How Colorado is trying to address transportation needs for people in mental health crisis

March 5, 2020

By: Forest Wilson

Originally appeared in the Colorado Independent

Lawmakers are pushing for a transportation system dedicated to getting people in crisis to care

One summer night, after his first year of college in 2012, Sandra Sharp’s son Drew grew increasingly anxious. He began having delusions of grandeur and became suicidal, Sharp said. 

On that night, Drew allowed Sharp to take him to the hospital in Steamboat Springs “so that I could know that I did everything that I could to prevent him from committing suicide,” Sharp told lawmakers during a recent House committee hearing. 

After being admitted to the emergency room, Drew spent the night being guarded by a police officer. The next morning, Sharp said, despite her pleas, officers shackled Drew and transported him to Mind Springs Mental Health Hospital in Grand Junction. 

“They said I no longer had any say over my son’s treatment, now that he was on a hold, he was the property of the state,” Sharp said.

When Drew arrived in Grand Junction he was comatose and could not speak because he was so traumatized by the experience, Sharp said. 

Her story is not unusual. People experiencing urgent mental health crises in Colorado are often transported to a hospital or treatment facility in the back of a squad car or by ambulance.  

But, a new bill in front of Colorado lawmakers seeks to change that by setting up a separate transportation system for those in the throes of a mental health crisis. Proponents say the new system would be better tailored to mental health needs and could save money in the long run. 

“For somebody who’s in a mental health crisis, being transported in a law enforcement squad car often requires transport in handcuffs,” Vincent Atchity, CEO of Mental Health Colorado, said. “And that is extremely shaming and stigmatizing.” 

It would be “unthinkable” to put people in need of other types of care into that situation, he added. Ambulances are also an expensive option, often with an unnecessary amount of medical services for a behavioral crisis, Atchity said.

The new system is primarily intended to help transport people placed on 72-hour involuntary holds because they are considered to be a danger to themselves or others. It could also be used to transport people between levels of behavioral health care. County commissioners would license private companies for transport, and Medicaid would cover the cost.

According to the most recent available data, between 2012 and 2016, the number of people placed on crisis holds in Colorado rose by more than 39% — or from about 28,000 to more than 39,000. Those numbers include people who were placed on holds more than once. A state analysis found that about 6% of Medicaid recipients using emergency medical services or a mental health treatment facility will need the new transportation service. That equates to about 972 Medicaid-covered trips per year at a total cost of $215,784.  

Drew has been hospitalized several times since 2012, Sharp said, and twice he was transported by ambulance, for which he had to pay out-of-pocket. She said her son’s mental health has deteriorated over the last year and he’s now in the criminal justice system. 

Republican Sen. Jim Smallwood, Democratic Sen. Jeff Bridges, and Democratic Reps. Julie McCluskie and Tracy Kraft-Tharp worked with Mental Health Colorado, Colorado Counties Inc., Signal Behavioral Health Network and other groups on the legislation. Kraft-Tharp was a member of the Colorado Mental Health Hold Task Force, which issued a 2016 report that called for overhauling the transportation system for people in behavioral health crisis.  

While the main goal is to save money and improve access, Smallwood said, such a service could also reduce the diversion of law enforcement from other duties. Taking a squad car and officer out of rotation for transport can be a challenge, Atchity added, especially in rural counties. 

Larimer County Sheriff Justin Smith added his support for the measure, saying in a statement: 

“We consider these instances to be medical and behavioral health matters, and it can be counterproductive to transport these individuals in the back of secured police cars,” 

Amy Nichols, executive director of County Sheriffs of Colorado, told The Colorado Independent that the organization sees the bill as beneficial all around. 

Safety is a top priority for sheriffs, police and other law enforcement officials, and we support efforts to help connect people in a behavioral health crisis with the care they need,” Nichols wrote. 

It’s hard to pin down what the exact savings would be to law enforcement. The current costs of crisis transportation for law enforcement vary widely, Amy Fletcher Faircloth, a spokeswoman for County Sheriffs of Colorado, said. In Larimer County, she said, it costs roughly $50 per hour to transport someone with one deputy. In Prowers County, transports could get close to $425 per trip, she said. 

A small-scale version of secure transport has been underway since 2018. The Colorado Office of Behavioral Health paid for transport services for people on 72-hour holds to the San Luis Valley Behavioral Health Group and the Center for Mental Health in Montrose. Jennifer Silva, chief clinical officer for the San Luis Valley Behavioral Health Group, said the service has been invaluable, allowing the center to transport 10 to 15 people per month in a more appropriate way. 

“Any time we had an involuntary hold we would call our local sheriff’s office and we would do a special motion to transfer that the judge signed,” Silva said. “Then the sheriff’s office would take this person, but they would take them handcuffed and shackled.”

The bill is projected to cost $1.2 million between 2020 and 2022. That estimate includes about $500,000 in federal funds. The costs include updates to Medicaid systems and contracts with companies who provide the service. 

The State Board of Health would be responsible for the transportation’s rules including staffing and training requirements, clinical standards and the circumstances under which someone can be picked up. 

The legislation requires the Colorado Department of Human Services to work with the state Commissioner of Insurance to expand private health plans to include coverage for secure transportation.

The Colorado Association of Health Plans and a representative from Anthem Blue Cross Blue Shield did not respond to requests for comment on whether they would support creating a benefit for secure transportation. A spokesperson for Kaiser Permanente declined to comment on the bill. 

The Public Health Care and Human Services committee passed the measure, 12-0, last week. It is now in front of the House Appropriations committee, and, if passed, will head to the Senate.