Mental health holds weigh liberty vs. public safety

When a person in a mental health crisis is an imminent danger to himself, herself or others, or is gravely disabled by a mental illness, mental health and law enforcement professionals may place them on a mental health hold. Mental health holds can last up to 72 hours, although they are sometimes much shorter.

That means a person would be taken to a hospital or a Colorado Crisis Services walk-in center, where he or she would be evaluated and treated to determine whether they should be involuntarily committed to treatment.

The threshold for placing someone on a mental health hold in Colorado is one of the highest in the nation, said Chief Medical Officer Patrick Fox of the Colorado Department of Human Services.

If a state sets the threshold too low, people who are not going to act violently may be unnecessarily detained, he said. But when the threshold is set too high, some violent people might not be prevented from harming themselves or others.

“There are going to be violent people that I don’t catch because they don’t meet the threshold,” Fox said. “It means that people break through.”

Camille Harding, director of the human services department’s Community Behavioral Health division, which oversees mental health holds, said placing someone with a mental illness on a mental health hold is a judgment about whether or not that person has the means to act on what he or she is doing.

Fox said he believes the threshold in Colorado is too high, an issue that’s been a point of contention in previous years among legislators, policy makers, law enforcement, mental health professionals and the public.

Fox and Deputy Brian Briggs of the Douglas County Sheriff’s Office also said knowing when to place someone on a mental health hold is a fine line to walk. Officials must weigh a person’s liberty against public safety.

“It’s tough,” said Briggs, who also considers the threshold very high. “It’s a serious matter, because you are literally taking away somebody’s rights.”

The most common example of when mental health holds are used are for suicidal people, Lone Tree Police Chief Kirk Wilson said.

It’s difficult for the state Department of Human Services to provide the exact number of mental health holds in a given year. Facilities that take mental health hold patients but are not regulated by the Office of Behavioral Health historically have not been required to report that information, leaving the state with incomplete data.

Based on information the department does have, it knows that in the 2016-17 fiscal year, at least 37,771 people were placed on mental health holds in Colorado, about 2,800 more than the previous fiscal year. Some of those individuals were placed on multiple holds, bringing the number of holds up to approximately 52,661, more than 13,000 than the previous fiscal year.

Senate Bill 17-207, signed by Gov. John Hickenlooper last May, increased funding for the state’s crisis services system and for law enforcement, Harding said. That will ensure walk-in centers and crisis stabilization units have the ability to triage people placed on emergency mental health holds.

The bill also made a key change to how mental health holds are carried out.

In May 2018, law enforcement officers will no longer take a person in a behavioral health emergency to jail if they have not committed a crime, and instead, must take them to a mental health or emergency medical services facility.

The bill also requires any hospital accepting mental health hold patients, including those not regulated by the Office of Behavioral Health, to report its data concerning mental health holds to the state by July 1, 2019.

The hope is that the state may gain more accurate numbers on mental health holds, a Colorado Department of Human Services spokeswoman said.