Behavioral Health Care in Colorado: Looking Back and Looking Ahead

“We need a new type of health facility, one which will return mental health care to the main stream of American medicine, and at the same time upgrade mental health services.”

This idea might sound familiar. There has been a lot of discussion recently about efforts to integrate behavioral health and mental health, both in Colorado and across the nation. But this quote is from President Kennedy’s Special Message to the Congress on Mental Health and Mental Retardation, sent in February 1963.

The new type of health facility proposed by President Kennedy was a community mental health center. The bill creating community health centers was passed by Congress and signed into law October 31, 1963.

The Colorado Behavioral Healthcare Council (CBHC), at its annual meeting, celebrated the anniversary of the Mental Health Act and President Kennedy’s historic focus on mental health care. And even though much has been accomplished in the past 50 years, much work remains to be done. Integrating and strengthening behavioral health care was a primary focus of conversations about the future at the CBHC meeting.

The CBHC conference sessions covered a range of topics. Some recurring themes I heard, both in presentations and individual conversations, were:

• Integration: Comprehensive care, including behavioral health services and physical health services provided by a unified care team, can help improve the consumers’ experience of care, the health of the community as a whole, and reduce the overall cost of care. There are several challenges to transforming how care is provided, including changing practice patterns, cultural differences between providers, training and logistics.
   
• Payment reform: Models of care continue to evolve, but models of paying for that care tend to change more slowly. This leads to a mismatch between desired care delivery and the reimbursement structure, which often makes financing new models of care challenging.
   
• Accountability: Providers are looking at different ways to track outcomes and measure success. This is closely associated with both new payment models and work towards behavioral health integration.

These themes are all important as Colorado prepares for significant changes in behavioral health policy.

Starting in 2014, most health insurance plans will be required to cover mental health and substance abuse disorder services, which are included in the Affordable Care Act’s Essential Health Benefits. In the 2013 session the Colorado Legislature significantly increased state spending on mental health, including funding for a behavioral health crisis response system and an enhanced Medicaid substance use disorder benefit. And Colorado is developing a State Innovation Model (SIM), an integrated and innovative vision of health care, which starts with a focus on integrating behavioral health with primary care.

This is a time of rapid change and new opportunities for health care overall, and perhaps even more so for behavioral health. The vision remains to bring behavioral health into the main stream of medicine, while strengthening behavioral health services overall. Fifty years later.