Thursday, September 7, 2017

Mental Health Colorado addresses crisis at mental hospital, state needs

Posted By on Thu, Sep 7, 2017 at 12:12 PM

UPDATE: DHS, which oversees CMHIP, literally on-boarded a new spokesperson the day we posted this blog. Nourie Boraie, formerly with the Senate Republicans' press office, told the Indy on Monday that the "ban on breaks" referenced in the Chieftain article linked below lasted just a day. "Obviously it's a difficult situation but our goal is to prioritize staff recruitment and retention," she says. "We're definitely working hard to make sure things move forward in positive light." Five representatives from DHS were present at the Mental Health Colorado meeting.

——-ORIGINAL POST: 12:12 p.m. THURS., SEPT. 7, 2017———-
The Colorado Mental Health Institute in Pueblo (CMHIP) treats pretty challenging patients — some referred from community health centers and some referred from the court system (if they're found "not guilty by reason of insanity" or their competency to stand trial is questioned, as in the case of Robert Dear Jr., the admitted Planned Parenthood shooter, who's currently committed to CMHIP). But the 449-bed, state-run hospital needs some help of its own.
CMHIP's campus. - COLORADO.GOV
  • Colorado.gov
  • CMHIP's campus.

The Pueblo Chieftain's Peter Roper has been following this protracted story that took a dire turn earlier this summer when state inspectors found that CMHIP was short about a hundred staffers, with about half of those being open nursing positions. That nearly caused the hospital to lose Medicare funding, which accounts for about 13 percent of its overall budget. (The specter of getting shut out of federal insurance is what closed a 20-bed addiction treatment program around that time.) To prevent further cuts, the Department of Human Services (DHS), which oversees the hospital, came up with a personnel plan to show the federal Centers for Medicare and Medicaid Services (CMMS) a good faith effort to address the staffing crisis that's been known and documented for years now.

The plan immediately instituted mandatory overtime, a freeze on employee leave and, until the hospital rescinded it under pressure, a ban on breaks. An employees' union has spoken out against working conditions they call "punitive" and "intentionally hostile." Needless to say, new recruits aren't exactly flocking to join their ranks.

All this prompted Mental Health Colorado, a nonprofit that works to "promote early intervention, expand access to affordable services, and eradicate stigma and discrimination," to convene stakeholders to brainstorm solutions not only for CMHIP, but also for the shortage in mental health professionals overall.

click to enlarge Mental Health Colorado President and CEO, Andrew Romanoff. - FILE PHOTO
  • File photo
  • Mental Health Colorado President and CEO, Andrew Romanoff.
President and CEO of Mental Health Colorado, Andrew Romanoff, tells the Indy that attendees acknowledged that CMHIP is in a "vicious cycle" where the staffing shortage has increased the burden on existing staff, which drives up turnover, making it a less attractive place to work — thereby perpetuating the staffing shortage. "We discussed not just recruitment but retention," he says. "How do we improve conditions, reduce their case load and increase pride in the profession?"

Himself a former state lawmaker specializing in health policy, Romanoff disclosed a few proposals that surfaced during the Sept. 5 meeting: loan forgiveness for professionals who commit to putting their degree to work in underserved areas; financial incentives to work with the toughest patients, not the easiest (as is currently the case); and paying health care professionals and social workers better overall.

"Unless you're really bad at math, nobody goes into this field to get rich," says Romanoff, who grew up with social worker for a mother and a prosecutor for a father. "But we want [workers] to make enough to support a family and maybe even buy a house."

"Nobody's under any illusions that the state is overflowing with dollars dedicated to any particular solutions here," he continued, adding that Tuesday's conversation touched on the potential for state/federal matching grants, employer-funded scholarships and public-private partnerships as potential financiers.

"We're also looking at ways to save money, and make care more efficient," Romanoff says. For example, the state will cover the cost of detox, no matter how often a patient needs it, but won't cover actual substance abuse treatment. "We're paying to treat the symptoms but not the underlying disorder [which] is penny-wise but pound-foolish," he says, hinting that legislation to make in-patient care for substance abuse a Medicaid benefit could surface in the next session.  

Personnel issues in the mental health field are, of course, not unique to Pueblo or even Colorado. They're nationwide.

"More people are seeking mental health care, and with that increase in demand, supply hasn't followed," Romanoff says. It's not that mental illness has become more common, though, it's that access to care expanded — in part because people are more comfortable seeking care now that society is beginning to address stigma and in part because mental health care is now defined as an essential benefit under the Affordable Care Act.

Expansive and complex though the issue may be, CMHIP is pursuing immediate fixes like training correctional officers to supervise patients, asking for paramedics to step in and holding hiring fairs.

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