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Jail use restricted under latest mental-health recommendations

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A task force made recommendations Tuesday in an effort to address a conundrum with mental health holds after Gov. John Hickenlooper last year vetoed legislation on the subject.

The task force was created after Hickenlooper in June expressed concerns with a bill that would have created a tiered system, where facilities designated for mental health holds would have been the primary location. If those facilities were unavailable, then the next tier would have been an emergency room.

Hickenlooper last year acknowledged that there is a problem with finding adequate facilities, but he feared the legislation would have eroded due process, which is what sparked the creation of the task force.

The 30-member panel – which included lawmakers, law enforcement officials and health care professionals – came up with eight recommendations, including eliminating the use of jails for persons placed on mental health holds who have not been charged with or convicted of a crime.

Many of the recommendations mirror the intent of the legislation last year, though Hickenlooper appears more confident about the due process aspect of the effort after the task force investigated.

“Those experiencing mental health crises should get the treatment they need in the setting that is most appropriate for their care,” Hickenlooper said in a statement. “We hope and expect that this effort will result in substantive changes to better the lives of Coloradans.”

Recommendations also include bolstering system capacity, streamlining regulations and maximizing the state’s existing behavioral health resources, understanding barriers to mental health inpatient care and developing a data tracking system to understand the scope of the problem.

The issue significantly impacts rural Colorado, where there is a lack of “designated facilities” to comply with law and offer patients adequate mental health treatment. When a designated facility is unavailable, patients are brought to a jail. Because there is a lack of compliant facilities in rural Colorado, jail is often the only option.

Hickenlooper’s veto upset hospitals and lawmakers who had worked to pass the measure last year. Some suggested that the governor did not understand the legislation, which is what led to the veto.

In his veto letter, Hickenlooper wrote that the bill “allows advanced practice nurses to determine if a person should be committed to a mental health facility longer than 72 hours.”

The Colorado Hospital Association, however, said, “In fact, the bill did not allow this, but was exactly the opposite – it would have allowed advanced practice nurses to release patients who were no longer in crisis, consistent with their scope of practice.”

The bill passed with bipartisan support from 88 of the legislature’s 100 lawmakers. It is likely to come up again in the upcoming session, which begins on Jan. 11. Legislation is likely to originate in the governor’s office, though it is unclear which lawmaker will carry the measure this year.

Under the bill last year, hospitals would have been allowed to hold a patient for up to 36 hours while awaiting specialty psychiatric care at a designated facility. Designated facilities can hold patients up to 72 hours. The bill would have emphasized that jails are a last resort for those experiencing a mental health crisis.

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.

Rep. Tracy Kraft-Tharp, D-Arvada, a sponsor of last year’s bill, said she is encouraged by the task force’s recommendations, but that she is concerned about jumping too quickly to repeal existing law before enacting most of the policy changes.

“We need to find the balance between support for our first-responders and making sure that we are providing a safe place for folks with a mental health issue,” she said.

 

 

 

 

 

 

 

 

 

 

 

 

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