On Our Minds Archives

Shale Wong, MD

The message is clear: mental health and substance use challenges for Coloradans of all ages are worsening. We’re struggling to respond with compassion and care. Our systems are strained and broken. Our workforce is limited, maldistributed, exhausted, and despite a deep desire to help it is not meeting the needs of Coloradans on the whole or for specific groups or cultures. Patients are waiting to seek help, to find help, and to be helped by a system of comprehensive, coordinated care with solutions to alleviate stressors and provide treatment.  

Several articles have recently pointed to the deficiencies of Colorado’s mental health system, including insufficiencies of workforce and structures plagued with fragmentation so extreme that they do not represent a system at all. How can this be? Colorado has strengths and vision for behavioral health that other states don’t even imagine. We have programs, practices and policies at local, county and state levels that have great potential to help serve our mental health needs. 

So why the failure that so many individuals face? Our current approaches are failing because they are fragmented, rather than integrated coherently with capacity to care for people. Our needs are too great to be met by piecemeal solutions.  A high-performing behavioral health system must weave together mental health, public health, primary care, and community assets into a whole, new, integrated system. This is the time to leap forward, not patch together fragmented pieces that are not working for so many people.

In Colorado, this is imminently doable.

The strengths and assets of Colorado’s behavioral health system are present and should be both recognized and accountable. Critical pieces of a transformational system exist if we invest, expand, and bring agencies and services together with greater alignment and cohesion. The first, often overlooked asset, is primary care that fully integrates behavioral health services. Most mental health services are provided in primary care offices. People seek help first from a trusted provider where they are already receiving care and can get a timely appointment. Addressing mental and physical health together is beneficial to individuals and families. Colorado developed this approach with support of tens of millions of dollars through our state innovation model. We have proven that this setting and source of care is ready for expansion with attention to payment reform, facilitating practice transformation, and supporting the pipeline of an integrated workforce. Focusing on prevention, early intervention, stress alleviation, and resiliency; primary care behavioral health can offer universal access to first-line care and prevent more severe behavioral health problems.  

People with more intense behavioral health concerns requiring longer-term care deserve specialized mental health settings positioned to address high intensity needs. Community mental health centers play this critical role. Emergency departments and hospitals are necessary for crisis care to ensure safety.  Care coordination is beneficial to help navigate care. Redistributing workforce to meet people where they are with the appropriate level of care will improve access, ensure engagement, and treatment that matches the need.

This requires a coordinated community approach to fully connect and develop assets across public health, social services, education, primary care and behavioral health. Community leaders throughout the state are already collaborating, but success takes more than vision and cooperation. Community-driven collaborative and integrated services require the building of a shared data infrastructure and human capacity to create connectivity and reliable paths to services. Statewide systemic change requires more than leadership. It demands dollars and resources to establish a better way. 

The urgency to redesign and implement a system that works for all Coloradans is upon us. The pandemic has wreaked havoc on the mental health of our nation and people of all ages. With that damage, there are now relief funds flowing into the state, including $400 million dedicated to supporting behavioral health relief. Funding is dedicated to coordinating care. Funding is committed to addressing opioid and substance use disorders. Leadership from our highest governing offices to grassroots community navigators are taking responsibility to work together. However, if we follow traditional methods for allocating and distributing these dollars, we run the risk of battling for siloed support, enabling continued fragmentation, and strengthening separated systems. There is an unacceptable risk that we will do just enough to sustain an insufficient status quo.

At this moment, we have an unprecedented opportunity to do it all better. To create a behavioral health system with greater access, a more diverse workforce, quality service, and reformed financing. To build on and connect our existing strengths. To immediately open doors and accept shared responsibility to expand coordinated and integrated services. To hear the cries of the Coloradans who are waiting for help.  To show up together, ready to serve.