Community mental health centers (CMHCs) are a good deal for the state of Colorado. Is that about to change?
Much More than a Provider
Colorado has 17 regional CMHCs that meet the behavioral health needs of communities across the state. Each CMHC is responsible for providing five categories of services: inpatient, outpatient, partial hospitalization, emergency care and consultative and educational programming. As the nonprofit CMHC for the people of Denver, WellPower provides a comprehensive range of services to meet the dynamic needs of the communities we serve.
This includes “traditional” mental health care, as well as programs that support every aspect of well-being: an urban garden providing access to fresh, healthy produce and fish; play therapy programs for children to process trauma; permanent supportive housing to combat homelessness; and our nation-leading public safety and justice programs like STAR and co-responder, which just launched a new partnership with Denver park rangers; and much more.
WellPower also responds to emergencies, providing support for people impacted by natural disasters and mass violence events, and we operate 24/7/365 emergency care for people who are in crisis. (Our Walk-In Center, part of the statewide Colorado Crisis Services network, has never closed – not even once – since it first opened in 2014.)
In short, WellPower is called on to be so much more than a healthcare provider; we are part of the community that offers just about every kind of service you can think of to help people and families live their best lives.
All of this must cost a lot of money, right? Yes, and no.
Colorado Taxpayers Get More Than What We Pay For
Years ago, the state of Colorado decided that we have a small pot of money to meet the behavioral health needs of everyone in the state, and that the best way to use it was to contract with 17 regional CMHCs. This fixed amount of funding was allocated between the centers based on the number of people each was expected to serve in their respective “catchment” area.
While this did keep the amount of public funding under a pre-determined level, there was a problem: Colorado’s investment in behavioral health has been among the lowest in the country for years. This amount is so low compared to the need for services (and, for reference, the cost of physical healthcare) that most CMHCs serve the number of people in their contract within the first six months of each year, and thus run out of state funding around the end of June.
Here’s where that good deal comes in.
Because of our mission as community-based nonprofits, CMHCs don’t stop serving people when the funding runs out halfway through the year; we just find a way to cover our costs for the rest. One way is to use the ”extra” revenue from services that (barely) make money to cover the costs of the services that lose money.
So, the state of Colorado gets a full year’s worth of complex, comprehensive, community-based behavioral health services for the price of just six months. WellPower and the other CMHCs don’t discharge people from services or refuse people care when the money from the state runs out, nor do we pass along the unfunded cost of services onto people we serve.
Building on What Works
Just about everyone – including the CMHCs – agrees that this is not the way it should work. As much progress as we’ve made over the past few decades, we have much more work to do to improve upon this “good deal.” For example, WellPower is continuing to develop new approaches to bringing services to people where they are (check out our new TherapyDirect program if you haven’t yet).
Increasing access requires building capacity to engage people in care and make sure they can get into high quality, affordable, relevant services when and where they want. Much of this work over the past several years has been supported by consistent investments in established provider organizations – the CMHCs.
We build on our decades of relationships with communities, providers and funders; we tap into the best new ideas, try them out and share lessons learned, both locally and nationally; we share whatever resources we can in service to our shared mission of ensuring every single person in Colorado can get the care they need.
But this may be about to change.
What Do We Have to Lose?
Expanding the options people have for finding care that works best for them is an important and urgent goal, and one that WellPower has been advocating for over the past three decades. More providers can mean more choices and a more robust behavioral health workforce – but only if funding also increases.
One element of the new Behavioral Health Administration (BHA) is the introduction of a novel type of provider entity – what will be called an “essential” provider – that can choose which service or services it offers. As a result, we’ll likely see more providers entering the field and choosing to offer only the most profitable services in exchange for smaller slices of state funding. Meanwhile, CMHCs will have fewer ways to serve increasing numbers of people with complex, layered needs (which tend to involve higher-cost and lower-revenue services – not exactly what smaller or profit-driven providers will be going for).
Well-intentioned competition may turn into fragmentation, administrative duplication, insufficient collaboration and ultimately a system that is much more complicated for people to navigate.
We Have to Get This Right
With this approach to the BHA, we can’t help but ask: are we as a state taking away a strong foundation – a “good deal” for the state of Colorado – when we should be building on what works and fixing what needs to work better? Sometimes it’s important to completely start over, to bulldoze an old building to make room for a new one. At other times, that approach is wasteful and even harmful. Are we planning a demolition when we should be thoughtfully working on a renovation?
All talk of deals and funding and contracts and competition aside, the whole point is that what we do as a state matters – how we renovate our behavioral health system matters. For this reason, WellPower continues to work with our elected leaders, community advocates and provider partners to make sure this new iteration actually meets the needs of Coloradans.
As much as we can’t afford to keep going as we have been, we also can’t afford to get the next steps wrong.
People’s lives depend on it.