DENVER – Rural hospital providers are hoping Gov. John Hickenlooper does not veto legislation that would address a conundrum with mental health holds.
The issue impacts the entire state, but is emphasized in rural Colorado, where there is a lack of “designated facilities” to comply with law and offer patients adequate mental health treatment.
The governor’s office has expressed concerns with legislation that would address the problem, fearful that the fix would erode due process.
Hospital providers worry that the governor might veto the bill, though they want him to sign the legislation or let it go into law without his signature.
The bill addresses state law, which requires that patients placed on a 72-hour emergency mental health hold be taken to a designated facility or to a jail. Because few hospitals in rural Colorado are designated facilities, sheriffs often incur the burden.
Jails were to be used only as a last resort for holding patients, as those facilities are not equipped for such programs.
The closest designated facility to Durango is in Grand Junction. Of the state’s more than 100 hospitals, only about 30 are designated facilities.
“If somebody is having a mental health crisis, most often the sheriff might be called, and then what does the sheriff do?” said Rep. Tracy Kraft-Tharp, D-Arvada, a co-sponsor of the legislation. “They can’t drive you eight hours; they might be the only person on shift.”
To become a designated facility, hospitals must meet certain requirements, including having a 24-hour psychiatrist, which can be too expensive for smaller rural hospitals.
Generally, a person experiencing a mental health emergency is taken to a hospital emergency room, as most people are unaware of the law.
Federal law requires all hospitals to screen and treat patients who come to an emergency room, including those experiencing a mental health crisis. But state law doesn’t allow most of those hospitals to hold patients.
“We don’t want to send somebody back out that we’re not sure about, that’s irresponsible,” said Haley Leonard, spokeswoman for Southwest Health System in Cortez.
The legislation would create a tiered system, where designated facilities would be the primary location. But if those facilities are unavailable, then the next tier would be an emergency room, where the hospital would be allowed to hold a patient for up to 36 hours while awaiting specialty psychiatric care at a designated facility.
If both those options are unavailable, patients would be brought to a jail.
“Mental health services are extremely challenging for rural areas,” said Kent Rogers, chief executive of Southwest Health System. “The way that the law works now is that jail is the destination for people that are having mental health issues, and that’s not the appropriate setting for these people.”
A spokeswoman for Hickenlooper said only that the governor continues to review the bill.
During the legislative session, the governor’s office expressed concerns with not offering patients fair treatment through the judicial system.
The Colorado Hospital Association sent the governor a letter on May 16, urging him to sign the bill.
Beyond the immediate problem, there also are concerns about overall mental health services in rural Colorado. The bill would collect data on mental health holds and require a report to the Legislature so that deeper issues might be addressed.
“Without this bill, Colorado communities will continue to be in limbo, putting individuals experiencing a mental health crisis at greater risk and creating liabilities for organizations and individuals seeking to provide medical care,” wrote Steven Summer, president and chief executive of the hospital association.
“Emergency responders will be forced to choose between violating the law and taking individuals to jails, even though all stakeholders agree that jail should be the destination of last resort. The state will continue to lack the information ultimately needed to justify additional resources for Colorado’s behavioral health system.”