A safety net with really really big holes
CO state mental health system is charging more and failing to protect the most vulnerable patients, your Friday long read from the Colorado News Collaborative
We go to Colorado News Collaborative for this week's long read by Susan Greene, read the whole article “State Mental Health Safety Net is ‘Failing’ Coloradans.” We include key excerpts below to convince you it’s worth your time!
Cycling through a system that never catches them
The voices in Vinnola’s head whisper and yell. They can be so loud, so constant, he figures everyone can hear them. Chronic paranoid schizophrenia and an addiction to shooting up whatever he can find to still the voices have landed the 29-year-old Denverite in emergency rooms, psychiatric wards and jails so many times that his mother stopped counting.
Crisis after crisis, Janet van der Laak had to push the Mental Health Center of Denver to provide care for her son instead of finding reasons to deny it. Each time the center dropped him from treatment, Vinnola lost more faith in seeking help. And the more faith he lost, the harder his mother pressed because he was free falling and she alone could not catch him.
“What kind of safety-net system blows off the hardest cases?” van der Laak once wrote in a note to herself. “Giving up on Matt, giving up on anyone in crisis should not be an option.”
As part of our ongoing “On Edge” coverage of mental health statewide, the Colorado News Collaborative has spent six months investigating a state behavioral health system that turns away some of the most vulnerable and at-risk Coloradans in crisis, with no recourse from state officials. We zeroed in on the 17 community mental health centers that are paid more than $437 million a year in tax dollars to serve as the core of Colorado’s safety net.
We learned that Colorado, the state with the nation’s highest rate of adult mental illness and lowest access to care, has been giving those centers non-compete contracts and a privileged rate status for nearly 60 years, without meaningful oversight.
Our investigation shows that the centers – most now facing workforce shortages – collectively have treated fewer clients during the pandemic than before it, despite skyrocketing mental health needs. At the same time, more than half the centers have been sitting on liquid reserves of $10 million or more. Denver’s center kept more than $40 million in liquid reserves while its clients faced record-long wait times for care.
COLab also found that, starting long before the pandemic:
The state’s payment system inadvertently created a financial incentive for the centers to take on fewer ill people and charge higher costs, while also protecting them from competition.
The centers have been charging taxpayers up to 17 times more than independent Medicaid providers for the same services, but with little transparency about the expenses those rates are based on.
Several centers, including those in communities with sizable immigrant populations, have had no Spanish-speaking care providers.
And some centers have been paid for programs they’ve not provided, with no pushback from the state agencies funding – and charged with regulating – them.
Before it sought and received lawmakers’ approval to create the new department, the state Behavioral Health Task Force heard more than 200 Coloradans statewide testify about the mental health reforms they want – and desperately need – from state government.
Matt Vinnola’s mom was one of them.
Her son was in jail at the time in 2019, awaiting a competency evaluation after having been involuntarily hospitalized eight times in a year. The Denver car saleswoman had come, she said, as “Matt’s mom, advocate and voice.”
Janet Van der Laak wanted to know why she could make a routine doctor’s appointment for her husband, but not an appointment at Mental Health Center of Denver for her adult son who is delusional, unable to remember his birthday or home address, and so sick he doesn’t always know he is sick.
She wanted to know what families like hers are supposed to do when the centers drop their loved ones from treatment.
She wanted to know what the centers are doing with hundreds of millions of tax dollars if not treating severely sick people like her son.
“MHCD dropped him… How do you drop someone who’s gravely disabled? How do you deny someone services like that?” van der Laak asked the task force. “We’re leaving out a huge, vulnerable population that we’re not treating.”
The Mental Health Center of Denver’s Clark says privacy laws keep him from discussing Vinnola’s case. “Could things have been dropped? It’s possible for them to have been dropped,” he says, adding that if a client is not seeking care for himself, the center “need(s) to focus on someone who wants treatment.”
Read the whole article here.
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