Week 1: Mental Health Initiative a step ahead in Douglas County

Many states, cities and counties find themselves ill prepared to deal with the growing mental health crisis in America, but a proactive move by Douglas County in 2014 is helping the county meet needs today.

The Douglas County Mental Health Initiative was created seven years ago in hopes that adults and youth experiencing mental illness, struggling with substance abuse, or going through a short-term crisis would get help, and not be thrown aside and ignored.

Today, with the Mental Health Initiative (MHI) servng as an arm of county government, arrests of those struggling with mental illness are down, fewer hospitals beds are being needlessly filled and citizens are starting to accept that help is out there for a bad day, week, month, or full-blown crisis, county leaders say.

RELATED: Douglas County commissioners commit funding, time to mental health

Shannon Breitzman, principal at Health Management Associates — a Denver-based independent national research and consulting firm specializing in publicly funded health care and human services policy — said Douglas County has set the example for Colorado and the nation in addressing the growing mental health crisis.

Breitzman commended the work Douglas County has put into developing a mental health program that works, because they have partnered with organizations, programs, and government agencies that all have the same goal — to help citizens suffering from all levels of mental illness.

“Mental health is as important as physical health,” Breitzman said. “Poor mental health only increases the risk of poor physical health such as a stroke, heart disease or diabetes.”

According to the National Alliance on Mental Illness, one in five U.S. adults experience mental illness, representing 20.6% of the population.

At the state level, Robert Werthwein, director of the Office of Behavioral Health at the Colorado Department of Human Services, said as work continues in overhauling how the state manages the mental health crisis, the Douglas County approach is on the radar.

“Douglas County leadership at all levels continues to be innovative in meeting the behavioral health needs of their community,” he said. “The Douglas County Mental Health Initiative fits well in the state’s reform of the behavioral health system. The state reform will be heavily reliant on input from local leaders that produce flexible solutions and meet the needs of Coloradans in their communities.”

In September, Werthwein attended a summit hosted by Douglas County, where he stressed that their success is because partnerships and careful program planning have everyone working together and rowing in the same direction.

Developing partnerships

Leading the project from the start has been Deputy County Manager Barbara Drake, who in 2014 was directed by county commissioners to lead efforts to develop a mental health program.

Creating a new department was not as simple as saying a program is approved and ready to go. To get it right, Drake said, it took years of planning, organizing, and developing something that would focus on helping all citizens, pushing the message that those having a rough time would have a safe place to turn without judgment or consequence.

To make the initiative successful, Drake said, county officials knew it would take a lot of partnerships and buy-ins. That meant partnering with law enforcement, working with hospitals, local therapists, social services, and dozens more agencies and organizations to cut through red tape and help someone struggling to get the help they need.

Laura Ciancone, MHI coordinator, said the county’s commitment to process mapping at the beginning is the reason for the program’s long-term success. Since its inception, MHI has developed 44 partnerships across Douglas County, she said.

Breitzman, of Health Management Associates, commended Douglas County for addressing mental health as a community issue and not just as one agency trying to do all the work without communicating with others.

During a Sept. 23 mental health summit in Douglas County, Werthwein, the director of the Colorado Office of Behavioral Health, said the state’s top agency for handling mental health is way behind the work Douglas County has been doing since 2014.

Werthwein said individual agencies throughout the state are working to solve the growing demand for mental health services. This model has resulted in agencies and organizations competing with each other rather than working together to achieve a common goal, he said.

‘Jails became the de-facto response’

After years of behind-the-scenes planning, organizing and aligning partnerships, MHI officially started helping citizens in 2016 and 2017. According to MHI data, since 2017 the program has served 3,255 unique individuals, and encountered more than 7,092 members of the community.

At the start, Drake said MHI took a serious look at how citizens struggling with mental health were being treated on an initial call, which often involves the police.

Drake said a common problem in America is that when police are called to deal with someone struggling with a mental illness, substance abuse or a crisis, it can mean handcuffs and arrests, or a trip to an emergency room where they are placed on hold and later just released to return to their vices without help.

“For so long, jails became the de-facto response for people,” Drake said. “That just complicates their lives. It creates a record.”

In 2017, the MHI developed a pilot program in partnership with the Castle Rock Police Department. A Community Response Team (CRT) was created where police officers are paired with mental health professionals. The team also includes an emergency medical technician and, on occasion, a case manager.

Instead of tying up police officers who would place a struggling citizen in a jail cell or hospital, the CRT started answering and following up with people, working to provide help and answers.

According to the MHI, since its launch in 2017, the CRT program has:

• Helped to avoid “unnecessary” visits to emergency rooms 1,116 times.

• Avoided jail bookings 541 times.

• Released 3,301 law-enforcement officers and 547 fire personnel back into service.

• Avoided an estimated $6.46 million in costs before reimbursement for fire and emergency crews, ERs and the county jail on mental-health matters.

With the adult CRT program working well, Ciancone said data showed a need to help school-aged elementary students, teenagers and young adults under the age of 25. Through partnerships with local schools and youth programs, MHI developed a Youth Community Response Team.

CRTs do the initial work, making contact and creating an official case file. From there, Drake said citizens are not left in the wind until the next episode. They are assigned to a case manager who does the follow-up work, she said. She calls them a key to MHI’s success.

An uphill climb

Receiving follow-up service is voluntary, but Drake said MHI has had a lot of success getting residents to agree to working with a case manager. According to MHI data, since 2018 an estimated 55.4% of those first contacted have agreed to receive continued assistance.

“The case management system keeps services on track,” Drake said. “We want to have meaningful connections that lead to positive results. We act in a facilitation role. It is important to get it right and help people get help they need at whatever level they need it.”

Case manager Steve Kalisch said he and his colleagues have a variety of tools to help cooperating citizens. Services can range from something as simple as offering a cup of coffee to check in, to cutting through the red tape to team citizens up with the appropriate medical professional, making sure medications are correct, finding them the right facilities to deal with substance and alcohol abuse or help in dealing with family dynamics, Kalisch said.

Drake said a common misconception is that programs like MHI are only available for people suffering from a major crisis, or those diagnosed with a specific mental illness. MHI in Douglas County is available for anyone with any kind of mental health, she said.

“We want to normalize good mental health,” Drake said. “Sometimes someone is having a bad day. Sometimes something traumatic has happened and they just need some support to deal with it temporarily. Sometimes we all go through times where we need some extra help.”

From the start, Drake said it has been an uphill climb for citizens to get past the stigma associated with mental illness and ask for help when they need it for themselves, a family member, or a child.

The initiative has created a variety of public service programs aimed at educating citizens that mental health is just as important as physical health, a message Drake said continues to be a priority as MHI has continued to grow into a program that is proactive with citizens and families and has expanded to help youth and young adults.