New laws and funding will help medical clinics improve mental health care

Nearly a quarter of residents in Routt and Moffat counties use the local community health center, which is why they have tried to incorporate mental health screening for anyone who comes in for a checkup or even for toothache.

Northwest Colorado Health, with offices in Steamboat Springs and Craig, began integrating mental health care ten years ago, trying to catch the first signs of depression and refer patients to treatment, on-site or health center appointments. community of the region. He added mental health screening to dentist appointments in 2017.

Yet like many of Colorado’s 20 community health centers scattered across the state, Northwest can’t hire enough counselors and social workers to keep a full staff and is constantly struggling to keep up with its behavioral health goals. Patients who cannot get an in-person appointment are connected via telemedicine to a therapist who does not live in Northwest Colorado.

“The asterisk is that when we’re full, we’re fully integrated,” said Stephanie Einfeld, CEO of Northwest Colorado Health. “This has really been our great barrier.”

Northwest Colorado Health is the community health center for Routt and Moffat Counties. Patients receive mental health screenings during medical and dental appointments, but the center struggles to hire enough behavioral health personnel. (Provided by Northwest Health)

Colorado has talked for years, if not decades, about the true integration of mental and physical health care, in what many experts see as the key to addressing the state’s suicide and mental health crisis. Now, an influx of federal coronavirus relief funds will increase the work.

A piece of legislation passed by Colorado lawmakers this year provides $ 35 million for community health centers, medical practices, and clinics to add mental health offerings, whether they are starting from scratch or have ambitious plans to scale up services. Another new law designates $ 11 million to add more mental health care to school health clinics and pediatrician offices. Two other bills focus on the recruitment and retention of therapists, psychologists and substance abuse counselors.

“We will never see this type of funding again,” said Senator Sonya Jaquez Lewis, who was a major sponsor of House Bill 1302 which invested $ 35 million in “whole person care.”

What many clinics need are technology upgrades to improve telemedicine options, as well as funding to hire more therapists, he said. Colorado has lost too many behavioral health workers to retirement and burnout in recent years, and then the coronavirus pandemic has taken depression and anxiety rates to new levels. “It’s always a balancing act with whole person care that you have to have the providers accessible and on hand,” said the senator, a Boulder Democrat and pharmacist.

Clinics can apply for grant dollars to expand hours to offer night and weekend behavioral health care to struggling working parents. They could use it to give employees advanced training so they can screen for mental health problems or provide therapy.

Under a complementary bill aimed at increasing the workforce, community colleges can seek funding to expand night and weekend programs for healthcare professionals who wish to pursue mental health or advance their careers but do not want to leave. the job. It also included: funding to expand a program in which robots are sent to remote parts of the state to teach healthcare workers how to perform certain procedures. In training courses, the robot is the patient.

Over the next five years or so, Jaquez Lewis expects colleges to offer free tuition to those interested in working in health care and mental health. And patients, regardless of where they go for health care, will receive preventative behavioral health care almost without realizing it.

“It’s done so perfectly as part of the regular questioning that the patient doesn’t even know what’s going on,” the senator said. “It’s not like, ‘Now we’re going to test you to see if you have any mental health problems.'”

“We’re trying to finally fit things into reality.”

The $ 35 million bill is a continuation of a dead federal grant program called the state innovation model. Under the program, 344 primary care practices received funding to complement mental health care from 2015 to 2019. A federal evaluation showed that the program resulted in fewer behavioral health-related visits to the hospital’s emergency wards, but then the funds stopped.

Efforts to better incorporate mental health care into medical practices come at the same time as Colorado is attempting to revamp the state’s community mental health system, which includes 17 centers across the state. New rules will open centers, which have operated under no-bid contracts to care for Medicaid or uninsured patients, to competition, even potentially from some of the state’s 20 community health clinics that offer medical and dental care.

The entrance to the Colorado Senate chamber at the Colorado Capitol. (Andy Colwell, Special for The Colorado Sun)

According to the Colorado Community Health Network, community health clinics, ranging from Tepeyac and STRIDE centers in the Denver metropolitan area to Uncompahgre Medical Center in Norwood, began offering mental health care as early as 2006 or 2007. But those services have expanded to the point that today centers often have a mental health professional attending medical appointments or, at the very least, have a medical employee asking screening questions about whether a person is feeling depressed or has thoughts of wanting to die.

The reason community health centers need to incorporate mental health care is that 1 in 7 Colorado citizens receive primary care from a local community clinic, said Taylor Miranda Thompson, senior quality initiative manager for the network. That’s 847,000 patients in 230 clinics in 45 of Colorado’s 64 counties.

“The goal of health centers is prevention, and that can mean identifying a patient with symptoms of depression … or chronic stress or difficulty sleeping, or even screening for suicidal thoughts,” he said.

Each of the 20 community health centers in Colorado connects with its local mental health center to relocate patients with more severe mental health problems.

In general, centers need more staff and funding for technology upgrades. When the pandemic hit, many quickly switched to telemedicine. Now that the sense of urgency has diminished and there are funds available, health centers are looking to upgrade their platforms, said Stephanie Brooks, director of community health network policy.

And in rural areas, health centers hope legislative reforms will bring better broadband services so patients have more reliable video connections during virtual appointments, he said.

“Health centers all have a telemedicine platform set up very quickly, but because they’ve had to set it up so quickly, they have more to do,” Brooks said. “You can do it fast, cheap or really well. I think they are working to make it really good ”.

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