HomeMy WebLinkAboutCOUNCIL - AGENDA ITEM - 07/10/2018 - LARIMER COUNTY BEHAVIORAL HEALTH PLAN UPDATEDATE:
STAFF:
July 10, 2018
Beth Sowder, Director of Social Sustainability
Jackie Kozak-Thiel, Chief Sustainability Officer
WORK SESSION ITEM
City Council
SUBJECT FOR DISCUSSION
Larimer County Behavioral Health Plan Update.
EXECUTIVE SUMMARY
The purpose of this item is to build upon past work sessions related to Larimer County’s plans for needed
behavioral health services across the county and focuses on the plan, information from City departments and Fort
Collins community partners about priorities and collaboration options.
Larimer County Commissioner Steve Johnson and Larimer County Behavioral Health Director Laurie Stolen will
present to Council with City staff.
GENERAL DIRECTION SOUGHT AND SPECIFIC QUESTIONS TO BE ANSWERED
1. Does Council agree with potential options presented for City collaboration?
2. Does Council have feedback on the Larimer County Behavioral Plan or have any questions about next steps?
BACKGROUND / DISCUSSION
Larimer County has worked with community partners and commissioned studies that identified major gaps in
critical behavioral health services, suggested recommendations for what services are most needed, at what
levels, and for what cost. The local ballot initiative failed in 2016 but work is continuing, and the County will
consider referring it to the ballot in November 2018. Because these gaps have a significant impact on local
residents and their families, government, health, and social services, this is an opportunity to discuss where the
County is now as well as ideas for collaborative local options moving forward.
The City has representatives from Police Services and Social Sustainability who are active members of the
Mental Health and Substance Use Alliance of Larimer County. This involvement, along with many other
community agencies represented, has been critical in the collaborative and comprehensive approach to the
recommendations for expanding critical behavioral health services in Larimer County. The Mental Health &
Substance Use Alliance provided a report showing service gaps in Larimer County. Some compelling data for
Larimer County includes:
• Approximately 53,800 people (20% of the County) have a mental illness-of those, 12,300 (4.6%) have a
serious mental illness.
• 25,000 (8.5%) of individuals 12 and over have a substance use disorder.
• Mental illness and substance use disorders often occur together - about a third of all people experiencing
mental illness and about half of the people living with a severe mental illness also experience substance
abuse-this equates to approximately 5.9% of adults (15,500) had co-occurring mental illness and
substance use disorder in Larimer County, and 2% (5,250) had co-occurring serious mental illness and
substance use disorder.
July 10, 2018 Page 2
Alignment with City Strategic Plans and Objectives
When looking at how expanding critical behavioral health services in Larimer County will impact the City
organization, there are anticipated impacts which align with City goals. The plan to expand needed behavioral
health services aligns with the City’s strategic plans and objectives.
Strategic Alignment
The expansion of critical behavioral health services in Larimer County is in alignment with Council priorities and
some of the City’s stated goals:
• Council Priority - Behavioral Health/Detox Facility
• The City’s 2016 Strategic Plan includes the following strategic objectives:
o Neighborhood Livability & Social Health: Leverage and improve collaboration with other agencies
to address homelessness, poverty issues, and other high priority human service needs.
o Safe Community: Improve community involvement, education and regional partnerships to make
our community safer and stronger.
• The Social Sustainability Department Strategic Plan has a goal that states: Foster increased availability
and access to mental and behavioral healthcare through:
o Work with local organizations to ensure 24-hour availability of mental and behavioral health care
and treatment.
o Encourage and support programs providing mental and behavioral health care for low-income
persons and persons experiencing other barriers.
o Through education, outreach, partnerships, and collaboration, increase the community’s general
awareness/acceptance of mental and behavioral health and illness.
o Support education, outreach, partnerships, collaboration, and prevention/intervention efforts,
increasing the community’s general awareness regarding substance abuse.
o Support increased discharge coordination and planning, improving continuity of mental and
behavioral health care and recovery for people leaving hospitals, correctional facilities, and other
similar situations.
o Support development of halfway housing and permanent supportive housing for persons with
mental and behavioral illness.
o Partner with other community entities to create a residential treatment facility for people with
drug and alcohol addictions.
o Support creation and operation of a detox facility in Larimer County.
• The Social Sustainability Gaps Analysis also included the following goals:
o Residents are able to rapidly access and receive the depth of treatment needed for mental
health, physical health, and substance abuse needs.
o High quality health care is delivered across the continuum of care: therapy, outpatient care,
inpatient care, residential treatment for addictions, mental health care.
Summary of Information and Support from City Departments and Community Partners
As the City was working with Larimer County to better understand how expanded behavioral health services
would support and work with various departments within the City as well as external community partners, the City
received information about priorities, potential partnerships, efficiencies, general assistance with social services,
and primary benefits that would come from having increased behavioral health services in Larimer County
(Attachment 1). A summary of the information received includes:
Top Three Priorities are the same as the Loveland Work Group (several others were also listed):
1. Homelessness
2. Suicide Prevention
3. Opioid Crisis
Many ideas for partnering opportunities, including but not limited to:
o Referrals and service provision coordination
July 10, 2018 Page 3
o Both centralized and distributive models would be helpful
o Help fulfill unmet needs - not duplicative
Local detox would help in the following ways:
o Care in Larimer County rather than sending out of community
o Increased/improved coordination of care
o Immediate capacity boost that is desperately needed
Would help with following primary social concerns:
o Homelessness
o Suicide
o Youth mental health
o Substance use disorders
Primary benefits include:
o Improved response time for emergency services
o Increased access to behavioral health services
o Reduction in repeat contacts/frequent utilizers
Potential Options for Collaboration with City Departments and Community Partners
Some potential ways City departments and community partners will collaborate with the County on the expanded
behavioral health plan have been explored. Some items are more general thoughts about coordinating services
and realizing efficiencies while others are more specific plans for collaboration.
Police Services
Fort Collins Police Services (FCPS) recognizes the sanctity of life as an utmost priority and as such will partner
with the County in finding efficiencies and ways to optimize support for individuals suffering from mental health
and substance disorder issues. FCPS will be part of the co-responder team comprised of multiple local agencies
pooling resources, including co-responder coverage, education and training of officers.
The co-responder program is a collaborative effort which will assist officers in effectively utilizing the new county
services, including enabling officers to get those experiencing a mental health crisis to the proper facility at the
first law enforcement contact, thus addressing the underlying mental health concerns and effectively reducing
recidivism as individuals receive appropriate resources.
Poudre Fire Authority
Many of the highest utilizers of emergency services are experiencing homelessness and have co-occurring
behavioral health needs and substance use disorder. Oftentimes, regardless of medical necessity, these people
are transported by ambulance to the emergency department because doing so is the only option available.
The ability of Poudre Fire Authority (PFA) to partner with representatives of Larimer County would be a
tremendous benefit, both indirectly and directly, and PFA is committed to this partnership. Efforts such as a co-
responder program, where a behavioral health professional is embedded with a PFA emergency responder,
coordination of services and access to more appropriate levels of care for a variety of patients, both in the
emergency medical setting, and in the behavioral health realm could be realized. Creative partnerships such as
this would ensure the community has access to needed emergency services (fire engines and ambulances),
moderate the volume in regional hospital emergency departments, and connect people with behavioral health
and/or substance use disorder with a resource capable of helping them.
Transfort
The ability to increase and expand public transportation to the behavioral health facility would be imperative;
however, there are still major considerations that would need to be worked out. The proposed location is
July 10, 2018 Page 4
approximately 2.5 miles from the nearest fixed route, so it would make very little economic sense to extend that
route. Based on the exact needs and clientele of the facility, it would be possible to design a specific service at
varying capacity and frequency levels. The cost would most likely be large enough that this would need to be a
funding (Budgeting for Outcomes)/policy discussion to make a commitment.
Social Sustainability
It is possible that certain additional services provided by non-profit community partners could compete for City
and Federal funding through the City’s annual competitive funding process. This could include funding for Mental
Health First Aid and Crisis Intervention Training as well as other services.
Restorative Justice
The Restorative Justice (RJ) programs could address any criminal behavior the youth have been involved in,
while other providers assist with the mental and behavioral health needs. RJ is committed to partnering with the
County in this way.
Natural Areas
It is possible that the City’s Natural Areas Department could partner with Larimer County to provide natural areas
or trails connecting to the proposed behavioral health facility site at Trilby and Taft Hill Roads. The City is open to
considering this, but more information about the land and how it would work between the City and the County
would need to be explored and discussed.
Outreach Fort Collins
Outreach Fort Collins (OFC) will focus on essential partnerships and community collaboration needed to
strengthen and expand integrated mental health and substance use disorder services. OFC will work proactively
and responsively in communicating and coordinating with local service agencies and community stakeholders in
identifying, connecting, and supporting individuals with mental health or substance treatment needs in the area
OFC serves. Should the ballot measure pass, OFC will work directly with Larimer County Behavioral Health in
optimizing efficiencies to better serve the community and its residents by utilizing trained crisis intervention and
coordinated entry for services.
Murphy Center and Homeward Alliance
Homeward Alliance, which includes the Murphy Center, serves approximately 165 individuals per day, including a
significant number of individuals with mental health issues. The proposed behavioral health facility would have a
profound positive impact on the people served and the community at large. Homeward Alliance expects to
collaborate regularly with the facility and its staff in countless ways, including but not limited to:
o Direct referrals between the Murphy Center and the new facility
o Case consultation regarding mutual clients
o Office provision, if appropriate (e.g. behavioral health staff could meet with clients at the Murphy
Center)
There are numerous other service providers who have committed to partnering and coordinating with the County
on the expanded behavioral health services. The ones listed above are identified specifically because the City
has a direct funding or coordination component.
Overview and Highlights of Larimer County Behavioral Health Plan
Larimer County has done a tremendous amount of work identifying the needs, gaps, and potential solutions for
expanded behavioral health in Larimer County.
During the spring of 2018, the County conducted a series of communitywide listening activities to get upstream
from crisis response with increased attention towards early identification and early intervention. There has been
an increased focus on suicide prevention awareness training in the schools and the community. The County
July 10, 2018 Page 5
focused their message on clearly defining their role in the effort as well as the investment that they are making in
the community. They clearly identified the “what’s in it for me” to all of Larimer County, and focused on building
and strengthening partnerships to build a community-driven and community-based solution.
They have utilized national experts and local professionals in determining that it is a community-wide issue that
requires community-wide solutions. The Solution will require a dedicated funding stream, and is 3-pronged:
1. Expand and enrich local behavioral health services throughout the County.
2. Facilitate connections between community-based services/providers in a centralized facility providing
stronger care coordination and building transition bridges across community-based providers and
services.
3. Build a regional behavioral health facility to provide crisis services and coordinated care.
A Community Master Plan for Behavioral Health Services (Attachment 2) includes the following components:
1. Larimer County 5-year Strategic Plan
2. Mental Health Substance Use Alliance Road Map Report
3. Site Design and Land Planning Report
a. The County has earmarked a parcel of land by Trilby/Taft Hill Roads for behavioral health
purposes, if this initiative passes.
4. Community Health Improvement Plan
5. Municipal Partnerships
6. School District Partnerships
7. Community Priorities
The distributive services throughout the county will include:
• Suicide Prevention Awareness and Training
• Innovations in professional development
• School behavioral health support
• Care coordination through case management services
• Support services in Permanent Supportive Housing
• Tele-psychiatry network of care
The community facility services will include:
• Care coordination with clients receiving care in facility or community services
• Assistance funds will provide help with service expenses, flexible funding for medications, transportation,
deductibles/co-pays, etc.
• Improvement of cross system communication will be critical to the overall success of this community
behavioral health reform effort
A centralized behavioral health services facility will bring missing critical levels of care to our community, allowing
residents to get the care they need, when they need it, at lower cost than what is currently available. This will
include:
• Medical clearance, triage and assessment
• Crisis Stabilization Unit
• Social and Medically Monitored Detox services
• Short-term Intensive Residential Treatment
The Master Plan includes significant cost analyses and outcome measures based on other communities who
have implemented expanded behavioral health into their communities. These include:
• Reduced emergency department admissions and re-admissions
• Reduced 911 calls and repeat calls
July 10, 2018 Page 6
• Reduced criminal activity/arrests
• Reduced jail use
• Reduced suicide
• Increased community connectedness and resilience
• Healthier families and kids
• Increased work productivity, less sick days, less insurance claims
Next Steps
• A citizen campaign team will form this summer, and they will take a resolution to the Board of County
Commissioners on July 24 asking them to refer this issue to the ballot this November.
• The Loveland City Council will have a work session to discuss this on September 11.
• Fort Collins City Council will consider a resolution supporting this ballot initiative at the September 18
Council meeting.
ATTACHMENTS
1. Summary of Information and Support from City Departments and Community Partners (PDF)
2. Larimer County Behavioral Health Plan Executive Summary (PDF)
3. Master Community Behavioral Health Plan Overview (PDF)
4. PowerPoint Presentation (PDF)
1
Larimer County Behavioral Health Plan – City Departments & Community Partners Feedback
Summary of info gathered from City Departments and community partners:
City Departments: Police, Municipal Court, Parks, Natural Areas, Safety Security & Risk
Management, Human Resources, Planning Development & Transportation
Community Partners: Library, SummitStone Health Partners, Outreach Fort Collins, Northern
Colorado Aids Project, Homeward 2020, Murphy Center/Homeless Gear, Catholic Charities,
Fort Collins Rescue Mission, Coordinated Assessment & Housing Placement System,
Volunteers of America/Supportive Services for Veteran Families, Housing Catalyst, Neighbor to
Neighbor
Summary of information received based on the following questions:
1. A Loveland working group identified the top three priorities for their community regarding
behavioral health. They are: 1. Homelessness, 2. Suicide Prevention, and 3. The Opioid
Crisis. Do you think these are also the top three priorities for Fort Collins? If not, what
other priorities would you include?
a. Most agree with the top three issues – but some would put them in different order
or would add others
b. Youth well-being
c. Crisis stabilization/crisis mental health
d. Mental Health/behavioral health (not just suicide prevention)
e. Substance use disorder (not just opioid crisis) treatment – more resources
toward methamphetamine
f. Community outreach/partnerships
g. Medicaid coverage – access to providers
h. Assertive Community Treatment (ACT)
i. Mobile supportive services
j. Coordination out of institutional settings (jail, hospital, etc.)
k. Inpatient/residential option
2. In what ways would you see your department/organization partnering with the County on
Behavioral Health Services? Do you think partnering and providing services in a
distributive model would be helpful?
a. Partner as referral with first responders and service providers including PSH
b. Coordinated provision of services needed
c. Centralized hub would be helpful
d. Some torn and see benefit of both distributed model and one central location
e. Centralize first – then look at distributive model later
f. Centralization would allow easier identification by the public and pooled
resources by creating economies of scale – would also improve the management
of the continuum of care
g. Longer term detox stays will serve as bridge to long term treatment programs
ATTACHMENT 1
2
h. Decentralization could decrease effectiveness but would help with transportation
and communication – and more options in different locations would be helpful
i. Partner – expand programs to offer BH support impacted by opioid crisis and
homelessness – road-blocks exist though
j. Would help people remain stably housed
k. Service providers could help with early identification of people who need BH
services
l. Partners would help fulfil unmet needs, not duplicate services that already exist
m. The LC BH plan is to provide services that should be offered in one location
(withdrawal management, short-term intensive residential treatment, crisis
stabilization services); outpatient services are already offered in a distributive
manner in the community and should not be part of the LC BH plan
n. Partners will help with care coordination
o. Curious about partnerships with EAP programs
3. How would having a local detox and behavioral health treatment facility assist in the
work/services you provide?
a. Care in our community of a needed service rather than sending our residents out
of the community
b. Better coordination of care
c. Relief to some providers, and decrease repeat/frequent utilizers
d. Provide an immediate capacity boost that is desperately under-resourced
e. Great benefit but need to be culturally sensitive and not stigmatize people
f. More immediate service
g. Need to be flexible enough to meet the needs – meet people where they are
4. How would this help with some of the primary social concerns in our community?
a. Homelessness
i. Many of the highest utilizers are homeless with co-occurring mental
health and substance use disorder needs
ii. Such severe issues need specialists to treat them
iii. Would not help those who choose homelessness
iv. Better intervention would help with effective treatment and help get
people off the street
v. Great benefit for homeless
vi. Get medication needed
vii. Address BH needs at crucial time to obtain/maintain stability to prevent
further decompensation
viii. Ensure getting services by trained professionals proficient in de-
escalation, trauma-informed care
ix. Help create a system of care and assist in navigating
x. Help with supportive services
b. Suicide
i. Place to refer patients that are threatening to harm themselves
3
ii. Patients would receive more efficient access to more appropriate levels of
care
iii. Important for veterans and youth
iv. People in treatment are less likely to commit suicide than those not
getting help
v. Another option would be helpful
vi. Providing a more comprehensive and collaborative continuum of care – a
comprehensive spectrum of services for those folks who need the most
care and who will not survive any lapses in care
c. Youth mental health, violence
i. Youth would be treated specializing in treating unique needs of minors
with mental health emergencies
ii. Getting more youth into needed treatment will be positive
iii. A county-wide approach that offers youth prevention, early identification
and early treatment would better support families in understanding their
youth’s needs and assist them in connecting to care
d. Vehicle crashes
i. Offer education and ways to get into treatment more quickly to address
the substance use issues
ii. The State needs to stop promoting drug/alcohol use
iii. Fewer DUIs – but need court-ordered treatment
e. Substance use disorders
i. Access to programs for treatment of these complex conditions will be
crucial to the long term success of these patients
ii. Very beneficial – provide service at the moment they need it –
coordinated discharge plan to help not relapse
iii. Measureable, solvable problem that can be tackled in a compassionate,
multifaceted way
iv. Individuals with mental illness are more likely to develop substance use
disorders down the road – early intervention and treatment can prevent
later problems
v. Withdrawal management services would allow individuals who are
intoxicated a safe place to be fully assessed and connected to services
5. Please, describe the primary way your department/service would benefit from having
increased behavioral health services in Larimer County.
a. Improve response time for PFA, Police, and emergency services
b. Increased access to behavioral health services – especially outreach where case
managers or therapists could go to clients’ homes and treat them to ensure
stabilization – would be very beneficial
c. This resource would provide first responders with a valuable resource for the
citizens they serve (not being placed in the criminal justice system)
d. Reduction in repeat contacts (frequent utilizers)
e. Support needed to change behaviors and connect to higher barrier services
4
f. Could lead to increase in stability within homeless population and decrease
overall levels of chronic homelessness
g. Greatly assist law enforcement in impacting the issues in our community and
providing better services, ultimately realizing less crime as a result.
h. Promotion of behavioral health impacts not just individuals, but the community as
a whole – untreated mental illness and substance use disorders are costly and
far reaching – impacting our legal system, schools, first responders, workplaces,
health care providers, etc.
i. The behavioral health initiative would promote a seamless array of services, and
navigation through those services – gaps in treatment would be filled, and
individuals would be able to access the service that will have the most beneficial
outcome for them
j. It would help the City Attorney’s Office, Municipal Judges, and Special Agency
Sessions case worker with sentencing and service options that are currently
limited or not available in this area
We have also heard different perspectives and concerns about the proposed site location at
Trilby and Taft Hill.
LARIMER COUNTY COMMUNITY MASTER PLAN FOR BEHAVIORAL HEALTH
EXECUTIVE SUMMARY
Changing the Paradigm
Larimer County, Colorado
July 2018
http://LarimerCountyMentalHealth.info
ATTACHMENT 2
Larimer County Community Master Plan for Behavioral Health: Changing the Paradigm - Executive Summary
City of Fort Collins
Beth Sowder, Director Social Sustainability
Andy Lewis, Chief Deputy District Attorney
Jerry Schiager, Assistant Chief of Police
Dan Dworkin, Psychologist, Police Department
Colorado State University
Anne Hudgens, Executive Director, CSU Health Network
Community Representatives
Bryan Sutherland, Substance Abuse Recovery Advocate
Karen Morgan, Consumer and Family Representative
Foothills Gateway, Inc.
Marla Maxey, Case Management Director
Health District of Northern Larimer County
Carol Plock, Executive Director
Homeward 2020
Holly LeMasurier, Director
Housing Catalyst
Michele Christensen, Director of Program Development
Larimer County
Laurie Stolen, Behavioral Health Project Director
Gary Darling, Division Director, Criminal Justice Services
Bill Nelson, Under Sheriff, Sheriff’s Office
North Range Behavioral Health
Kimberly Collins, Administrative Director
Poudre School District
Darcie Votipka, Director of Student Services
State of Colorado
Chris Gastelle, Chief Probation Officer
SummitStone Health Partners
Michael Allen, Chief Executive Officer
University of Colorado Health
Janice Mierzwa, Regional Senior Director of
Emergency Services
Monica Smith, Administrator,
Mountain Crest Behavioral Healthcare
Health District of Northern Larimer County
Carol Plock, Executive Director
Lin Wilder, Director Community Impact
Kiley Floren, Project Implementation Coordinator,
Community Impact
Ann Noonan, Behavioral Health Strategy and
Implementation Organizer
Brian Ferrans, Behavioral Health Strategy and
Implementation Manager
SummitStone Health Partners
Michael Allen, Chief Executive Officer
Brooke Lee, Director of Access and Adult Services
Larimer County
Laurie Stolen, Behavioral Health Project Director
Gary Darling, Division Director, Criminal Justice Services
Michael Ruttenberg, Clinical Director,
Community Corrections
Josh Bellendir, Lieutenant, Jail
UCHealth
Janice Mierzwa, Regional Senior Director of
Emergency Services
Laurie Stolen, Larimer County Behavioral Health
Project Director
Nina Bodenhamer, Community Engagement Specialist
Larimer County Community Master Plan for Behavioral Health: Changing the Paradigm - Executive Summary
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Larimer County is taking a bold stand to change our community’s paradigm regarding the lack of
critically needed behavioral health resources and services for citizens in Northern Colorado. In 2013
over 300 citizens came together to identify the most pressing needs in our community and identified, “Public
Safety and Community Health” as a core mission and mandate of Larimer County. Through the 2013 – 2018, 5-Year
Strategic Plan, the County Commissioners resolved to address the complex community challenge of improving
mental health and addiction services.
The Community Master Plan for Behavioral Health (the Plan) has been nearly 20 years in the making. This blueprint
has been collaboratively orchestrated with engagement from key stakeholders including national experts, licensed
community providers (mental, behavioral and primary care health fields), municipalities, higher education, public
education and community members. It establishes a strategic outline for continuous progress and advancement
toward improving the community’s connectedness, resilience and overall health, lessening inequity in access to care
and ensuring the efficiency of behavioral health services.
This effort is NOT about growing County government. Instead, through a thoughtful and participatory process,
Larimer County has designed and will facilitate the implementation of a strategic blueprint to positively impact our
community’s behavioral health using short-term steps, a 25-year dedicated investment in our community, and a
three-pronged approach:
1. Expand and enrich local behavioral health services across the County (Distributive Services);
2. Facilitate connections between community-based services with services/providers in a regional, centralized
facility providing a stronger care coordination system and building transition bridges across providers and
services in and outside of the facility, (Distributive and In-Facility Services) and;
3. Build a regional behavioral health facility to provide coordinated care and crisis services (Facility Services).
Behavioral health includes not only ways of promoting well-being by preventing or intervening in mental illness
such as depression, anxiety, bi-polar disorder or Post Traumatic Stress Disorder, but also has as an aim preventing
or intervening in alcohol/substance abuse or other addictions. A person struggling with his or her behavioral
health may face stress, depression, anxiety, relationship problems, grief, addiction, ADHD or learning disabilities,
mood disorders, and/or other psychological concerns.1 The need for expanded behavioral health services in
Larimer County is
taking a bold stand to
change our community’s
paradigm regarding the lack
of critically needed behavioral
health resources and
services for citizens in
Northern Colorado.
Larimer County Community Master Plan for Behavioral Health: Changing the Paradigm - Executive Summary
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our community is real. Statistics, nationally and for
Larimer County, are shocking:
• 1 in 5 individuals have a mental illness.2 In
Larimer County, (based on population), this
translates to over 66,000 people (adults and
youth) suffering from a mental illness.
• There are approximately 5.9% of adults (15,500)
in Larimer County with co-occurring mental
illness and substance use disorder and 2%
(5,250) with SERIOUS co-occurring mental
illness and substance use disorders.3
• Depression is the leading cause of disability
world-wide4;
• In Larimer County, even for those wanting
treatment (estimated 4700 individuals in
2018)5, many of those services simply
do not exist, insurance coverage is
required and not available and/
or long wait times for services
are ever present.
Youth face additional challenges:
• 20% of youth ages 13-18 live a
with mental health condition.6
• Depression has a significant
impact on adolescent development,
well-being and can adversely affect
school and work performance, impair peer
and family relationships, and exacerbate the
severity of other health conditions such as
asthma and obesity.7 8 9 Depressive episodes
often persist, recur, or continue into adulthood.10
• Youth who have had a Major Depressive Episode
(MDE) in the past year are at greater risk for
suicide and are more likely than other youth to
initiate alcohol and other drug use, experience
concurrent substance use disorders, and
smoke daily.11 12 13 In Colorado (2014-2015), 13.7%
of youth age 12-17 had a Major Depressive
Episode (MDE) in the past year14 and 58.7% did
NOT receive treatment at this critical juncture
in their life.15
In 2016, more than 26,600 Larimer County residents
did NOT receive treatment when it was needed. 16
158 people (2016-2017) died by suicide; surpassing
660 citizens over a ten-year period.17 Our County
has one of the highest suicide rates in the Country.18
Behavioral health issues are complex diseases that
require individualized treatment approaches tailored
to the person’s severity of disease and specific
healthcare needs, just like any other chronic health
condition; requiring a system of care that has a range
of levels and types of care available to appropriately
meet the needs of patients accessing the system.
When levels of care are not available, individuals
often go untreated, receive limited or fragmented
treatment, resulting in the utilization of more costly
services in emergency departments, crisis care and
even the County jail. Treatment, if available, does
Larimer County Community Master Plan for Behavioral Health: Changing the Paradigm - Executive Summary
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Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Society of Addiction
Medicine (ASAM) were utilized in crafting this plan. SAMHSA’s Law Enforcement Sequential Intercept model,
which offers a framework for interface and diversion, as well as current Larimer County programs, informed the
process. Perhaps most influential in the design of the Community Master Plan for Behavioral Health has been the 19
year work of the Mental Health and Substance Use Alliance (MHSU Alliance), a partnership of local organizations
working with a national consulting firm, NIATx Foundation. The MHSU Alliance has studied this set of problems
and produced, in 2016 and again in 2018, a comprehensive community reports. The 2018 report is titled What Will
It Take? Solutions for Mental Health Service Gaps in Larimer County. The key finding: While many quality services
currently exist in our community, Larimer County does not have a continuum of behavioral health treatment
and support services that is sufficient to meet the needs of our residents.22 The Alliance recommends the
development and expansion of treatment capacity to provide services for over 5000 residents each year with funds
earmarked for a distributed service model through community based services, (including early identification
and intervention services, suicide prevention programs, expansion of outpatient services—supportive-housing
and ongoing assistance for those with more intensive needs) AND the development of a 24-7 Behavioral Health
Services Center, which would become the hub for crisis and withdrawal management (detox) services, as well as
coordinated care.23
In addition to listening to experts, the County also held/attended over 300 meetings, provided over 250
presentations, surveyed and met with community members and key shareholders including, but not limited to:
municipalities, higher/public education, and service providers to understand community identified priorities.
Among other items, these shareholders repeatedly highlighted meeting the needs of youth, prevention and early
identification and intervention services.
Including the steps detailed above, a significant foundation has been laid, should the voters approve a new long-
term (25 year) dedicated behavioral health funding stream, including:
• Larimer County Board of County Commissioners have earmarked land at the intersection of South Taft Hill
Road and Trilby Road for a new behavioral health facility;
• A ten-year financial pro forma and a proposed first year budget have been compiled from the significant
data gathered through and by Larimer County, the Mental Health and Substance Use Alliance and the NIATx
Foundation.
One way or another, we all pay for a lack of comprehensive behavioral health services in our community. With the
support of municipalities, shareholders and the community, Larimer County intends to change the behavioral health
paradigm to meet the needs of our citizens.
The key fi nding:
While many quality
services currently exist in our
community, Larimer County
does not have a continuum of
behavioral health treatment
and support services that is
suffi cient to meet
the needs of our
residents.
Larimer County Community Master Plan for Behavioral Health: Changing the Paradigm - Executive Summary
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(Endnotes)
1 June 25, 2018 - Retrieved from insighttelepsychiatry.com/defining-behavioral-health/
2 June 22, 2018 Retrieved from https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers.
3 Mental Health and Substance Use Alliance What Will It Take?: Solutions to Mental Health Service Gaps in Larimer County, page 7
4 June 22, 2018 Retrieved from https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
5 Mental Health and Substance Use Alliance What Will It Take?: Solutions to Mental Health Service Gaps in Larimer County, page 43.
6 June 22, 2018 Retrieved from https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
7 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2008). The NSDUH report: Major depressive episode among
youths aged 12 to 17 in the United States: 2004 to 2006. Rockville, MD: Office of Applied Studies. Retrieved from
https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2009115665.xhtml
8 Van Lieshout, R. J., & MacQueen, G. (2008). Psychological factors in asthma. Allergy, Asthma and Clinical Immunology, 4 (1), 12–28.
9 Goodman, E., & Whitaker, R. C. (2007). A prospective study of the role of depression in the development and persistence of adolescent obesity.
Pediatrics, 110 (3), 497–504.
10 Weissman, M. M., Wolk, S., Goldstein, R. B., Moreau, D., Adams, P., Greenwald, S., & Wickramaratne, P. (1999). Depressed adolescents grown up. Journal of
the American Medical Association, 282, 1701–1713.
11 Shaffer, D., Gould, M. S., Fisher, P., Trautman, P., Moreau, D., Kleinman, M., & Flory, M. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives
of General Psychiatry, 53, 339–348. Retrieved from http://archpsyc.ama-assn.org/cgi/content/abstract/53/4/339
12 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2007). The NSDUH report: Depression and the initiation of
alcohol and other drug use among youths aged 12 to 17. Rockville, MD: Author.
13 Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015
National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/.
14 SAMHSA Behavioral Health Barometer Colorado, Volume 4, National Surveys on Drug Use and Health, 2011-2015, page 5.
15 SAMHSA Behavioral Health Barometer Colorado, Volume 4, National Surveys on Drug Use and Health, 2011-2015, page 6.
16 Mental Health and Substance Use Alliance What Will It Take?: Solutions to Mental Health Service Gaps in Larimer County, Executive Summary, page x.
17 Office of the Larimer County Coroner, Medical Examiner, annual reports 2016 and 2017, annual statistics over a ten year period of 2007 – 2017.
18 Mental Health and Substance Use Alliance What Will It Take?: Solutions to Mental Health Service Gaps in Larimer County, page 8.
19 June 25, 2018 Retrieved from https://mhc-tn.org/about-mental-illness/facts-stats/
20 June 25, 2018, Retrieved from https://www.samhsa.gov/sites/default/files/cost-benefits-prevention.pdf
21 National Research Council and Institute of Medicine. 2009. Preventing Mental, Emotional and Behavioral Disorders Among Youth People: Progress and
Possibilities. Washington, DC: The National Academies Press. http://doi.org/10.17226/12480.
22 Mental Health and Substance Use Alliance What Will It Take?: Solutions to Mental Health Service Gaps in Larimer County, Executive Summary, page 3.
23 Mental Health and Substance Use Alliance What Will It Take?: Solutions to Mental Health Service Gaps in Larimer County, Executive Summary page 3.
2018 Larimer County Community Plan for Behavioral Health
The 2018 Larimer County Community Plan for
Behavioral Health is a strategic blueprint for a continuum
of coordinated behavioral health care. It is informed
by health providers, mental health practitioners,
educators, community and elected leadership,
hospital and criminal justice staff, and
residents across Larimer County.
This plan includes evidence based best practices,
expands early identification and intervention,
and increases the efficiency and
success of community based
treatment and support services.
August 2017
Updated and Revised April 2018
February 2018 - Ongoing
Ongoing
Forum & Survey
February 2018
Site Design & Land Use
Over a dozen
community
stakeholders
and health
professionals
come
together for a 3-day charrette, hosted
by Denver-based HDR, to facilitate the
development of a common vision and
preliminary service plan for a potential
behavioral health facility.
Data-Driven Community Assessment
What Will It Take:
Solutions for
Mental Health
Service Gaps in
Larimer County
The Health District
of Northern
Larimer County,
Summitstone
Health Partners &
Larimer County
hire nationally
recognized experts, NIATx, to compile data
on currently available services, current
needs, and provide recommendations to
address gaps and challenges. This report—
coupled with community input—forms
the backbone of the 2018 Larimer County
Community Plan for Behavioral Health.
Coordinated Community Care
Funding to expand and
strengthen existing programs,
and refine measurable
outcomes will: efficiently and
more effectively meet the
need of those struggling with
mental illness, and invest in the success of our
community-based services.
1
Steve Johnson, Larimer County Commissioner
Laurie Stolen, Behavioral Health Project Director
Jackie Kozak Thiel, Chief Sustainability Officer
Beth Sowder, Social Sustainability Department Director
7-10-18
Larimer County Behavioral Health
City of Fort Collins City Council Work Session
ATTACHMENT 4
Presentation Overview
2
• Introduction
• Alignment with City Plans/Goals
• Summary of Information Learned
• Options for Collaboration and Partnerships
• Overview/Highlights of Behavioral Health Plan
• Next Steps
Direction Sought
1. Does Council agree with options
presented for City Collaboration?
2. Does Council have any feedback on
the County’s Plan or have any
questions about next steps?
3
Larimer County Data
Mental Health & Substance Use Alliance of Larimer County:
• 20% (53,800) people have a mental illness
• 4.6% (12,300) have a serious mental illness
• 8.5% (25,000) people have a substance use disorder
• Mental Illness and Substance Use Disorder often occur together:
• 5.9% (15,500) co-occurring
• 2% (5,250) serious mental health and substance use disorder
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CITY STRATEGIC PLAN
Leverage and improve collaboration with
other agencies to address homelessness,
poverty issues and other high priority human
service needs.
PLAN & STRATEGY ALIGNMENT
Larimer County Behavioral Health Plan
5
Council Priority: Behavioral Health Detox Facility
Top 3 Priorities Homelessness, Suicide Prevention, Opioid Crisis
Referrals, Service Provision Coordination, Centralized
and Distributive
Ideas for Partnering
Opportunities
Local Care, Increased & Improved Care Coordination,
Local Detox would help Capacity Boost
Homelessness, Suicide, Youth Mental Health,
Substance Use Disorders
Addresses Several
Social Concerns
Improved Response Times, Increased Access,
Anticipated Benefits Reduction in Recidivism
6
Information and Support
City Departments & Community Partners
Collaboration Options
Police
Services
Poudre Fire
Authority
Transfort
Social
Sustainability
Restorative
Justice
Natural
Areas
7
Community Partners
• Outreach Fort Collins
• Murphy Center and Homeward Alliance
*numerous other service providers have committed to partnering and
coordinating as well
8
Collaboration Options
Community Wide Listening
• Moving ahead of crisis response with increased attention toward
early identification and early intervention
• Increased focus on suicide prevention awareness training
• Clearly defining the County’s role in the effort
• Clearly defining the investment we are making in our community
• Showing the WIIFM (what’s in it for me) to all of Larimer County
• Building/strengthening partnerships to build a community driven
and community based solution
9
The Solution is
Community Wide
Our work is informed by national experts and local professionals: What
Will It Take? Solutions for Mental Health Service Gaps in Larimer County.
The solution will require a dedicated funding stream, and is 3-pronged:
1. Expand & enrich local behavioral health services throughout the County.
2. Facilitate connections in a centralized facility to provide stronger care
coordination and transition bridges across providers/services.
3. Build a regional behavioral health facility to provide crisis services and
coordinated care.
10
A Community Master Plan for
Behavioral Health Services
Includes:
• Larimer County 5 year Strategic Plan
• MHSU Alliance Road Map Report
• Site Design and Land Planning Report
• Community Health Improvement Plan
• Municipal Partnerships
• School District (PSD/TSD/EPSD) Partnerships
• Community priorities
Completed- Summer 2018
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Plan Details
Distributive Services Throughout the County
• Suicide Prevention Awareness and Training
• Innovations in professional development
• School behavioral health support
• Care coordination through Case Management Services
• Supportive services in Permanent Supportive Housing
• Tele-psychiatry network of care
Plan Details
Community-Facility Services
• Care coordination clients receiving care in facility or community
services
• Assistance funds help with service expenses, flexible funding
for medications, transportation, deductibles/co-pays, etc.
• Improving cross system communication critical to overall
success of community behavioral health reform effort
Plan Details
Facility Services
A centralized behavioral health services facility would bring missing
critical levels of care.
• Medical clearance, triage and assessment
• Crisis Stabilization Unit
• Social and Medically Monitored Detox Services
• Short-term Intensive Residential Treatment
Return on Investment
The Master Plan includes cost analysis and outcome measures
Learning from those who have gone before us…
• Reduced ER admissions and re-admissions
• Reduced 911 calls and repeat calls
• Reduced criminal activity/arrests and jail use
• Reduced suicide
• Increased community connectedness and resilience
• Healthier families, healthier kids
• Increased work productivity, less sick days, less insurance claims
Summer Campaign Team forming for Election Process
July 24 Larimer County Board of Commissioners consider
request to refer initiative to the November ballot
September 11 Loveland City Council Work Session
September 18 City Council consider resolution supporting the
ballot initiative
16
Next Steps
Direction Sought
1. Does Council agree with options
presented for City Collaboration?
2. Does Council have any feedback on
the County’s Plan or have any
questions about next steps?
17
Laurie Stolen
Larimer County Behavioral Health Project Director
205 E 6th
St
Loveland, CO 80538
stolenle@larimer.org
970-619-4420
larimercountymentalhealth.info
18
UC Health, SummitStone Health Partners,
Health District of Northern Larimer County,
Poudre School District, Thompson School
District, Estes Park School District, and
Many, Many More...
Mental Health
Providers & Professionals
Local mental
health care
professionals and
providers work
passionately every
day. Yet, too many
residents go without access to care
and treatment they need. Professionals
offer invaluable perspective on current
gaps in services, growing needs, and
recommendations for integrated care.
Community Listening
Community events,
surveys, and coffee
chats allow residents
to give feedback.
Berthoud, Estes Park,
Fort Collins, Laporte,
Loveland, Red Feather
Lake, Wellington.
November 2017 –
May 2018
Cities & Their Elected Officials
Cities across Larimer
County host community
meetings, Council work
sessions, surveys, and
coffee chats to gather
input, concerns and
priorities from residents.
ATTACHMENT 3
work. 70-90% of individuals with mental illness see
an improvement in their symptoms and quality of
life after participating in treatment.19 For every $1
spent on substance use treatment there are $4 to
$7 in economic benefits20 and SAMHSA states the
following regarding mental illness intervention and
prevention savings, “Data have shown that early
intervention following the first episode
of a serious mental illness can make
an impact. Coordinated, specialized
services offered during or shortly
after the first episode of psychosis
are effective for improving clinical
and functional outcomes.” In
addition, the Institute of Medicine
and National Research Council’s
Preventing Mental, Emotional and
Behavioral Disorders Among Young
People report in 2009 notes that cost-
benefit ratios for early treatment and
prevention programs for addictions and mental
illness programs range from 1:2 to 1:10.21 This means
a $1 investment yields $2 to $10 savings in health
costs, criminal and juvenile justice costs, educational
costs, and lost productivity.
Although our County has many quality services, it
does NOT currently have the range of services (a
continuum of care to meet differing severity and
scope of needs) NOR does it have a regional facility
where crisis and coordinated care can be effectively
and efficiently managed. A broader care continuum
that is both distributed throughout Larimer County
and available through a centralized facility needs
to be available to meet the needs of thousands of
residents who need services. The County’s goal is to
facilitate quality behavioral health care to meet the
needs of our residents, at the right level, at the right
time, and at the right cost.
Experts and local professionals, shareholders and
citizens have provided input to and guidance
about the Community Master Plan for Behavioral
Health. National emerging best practice models
and Continuums of Care, such as those from the
158 people
(2016-2017) died by
suicide; surpassing
660 citizens over a ten-year
period. Our County has one
of the highest suicide
rates in the Country.
Merry Hummell, Hummell Consulting Services
Brian Ferrans, Behavioral Health Strategy and Implementation
Manager, Health District of Northern Larimer County,
Kelsey Lyons, Health Planning and Evaluation Specialist,
Larimer County Department of Health and Environment
Mike Ruttenberg, Clinical Director, Larimer County
Community Corrections
Mental Health Guidance Team:
Report Prepared By: Contributing Authors:
Mental Health & Substance Use Alliance (MHSU Alliance) - Steering Committee:
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Larimer County Board of County Commissioners
Lew Gaiter III, District 1
Steve Johnson, District 2
Tom Donnelly, District 3
Larimer County Staff
Linda Hoffman, Manager
Lorenda Volker, Assistant Manager
Laurie Stolen, Behavioral Health Project Director