Colorado Crisis Care

Starting July 1, a new set of agencies will manage the state’s comprehensive behavioral health crisis system and ensure statewide coverage. Crisis services will be managed across seven regions, instead of four, to align with the state’s Medicaid regions. The annual budget for Fiscal Year 2019-2020 among the regions is $29.35 million, which is an increase of $1.5 million from the previous fiscal year. 

The new structure contracts with agencies called Administrative Service Organizations, and reflects community recommendations to improve the state crisis system, which was put into place in 2014 following the Aurora theater shooting. Each agency has developed and will manage a network of providers that will deliver crisis behavioral health services including mobile response, walk-in, stabilization and respite crisis services. In addition, the state is working with the ASOs to expand community-based mobile response, which has been historically underutilized. 

Switching from four to seven regions will simplify the process for patients accessing care and better enable the state to analyze and track community behavioral health services and unmet needs. ASOs are legal entities with the ability to support the crisis system through required data reporting, care coordination, and managing contracts with providers and ensure quality patient care.  

OBH has executed contracts with all seven regions, which start on July 1. OBH has every confidence that these new ASOs will support a system that is integrated into the behavioral health care continuum, coordinates across care transitions, and collaborates with local, regional, and state partners. The Office of Behavioral Health and the ASOs are committed to enhancing the behavioral health crisis system to ensure comprehensive, coordinated, easily accessible, culturally informed, and integrated services are available for people experiencing a behavioral health crisis.

Coloradans in need will still access the system in the following ways:

To find your ASO, visit the Find Behavioral Health Help page on the CDHS website. The ASOs should be contacted for the following needs:

The state’s public behavioral health system also includes the 17 Community Mental Health Centers (CMHCs), which provide coverage for every county in the state. All CMHCs by statute are required to provide “at least the following services provided for the prevention and treatment of behavioral or mental health disorders in persons residing in a particular community in or near the facility so situated:

(a) Inpatient services;
(b) Outpatient services;
(c) Partial hospitalization;
(d) Emergency services;
(e) Consultative and educational services.

Sixteen of the 17 CMHCs have contracted with the ASO in their region to provide crisis services. OBH has also been working with the CMHCs to create more flexible budgets for their state contracts and encouraged them to prioritize emergency services.  

DENVER (March 26, 2019) — The Colorado Department of Human Services, Office of Behavioral Health has announced new contractors for Colorado Crisis Services regions statewide and the crisis line, as well as planned improvements to the crisis system. The comprehensive statewide behavioral health crisis care system for individuals, families and communities was created in response to the Aurora theater shootings in July 2012 and has provided more than half a million services to Coloradans.

Colorado Crisis Services will now be administered in seven regions to ensure a robust network of providers and to align with the state’s Medicaid regions, simplifying the process for patients accessing care and better enabling the state to analyze and track community health and wellness. The new contracts will begin summer 2019, and the regional crisis contractors, called Administrative Services Organizations (ASOs), will provide a network of walk-in crisis centers, crisis stabilization centers and respite and mobile crisis services in their regions. The crisis system has an annual budget of more than $31 million.

“As a state, we are always working to improve the customer experience and partner across local and state agencies. These changes support efficient and aligned care systems and allow us to better track health by community,” said Robert Werthwein, Director of the Office of Behavioral Health and acting CDHS Deputy Executive Director for Operations. “These administrative regions will coordinate services from local community mental health providers, and as a result we expect patients to see strengthened partnerships with local systems like law enforcement, county services, and hospitals.”

The new ASOs for the crisis system are as follows, each listed with the maximum amount of annual funding they’ll be awarded via contract:

Region 1: Rocky Mountain Health Plans, $7,538,371
Region 2: Beacon Health Options, $2,133,461
Region 3: No Award, $5,898,147
Region 4: Health Colorado, $2,750,242
Region 5: Signal Behavioral Health Network, $2,935,660
Region 6: Signal Behavioral Health Network, $3,689,981
Region 7: Beacon Health Options, $3,102,617

Region 3 did not receive a qualifying bid, so that region’s vendor will be selected by competitive negotiation and announced at a later date. See a map of the regions below.

The crisis line competitive bid was won by current provider Rocky Mountain Crisis Partners, which has operated the state’s crisis line since inception. The crisis line has a budget of $3,068,291 and served 54,826 individuals last year through text, online chat, and call services. 

The Department re-procured the crisis system because the current contracts were due to expire. Stakeholder and consumer feedback, including the work of the Crisis Steering Committee,  prompted changes to the crisis system, such as more focus on mobile response and coordination with law enforcement and others responding to behavioral health emergencies to get people connected to care.

“We hope that by expanding focus on mobile services, and aligning with county efforts for these services, we can bring care to people in their homes and communities when they need it most,” Werthwein said. 

A report from the Colorado Crisis Steering Committee provides recommendations to the Colorado Department of Human Services for upgrades to the behavioral health crisis system. The Colorado Crisis Services system is a $33 million statewide resource for people in need of mental health or substance use help, information and referrals.

The Committee, which included representatives from community mental health centers, local public health offices, law enforcement and other government agencies, convened eight times between March and June. Over this period, the Committee spent time understanding how the current system functions and identifying prioritized recommendations for system improvements.

The Committee embraced the idea of “No Wrong Door.” In other words, if a person is in need of crisis services, they should be able to access services using any of the modalities available through the crisis system, which includes the hotline, walk-in centers and mobile response. The crisis system aims to provide the right services in the right locations at the right time. The report said the system should be flexible and integrated while meeting community needs and acknowledging each community’s nuances. Given the ever-changing environment in which we live, the system should remain current and relevant, the report said.

DENVER (Jan. 5, 2018) — The Colorado Department of Human Services (CDHS) today announced plans to convene a multi-stakeholder committee to provide recommendations to CDHS for upgrades to Colorado’s behavioral health crisis system.

“This is an opportunity to enhance the system and to hear from all who are affected by it,” said Reggie Bicha, Executive Director of the Colorado Department of Human Services. “Colorado Crisis Services has produced many good outcomes for the state of Colorado, and this is the time to make adjustments to ensure it is functioning as effectively as possible for people in need of these services, and for taxpayers.”

Gov. John Hickenlooper initiated “Strengthening Colorado’s Mental Health System: A Plan to Safeguard All Coloradans” in response to the Aurora theater shootings in July 2012. The creation of a comprehensive statewide behavioral health crisis care system for individuals, families and communities was a key component in the plan.

The crisis system in Colorado includes a 24-hour hotline staffed by professional counselors, a peer line, walk-in crisis centers, crisis stabilization centers and respite and mobile crisis services. The hotline launched in August 2014, and the on-the-ground aspects of the crisis response system opened in December 2014. From inception through October 2017, Colorado Crisis Services has provided 582,969 services. In October 2017, the crisis system provided 23,305 services.

Over the next six months, the committee will work to:

The committee is expected to convene subcommittees to provide different and necessary perspectives on the crisis system.

CHDS’ decision to evaluate the system comes as a series of upgrades are planned. Senate Bill 17-207, which was signed by Gov. Hickenlooper in May, provided $7.1 million to the Office of Behavioral Health to expand the crisis system and better equip law enforcement to respond to individuals in mental health crisis. In addition, the Long Bill allocated $2.6 million for Law Enforcement Assisted Diversion (LEAD) pilots to assist law enforcement with redirecting individuals to community-based services instead of jail.

The planned regional improvements will increase collaboration with local law enforcement, improve capacity to conduct face-to-face (including telehealth) assessments; ensure that walk-in centers, crisis stabilization units and acute treatment units are able to accept and triage individuals on emergency mental health holds; and expand local partnerships to ensure jails are not used as a placement option for individuals on emergency mental health holds.

The final conclusions and recommendations from the committee will be compiled in a report by
June 1, 2018. The committee will include the following members:

This report provides a brief overview on the status of Colorado Crisis Services expansions. Senate Bill 17-207, which was signed by Gov. John Hickenlooper in May 2017, provided $7.1 million to the Office of Behavioral Health (OBH) in the Colorado Department of Human Services to expand the crisis system and better equip law enforcement to respond to individuals in mental health crisis. In addition, the Long Bill allocated $2.6 million for Law Enforcement Assisted Diversion (LEAD) pilots to assist law enforcement with redirecting individuals to community-based services instead of jail.

This first infusion of funds to improve the crisis system, which is more than $3.4 million, supports enhanced partnerships between law enforcement and the four regional crisis contractors -- West Slope Casa, Southern Colorado Crisis Connection, Northeast Behavioral Health and Community Crisis Connection. The planned regional improvements will:

The Office of Behavioral Health has worked closely with the crisis contractors to finalize contracts for this purpose. This collaborative process required multiple iterations as requested by the contractors to meet the needs of each community and address feedback from community partners and providers. The Department was pleased to provide continuing technical assistance during this time to ensure the amendments met the legislative intent and unique regional needs. Contracts with three of the four regional crisis partners and the rural enhancement contract were fully executed as of October 30, 2017. The Department has given the remaining contractor until November 3 to submit their final version of the contract for their region. The contractor requested to change their contract on October 30 due to their concerns about capital construction timelines. The Department will expedite the contract to ensure full execution in the timeliest manner possible.

Additional enhancements through both Senate Bill 17-207 and the Long Bill will be completed through the state solicitation process, many of which are out for bid. Awardees are ideally announced within 30 days of closing each bid, depending on the number of proposals and the
scheduling of the state procurement office scoring committee.

• Ensure that walk-in centers, crisis stabilization units and acute treatment units are able
• to accept and triage individuals on emergency mental health holds; and
• Expand local partnerships to ensure jails are not used as a placement option for
• individuals on emergency mental health holds.

Colorado Crisis Services recently entered into a partnership with the Department of Agriculture, Colorado State University, the Farm Bureau and the Rocky Mountain Farmers Union to spread the word about crisis services to agricultural communities.  

With the economic downturn, the four agricultural entities wanted to make a proactive effort to provide information about Colorado Crisis Services. These four entities will share crisis contact information and invite Colorado Crisis Services to the table or speak at events.

The goal is to reach family, friends, and neighbors of farmers and ranchers who might need support. The Department of Agriculture says this effort is in the spirit of “neighbors helping neighbors,” a common practice in agricultural communities.

In addition, Colorado Crisis Services hotline staff will undergo training specifically for the needs of the agricultural community. 

The Office of Behavioral Health held a stakeholder meeting Aug. 17 to discuss changes to the Colorado Crisis Services system and to answer questions. A recording of the meeting is available here, and a PDF of the slide deck is here.

Colorado Crisis Services was created five years ago and has since provided thousands of Coloradans with timely access to services when needed, regardless of payer source. Over the last several months, the Colorado Department of Human Services met with multiple stakeholders in a public steering committee, which provided the state with recommendations on how to improve the crisis system. 

The steering committee recommendations and the feedback received on Aug. 17 will be used as the Office of Behavioral Health moves forward with improvements to the system.

DENVER (May 18, 2017) — Today Gov. John Hickenlooper signed Senate Bill 17-207, strengthening Colorado’s crisis response system and effectively ending the use of jails as a placement option for individuals on an emergency mental health hold.

The crisis system in Colorado includes a 24-hour hotline staffed by professional counselors, a peer line, walk-in crisis centers, crisis stabilization centers and respite and mobile crisis services. This bill provides more than $7 million to the Office of Behavioral Health (OBH) in the Department of Human Services to expand the crisis system and better equip law enforcement to respond to individuals in mental health crisis.

The legislation is the product of recommendations from the Mental Health Hold Task Force, which was created at the governor’s request in 2016 to identify ways Colorado’s system could better serve individuals in a mental health crisis. The task force -- composed of a diverse set of stakeholders including law enforcement, mental health advocates, hospitals, clinicians, regulatory agencies and people with lived experience and their families -- worked with the Colorado Commission on Criminal and Juvenile Justice to create the solution presented in SB 17-207.

“Until now, people in Colorado could spend up to 72 hours in jail simply because they had a behavioral health issue and needed help,” said Nancy VanDeMark, OBH director. “Through the hard work of many people, we’re now able to expand and enhance the availability of crisis response services statewide. Coloradans in crisis will be connected with the right behavioral health services in an appropriate setting.”

Through SB 17-207, OBH will in the coming year expand the availability of mobile clinicians, use of telehealth, options for crisis stabilization in underserved communities, transportation for people in crisis, and collaboration between behavioral health clinicians and law enforcement.

The transportation program will have drivers trained to transport people in mental health crisis to a mental health center or hospital, reducing the use of law enforcement and ambulances. The bill directs $5.2 million to pair law enforcement officers with behavioral health providers to assist with individuals in behavioral health crisis, called a co-responder model.

In response to the  Aurora theater shootings in July 2012, Governor John Hickenlooper initiated “Strengthening Colorado’s Mental Health System: A Plan to Safeguard All Coloradans.” A key component of this plan was the creation of a comprehensive statewide behavioral health crisis care system for individuals, families and communities. The goal of this crisis care system is to ensure people are receiving the right services, at the right place and at the right time. Often, the most difficult part about getting help for a mental health, substance use or an emotional issue is knowing where to begin – especially when an issue reaches a crisis point. Colorado Crisis Services is that single point of entry for any individual experiencing a crisis.

Crisis Services will: 

Key Service Components