During an ongoing mental health crisis, without easily accessible long-term care, many Coloradans with serious mental illness (SMI) end up cycling in and out of emergency departments and jails. A new bill aims to create more options by adding treatment beds at a state hospital as well as in smaller community facilities.
Sarah Morales and her family, who live in Fort Collins, have experienced this bed shortage firsthand. She describes one of her sons as having been a good high school student and an outstanding soccer player before experiencing his first psychotic break at age 16. Morales has been tracking his hospitalizations ever since.
“I keep a spreadsheet,” Morales said. “It's like going on over 40 times. They've all been involuntary because part of his illness is that he doesn't realize that he's sick.”
An involuntary mental health hold, also called an M1 hold, generally puts an individual in the hospital for up to 72 hours. The goal is stabilization; Morales points out that this is nowhere near long enough to treat someone like her son, who has schizophrenia and bipolar disorder. He struggles with paranoia and tactile hallucinations, meaning he feels sensations on his skin or inside his body.
“So he's in a lot of pain, and he also has a dual diagnosis, which means he has started using substance,” Morales said. “And I think that is to try to help with the pain and self-medicate.”
Sometimes families, including Morales’, call their local co-responder team to help get their loved one to the hospital. These units, which respond to mental health calls for service, are generally housed within police departments and sheriff’s offices. Cheryl Jacobs, a deputy with the Larimer County Sheriff’s Office, created her county’s program a few years ago.
“I would much rather take somebody on their own accord rather than against their will and then we're always going for the lowest level of care,” Jacobs said. “If it's somebody who is truly in crisis and needs an M1 hold then you are going to put them in protective custody and take them to the closest ER.”
Jacobs says that about a quarter of their contacts are people they see multiple times a month. Oftentimes, their contacts who have SMI are not getting stabilized long-term.
“There's going to be people that aren't able to care for themselves and live in the community and just need a long-term, higher level of care,” Jacobs said.
For Morales, all of the incidents involving her son blend together, but she describes a recent situation — she had found him at a soup kitchen in Loveland, after he had been missing for a few days.
“He was just really in a bad place. Hadn't probably changed clothes in days,” she said.
While Morales was calling for help, someone spotted him, running with his pants down. Soon after, the police arrived and took him to jail. At that time, her son was on the waitlist to get into the Colorado Mental Health Institute at Fort Logan, one of two state-run psychiatric hospitals in Colorado. Soon after the incident, he was put on the list for the other one in Pueblo, which is for people involved in the criminal justice system. Morales says her son had to wait for many months to get in.
“There just aren’t enough beds. So it’s like he’s constantly being hospitalized for a day or two,” Morales said. “It just requires a lot more intensive treatment.”
A legislative fix
Many families, advocates, law enforcement officers and lawmakers who interact with the behavioral health system describe it as broken. One of the key pieces is a shortage of treatment beds where people can go for longer-term support like therapy, medication and case management. Colorado falls far below the recommended number of beds for its population, according to the Treatment Advocacy Center, a national nonprofit.
A new bill, HB-1303, aims to address that shortage by adding 16 beds to Fort Logan and another 125 to small community treatment facilities.
“It’s a good start. There certainly is more that needs to be done,” said Perry May, the deputy executive director of health facilities with the Colorado Department of Human Services.
The 125 community beds would offer a lower level of care than hospitalization. For someone in crisis, these spots could be an alternative to going to the emergency department. For someone being discharged from the state hospital, these beds could be a place to go before going home. Proponents of the bill say the extra beds could also free up space in state hospitals, as some of those patients move into the community beds.
“This really is a level of care that hasn't existed in Colorado per se. A missing level of care,” May said.
HB-1303 is part of a larger package of behavioral health bills that would initially be funded through coronavirus stimulus dollars that Gov. Jared Polis and state lawmakers put aside last year. A task force was formed to figure out how to spend the $450 million. Increasing bed capacity was one of its recommendations.
Patrice Marqui’s 44-year-old son, who was diagnosed with schizophrenia decades ago, was put in jail after getting into an altercation with his neighbor in October of 2020. After being found incompetent to stand trial, he was released back into the community instead of to the state hospital and ended up his mother’s house in Loveland.
“Basically I was running a behavioral health hospital out of my home, giving him his meds, making sure he was sleeping, all those kinds of things,” Marqui said. “And that lasted about one week when he thought there was somebody in our house with a knife. And he became very aggressive and frightened, and he attacked me. I had a few stitches, but I think I was more upset with the system.”
Various statistics suggest that the scale of this problem is significant. Around 50,000 involuntary mental health holds were issued in Colorado in 2019. At the jail in Larimer County, around 40% of people in custody have an SMI. Out of the millions of Americans with an SMI, around 60% got treatment or took medication in 2020, according to data from the federal government.
“I'm the type of person that thinks really very few things should be funded by the government, but this is something that should be funded by the government,” said Rep. Shane Sandridge, a Republican from El Paso County and one of the bill sponsors.
During its first committee hearing in March, one lawmaker did vote against the bill. In an email, Rep. Rod Pelton wrote that it was because of cost, not cause. The details of the ongoing costs to the state are still being worked out.
‘I can’t just give up on my child’
Despite the bed shortage, Sarah Morales and her son have had some positive experiences with treatment. She says he has been stable over the years, following a few months-long stays in state hospitals.
“So when he's stable, he loves music and he loves soccer… He does love cigarettes which is not my favorite thing because I’m in health care,” Morales said. “But I've kind of gotten over it.”
Morales says he’s doing okay thanks to a variety of services in Larimer County. He’s living in Fort Collins at a community facility for people struggling with both substance abuse and mental health. There, he gets help managing his medications and finding long-term housing.
“I mean, I think with enough support, he can be stable enough,” she said.
This has been Patrice Marqui’s experience as well. Since attacking her, her son has gotten connected with several local programs in Larimer County, including permanent supportive housing and the competency docket, which is a program to help individuals get restored to competency in the community by connecting them with the right services, like rides to court dates and access to therapy.
Competency court itself takes place once a week and includes case workers and behavioral health professionals, in addition to the judge and the lawyers.
“It's like I got my son back for a while when he was on his meds religiously, and it was so wonderful to see my son that I hadn't really known for 20 years because he was so sick,” Marqui said.
Dr. Jasjot Johar, an emergency physician and medical director at Banner McKee Medical Center in Loveland, points out that the needs of individuals who come to the hospital in crisis vary widely; long-term hospital stays are not always the answer.
“There was a day, honestly, before any of our generation where a lot of people with serious mental illness were just institutionalized,” Johar said. “We obviously got away with that and it goes to try to integrate people into society and live a much more functional life.”
When these patients are discharged, Johar says their team has generally found a safe next step — sometimes that means outpatient counseling, sometimes that means inpatient psychiatric care. Patients are transferred out of Northern Colorado, if necessary, to a handful of behavioral health facilities in Denver or Colorado Springs.
“How long is the right time for someone to be hospitalized? Did they only need three days to get stabilized and back on medications? Did they need a week? Do they need two weeks? I think that's variable by everybody,” Johar said. “I totally empathize with the families who see their loved ones kind of cycling.”
Morales has made a real effort to talk about her experience in recent years, advocating at the Capitol, joining support groups.
“I'm trying to remain hopeful and optimistic, I guess, in terms of the future,’ Morales said. “And so I'm always thinking like, maybe there's going to be a treatment, maybe they're going to come up with the right medication. You know, I have to as a mom, I can't just give up on my child.”
If the legislation gets signed into law, more space for patients could be ready early next year, according to the Colorado Department of Human Services.
