Colorado Course CorrectionsOn October 30 and 31 of 2018, experts and leaders in health, safety, and criminal justice from all over Colorado gathered for the Course Corrections: Steps to Health & Justice Summit. The purpose of this gathering was 1) to acknowledge Colorado’s urgent need for an alternative to incarceration and criminal justice system involvement for people living with mental illness and/or those who may be experiencing a mental health crisis, 2) to build consensus regarding what course corrections are most urgently required, and 3) to provide recommendations for improving health, reducing incarceration, maintaining public safety, and saving taxpayer dollars.
In conclusion, 2018 Course Corrections participants observe and declare the following:
The State of Colorado is in the midst of a public health crisis. Coloradans with mental health needs are too often neglected, stigmatized, or inadequately supported. Failure to address these health needs results in premature death, injury, substance use and addiction, long-term disability, and many other preventable threats to public safety and wellbeing. The arrest, punitive detention, and criminalization of Coloradans with unaddressed health needs gravely exacerbates this crisis, is a wasteful misapplication of resources, and yields poor health and public safety outcomes at tremendous cost to individuals, communities, and the economy at large.
Colorado’s mental health crisis demands an urgent and immediate shift in awareness, and rebalancing of effort and investment across multiple systems which share accountability for necessary improvements. We must apply transparent intelligence, coordinated effort, and resources to addressing health needs cooperatively, preventively, and restoratively, and to supporting healthful human development and successful community integration.
Addressing the chronic and acute mental health needs of those Coloradans who are in crisis today, who are at the point of arrest, and who are being held in jails, prisons, and juvenile detention facilities is critical. These individuals are at heightened risk of physical harm, and extremely vulnerable to poor health and social outcomes, long-term disability, and premature death. Colorado must set and pursue bold yearly goals for steady reductions in arrests and incarceration without sacrificing public safety, and bold five- and ten-year goals for cost-shifting and cost-saving increases in access to supportive housing, employment, health care, and other resources essential for optimizing human outcomes.
Resolving this public health crisis across the lifespan and putting an end to the neglect and punishment of Coloradans with unaddressed health needs, starting with today’s children and today’s incarcerated adults, will make Colorado the strongest, healthiest, most equitable, and most prosperous state in ten years.
To hasten progress toward this end, we urge public and private sector leadership, law enforcement, and all Coloradans to prioritize the following course corrections.
CHILDHOOD AND YOUTH
Supporting mental health awareness and the development of healthy behaviors in early childhood is vital to lifelong wellbeing. It helps ensure future prosperity for individuals and communities. Every dollar
spent on supporting a child’s positive health and education outcomes today saves seven dollars in costs associated with later criminalization and improved earnings potential.
• EXPAND access to mental health awareness education, support, and care for children and families. Set standards and expectations for the inclusion of wellness support services, education, and curricula in all childcare settings.
• UNIVERSALIZE access to quality early childcare and education for all working parents.
• PROVIDE early identification and treatment of trauma and adverse childhood experiences in childcare, pre-school, and health care settings; and require culturally-competent trauma-informed training across the workforce. Youth should have access to education on trauma, as a preventive and supportive method of care.
• FUND comprehensive outreach and support programs targeted at the children of parents who were in foster care themselves, parents with substance use issues, incarcerated parents, and single parents under 25.
Individual access to health care across the lifespan builds community wellbeing. Preventive and supportive health care is more cost-effective and yields better long-term outcomes than waiting until acute, crisis care, or long-term care is needed. While focusing on health and wellness promotion, we must also ensure that affordable and high quality mental, substance use disorder, and physical health services are available to everyone.
• INVEST in training, deploying, and retaining a world-class health care workforce that provides preventive and supportive care for Coloradans’ minds and bodies, as well as youth engagement, education, access to services and resources, and crisis response. Train all clinicians and first responders on mental health, addiction, and trauma needs assessment, and on pathways to support and care.
• INVEST in a fully accessible, high quality, culturally competent, comprehensive, and affordable continuum of health care for all people, including those with mental health needs, substance use disorders, and people with disabilities. Quality care must range from preventive and low acuity outpatient care, to crisis care, to high-need, long-term, and inpatient care.
• INCENTIVIZE brain, behavior, and trauma research.
• ENHANCE the capacity and capabilities of crisis response and crisis stabilization centers to support health, safety, and freedom for all, including those with mental health needs, substance use disorders, and people with disabilities. Include access to peer support specialists. Continuously assess and improve current crisis systems.
• UNIVERSALIZE home visiting nursing programs to households after all births, to screen for family and child needs, and to connect with follow-up services for identified needs.
• FUND a world-class addiction, pain management, and mental health treatment system, similar to our oncology system, with standards, evidence-based treatment, well-trained experts and peer support specialists, medication assisted treatment, and adequate provision of all levels of care.
• STANDARDIZE the practice of providing home-based individual and family follow-up to emergency services.
• STANDARDIZE routine, culturally competent, and trauma-informed patient education in self-care, and screenings for mental health needs in all primary care settings.
• ESTABLISH health clinics with integrated health services at all schools.
Education is a key factor in promoting better individual health outcomes in communities. Ensuring access to supportive educational programs for students of all ages and guaranteeing access to education for incarcerated citizens will yield cost-savings and a more robust economy.
• INVEST in comprehensive resources and programs that meet basic survival and wellness needs of students.
• INVEST in quality education and vocational training to increase access for all Coloradans.
• END the use of harsh, inequitable discipline in schools and terminate the school-to-prison pipeline. Reform school discipline policies to ensure that behavioral concerns, especially those related to substances, mental health, trauma, and other adverse childhood experiences, are addressed from a health care perspective and approach.
• CULTIVATE literacy regarding wellness and make resources available to support wellness among students and families. Everyone should have a mental health plan, and a personal diagnostic and first aid toolkit, as well as an advance directive regarding care preferences in case of health crises.
• TRAIN all teachers and school administrators in trauma and trauma-informed classrooms and evidence-based practices.
• CONNECT at-risk youth in the school system, and at-risk families, with appropriate levels of wraparound support and care.
• IMPLEMENT strategies to educate a world-class health workforce that provides preventive and supportive care for Coloradans’ minds and bodies, as well as youth engagement, education, access to services and resources, and crisis response. Train all clinicians and first-responders on mental health, addiction, and trauma needs assessment, and on pathways to support and care.
Employment helps us build meaningful lives and is often essential for good mental health. Every community member should have a chance to do meaningful work, including those living with a mental illness and those who have a criminal record.
• REMOVE regulatory barriers to employment for people with health needs—both physical and mental, and for people with history of justice system involvement.
• INCREASE employment opportunities for people of all abilities.
• ENSURE success by providing training, internships, apprenticeships, and supports for people with mental health needs, as well as for those who have been involved in the justice system.
Secure housing is a basic human need. Providing supportive and discrimination-free housing, for those who face homelessness or struggle with physical and mental health challenges, improves health outcomes and saves taxpayer dollars.
• PASS legislation to secure and maintain investments in affordable, accessible, supportive housing across a wide continuum of housing services to ensure that each community has access to the levels of support that their loved ones need to be successful.
• INCREASE accountability with regard to discriminatory housing practices.
• EXPAND integrated housing programs to support individuals with complex health needs.
Every day, first responders, public safety officers, and prosecutors engage with people in need of mental health support and care. When health-driven behaviors result in police encounters, alternatives to arrest and criminal charges should be available and prioritized.
• UNIVERSALIZE crisis intervention team training, community policing, and co-responder models to redirect people toward health care and minimize arrests.
• COORDINATE with community-based peer support services for reducing prevalence of risks to health and safety, and for optimizing response to crises and successful outcomes.
• INCREASE capacity and capabilities of the crisis response system so that it is equipped to assist law enforcement with high acuity individuals.
• SHIFT the response to substance use and addiction, from public safety and law enforcement, to health care. Ensure that people in possession of or using substances are directed to treatment and recovery, with the goals of decriminalizing substance use disorders, reducing harm, and improving outcomes.
• INVEST in and implement shared data systems across sectors to support collaborative intervention efforts.
• ADDRESS any policy or practical barriers restricting the use of M-0.5 holds (involuntary transport for immediate evaluation for criteria lower than M1 standard).
When arrests and criminal charges cannot be avoided, communities must strive to achieve justice for all, while preserving individual rights. American justice must favor freedom and address and correct for inequities that arise from differences in health, race, and privilege.
• END the use of jails for emergency holds for alcohol and drug intoxication. All involuntary holds for emergent health conditions should be restricted to health settings.
• REDUCE jail and prison populations through policies that focus on bail reform, post-arrest, and pre-file redirection to health care (including outpatient competency restoration, detox, assisted outpatient treatment, etc.).
• IMPROVE the process of civilly committing individuals to least restrictive outpatient or inpatient care when their health is the primary driver of unlawful behaviors.
• END the use of exorbitant and inequitable fees and penalties for people in need of mental health and substance use disorder care. Criminalization of Coloradans with unmet health needs should not be a revenue source for community agencies.
• PROVIDE equitable access to legal representation for people in need of mental health and substance use disorder care, reducing coercive plea bargain deals that have long term consequences.
• PASS a bill to end mandatory minimum sentencing for people with unmet health needs.
• DECRIMINALIZE possession of controlled substances for personal use, and symptoms of mental illness and all unmet health needs. Replace criminalization with systematic redirection to health care and other public health-based approaches to supporting wellness and reducing harm.
• TRAIN all judges to assess law enforcement and justice responses to health-driven behaviors and crises in light of parity. Mental health- and physical health-driven behaviors and crises should meet with equivalent compassion and intelligence. Address health needs and root causes before criminal judgment.
• ENSURE that when people with mental health needs enter a clinical setting or call for help, they get quality care, rather than forcible restraint by police or untrained first responders, and transportation in police vehicles.
Colorado communities have the capacity and intelligence to implement proven interventions that successfully correct the behaviors of individuals in detention, and that interrupt cycles of crime.
• UNIVERSALIZE access to quality education and vocational training in outcomes-focused correctional settings.
• PROVIDE continuity of quality, trauma-informed health care for all juveniles and adults in custody.
• PROHIBIT the use of prolonged solitary confinement.
• EXPAND case management within corrections before parole to ensure continuity of care, successful community integration, and department accountability for improved outcomes.
• ASSIGN the same Joint Budget Committee analyst for the Department of Labor and Employment and the Department of Corrections to promote shared accountability for return to workforce.
Prevented from voting, securing housing, finding work, and rebuilding their lives, people who have completed a criminal sentence still face lifelong exile. In Colorado, justice-involvement is too often costly and destructive, rather than corrective and restorative. We must do better.
• IMPROVE reentry programs to ensure successful transitions.
• INCREASE access to affordable, supportive housing, and eliminate release to homelessness.
• INCREASE education of parole officers about affordable housing options and other resources available to those on parole.
• REMOVE barriers to employment, education, and vocational training.
• ENSURE continuity of health care.
• SHARE data, using health information exchanges, in order to improve community reintegration outcomes and avoid re-traumatization.
• PARTNER across sectors to ensure continuity of access to services and resources individuals need to stabilize and thrive in the community.
DATA AND INTELLIGENCE
Efforts to integrate data sources and to apply existing intelligence to reform systems and practices must be a priority for the state. Integrated data must be used to promote individual health and personal freedom, while preserving public safety, protecting privacy, and reducing wasteful spending.
• SUPPORT AND ACCELERATE efforts to integrate and apply data for the purposes of improving mental health and substance use outcomes, reducing the criminalization of Coloradans based on health-driven behaviors, and achieving equity.
• COLLECT consistent data across health care, public safety, and justice systems. Equity requires accountability regarding access to quality care, arrests, detention in jail, and other restrictions of liberty.
COURSE CORRECTIONS PARTICIPANTS (2018):
Vincent Atchity, Executive Director, The Equitas Project
Barb Becker, Director of Mental Health First Aid Colorado, Colorado Behavioral Healthcare Council
Amanda Bent, Policy Manager, Drug Policy Alliance
Aubrey Boggs, Advocacy and Outreach Coordinator, Colorado Mental Wellness Network
Joelle Brouner, Executive Director, Colorado Developmental Disabilities Council
Maureen Cain, Director, Legislative Policy and Organizational Communication, Office of the Colorado State Public Defender
Susana Calderon, Regional Public Health Advisor, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health (OASH), Region VIII
David Cecil, Healthcare Policy and Advocacy Director, Johnson and Johnson
Dr. Lisa Clements, Vice President, Population Health, Beacon Health Options
Frank Cornelia, Director of Government and Community Relations, Colorado Behavioral Healthcare Council
Gary Creager, Chief of Police, City and County of Broomfield
Gary Darling, Director, Criminal Justice Services, Larimer County
Zack Depledge, Intern, Colorado Behavioral Healthcare Council
Doyle Forrestal, Chief Executive Officer, Colorado Behavioral Healthcare Council
Tom Gangel, Operations Manager, Mind Springs Health
Alison George, Director, Colorado Department of Local Affairs, Division of Housing
Tina Gonzales, Criminal Justice Systems Coordinator, Beacon Health Options
Moses Gur, Director of Policy and Member Engagement, Colorado Behavioral Healthcare Council
Daric Harvey, Chief of Police, Cañon City Police Department
Peggy Heil, Behavioral Health Specialist, Colorado Department of Public Safety
Stan Hilkey, Executive Director, Colorado Department of Public Safety
Steve Holloway, Branch Chief, Primary Care Office, Colorado Department of Public Health and Environment
Morgan Honea, CEO, CORHIO
Terri Hurst, Policy Coordinator, Colorado Criminal Justice Reform Coalition
Hope Hyatt, Executive Director, Colorado Mental Wellness Network
Mark Ivandick, J.D., Attorney, Disability Law Colorado
Nancy Jackson, Commissioner, Arapahoe County Board of Commissioners
Mandy Kaisner, Chief Clinical Officer, Solvista Health
Karen Knickerbocker, Attorney, Office of the Colorado State Public Defender
Tim Lane, CDAC Staff Attorney, Colorado District Attorneys’ Council
Hassan Latif, Executive Director, Second Chance Center
Dr. Jenn Leiferman, Director, Population Mental Health and Wellbeing Program, Colorado School of Public Health
Jennifer Longtin, Principal, JLongtin Law
Denise Maes, Public Policy Director, ACLU of Colorado
Kate McCallum, Ph.D., Postdoctoral Fellow, Denver FIRST, University of Denver
Beth McCann, Denver District Attorney, Denver District Attorney’s Office
Dr. Michael McCormick, Administrative Director, North Range Behavioral Health
Gretchen McGinnis, Senior Vice President, Colorado Access
Kristi Mock, Vice President and Chief Operating Officer, Mental Health Center of Denver
Jenny Nate Cornelia, Behavioral Health Director, Colorado Access
Lucienne Ohanian, Chief Deputy, Colorado State Public Defender
Carol Plock, Executive Director, Health District of Northern Larimer County
Rick Raemisch, Executive Director, Colorado Department of Corrections
Elsa Ramirez, Executive Officer, U.S. Department of Health and Human Services
Jamie Ray, Care Manager, Second Chance Center
Sue Renner, Vice President, Philanthropy, David and Laura Merage Foundation
Melissa Sandoval, Program Assistant, Community Prevention and Early Intervention Programs/Criminal Justice, Department of Human Services
Paul Sedillo, Chief of SUD Operations, Southeast Health Group
Jagruti Shah, Director, Criminal Justice Services, Office of Behavioral Health
Jonathan Shamis, Judge, Colorado 5th Judicial District
Gina Shimeall, Attorney, Defense Attorney
Dr. Shannon Sliva, Assistant Professor, University of Denver
Charles Smith, Ph.D., Regional Administrator, SAMHSA, U.S. Department of Health and Human Services – Region VIII
Lauren Snyder, State Policy Director, Mental Health Colorado
Natalie Strom, Membership Services and Communications Coordinator, Colorado Behavioral Healthcare Council
Lori Swanson-Lamm, Director of Intensive Services, Jefferson Center for Mental Health
Joe Thome, Director, Division of Criminal Justice
Kristin Toombs, Office of Homeless Initiatives Director, Department of Local Affairs, Division of Housing
James Van Beek, Sheriff, Eagle County
Jason Vitello, Behavioral Health Coordinator, Denver Public Health
Susan Walton, Director, Park County Human Services
Art Way, State Director, Drug Policy Alliance
Dr. Robert Werthwein, Director, Office of Behavioral Health, Colorado Department of Human Services
Gwendolyn West, Project Coordinator, The Equitas Project
Doug Wilson, Colorado State Public Defender, 2006-2018; Equitas National Advisor
Carl Clark, M.D., President and C.E.O., Mental Health Center of Denver
Andrea Stojsavlejevic, Policy Manager, Healthier Colorado