This story is part of an ongoing investigative series, called “On Edge,” about Colorado’s mental health system by the Colorado News Collaborative.
Mental Health Partners, a private nonprofit serving Boulder County, has abruptly closed its weekend walk-in crisis center and cut its weekday hours of operation, citing a worker shortage.
The facility, located at 3180 Airport Rd., was the county’s only dedicated in-person center open around the clock daily to anyone seeking care for a mental health emergency, such as psychosis or suicidal thoughts. The change took effect on Feb. 6.
The decision to reduce hours at the walk-in center highlights the difficulty of hiring mental health clinicians amid the national labor shortage.
It also reflects a statewide safety-net system unable to meet the needs of people experiencing a mental health crisis, as detailed in an ongoing investigative series by the Colorado News Collaborative.
State regulations generally require walk-in crisis centers to be staffed 24 hours a day, seven days a week all year round unless the state grants providers a rules waiver. Mental Health Partners — which receives about half of its revenue from local, state and federal tax dollars — notified the state of its plans to cut hours at its Boulder clinic just days before it closed, according to state records.
As of Monday afternoon, officials at the Colorado Office of Behavioral Health still hadn’t approved the waiver, according to Maria Livingston, the interim communications director for the Office of Behavioral Health.
The sudden closure of the walk-in center leaves a hole in the region’s mental health safety net. Mental Health Partners is under contract to provide emergency services in Boulder and Broomfield Counties. Like crisis centers in other communities, Boulder’s walk-in center is intended to keep people out of costly hospital emergency rooms, where wait times can last hours.
The reduction in emergency services comes at a time when the Boulder County community has endured unprecedented strain, reeling from one tragedy after another. Last March, 10 people were killed in a mass shooting at the King Soopers grocery store. In late December, the Marshall Fire destroyed more than 1,000 homes and left hundreds of workers filing for unemployment. Meanwhile, economic insecurity, social isolation and grief lingers as the Covid-19 pandemic stretches into its third year.
Jennifer Banyan, the director of Jewish Family Service in Boulder, which has partnered with the Community Foundation Boulder County to provide counseling to people affected by wildfires or the pandemic, said demand for therapists has nearly doubled since the Marshall Fire.
Banyan said it is difficult to predict when the need to talk to a therapist turns into a crisis.
“We never know when the crisis is going to happen. We never know when the ability of a teenager who’s just gone through this is going to end. We don’t know when it’s going to become too much,” Banyan said. “We’re not out of the woods on shock and trauma. We’re just entering it.”
In the last year, demand for the walk-in crisis center has trended upward, according to state data. In 2020, 66 people in Boulder County died by suicide, more than any prior year for the past 15 years, data show.
“We haven’t had to close or reduce hours at the crisis center to this degree in the past, so this decision was heavy and was very difficult,” said Dixie Casford, one of two CEOs at Mental Health Partners. “We did not have the crisis clinicians to staff it.”
The clinic is now open weekdays from 7 a.m. to midnight and closed on weekends. Casford said the nonprofit plans to reinstate the crisis center’s full hours of operation as soon as it can find the staff to run it.
Which services are left in Boulder?
Colorado, a state with one of the highest rates of adult mental illness and the least access to care, relies on 17 regional “community mental health centers,” including Mental Health Partners, to provide some of the state’s only emergency mental health services outside of hospital emergency rooms. The centers also provide inpatient hospitalization, outpatient treatment and counseling for people who are on Medicaid, indigent or uninsured — and for anyone in crisis.
In December, the Boulder walk-in center provided nearly 200 services to individuals, according to the most recently available state data. When making the decision to cut hours, Casford said Mental Health Partners reviewed data indicating the center was used the least between the hours of 12 a.m. to 7 a.m.
Casford said its addiction withdrawal center will still be open 24 hours a day at the same location as its walk-in center.
And when the walk-in center is closed, she said people should call the state’s crisis line at 1-844-493-8255 or text “TALK” to 38255. She said mobile crisis services, which involve clinicians visiting people’s homes or wherever they are in crisis, are still available in the region.
Casford said residents who don’t need mobile response should visit the walk-in crisis centers at SummitStone in Fort Collins, open 8 a.m. to midnight, or the Jefferson Center in Wheat Ridge, open 24/7.
Walk-in centers were designed to keep people experiencing mental health crises not only out of hospital emergency rooms, but also out of jail. About 70% of people incarcerated at the Boulder County Jail — which is across the street from the Mental Health Partners crisis center — have diagnosed mental health conditions, according to Jeff Goetz, the jail’s division chief.
Goetz said some people booked into the jail say they are suicidal. As a matter of jail policy, he said officers won’t release them unless a mental health professional gives them the okay to do so. Officers have relied on the Mental Health Partners crisis clinicians for these mental health evaluations during the nighttime hours, when the jail’s mental health professionals were off work, Goetz said. Now, he said, some people might end up spending the night in jail waiting for an evaluation.
“It could delay releases” from jail, Goetz said.
Labor shortage
Other mental health providers are short on clinicians, too. The City of Boulder’s co-responder crisis intervention program has struggled to staff up. The state recently closed nearly 100 beds at its inpatient mental health hospital in Pueblo due to staffing shortages.
Casford said Mental Health Partners would want 17 crisis clinicians on its payroll to keep the walk-in center open 24/7. She said it has six.
In job listings, Mental Health Partners advertises salary ranges for crisis clinicians starting at about $50,000, and like some other mental health providers, requires clinicians to work some weekends, holidays and overnight shifts.
Casford said the company pays competitive wages for the Denver Metro Area. But she said it’s hard to compete with private care providers.
“I’m not saying all of the clinicians are satisfied with the salaries they are receiving right now,” she said. “We’re competitive with community mental health [centers]. We have to look at that differently now.”
An analysis by the Colorado News Collaborative of recent financial records filed by Mental Health Partners indicates the nonprofit paid its care providers less than all but three of Colorado’s 17 community mental health centers — about $64,000 a year compared to the statewide average of approximately $70,000.
To make the job more attractive, Casford said, Mental Health Partners is considering raising salaries, adjusting benefits and changing work hours to give clinicians more time off. She said the nonprofit is discussing with the state ways to reduce administrative requirements for staff, too.
Reconsidering walk-in centers
Mental Health Partners is requesting a state rules waiver to cut the hours of its walk-in center until April.
Separately, Livingston, of the state Office of Behavioral Health, said the agency was discussing with Mental Health Partners the terms of its state contract, which includes a payment of about $250,000 from the state for emergency mental health services for fiscal year 2022.
Meanwhile, Casford said her organization is considering whether the walk-in center is the best way to provide emergency mental health services. She said it may be time to make adjustments to its services given the staffing challenges, $450 million in behavioral health money for Colorado under the federal American Rescue Plan Act, and proposed reforms being contemplated by state lawmakers.
“Is [the walk-in center] still the best way to provide this service to people? And is there something that we need to look at and reevaluate?” Casford said. “Anytime that you have something like this that’s been operating for a period of time, you definitely should do reviews of it and say, ‘Is this meeting the need?’”
Nancy VanDeMark, the former director of the Colorado Office of Behavioral Health who now works as a consultant, said the state’s policy on delivering mental health services has left too few mental health providers trying to meet a growing demand for services.
Community mental health centers, including Mental Health Partners, benefit from the state’s non-compete contracts. This financial advantage is in part intended to keep the centers open and able to provide emergency services.
But when the centers can’t meet the need, as is the case today across Colorado, VanDeMark noted no one else is ready to step in.
“I believe that we’ve starved our communities of providers by restricting competition,” VanDeMark said.
She added, “When there is only one option, clients have limited choice and it is hard for communities to piece together all the services needed.”