Larimer County takes lead in mental health treatment

By Cherry Sokoloski
North Forty News

Throughout Colorado, people are looking to Larimer County for new, innovative ideas. The issue: effective diagnosis and treatment of mental illness and substance abuse. Led by the Health District of Northern Larimer County, community leaders from many areas have joined together to address these concerns, and the ideas they have developed are now models for other counties in the state.

"Our community is out in front with this work," said Richard Cox of the health district.

The project, called the Community Mental Health and Substance Abuse Partnership, is now in its fifth year. It is a collaboration of more than 30 agencies, all facing tight budgets and increased demands for services. The group already has some programs up and running, while others are still on the drawing board. Two innovative programs are slated to begin early in 2005.

The goal of the community partnership, said project manager Erin Hall, is to "not let people fall through the cracks" when it comes to mental health and substance abuse services. She makes the case this way: It's much less expensive to treat mental health issues up front than to wait until they reach a crisis stage. Partners are developing ways to make these services easier to access, and they are improving the coordination among agencies that deal with mental health and substance abuse issues. An end result, Hall said, will be improved efficiency and reduced costs.

Mental health and substance abuse are not small problems in the community. In fact, a 2002 health district study found that substance abuse and mental illness combined constitute the highest health burden in Larimer County, more serious than cardiovascular conditions and cancers. The partners, from law enforcement to educators, see the effects of untreated mental health issues in their everyday work, Hall noted.

Important players in the project include Poudre Valley Hospital, Larimer Center for Mental Health, Island Grove Regional Treatment Center, Larimer County Health and Human Services, the Larimer County Sheriff's Department and District Attorney's office, Colorado State University and Poudre School District. The fact that many of the partners are not mental health providers "speaks to the broad impact of mental health and substance abuse issues," said Hall. She added that problems in these areas have escalated dramatically in the past few years because of tough economic times.

An important message that the group is trying to get across is that treatments for mental illness and substance abuse really do work. For mental health issues, Hall said, treatment with therapy and medication are effective at least 60 percent of the time.

A special target group for the project includes low-income people and those with no health insurance, but the project is aimed at reaching all Larimer County residents in need of services, Hall said.

Motivator: no money

A big motivator behind formation of the partnership was money, or the lack of it. With the state's current fiscal crisis, funds to local mental health centers have been drastically cut in recent years. Randy Ratliff, executive director of the Larimer Center for Mental Health, said that between 2002 and 2004, state cuts to the center totaled $970,000. As a result, the center had to cut 700 patients from its rolls to balance the budget. In the current fiscal year, legislators restored $55,000 to LCMH, but Ratliff anticipates more cuts ahead.

"Mental health and substance abuse services are massively underfunded in Colorado," Hall said.

It became clear to the partners that they had to make the most efficient use of the few dollars available, since the situation may not improve for some time. The value in changing the approach can be illustrated by two local poster people for the new program, "Joe" and "Susan."

Joe's story reveals how the system used to work. A 45-year-old man with mental health and substance abuse problems, he was treated by eight different agencies, from Hope Center to Mountain Crest to the Larimer County Detention Center, with very little coordination among any of them. When the agencies totaled up their costs for treating Joe, the sum was a whopping $250,000.

The story of "Susan" is dramatically different. A single mother, she struggled with severe depression. However, she was connected with the Larimer Center for Mental Health, and after two and one-half years of outpatient therapy and medication she got a job, enrolled at a community college and became a more effective parent. Total cost of her treatment: only $760. By comparison, if her condition had reached a crisis stage, three days at Mountain Crest would have cost $4,635.

The new Larimer County approach, Hall emphasized, is all about "improving lives and saving lives." She pointed out that untreated mental illness and substance abuse have multiple indirect costs, to the individual and society. Many people land in jail for petty offenses, while others end up in hospital emergency rooms when their conditions hit a crisis level. Some become homeless when they can't function in society, and others commit suicide to escape the overwhelming pain of depression. Suicide, Hall said, is "the ultimate cost our society pays" when mental health issues go untreated. The economy suffers, too, Hall added, since these issues affect productivity.

Hall is convinced that the new programs will save both lives and dollars. With early intervention, costs should go down in primary care, emergency services and intensive treatment facilities. In addition, society will benefit when people are able to function better, go back to work and pay taxes.

Programs in place

The work of the partnership is beginning to bear fruit. There's a referral service called Connections, in place since 2002, which points people to appropriate services when they are struggling with issues such as depression, anxiety, bipolar disorder or substance addiction. Also, gatekeepers, or people in a position to deal with mental health issues early on, are being trained in how to identify them and refer people to the services they need. Gatekeepers include school personnel, health and human services staff and law enforcement officers.

Early next year, two more groundbreaking programs are set to begin. At Poudre Valley Hospital, an emergency assessment center will be in place. Mental health professionals at the center will be able to provide immediate placement of patients at appropriate treatment centers or agencies, rather than sending them away with suggestions or referrals.

In addition, a program called "integrated care" will begin at two local clinics that serve low-income and underinsured patients, Salud Family Health Center and the Family Medicine Center. Through this program, mental health professionals will rotate between the two clinics, providing easy access to counseling and prescriptions for patients with mental health/substance abuse issues.

Funding for the partnership project comes from the health district, voluntary contributions from the principal partners and a $361,000 grant from the Robert Wood Johnson Foundation.

For information on how to access affordable mental health and substance abuse services, contact Connections at 970-221-5551. This office provides information, referral, care coordination and consumer advocacy.

Next month, the North Forty News will take a closer look at one of the new mental health/substance abuse approaches called integrated care.