Emergency 72-Hour Mental Health Bill Debated Today

Senator Redefines Medicaid ‘Access’ to Care

A bill that would change emergency procedures for individuals in mental health crises (Senate Bill 16-169) is up on Second Reading in the House today. The bill has drawn support, and opposition, from a wide variety of stakeholder groups. It has passed the Senate and has undergone over 40 amendments during the legislative process. The bill has been hard fought by one of its sponsors, State Representative Lois Landgraf. In an interview with Catherine Strode, she says working the bill has been a ‘painful’ experience but one she will definitely repeat next session if it does not pass in the current one.

What is the impetus for the bill?
“This particular bill helps open up beds when a person is in a mental health crisis. Right now, if a person has a mental health crisis, they have to go to a designated facility of which there are limited number. If someone takes them to an emergency room, and the emergency room holds them, the emergency room is in violation of federal law. The idea is to allow them to hold somebody for a period of time, protect their civil rights, and then have them moved to a designated bed, a designated facility, when one comes open. That’s the idea behind the bill. The end goal is to increase capacity, increase accessibility, and ensure people’s civil rights are maintained. That’s the end goal and everybody realizes that.”

What is the involvement of the Colorado Sheriffs Association in the bill?
“The Colorado Sheriffs Association added language around jails. Police and sheriffs would have options available to them. That’s the goal. What happens in a lot of areas (rural Colorado especially) if there are no designated beds and you can’t go to an emergency room, people are put into a jail. They’re put into a jail because they are a danger to themselves or to others. The bill will open up options which would reduce the number of patients that would end up in a jail. If a person is put into jail under this bill, after 24 hours they have to have a court order to hold them for an additional 24 hours. There’s a process in place to ensure their civil rights are protected. Within so many hours, you have to be evaluated, they have to find a bed, and within so many more hours you have to be transferred to that location. It’s not a ‘put them in jail, leave them in jail until you decide what to do with them.’ Jails are not the place where people with mental health crises should be. Nobody would argue with that. If there’s no capacity elsewhere, is it better to turn somebody out and let them hurt themselves, kill themselves, or hurt others? Not in my opinion.”

What is the opposition to the bill?
“They would like to make it illegal to put a person with a mental health crisis into a jail. The problem is, we can’t take that off the table as a tool to use when it’s needed. I question whether a policeman is just going to keep somebody in the back of their car for 24 hours. The Governor’s office did bring in one amendment that in two years, the use of a jail for a mental health crisis was off the books. It’s a lofty goal, one that everybody would love to achieve within a week. It’s not practical. That amendment failed but they continue to want to bring it back. They also want the finding of a mental health crisis to be ‘clear and convincing evidence’, requiring a mental health expert, or a physician, to make that diagnosis. There are areas in Colorado where those people aren’t available to do that work. The Hospital Association requires the ‘preponderance of evidence.’ We have to stick with a preponderance of evidence.”

Is there protection in the bill for the mentally ill not to end up in the criminal justice system?
“No. This is just 72-hour holds. That is a concern. When somebody who has a severe mental health problem is acting out violently, and taken to a jail because there are no other options, and they lash out at a police officer, you go from mental health to a crime. That would be a different subject and I think that’s something we should be looking at.”

Do you consider the bill an incremental solution?
“Absolutely. Passing the bill is a step in the right direction. It is also a good faith gesture to pass this because this has been so painful. I actually said in committee that it really discourages anybody from undertaking mental health bills. We’re talking upwards of 50 amendments to this bill that have been run. The people on this bill have just been working to death. If the bill doesn’t pass, things go on as they are now. People will continue to be put in jail, people will not be able to use emergency rooms, or, when they do they’ll be violating law. Nothing will change, nothing will improve.”