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


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

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

After crisis care, Medlock plans to focus on caring for children, significantly bolster the workforce of mental health professionals in the state, launch a better accountability system for providers, and reach communities that are currently underserved by mental health services. An addiction psychiatrist by trade, she also plans to fully integrate state approaches to mental health and addictions services to tackle head-on the fallout of fentanyl in our communities.

What I like is that it puts one person in charge of each of these issues, and they will be tasked with making them better.

Finally, we moved beyond the study, subcommittee, task force, and endless discussion phase of the issue to address our broken mental health system. We now have skin in the game: we have entered the phase of solving real problems by real people.

Medlock herself is in charge of the new Behavioral Health Administration created by Gov. Jared Polis that will assume responsibility for approximately 120 mental health and addictions programs that are now spread across multiple state agencies.

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

Medlock wastes no time. She has spent her first two months touring mental health facilities across the state and next week she is planning a statewide summit of crisis service providers.

“We’re going to talk about how do we design a crisis system that inspires, how do we reinvent a crisis system for Colorado, how do we become a crisis system that can prevent the involvement of justice, how do we become- we have a crisis system that is able to address both mental health and addiction issues? »

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

This does not include emergency rooms, although they have been a default first stop for many people unsure where to turn in a crisis. “An effective crisis system should minimize the redirection of people to emergency rooms,” she said.

Medlock was most recently Chief Medical Officer of the Washington DC Department of Behavioral Health. She is on the faculty of the Massachusetts General Hospital Center for Law, Brain and Behavior and was a Clinical Psychiatry Fellow at Harvard Medical School.

She takes office amid a debate over monumental legislation that would transform Colorado’s entire mental health care system and decide how to spend $450 million in ‘once in a generation’ federal coronavirus aid for reform mental health care and addictions. treatment in Colorado.

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

Medlock acknowledged these stories without flinching.

“At the provider level, the lives affected, the stories that were told, the opportunities missed were truly reported. And we look forward to establishing a new accountability framework,” she said. “We are adding new FTEs to our administration to build a new accountability system for safety net providers.”

When I asked him if this comprehensive bill would blow up the current system, Medlock was diplomatic but tough. “We want to use the word ‘transformation’,” she said. “We invite all providers to join us in the future of equitable person-centred care. We are changing the whole landscape of how we measure access, quality and accountability, to put people first and the value of their lives.

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

“The way forward, based on lessons from other states, is that we don’t necessarily need to consolidate all of these programs into the BHA, but we need to develop methods to connect behavioral health administration to these other agencies and programs so that we can have a unified strategy for delivering services, measuring access, and measuring quality of services. This is where universal contractual provisions come in and it is really essential to our transformation process.

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

“First, we just need to have enough beds for people who need that level of treatment. Putting more beds online so our kids don’t 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 child, youth and family advisor to lead the effort.

She is also hiring a Workforce Development Policy Officer to oversee efforts to hire many more mental health professionals, which is badly needed.

During her statewide tour, she said she was struck by the cultural complexity of the state. “People from all walks of life and all stories and histories are here, each with a story worth telling, hearing and living.

“The overriding need I see is for fairness, given the complexities that exist in the state.”

People want to see fairness in contracts, she noted, they want to see a behavioral health administration that not only invests in large institutions, but also invests in community organizations that provide care to marginalized communities. . They want to see fairness in the design of the system.

“That includes racial and ethnic minorities,” she said. “This includes tribal governments. This includes people with disabilities, including those who may not be able to afford services. They also deserve the best care.”

Clearly, this job is a lifelong mission for Medlock, and that’s exactly what Colorado needs: someone who comes to work out of passion, who sees problems clearly, and isn’t afraid to knock over a few tables. to make things better.

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

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


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