 64 counties.
“The focus for health centers is prevention, and that can mean identifying a patient with depression symptoms … or chronic stress or difficulty sleeping, or even screening for thoughts of suicide,” she said.
Each of the 20 community health centers in Colorado connects with its local mental health center to hand off patients who have more severe mental health issues.
Across the board, the centers need more staff and funding for technology upgrades. When the pandemic hit, many quickly transitioned to telehealth. Now that the sense of urgency has decreased, and there is funding available, health centers are looking to upgrade their platforms, said Stephanie Brooks, the community health network’s policy director.
And in rural areas, health centers are hoping that legislative reforms bring better broadband services so that patients will have more reliable video connections during virtual appointments, she said.
“The health centers all have some very quickly set up telehealth platform, but because they had to set it up so quickly, they have more to do,” Brooks said. “You can do it fast, cheap or really good. I think they’re working on making it really good.”