Report: 2017-2018 Mental Health Ballot Measures in Colorado Counties

Posted January 12, 2021

Executive Summary

Mental Health Colorado sought to better understand the stories behind 2017 and 2018 local ballot
measures that provide funding for mental health services in five Colorado counties. We collected
information from publicly available documents and spoke with key informants from the counties, all of
whom play leadership roles in the passing, implementation, or sustainability of their respective ballot
measures. This was an effort to hear more about the work being done, what successes and challenges
were experienced, what further work is in the planning stages, and how we can be better advocacy
partners. We analyzed interview transcripts and reviewed public information to create profiles for each
community. Key informants graciously provided feedback and reviewed their respective county’s profile
before drafts were finalized. We are incredibly grateful to all the individuals who participated in our
research and for their efforts to advance mental health services available within their communities.

View the full report


Successful ballot measure passage and implementation occurred when the communities utilized
collaborative outreach and community engagement. These efforts helped create buy-in throughout each
county, which extended beyond voting into implementation and the continued involvement of
stakeholders. Because these were local efforts, decision-makers were well informed regarding specific
needs and gaps within their communities and had control over where to distribute funds. Counties
employed polling, continuous needs assessments, and community meetings or focus groups to set
priorities and ensure their work continued to fill the gaps identified by the residents themselves.
Ballot language was incredibly important, both for measure passage and implementation, as it needed to
be specific enough to be inclusive of all communities within a county, name the mental health needs that
would be addressed, and prioritize mental health services. These elements were necessary in setting up a
transparent roadmap for the work. However, having some flexibility allowed counties to address
emergency services required to respond to the COVID-19 pandemic and other emerging needs.

Needs and Challenges

Several informants discussed the challenge of working with complex and unbalanced funding streams
from the state. One of the largest remaining needs addressed by multiple county leaders included
developing services related to substance use conditions and crisis response, including detoxification
services. Additional needs were found within the criminal justice sector in providing jail-based services or
finding alternatives to jails through co-responder or peer crisis response.

Some key informants also discussed how the state could be a better advocacy partner by implementing
recommendations from the Behavioral Health Task Force as soon as possible; fixing complex funding
streams and addressing high-administrative costs, mainly at the state-level; collaborating more with local
communities so that they may have more input on where state funding is allocated; changing licensure
regulations so that wrap-around services can be available in one facility; and addressing unequitable and
unbalanced funding, as well as making resources available for different communities.

Overall Recommendations

  • Begin voter and stakeholder engagement early and maintain it throughout the development of
    the proposed ballot measure.
  • Inform the planning process with up-to-date county needs assessment.
  • Inform the planning process by learning from other counties that have passed similar measures.
  • Be transparent regarding the costs associated with closing gaps in services.
  • Be very attentive to language in crafting the measure.
  • Include specific references to communities, large and small, within the county in the measure
    language to signal plainly that funds generated will be distributed inclusively.
  • Include an advisory board that will be responsible for allocating funding and tracking
  • Provide regular progress reports to the community to keep them engaged and to keep mental
    health as a shared concern.
  • Be prepared to change direction and to modify initiatives based on performance—be accountable
    and plan for continuous learning and adaptation.

Mental Health Colorado would like to thank the key informants for their participation in this effort. We are
encouraged by the work local counties are doing to support the mental health of their communities, and
plan to continue to be advocates for work such as this throughout the state.

View the full report

Thank you to The Colorado Health Access Fund for their partnership and support