Agreement aims to expand community behavioral health services and shorten wait times

The Colorado Department of Human Services (CDHS) has reached an agreement that resolves an eight-year-old federal lawsuit over wait times for court-ordered competency services by expanding community-based services, providing treatment for people in jail waiting for services, and expediting inpatient services for Coloradans experiencing a serious mental health episode.

The parties’ agreement, which was filed Friday in federal court in the form of a consent decree, also provides for a maximum of $10 million in fines in a 12-month period if CDHS fails to meet a series of timeframes for providing competency evaluations and restoration services. Any fines levied will be used to enhance community mental health services.

“I'm pleased that we are tackling this long-standing issue in a way that is smart and beneficial to those Coloradans who so desperately need our help," said Michelle Barnes, CDHS' Executive Director. "This agreement, which has the added benefit of resolving a nearly decade-old legal dispute, will translate into tangible improvements to a system that serves some of Colorado's most vulnerable citizens. I am looking forward to forging robust partnerships with our dedicated stakeholders, members of the legislature and the judiciary to best serve these citizens."

By statute, CDHS is responsible for providing court-ordered competency evaluations and restoration services for criminal defendants ordered to its custody by the courts. CDHS has struggled to meet an influx of people needing these services. Since 2000, the number of orders to complete inpatient competency evaluations has grown by 592 percent, and the number of orders to provide inpatient restoration services has grown by 1251 percent. Despite many and varied efforts to increase capacity, CDHS has been unable to keep up with the demand for these inpatient services. 

The increased caseload caused CDHS to fail to meet timeframes laid out in prior settlement agreements between the parties. As a result of this failure, the plaintiff (Disability Law Colorado, which is a federally funded non-profit designated to advocate on behalf of Coloradans who live with mental health disorders and developmental disabilities), reopened the lawsuit against CDHS. This month, CDHS and DLC participated in multi-day mediation in an effort to create a holistic solution to the underlying issues and resolve the parties’ legal dispute.

“We are pleased that the parties worked together to resolve this important case. This is a big deal for Colorado. I am proud of the great work by our team and our client, the Colorado Department of Human Services, to develop a negotiated plan that will ultimately best serve the individuals impacted by this issue,” said Colorado Attorney General Phil Weiser.  

The consent decree sets up a complex series of staggered timeframes for admission to state-run, inpatient treatment. The agreement allows CDHS to prioritize the most acutely ill patients by requiring CDHS to admit them for restoration treatment more quickly.

“This is the right way to structure in-patient hospital admissions so that individuals who have serious mental health episodes get help first,” said Robert Werthwein, Director of CDHS’ Office of Behavioral Health and acting Deputy Executive Director for Operations. “It's no longer a one-size-fits-all approach; it's an approach that focuses on the clinical needs of each individual defendant.”

Beginning June 1, 2019, for the most ill people who urgently need inpatient care in addition to restoration to competency, CDHS must offer admission within seven days, a vastly reduced timeframe from the 28 days in the parties’ prior settlement agreement. The agreement shortens timeframes for patients with very high needs, which are a minority of those ordered to CDHS. Over a period of years, the timeframes for offering a treatment placement for those less urgently in need will gradually reduce as well. 

In addition, the consent decree requires CDHS to support efforts to get people care that helps divert them from the criminal justice system, and to bond out of jail so they can receive treatment in the community. It also requires CDHS to work with stakeholders statewide, to create a roadmap for improving mental health services in Colorado. 

Specifically, the consent decree requires CDHS to:

  • Develop a comprehensive, cohesive plan to maintain compliance with the consent decree.
  • Adhere to the timeframes within which pretrial detainees must receive competency services from CDHS.
  • Implement a coordinated wide-scale outpatient community restoration program.
  • Create a team that will develop a centralized, data-driven system that disseminates data in a manner to better inform decisions and planning.
  • Create a forensic support team that will include a full-time supervising coordinator to interface with other critical stakeholders in both the judicial and executive branches, to improve the efficiency in the delivery of competency services statewide.
  • Develop and implement a triage system that considers clinical need and makes recommendations to state courts based on information gathered through that system.
  • Implement state-wide uniform standards for competency evaluators and evaluations and conduct training for forensic evaluators and restoration providers to ensure high quality evaluations.
  • Prepare budget requests and propose and support legislation which are calculated to meet the terms of the consent decree.

“CDHS is invested in building the best system possible for its clients and this is a great first step,” Werthwein said. “We feel confident that in partnership with the General Assembly, the judiciary and stakeholders, CDHS will meet the terms of this consent decree and will best serve Coloradans in need of mental health care.”

March 15, 2019