In November, Colorado voters will have a chance to raise the tax on cigarettes by $1.75 per pack.
Initiative 143, which would also raise taxes on other nicotine products by 22 percent, is projected to bring in about $315 million in its first year, money that would flow to smoking cessation programs, campaigns to keep kids from lighting up, and research into the variety of diseases that nicotine causes. It also would be one of the largest funding sources in recent memory for mental health programs.
A portion of the tax is dedicated to veteran programs, including help for post-traumatic stress disorder and other mental illnesses, while another portion is set aside for children's mental health care, including adding prevention, early intervention and treatment programs.
Andrew Romanoff, president and CEO of Mental Health Colorado, says he's excited about the tens of millions that could flow to those programs, particularly dollars for mental health care in schools. The former Colorado Speaker of the House explains that half of mental illnesses show symptoms by age 14, while three-fourths show symptoms by 24. But for young people, he says there's an average gap of eight to 10 years between when mental health symptoms first appear and when the illness is actually treated. If treatment is offered in schools, rather than at an outside clinic, he says kids are far more likely to get treatment.
But Romanoff says that getting Initiative 143 passed is just one challenge for mental health advocates, who see flaws throughout the system, whether it's identifying mental illness, keeping the mentally ill out of jails or helping those with the most severe diseases live healthy lives.
Mental Health Colorado is in the midst of its "Conversation with Colorado," eight public meetings across the state on mental health care.
More than 350 people have filled out a survey at the first six of those meetings, including 55 people from Colorado Springs. While not representative samples, the surveys are startling. Only 4 percent statewide say they are very satisfied with mental health services in their community, and in the Springs it's only 2 percent. Likewise, 57 percent statewide are "not satisfied" with services available, while 72 percent say that in Colorado Springs.
The survey found that the biggest barriers to getting mental health care are cost and difficulty getting an appointment. But stigma also played a role: Forty-nine percent are concerned about what might happen should someone find out they have a mental illness.
"It carries a scarlet letter," Romanoff says of mental illness, "and we've got to figure out a way to combat that."
Meanwhile, the survey shows the highest barriers to kids getting mental health care are that their symptoms are not identified (70 percent) or their parents don't know where to go (75 percent).
And remember, these are people who showed up to a meeting on mental health.
On a larger scale, the state's 2015 Colorado Health Access Survey found that 9 percent of Coloradans say they needed mental health care but did not get it, compared with 7.8 percent in 2013, although fewer people said they didn't seek care because of cost concerns (75.6 percent in 2013 compared to 57.3 percent in 2015). Difficulty securing an appointment and the stigma associated with mental illness were growing concerns.
On the bright side, a 2015 National Alliance on Mental Illness report noted that Colorado is one of 11 states that increased funding for mental health care in 2013, 2014 and 2015. Of note:
• According to Mental Health Colorado, the Legislature passed bills in the last session that directed nearly $13.5 million in additional dollars for such needs as adding county child welfare workers, increasing early intervention, adding mental health specialists for kids and boosting programs and intervention teams.
• In 2014, Gov. John Hickenlooper announced a statewide initiative, Colorado Crisis Services, which was given a $25 million annual budget. The new program offers mental health crisis stabilization centers (sort of ERs for mental health) that are always open, scattered throughout the state, including Colorado Springs. The program also has mobile units, a crisis hotline and respite services (tinyurl.com/AP-mental-health).
• Also in 2014, Medicaid expanded to cover anyone in the state who made approximately 138 percent of the federal poverty level or less.
Since Medicaid covers mental health care, that led to a scramble. Charlton Clarke, director of health care services at AspenPointe, which treats outpatient mental health patients in Colorado Springs, says that, "initially, when Medicaid expanded, there was sort of a big wave of people who now had care, or had the ability to get health care, and it was a bit of a crush in the beginning."
He adds, "We had to work really hard to make sure that they got seen."
To put the change in perspective, numbers from the Colorado Department of Health Care Policy and Financing show that in December 2013, just before Medicaid was expanded in Colorado, 772,954 Coloradans were on Medicaid. But in the 2015-16 fiscal year (July 1 to June 30) the year-to-date average of Medicaid patients at the end of July was 1,327,920. Of those, 442,530 were people who would not have qualified for Medicaid before the 2014 expansion.
In general, however, the more care you need, the harder it is to get in Colorado. Inpatient beds are in high demand, and group homes and supportive care can be difficult to access.
In many areas, a mentally ill person in crisis is brought to a jail instead of a hospital because there's nowhere else to take them. Romanoff says that Colorado could just as easily spend money to expand mental health facilities rather than house the ill in jails.
"It's a choice," he says. "This is not a law of nature; it's not a divine commandment."
In June, Hickenlooper vetoed Senate Bill 169, which would have expanded the ability of police to hold people with mental health issues. In his veto, Hickenlooper called the bill "well-intentioned," but was concerned that it infringed on the rights of mentally ill people. The governor directed the Department of Human Services to form a task force and report back to him on how to end the practice of holding mentally ill people in jails when they have committed no crimes.
The situation could already be improving slightly in the Springs. While neither Cedar Springs Hospital nor Peak View Behavioral Health — which offer inpatient mental health treatment locally — responded to calls from the Independent, Peak View recently announced plans to open a new 20-bed unit for youth ages 9 to 17 in September. It will also host a grand opening for a new 8,000-square-foot outpatient building in November.
Romanoff, meanwhile, says it can be even more difficult to get someone with a mental illness into supported long-term care (including home care options and group homes, for instance). He says to get such services, most people must first apply for and receive Social Security benefits for their disability — initial applications are routinely refused — and then apply for a housing program.
While the government has several housing programs for those who know where to look, most people go through Medicaid waiver programs, which can be difficult to access.
Marc Williams, spokesperson for the Colorado Department of Health Care Policy and Financing, said he believed that waiver programs' stringent requirements, limited funding and limited facilities (such as group homes) were all barriers. At times, he said, the programs have had long wait lists.
"Unfortunately, he says, "those types of resources are finite."