Reasons for facility closures over the last five years include the possibility of less demand, increasing costs and economic stressors of the pandemic.
DENVER — In May 2021, Children’s Hospital Colorado declared a state of emergency for kids’ mental health. Nearly a year later, resources continue to disappear in the state.
As of February 28, 2022, Colorado has a bed capacity of 216 when it comes to psychiatric residential treatment for kids. There are another 156 beds for kids with more acute needs. And according to the Colorado Department of Human Services, 16 congregate care facilities for youth shut down in the last five years.
Over a decade ago, the philosophy on treatment changed with the belief kids would do better receiving treatment in familiar settings versus in a facility. Fifteen years ago, Colorado had more than 1,600 youth placed in congregate care settings. That population is now less than 300.
In an email to 9NEWS, the state wrote:
“Many youth who were previously served in residential facilities are able to be successfully served in their home or in family-like settings with outpatient services and supports. Very few youth demonstrated requiring the type of acute clinical care offered in congregate settings as most families benefited from local resources and referrals to community services aimed to strengthen families.”
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But the concern over closing facilities creates a ripple effect for groups serving kids, as well as for Children’s Hospital Colorado.
Dr. Ron-Li Liaw, the hospital’s Mental Health-in-Chief, said the loss of residential beds for kids, as well as acute psychiatric beds, is being felt in their hospital. Kids are coming into their emergency department for help with nowhere else to go. Liaw said, at times, half of the department is filled with kids in a behavioral health crisis.
She also said some kids have stayed at the hospital for five to six months with nowhere to go for long-term care needs. She said this isn’t the right kind of care for kids, but they are doing the best they can while working to expand capacity.
A big struggle is finding enough staffing.
Becky Miller Updike is the executive director for the Colorado Association of Family and Children’s Agencies and partners with Children’s Hospital Colorado.
The group oversees 40 agencies statewide, offering a continuum of care.
“When you are really sick you go the [intensive care unit],” she said. “We need that kind of care for kids and it’s lacking.”
Without enough resources, some kids are bounced around from place to place for help.
So, how did Colorado get to a place with more kids facing mental health issues with more severity, but fewer resources available?
Updike points to the nationwide philosophical change, that it is better to treat kids in a familiar setting versus a facility.
Overall, reasons for facility closures over the last five years include the possibility of less demand, increasing costs and economic stressors of the pandemic. Updike said other facilities have shut down because of safety violations.
The issue, she said, is that some facilities closed down without new options.
Funding has been an issue, too, when it comes to reimbursements for providers.
Liaw said investments that were needed in kid’s behavioral health a decade ago didn’t happen. Colorado in particular is fractured and regional-based when it comes to the care system.
She also said that, for some reason, mental health care and physical health care were considered separate and behavioral health didn’t get funded well.
While investments are being made now, it’s a big game of catch up.
Children’s is working to double, and in some cases triple, services. They also want to work more on preventative care.
Updike said it’s important to build up resources across the continuum of care.
“We continue to work with providers to change their licensing designation or, in some cases, stand up new units to meet the changing needs of Colorado kids. While fewer children/youth require residential settings to receive treatment than in the past, those who do, require much more intensive staffing and services than what has traditionally been available in facilities. This is why Colorado has provided funding for new, high-acuity Psychiatric Residential Treatment Program beds under SB21-137 and through American Rescue Plan Act (ARPA) funds.”
The state legislature is debating several bills that, if approved, would set aside funding for additional beds and bringing mental and physical health more in-line with each other.
The state is also launching a behavioral health administration at the beginning of July to streamline resources and funding.
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