When counties like Larimer and Boulder encounter gaps in mental and behavioral health services and a private enterprise isn’t on board, then an initiative sometimes is the best answer.
In Larimer County, voters approved a 2018 ballot initiative to designate funding for behavioral health and to build the county’s first acute care behavioral health facility, paid for by a .25% sales and use tax. And in Boulder County, strategic planning is underway to improve mental and behavioral services.
“The initiative in 2018 was the first successful ballot initiative after several failed ballot initiatives to address mental and behavioral health issues in the community,” said Laurie Stolen, director of Larimer County Behavioral Health Services.
A similar initiative put forth in 2016 as part of Larimer County’s five-year strategic plan failed, but when Stolen helped created a community master plan for behavioral health services and increased awareness of the need, voters realized their fellow residents were not getting the right level of care in the emergency room or if they landed in jail, ending up costing them in their tax base. Essentially, the county lacked a continuum of behavioral health treatment and support services that was sufficient to meet the needs of its residents.
“If we had the funding, we could do better and ultimately save lives,” Stolen said.
The sales and use tax extends 20 years through 2038, generating an average of $20 million to $22 million a year to cover three areas of service through the county’s Behavioral Health Services department established by the initiative.
The first area of service is the facility, Larimer County Behavioral Health Services at Longview in Fort Collins, 2260 W. Trilby Road.
The second is the Impact Fund Grant Program for the county to invest directly in initiatives that serve the community’s behavioral needs. The Impact Fund is for two types of grant funding, targeted and responsive, and is for things like care coordination, workforce development, crisis-to-care collaboration and behavioral health in nontraditional settings.
The third is the Bridge Fund, which will become available after the Longview campus opens. The fund will reduce barriers to care and help patients reintegrate into the community with things like housing, transportation and care coordination. The fund also will help those who are uninsured or underinsured, so that they get treatment regardless of their ability to pay, addressing common barriers to behavioral care.
“We don’t want people to keep cycling through crisis. We want to catch them early and maintain stability and reduce (their chance of) falling back into crisis care, which is expensive,” Stolen said. “The goal is stabilization, then reintegration into the community with outpatient care.”
Construction of the first building located at the Longview campus, Acute Care, began December 2021 with completion expected in fall 2023 on the $48 million project. The building will span 57,000 square feet on 48 acres and house 64 beds with six levels of care to stabilize and treat patients suffering mental health episodes and substance use crises.
The levels will include behavioral health urgent care, 23-hour observation for all ages, two levels of withdrawal management, a crisis stabilization unit (a short-term residential program for moderate to severe acute psychiatric and co-occurring crises), and short- term intensive residential treatment (a short-term residential program for recovery after detox), plus an on-site pharmacy and a laboratory.
“This is not considered in-patient level of care,” Stolen said. “This is considered acute care up to 30 days.”
The average length of stay is expected to be three to five days for most levels of care and 12 days for the short-term intensive treatment program.
Larimer County contracted with SummitStone Health Partners to provide the services with the county continuing to own the building but not the operations, which will require an estimated 150 to 180 new staff to carry out. SummitStone launched an internship curriculum and is creating a workforce development program, since the facility, a National Center of Excellence, will serve as training grounds for careers in behavioral health.
“Up until now we have not had the needed services within our community to treat our residents,” Stolen said. “We have been sending people out of the county and out of the state to get care.”
The state has a total of 17 community mental health centers, but it’s not enough. Patients typically are relocated to detox facilities in Greeley, Denver or Jefferson County, presenting a challenge to having their families close by and being able to reintegrate back into their own communities, Stolen said.
The care they will be able to get locally will be top level, Stolen said.
“We are combining levels of care. That is unprecedented anywhere in the nation, let alone the state,” Stolen said. “Normally levels of care are still treated in silo for substance disorder treatment, another for mental health care, and one for physical care. We will be doing all those things in one facility.”
The Longview campus will include additional offerings in future phases, such as primary care, adolescence care, equine therapy and a wellness campus.
Boulder County has a community mental health center, Mental Health Partners, which also serves Broomfield. But it lacks a mental health and detox facility and services for those with high acuity mental illness and substance use disorders, plus step-down level of care after an inpatient stay.
“Those kinds of patients take a different kind of care and that kind of care is really hard to get everywhere in the state,” said Rep. Judy Amabile, a Democrat serving House District 13 at Boulder. “What we’re seeing is people are cycling in and out of short-term stays.”
Amabile would like to see Boulder access some of the $450 million in American Rescue Plan Act funds set aside for mental health in the state of Colorado to put into infrastructure similar to Larimer County. A sales tax initiative could then be passed to generate operational funding for the facility, she said. Other possible actions for the county to take include setting up group homes, expanding mental health diversion programs and adding competency restoration services for outpatient care, she said.
“We have huge unmet mental health needs in Boulder County, which you see every day in the city and in the jail,” Amabile said. “If we address mental health needs … we will save money in the long run and have a more healthy humane society.”
The county, along with municipal, nonprofit and foundation partners, is working on A Collaborative Approach to Behavioral Health Strategic Planning (The Road Map) for Boulder County to develop a cohesive cross-sector behavioral health strategy. The county is in the first year of the two-year process, which will benefit from another behavioral focus that also is benefitting from the ARPA allocation to Boulder County to address certain impacts from the pandemic.
The county commissioners led a community engagement process to find out from the public how the pandemic impacted them and how funds could be used to address those impacts. Three working groups were created to work from January through March 2022 to identify and recommend project, program and policy solutions that address the three main challenges identified in phase one of the community engagement process: Economic Challenges, Housing Affordability, and Mental Health and Social Resilience .
Two of the identified impacts in Mental Health and Social Resilience are a lack of equitable access to behavioral health services and a difficulty in resource navigation. With equitable access, for example, grants could be provided to community-based organizations or contracts established with school districts for school-based behavioral health services.
“We’re in the process of writing the plan,” said Robin Bohannan, director of Boulder County Community Services. “We did community assessments in the past. All of those assessments and conversations have never been pulled together into an agreed-upon plan. This is how we, as Boulder County, geographically are ensuring services are available to the community.”
The Behavioral Health Strategic plan will identify what’s working well in the community, gaps in services, and ways to address those gaps and come up with new resources and funding mechanisms. Some gaps include family health and stability services and treatment resources to keep offenders out of the criminal justice system.
“We want it to be driven by community voices and experts (saying) this is what’s needed and this is how we can get there,” Bohannan said. “We’re at a tipping point. It’s likely there are resources coming down the pipeline. It’s about time.”
The Boulder County Board of Commissioners is considering asking the voters during the November 2023 election to extend an existing 1.85% sales tax measure that funded the construction and staffing of an alternative sentencing facility that expires in 2024. The extension would fund behavioral health services and some of the items outlined in the Behavioral Health Strategic plan. With a vote next summer, the board will identify the needs and the best use of the funds to present to voters.
“We’ve known for quite a number of years behavioral health services aren’t sufficient to meet the need that has been exacerbated by the pandemic,” said Boulder County Commissioner Claire Levy. “We feel that the time has come to develop a county source of funds. … Behavioral health services need to be offered in parity with physical health services, and the need is not being met from existing resources.”