April 13, 2024


Extraordinary care

New behavioral health chief wants state to ‘reimagine’ crisis care | Vince Bzdek | Health

Dr. Morgan Medlock, Colorado’s first-ever mental health czar, says Job One in fixing the broken behavioral health system in Colorado is transforming crisis care.

“We need to really build out a continuum of services, but I am really focused in on the crisis system,” Medlock, the state’s new commissioner of behavioral health, told The Gazette in an interview. “We want to see a system that can truly catch people, and that can truly be a support and a safety net for individuals.”

After crisis care, Medlock plans to zero in on children’s care, dramatically beef up the workforce of mental health professionals in the state, launch a better system of accountability for providers, and reach out to communities that are underserved by mental health services now. An addiction psychiatrist by trade, she also plans to fully integrate the state’s approaches to mental health and addiction services to take on fentanyl fallout in our communities head-on.

What I like is that she is putting a person in charge of each of these problem areas, and they will own the job of improving them.

Finally, we’ve moved beyond the study, subcommittee, task force, and endless-talk-about-the-problem phase of addressing our busted mental health system. We’ve got some skin in the game now: We’ve entered the real-people-solving-real-problems phase. 

Medlock herself is in charge of the new Behavioral Health Administration created by Gov. Jared Polis that will take over responsibility for about 120 mental health and substance abuse programs that now are spread throughout several state agencies.

The office was created after a governor’s task force recommended a top-to-bottom reinvention of Colorado’s troubled mental health care system, which has been ranked among the worst in the country by recent studies.

Medlock is wasting no time. She’s spent her first two months touring state mental health facilities and next week she is planning a summit of crisis providers around the state.

“We’re going to be talking about how we design a crisis system that inspires, how do we reimagine a crisis system for Colorado, how do we become a crisis system that can prevent justice involvement, how do we become a crisis system that is able to address both mental health and substance use challenges?”

The spectrum of crisis care includes the state’s crisis hotline, the mobile crisis team, walk-in centers where you can receive help without an appointment, crisis stabilization units that have some beds and longer care options, and also respite centers that provide support for caregivers.

It does not include emergency rooms, though they have been a default first stop for many people who aren’t sure where to turn when they are in crisis. “A crisis system that is effective should minimize redirecting individuals to emergency rooms,” she said.

Medlock was most recently chief medical officer for the Washington D.C. Department of Behavioral Health. She is on the faculty at Massachusetts General Hospital Center for Law, Brain and Behavior and was a clinical psychiatry fellow at Harvard Medical School.

She assumes office in the midst of debate over monumental legislation that would transform the entire mental health care system in Colorado and decide how to spend $450 million in “once-in-a-generation” federal coronavirus aid to reform mental health care and substance abuse treatment in Colorado.

The legislation would create new regional “behavioral health administrative service organizations” that would essentially supplant the troubled community health centers around the state. The Gazette and other publications have reported on acute problems with the community health centers in recent months, with patients and their families telling horror story after horror story of falling through the cracks.

Medlock acknowledged those stories without batting an eye.

“At the provider level, the lives impacted, the stories that have been told, the missed opportunities have been verily reported on. And we are eager to establish a new accountability framework,” she said. “We’re adding new FTEs to our administration to build a new system of accountability for safety-net providers.” 

When I asked her if this comprehensive bill blows up the current system, Medlock was diplomatic but tough. “We’re wanting to use the word ‘transformation,’” she said. “We’re inviting all providers to move into the future of people-centered, equitable care with us. We are changing the entire landscape for how we measure access, quality and accountability, in order to put people and the value of their lives first.”

When it comes to the agencies that the BHA will directly oversee, Medlock sees accountability as the key as well.

“The path forward, based on lessons from other states, is that we don’t need to necessarily consolidate all those programs in the BHA, but we need to develop methods for connecting the Behavioral Health Administration with those other agencies and programs so that we can have a unified strategy for delivering services, measuring access and measuring quality of services. That’s where the universal contracting provisions come in and that’s really critical to our transformation process.”

When it comes to children, Medlock is very concrete about first priorities, as well.

“First of all, we just gotta have enough beds for people that need that level of treatment. Bringing more beds online so our kids do not have to go out of state.” Polis already has a plan to use federal pandemic rescue fund dollars to achieve that goal.

Medlock is in the process of hiring a senior adviser for children, youth and families to see the effort through.

She is also hiring a workforce development policy officer to oversee the effort to hire many more mental health professionals, a gaping need.

During her statewide tour, she said she has been struck by the cultural complexity of the state. “People from all walks of life and histories and stories are here, each with a story that deserves to be told and heard and experienced.

“The overarching need that I’m seeing is one for equity, given the complexities that exist in the state.”

People want to see equity in contracting, she noted, they want to see a Behavioral Health Administration that not only invests in large institutions but also invests in community-based organizations that are providing care in marginalized communities. They want to see equity in system design.

“That includes racial and ethnic minorities,” she said. “That includes tribal governments. That includes individuals experiencing disability, includes those who may be unable to pay for services. They deserve the very best care, as well.”

Clearly, this work is a lifetime mission for Medlock, which is just what Colorado needs: someone who comes to the job out of passion, who sees the problems clearly and isn’t afraid to turn over a few tables to make things better.

“We do this work because we have a personal connection to it and we believe we are designing a system for our own family members. It’s personal for all of us,” she told me.

“I wish I had the power to turn back time and change lives that have already been impacted by our broken system, but since I can’t do that, we want to redeem the time. And redeeming the time means building trust, meaningful action, and using the time we have to make a difference.”