HomeMy WebLinkAboutCOUNCIL - AGENDA ITEM - 01/23/2018 - LARIMER COUNTY BEHAVIORAL HEALTH UPDATEDATE:
STAFF:
January 23, 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 Update.
EXECUTIVE SUMMARY
The purpose of this item is to provide information about Larimer County’s plans for needed behavioral health
services across the county. It includes information about the background, current need, local data, local
solutions, and next steps. This is a continuation of work done in the past with updated data and options for
collaborative solutions. Studies identified major gaps in critical behavioral health services, suggested
recommendations for what services are most needed, at what levels, and for what cost. Unfortunately, the local
ballot initiative failed in 2016, but work is continuing. Because these gaps have a significant impact on local
residents and their families, government, health, and social services, this is an educational presentation to
discuss where the County is now as well as ideas for collaborative local options moving forward.
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 have direction for how the City should collaborate with the County on regional behavioral health
solutions?
2. Does Council have any additional insights about this issue or proposed solution?
BACKGROUND / DISCUSSION
The Need Is Real
The local need for behavioral health services in Larimer County is real.
• Mental illness is more common than cancer, diabetes, or heart disease. - U.S. Surgeon General
• Depression is the leading cause of disability worldwide. - World Health Organization
• 20% of youth ages 13-18 live with a mental health condition. - National Alliance on Mental Health
• Every year, 1 in 5 Larimer County residents struggle with mental illness. - State of Mental Health in America
• In 2016, 83 Larimer County residents dies by suicide. - Larimer County Coroner
The need is evident, but many Larimer County residents are not able to receive mental health care when it is
needed. In fact, according to the Colorado Health Access Survey, 2017, 26,686 Larimer County residents did not
get needed care for the following reasons:
• 31% could not afford it or did not have insurance
• 23% were concerned about what would happen if someone found out
• 45% had difficulty getting an appointment
• 19% were uncomfortable discussing personal problems
January 23, 2018 Page 2
The Need Is Local
The lack of critical behavioral health services has a direct impact on major City of Fort Collins concerns.
Community residents, their families, and workplaces, are all directly significantly impacted by the lack of adequate
depth and continuum of mental health and substance use disorder treatment. The gaps in services also has a
substantial impact on services and issues with a direct relationship to the City, including police services, the
criminal justice system, businesses, poverty, homelessness, Outreach Fort Collins, and Support Services for
those living in Permanent Supportive Housing.
City Alignment and Impacts
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.
When looking at how expanding critical behavioral health services in Larimer County will impact the City
organization, there will likely be both quantitative and qualitative results.
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.
January 23, 2018 Page 3
Quantitative Data and Projections
Fort Collins Police Services
Looking at Fort Collins Police Services calls for service (alcohol, drug, suicide, and welfare calls), there would be
a potential reduction in calls varying by call type by 5-15% (chart provided in PowerPoint presentation,
Attachment 3). This could realize efficiencies that would be the equivalent of almost a half-time police employee;
however, it would be expected that these efficiencies would be effectively used rather than an actual reduction in
workforce.
Additionally, it is expected that more of an impact would come from calls for service for the most frequent and
heavy consumers of multiple services (Police, Mental Health, Medical, etc.). Of a group of 131 high service
utilizers monitored by the Interagency Group convened by Fort Collins Police Services, 92 (70%) had contacts
with a police officer between January 1, 2015 and June 30, 2016. For those 92 individuals, there were:
• A total of 1,125 police contacts (ranging from 1 to 178 contacts per individual)
• 1,584 officer hours spent
o Top 25 individuals’ cases used nearly 1,100 of the total 1,585 officer hours
• Costs for these contacts include officer time, dispatch, booking, and court costs, if needed
This data led to a collaborative effort in 2017. Fort Collins Police Services partnered with UC Health and
SummitStone Health Partners to create a Mental Health Co-Responder position that would be housed in Police
Services. This position is currently in the hiring process. Reasons for this include:
• Calls for people in mental health crisis continue to increase with police being the main point of contact
• Such calls are often unpredictable and volatile putting police officers at risk
• Repeated calls to police and dispatch divert law enforcement resources from their primary mission
• While many officers are trained in mental health crisis management skills they do not have the level of
expertise as a mental health professionals
• The Mental Health Co-Responder on scene will provide the most accurate assessment and then referral to
the most appropriate treatment facility due to familiarity with all available community resources
• The Mental Health Co-Responder will provide follow-up as well as assessment in an effort to reduce
recidivism
• The Mental Health Co-Responder will respond to officer and dispatch alerts of new frequent callers with a
mental health disorder in an effort to prevent escalation and use of police resources and intervene effectively
• The Mental Health Co-Responder will coordinate efforts with Outreach Fort Collins, Fort Collins Police
Interagency Group and Police Psychologist, and three additional county Co-Responders funded by a state
grant
• Fort Collins is one of the last two police departments on the Front Range to adopt this best practice
Poudre Fire Authority
In addition to Fort Collins Police Services, Poudre Fire Authority (PFA) is also impacted significantly with calls for
service regarding mental health or substance use disorders. Over the last five years, Poudre Fire Authority has
seen a call volume increase of 27%. A more granular analysis reveals the majority of the increase in requests for
service occurred in downtown Fort Collins, resulting in a 48% increase in the response area of PFA Station #1.
This increase in call volume can have a dramatic impact on response reliability for higher acuity calls and
projections for increases in call volume over the next five years will result in decreased service levels with PFA’s
current deployment strategy. To ensure PFA’s continued ability to provide prompt, skillful and caring service,
innovative response models such as the Roving Alternative Medical (RAM) unit are being explored.
The data from the RAM trial demonstrated a significant impact in addressing the increasing volume of low acuity
medical responses, provided a better response reliability for downtown Fort Collins, and allowed Engine #1 to
respond to the higher acuity calls for which that unit is designed. Beyond increased operational efficiencies the
RAM unit was also able to integrate PFA into the regional Inter-Agency Treatment Group (IATG). This group
involves 24 regional entities focused on addressing frequent users of the 911 system and seeks to address the
January 23, 2018 Page 4
underlying issues that result in activation of the response system for non-emergent calls. The ability to integrate
programs such as the RAM and the IATG into resources such as those described by the Community Mental
Health and Substance Use Alliance of Larimer County would create unprecedented opportunities for collaboration
and care in our community.
Additional minor efficiencies could be realized in Parks, Municipal Court, and Natural Areas.
Qualitative Benefits
Potential benefits for Housing and Human Services Programs include:
• The expansion of behavioral health services will also offer greater ability for residents of permanent
supportive housing have access to support services they need to retain their housing. There is a high
incidence of mental illness and substance use disorder in the homeless population. Evidence shows that
overall the population of those who were formerly homeless who became housed and receive behavioral
health treatment make significant health and functional improvements, and have significantly less use of
emergency service.
• The Homeward 2020 Community Collaborative guides strategy and long-term solutions to address
homelessness through our community’s 10 Year Plan to Make Homelessness Rare, Short-Lived and Non-
Recurring. The plan focuses on Housing First approaches to provide permanent pathways out of
homelessness in Fort Collins. Housing First approaches prioritize efforts and investments in housing and
community services leading to rapid rehousing and supportive housing, homelessness prevention, and
ultimately, support for individuals to achieve stability, wellness and housing retention.
A Larimer County Behavioral Health Services Facility would provide treatment for many people experiencing
chronic homelessness Homeward 2020 strives to permanently house and positively reintegrate into the
community. Homeward 2020 recognizes the inextricable relationship between housing and healthcare
provision to effectively serve our entire community, and specifically people experiencing chronic
homelessness. Recent Housing First Initiative data shows over 70% of chronically homeless individuals in
Fort Collins self-identify as having a disability. Many have diagnosable substance use and mental health
disorders which can be effectively treated and could support long-term housing and health stability.
Homeward 2020 supports efforts to provide world-class, comprehensive behavioral healthcare in our
community.
• The Coordinated Assessment and Housing Placement System (CAHPS) focuses on assisting households
experiencing homelessness to find permanent housing that will work best for them. To make these moves into
housing successful, supportive services are often needed, particularly for individuals who are living with
disabilities, including mental health and/or substance use disorders. A Behavioral Health Facility will aid in
these efforts to house individuals experiencing homelessness. For those who have been housed (or who are
still seeking housing), if behavioral health treatment or recovery support are services identified that would
benefit the individual and help them retain their housing, this facility could provide easier, swifter access to the
type of behavioral health treatment someone made need. Currently, the range of treatment options that would
be beneficial may not always be available to someone in Larimer County, or a long wait may be required.
Nobody should have to go without treatment if they are seeking it, and nobody should have their housing put
at risk because they are unable to access appropriate care.
Those who are actively working to implement CAHPS also recognize that there may be funding from this
effort allocated to supportive services for individuals living in permanent supportive housing. Permanent
supportive housing is designed to serve individuals who are disabled -- many with severe mental illness or co-
occurring disorders -- and who have experienced homelessness, often because of their disabilities. Those
agencies implementing CAHPS are actively working to address the lack of housing units available by
expanding landlord engagement efforts and applying for new housing vouchers and rental assistance as
those opportunities become available. What is currently missing are flexible, customized supportive services
that assist individuals to access and retain their housing. With additional resources directed towards those
supportive services, greater progress will be made in addressing homelessness and helping those
experiencing homelessness -- specifically individuals living with disabilities who may require greater support --
to access housing.
January 23, 2018 Page 5
• The expansion of behavioral health services will positively impact the coordination of services for many of the
non-profit service providers who receive funding from the City’s Human Service Program funds.
• The expansion of behavioral health services will positively impact Municipal Court, Special Agency Sessions,
and Outreach Fort Collins by providing an immediate referral option.
The Solution is Local
The work done has been informed by national experts and local professionals - see attached executive summary
of What Will It Take? Solutions for Mental Health Services Gaps in Larimer County. (Attachment 2)
The solution will require a dedicated funding stream, and is 2-pronged:
1. Expanded and enriched local behavioral health services across the county.
2. A regional behavioral health facility to coordinate those integrated services.
Larimer County is uniquely positioned because of lessons learned from the unsuccessful November 2016 ballot
initiative. The two primary lessons include:
• More countywide collaboration is needed
• Increased clarity in intent and of messaging
Larimer County’s revised efforts are to facilitate the most economic and effective mental health care to meet the
needs of our residents:
• At the right level
• At the right time
• At the right cost
Next Steps
Larimer County is in the process of working with the communities within the county to understand the role each
community would like to play and to identify opportunities for collaboration. Through this work, the County seeks
to understand the answers to these questions:
1. What role does the City of Fort Collins want to play?
2. What are the City of Fort Collins’ top priorities for behavioral health services?
3. What gaps and duplication of services exist between communities?
4. Do opportunities exist to enrich and expand services into regionally coordinated mental health care?
ATTACHMENTS
1. How Did We Get Here? Larimer County Timeline (PDF)
2. What Will It Take? Solutions for Mental Health Service Gaps in Larimer County Executive Summary (PDF)
3. PowerPoint Presentation (PDF)
Larimer County is 2,640 square miles with a population of more than 330,000 residents who live in diverse geographic locales, including rural,
suburban and unincorporated areas. Mental illness recognizes no boundaries and 1 in 5 residents—over 66,000 people—in our County struggles
with mental illness.
Pubic Safety and Community Health are core to the mission & mandate of Larimer County.
• People with mental illness are 5 times more likely to be arrested than the general population, impacting law enforcement,
jails, courts, and the District Attorney’s office.
• 75% of women in local jails have mental illness, if mothers, the impact ripples through County Department of Human
Services, Child Protection, and Child Welfare offices.
Mental Health and
Substance Abuse Alliance
20+ organizations and service
providers form a membership
group to locally influence a
well-coordinated, well-funded
continuum of mental health
and substance abuse services.
Today, the Alliance continues its
collaborative effort to improve
the lives of those impacted
by behavioral health.
Larimer County Board
of Commissioners
approve funding and
staffing for a Wellness
Court, which ensures
community safety while
providing an alternative
to incarceration for
people whose mental
health issues affect
their criminal behavior.
Community Health Survey,
Health District of Northern
Larimer County
Results show cost and lack
of health insurance continue
to be the major barriers to
accessing mental healthcare.
Nearly 3 in 4 (71%) uninsured
respondents reported
having put off mental health
care in the past 2 years.
A Concerned Community
Poudre High School hosts
a mental health event for
middle school and high
school families open to
the Northern Colorado
community. Breakout
sessions address topics
including anxiety, body
image, depression,
self-harm, substance
abuse, grief and more.
1999 October 2013 November 2015
May 2013 February 2016
What Will It Take? Solutions
for Mental Health Service
Gaps in Larimer County
The Health District of Larimer
Larimer County is uniquely positioned to facilitate the most economic and effective ways to address this complicated social issue. From Estes
Park to Berthoud, from Wellington to Loveland, from Fort Collins to Red Feather, the County seeks to create quality mental health care to meet
the needs of our residents, at the right level, the right time, and at the right cost.
Public Information &
Shareholder Engagement
The failed ballot measure
to fund mental health
services brought to light
a critical call to action:
more County-wide
engagement is necessary
to develop and build
solutions to this growing
community challenge.
Defeated by less than
8,000 votes, Larimer
County ballot issue 1A
sought a tax increase to
expand service provision
and build a new mental
health and detox facility.
The campaign generated
months and months
of robust community
engagement and
campaign outreach.
83 Larimer County
residents died by
suicide in 2016.
- Larimer County Coroner
A Concerned Community
“Mental health care is
critical to the health of our
community,” said Erica
Siemers, the senior director
of the foundation. With
over 600 attendees, PVH
and MCR Foundation’s
38th annual Spring Benefit
focuses on the critical need
for mental health care in
northern Colorado.
May 2016 November 2016 May 2017
July 2016 Ongoing
Larimer County, in
collaboration with local
partners, is working
diligently to assess
resources, foster
coalitions with dedicated
providers, and engage
our community in a
committed effort to
identify lasting solutions.
January 2017
Larimer County Live
Telephone Town Hall:
Mental & Behavioral Health
Over 80,000 calls were
made to County residents.
in Larimer County
Executive Summary
Community Mental Health and Substance Abuse
Partnership of Larimer County
An Unincorporated Non-Profit Association
February 23, 2016
REVISED 3/31/2016
What Will It Take?
Solutions for Mental Health
Services Gaps
ATTACHMENT 2
1
Community Mental Health and Substance Abuse
Partnership of Larimer County
An Unincorporated Non-Profit Association
Executive Summary
What Will It Take?
Solutions for Mental Health Services Gaps in Larimer County
February 23, 2016
Introduction
While many quality behavioral health treatment and support services are being provided in
Larimer County, the current continuum of services being offered is not sufficient to meet the
needs of the many people who have mental illnesses and/or substance use disorders. As a result,
these people often simply can’t get the level of care that they need to address their illness.
Awareness of the gaps in behavioral health services has been growing over time to the point that
several major community organizations have mentioned the need for an improved behavioral
healthcare system in their strategic planning, including Larimer County, the City of Fort Collins,
and the Health District of Northern Larimer County. The Community Mental Health and
Substance Abuse Partnership of Larimer County, a collaborative effort between over twenty
organizations, consumer and family advocates, and treatment and service providers, established
creating a plan for the expansion of critical behavioral health services as its highest priority in
2015. This document is the result of this priority area and the work of a sub-group of Partnership
Members known as the “Plan Guidance Team” and is intended to inform the planning process.
To aid in data collection, analysis and development of recommendations, the Partnership
engaged the services of the NIATx group, a multidisciplinary team of consultants with a unique
blend of expertise in public policy, agency management, and systems engineering that has
worked with 1000+ treatment providers and 50+ state and county governments.
The purpose of this document is to help citizens and service providers understand existing
challenges, garner commitment to making changes and improvements, and stimulate significant
development and expansion of critical behavioral health services in Larimer County. The
ultimate goal is to guarantee Larimer County’s capacity to meet the growing behavioral health
needs of its citizens. This document seeks to accomplish the following:
1. Delineate what is needed for a more complete continuum of care capable of providing
adequate levels of affordable care for those with behavioral health needs (focusing on the
best evidence, high quality, and access to care), understand what actually exists in our
community, and determine the gaps.
2. Determine a cost estimate for filling the gaps, potential revenue sources, and the
remaining need for funding.
2
The Need
Behavioral health disorders, including mental illness and substance use disorders are serious,
chronic health issues that can be potentially life-threatening, similar to other chronic health
disorders such as diabetes and heart disease. These disorders of the brain are common and can
affect anyone at any age or socioeconomic status. It is estimated that there are approximately
44,300 adults who have mental illness and 31,000 who are dependent on alcohol or drugs living
in Larimer County, although many have both disorders and the impact of the disorders varies.
Behavioral health disorders are treatable and treatment effectiveness is improving. However, the
majority of those with these disorders never receive the treatment they need to help restore their
functioning. Though these conditions are treatable health disorders, consumers and families
regularly report great difficulty in getting access to the recommended range of services – a
situation that is quite different than access to care for other chronic illnesses such as heart disease
and diabetes.
Lack of treatment is particularly true for those with substance use disorders (thus this study
focused heavily on estimating unmet need for these disorders). NIATx estimated that of the
approximately 31,000 people meeting the criteria for needing treatment for substance use
disorders, only 2,800 people actually receive that care each year in Larimer County, leaving over
28,000 people needing, but not receiving, treatment annually. Of those 28,000, it is estimated
that approximately 1,400 actually want or would seek treatment but do not receive that treatment.
Providing an improved continuum of care for the 4,200 people needing and seeking treatment
(2,800 who currently seek treatment and an additional 1,400 who need but don’t receive that
treatment) is critical to their recovery.
When people with behavioral health disorders do not receive appropriate, timely, or adequate
treatment the result is often greater suffering from symptoms, poor quality of life, reduced ability
to function and use of more intensive and higher cost levels of treatment. People with behavioral
health disorders are also at risk for unstable employment, poverty, chronic health conditions,
early death, and suicide. Many people who don’t get the right treatment enter a cycle of repeated
use of the highest cost services in our community such as emergency departments, law
enforcement or criminal justice, including jail.
While many quality services are being provided here, the key finding of this investigation is that Larimer
County does not have a continuum of behavioral health treatment and support services that is sufficient
to meet the needs of the many people with mental illnesses and/or substance use disorders. As a result,
these people often simply can’t get the level of care that they need to address their illness.
Recommended Solutions to Meet the Need
Specifically, this planning process recommended that four key levels of care and a range of support services be
added or expanded in order to provide adequate standards of care in Larimer County.
A full complement of Withdrawal Management (Drug/Alcohol Detoxification) services
Residential Treatment for Substance Use Disorders (SUDs)
Acute Treatment Unit (ATU) for just-under-hospitalization level of care
Intensive Outpatient Treatment Services (IOP)
Support Services (moderately intensive to intensive care coordination, medications, and support services
for those living in Permanent Supportive Housing, assessment, and client assistance funds).
The study also recommended that many of these services be provided in a 24-7 Services Center providing a
new state-of-the-art model of care and enabling more seamless transitions between levels of care. Part of the
new model would include a more thorough, formal, patient-centered assessment process in order to better
guide transitions into and between the levels of care.
3
Specific recommendations to create and support adequate services in each of these areas include:
1. Expand treatment capacity to accommodate the estimated need for services for up to 4,700
adults. This includes an estimated 2,800 people currently receiving some level of treatment,
plus an additional 1,400 adults estimated to need and seek treatment in Larimer County but
who are currently unable to receive that treatment, plus an allowance of 500 people for
anticipated growth. The total annual utilization of all services included in the recommended
model is estimated at approximately 12,000 admissions (defined broadly).
2. Create a more complete continuum of care and the ability to place patients into
appropriate levels of care based on assessment and re-assessment. Provide most
services in one facility, with specific services supported and provided in the community.
3. Create a medically monitored Withdrawal Management Center (Drug/Alcohol
Detoxification) in Larimer County with 12 beds and the capacity for up to 822 ASAM
level 3.7 admissions in order to support detoxification from alcohol or drugs and transition
individuals into treatment. Two additional levels of withdrawal management services would
be available in the community (but are not included in the funding recommendations
included in this document): Ambulatory (ASAM level 2.0) managed on an outpatient basis,
and Intensive Inpatient (ASAM level 4.0) provided in a hospital setting.
4. Create or support several levels of residential care to support up to 500 short-term and
long-term supported residential admissions as follows:
Create Short-Term Intensive Residential Treatment (IRT) designed to provide a safe
therapeutic environment where clinical services and medications are available to treat
patients who are medically stable and withdrawn from substances. Capacity: 11 beds,
average length of stay (ALOS) of 12 days, and 305 admissions.
Support Low Intensity Residential (LIR) services designed to build and reinforce a
stable routine in a safe and supportive context for residents who lack a stable living
environment. Capacity: 52 beds (in the community, not part of facility), ALOS of 90 days,
and 190 admissions.
Encourage the development of independent, voluntary sober housing, like “Oxford
Houses” in the community to provide safe and supportive living environments for those
who choose and can pay for this type of residence. No external financing is
recommended for this type of housing.
5. Encourage the development of community capacity for Intensive Outpatient Services
(IOP) for individuals who require a more structured substance use disorder outpatient
treatment experience than traditional outpatient treatment. Capacity: 1,089 IOP admissions,
an average of 30 visits per admission, and an average daily census of 50. (Note: Since health
insurance is likely to cover these services, the only amount included in the budget
recommendations in this document is client assistance for up to 218 uninsured or
underinsured individuals.)
4
6. Encourage the development of community capacity for Outpatient (OP) Substance Use
Disorder Treatment to provide up to 3,800 admissions, with 30 FTE providing 10 sessions
per admission for people who can benefit from outpatient treatment. (Note: Since health
insurance is likely to cover these services, the only amount included in budget
recommendations is client assistance for up to 780 uninsured or underinsured people.)
7. Create an Acute Treatment Unit in Larimer County to provide short-term crisis
stabilization for individuals whose symptoms and treatment can be managed in non-hospital
settings. Capacity: 12 beds, ALOS of five days and capacity to provide up to 986 admissions.
8. Provide specific behavioral health support services to include:
Moderately intensive to intensive care coordination for up to 250 clients
Client assistance fund to help cover needs such as transportation, co-pays (including IOP
and OP), medications, and personal emergencies for up to an estimated 1,620 clients
Approximately 7,650 patient-centered, intensive assessments to ensure placement in
appropriate levels of care
Support services in Permanent Supportive Housing for up to 100 clients with chronic
health conditions who lack family/social supports, and are disconnected from
employment and other community functions. (Housing to be provided by other sources.)
Financial Resources Needed to Provide These Services
After NIATx completed a preliminary report with a first round of cost, revenue and facilities
estimations, local experts in behavioral health, budgeting and facilities amended these figures to
represent local circumstances and input. The annual costs to provide these services have been
estimated at $15.77 million. Available revenues from client fees and insurance are estimated at
approximately $4 million. The remaining need for funding is estimated at $11.77 million.
Projected Overall Operating Budget
Personnel $8.58 million
Client Assistance $2.40 million
Operational (operational costs,
maintenance, equipment, contracted
services, etc.)
$4.79 million
TOTAL: $15.77 million
Less Revenues $ 4.00 million
Needed Annual Funding: $11.77 million
Facilities Needed and Associated Costs
Estimates for facility space and costs are currently estimated based on providing most services in
one facility. Based on current estimates, a 51,000 square foot facility would be required to
provide these services. The total facility and land costs are estimated at $20.42 million. Facility
costs have not been estimated for Low Intensity Residential services.
5
Benefits and Value to the Community
There is ample evidence to demonstrate significant value and benefits of behavioral health
disorder treatment. Patients and families benefit from increased health, well-being and ability to
function in their family, work, community and society (similar benefits as those seen for
managing symptoms of diabetes or hypertension). Communities realize reductions in related
costs. Additionally, the National Institute of Health estimates that every dollar spent on addiction
treatment yields a return of between $4 and $7 in reduced drug-related crime, criminal justice
costs, and theft. When healthcare related savings are included, total savings can exceed costs by
a ratio of 12 to 1.
Summary, Estimated Increased Capacity for Critical Services
To Be Developed Under Proposed Budget
Capacity Utilization
Assessments 7,655 assessments
Acute Treatment Unit (ATU) 12 beds 986 admissions
Withdrawal Management (medically monitored detox) 12 beds 822 admissions
Short-term Intensive Residential Treatment (IRT) 11 beds 305 admissions
Low-intensity Residential (LIR) (funding for staff, not facility; beds to
be outside of facility)
52 beds 191 admissions
Client Assistance (transportation, medication, co-pays, etc.)
Includes client assistance for IOP and OP for un- & under-insured
1,620 clients
Care Coordination (moderately intensive to intensive) 250 clients
Support Services (for those in Permanent Supportive Housing (PSH)) 100 clients
TOTAL 11,929
Additional Substance Use Disorder Treatment Capacity Needed and to Be Encouraged
(Insurance Coverage Available)
Intensive Outpatient (IOP)
Treatment
1,089 (capacity needed; 220 clients included in client assistance, above)
Outpatient (OP) 3,800 (capacity needed; 780 clients included in client assistance, above)
TOTAL 4,889
For more information contact:
Lin Wilder
Community Mental Health and Substance Abuse Partnership of Larimer County
lwilder@healthdistrict.org
Larimer County Behavioral Health
January 2018
Steve Johnson, Larimer County Commissioner
Laurie Stolen, Larimer County Behavioral Health Project
Director
1
ATTACHMENT 3
Presentation Overview
1. Introduction
2. Thank You for the Opportunity
3. The Need is Real
4. The Need is Local
5. A Shared Solution
6. How Can We Partner? An Invitation to Collaborate
2
Direction Sought
1. Does Council have direction for how the City should
collaborate with the County on regional behavioral
health?
2. Does Council have any additional insights about this
issue or proposed solution?
3
The Need is Real
• Mental Illness is more common than Cancer, diabetes or heart disease.
‐ U.S. Surgeon General
• Depression is the leading cause of disability worldwide.
‐ World Health Organization, 2017
• 20% of youth ages 13 –18 live with a mental health condition
‐National Alliance on Mental Health
• Every year, 1 in 5 Larimer County residents struggle with mental illness.
‐State of Mental Health in America
• In 2016, 83 Larimer County residents died by suicide
‐Larimer County Coroner
Barriers
Why not? Barrier due to cost or insurance: 31.2%
Concerned about what would happen if someone found out: 22.7%
Difficulty getting appointment: 45.2% (Colorado average: 35.2%)
Uncomfortable discussing personal problems: 18.8%
26,686 Larimer County
resident didn't receive
mental health care when
needed.
Source: Colorado Health Access Survey, 2017
5
The Need is Local
• Impact on City Services, residents, families, workplaces
• City Alignments and Impacts
• Alignment with City’s Stated Goals
• Fort Collins Police Services
• Poudre Fire Authority
• Housing and Human Services
6
Larimer County Behavioral Health
7
Council
Priority
Neighborhood
Livability & Social
Health
Safe
Community
SSD Strategic
Plan
Police
PFA
Human
Services
Collaboration
Leadership Strategic Alignment Service Delivery
• Potential reductions in
calls vary by type from 5‐
15%
• Efficiencies could be
realized within police for
avoided calls
• Most impact would come
from time saved
responding to frequent
utilizers
8
Quantitative Benefits
FCPS Response Hours & Cost
-
2,000
4,000
6,000
8,000
2013 2014 2015 2016 2017
Annual Call Volume
Alcohol Drug Suicide Welfare
-
200
400
600
800
1,000
1,200
2013 2014 2015 2016 2017
BH/SU Patients Evaluated
Transported to ED Not Transported to ED Other
• Call volume for all types
increased 27%
• Majority increase (48%)
Station 1 – downtown
• Impacts reliability for higher
acuity calls
• Projections for increase in
call volume next 5 years
9
Quantitative Benefits
PFA Evaluations
Housing and Human Services Programs
• Residents of Permanent Supportive Housing
• Homeward 2020 Collaborative
• Coordinated Assessment & Housing Placement System
• Human Service Programs
• Municipal Court, Special Agency Session
• Outreach Fort Collins
10
The Solution is Local
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 2‐
pronged:
1. Expanded & enriched local behavioral health services across
the County.
2. And, a regional behavioral health facility to coordinate those
integrated services.
11
Larimer County is Uniquely Positioned
Lessons Learned from November 2016:
• More County‐wide Collaboration
• Increased Clarity in Intent and of Messaging
Our revised efforts are to facilitate the most economic and effective
mental health care to meet the needs of our residents:
• At the Right Level
• At the Right Time
• At the Right Cost
12
Direction Sought
1. Does Council have direction for how the City should
collaborate with the County on regional behavioral
health?
2. Does Council have any additional insights about this
issue or proposed solution?
13
Laurie Stolen
Larimer County Behavioral Health Project Director
200 West Oak, Fort Collins, CO 80521
970.498.7144
14
“This provides a unique
opportunity for citizens
to engage with their
community leaders on this
important issue. We want to
provide every opportunity
to our citizens to have their
voices heard,” said Tom
Donnelly, Larimer County
Board of Commissioner
What role do
YOU
want to play?
How Did We GET HERE?
Larimer County Board of
Commissioners dedicate a
month of listening sessions to
Mental and Behavioral Health
to seek public input, gather
information on the public’s
concerns, to exchange ideas,
and share their views on this
complex community issue.
County, Summitstone Health
Partners and Larimer County
hire nationally recognized
experts, NIATx, to compile
data on currently available
mental health services,
current needs, and provide
recommendations to address
gaps and challenges.
July 2014
Over 300 well-informed
citizens come together to
identify the most pressing
mental health needs in our
County. Larimer County Board
of Commissioners resolve
to address this complex
community challenge through
the Larimer County
Strategic Plan.
70 – 90% of individuals
with mental illness see
an improvement in their
symptoms and quality
of life after participating
in treatment.
- National Institute of
Mental Health
A copy of this valuable community
report can be found at:
LarimerCountyMentalHealth.info
How Did We GET HERE?
ATTACHMENT 1