Treatment Advocacy Center Staff Testify in Support of Colorado SMI Bill
DJ Jaffe Advocate Sabah Muhammad testified to the members of the House Public & Behavioral Health & Human Services Committee on March 29 in support of HB22-1303. Legislative and Policy Counsel Michael Gray also submitted written testimony:
Chairperson Jenet and the members of the House Public & Behavioral Health & Human Services Committee:
The Treatment Advocacy Center supports HB22-1303 and respectfully asks that this committee approve it for passage of the House. The Treatment Advocacy Center is a nationwide nonprofit dedicated to eliminating barriers to the treatment of severe mental illness (SMI). The relative lack of inpatient psychiatric beds in Colorado is a barrier to treatment and HB22-1303 would provide better access to care.
Colorado, like most states, has a bed shortage for both civil and forensic patients. Our research indicates that 40- 60 beds per 100,000 population is the optimal number for access to treatment, and 30 beds per 100,000 population is the absolute minimum. Colorado’s 10 state hospital beds per 100,000 people fails to meet this minimum standard. For comparison, a psychiatric bed supply range of 25-30 is considered a mild shortage, 15-25 as a moderate shortage, and less than 15 per 100,000 population as a severe shortage of psychiatric beds. In addition to a bed shortage, Treatment Advocacy Center also reports underutilization of Colorado’s involuntary commitment laws, which prevents access to beds and early intervention for people with SMI.
When people experience a psychiatric emergency, publicly supported state psychiatric beds are where they are most often admitted for treatment. Without access to hospital care, acutely ill individuals deteriorate, emergency rooms fill with acutely ill, and police find themselves increasingly diverted to mental health calls. This causes a bottle neck effect where almost no one accesses the treatment they need in a timely manner.
The pandemic made this bottle neck effect even more deadly for the most vulnerable citizens in Colorado. Individuals with a diagnosis of schizophrenia are at a substantially elevated risk of dying from COVID-19. Schizophrenia is second only to age as the largest risk factor in COVID-19 mortality. People with major psychiatric disorders are more likely to have comorbidities associated with worse outcomes of COVID-19.
Psychiatric bed shortages affect everyone, including family members of people with SMI. Families navigated barriers to treatment for their loved ones long before COVID-19, but insufficient bed numbers driven even lower by the pandemic exacerbated their plight. Lacking sufficient inpatient treatment options, family members watch their loved ones suffer untreated crises, homelessness, and criminalization. HB 22-1303 delivers the hope and promise of treatment to at least 49,605 Coloradans with a diagnosis of schizophrenia and 103,720 with a diagnosis of bipolar disorder.
Further Recommendations
- Stop eliminating public psychiatric beds
- Continue to restore enough beds to create access to inpatient care for qualifying individuals in crisis so that the recommended 60 beds per 100,000 citizens is met
- Identify and reform public policies that incentivize bed shortages
- Make active use of the state’s civil commitment laws to provide more timely treatment to individuals in need of treatment psychiatric crisis services.
- Amend Colorado’s Sec. 1115 Medicaid waiver to include the institutions for mental diseases (IMD) exclusion for people with SMI. Colorado already has a waiver for the IMD exclusion relativeto substance use disorder but not for SMI.
Thank you for considering this testimony.