County advocates for better mental health service, follow-through

Skeptical of new Center for Mental Health merger

[  By Katherine Nettles  ]

As the regional mental health organization Center for Mental Health prepares to merge with a larger and more generalized healthcare system, not everyone is feeling optimistic about local services improving in the Gunnison Valley. Gunnison County commissioners have been outspoken about concerns for how the Center for Mental Health (CMH) is struggling to serve Gunnison County residents in a timely manner, at reasonable costs and with consistency.

CMH representatives have responded that they are sympathetic to those concerns and plan to keep a presence in both Crested Butte and Gunnison, although they are about to lose their current office space in Crested Butte. The hope is to find a new, reasonably affordable space in the North Valley and streamline administrative duties with the larger network they are joining. 

During a meeting with CMH officials in late February, commissioners openly discussed their recent criticism of the mental health provider. CMH currently has 11 clinic locations serving Gunnison, Delta, Montrose, Ouray, San Miguel and Hinsdale counties and receives state funding for providing services to adults, children and families including individual and group therapy, psychiatry and substance use services. CMH plans to merge with Axis Health Systems effective July 1, which will combine the current region with five southernmost counties of southwestern Colorado. This includes Dolores, San Juan, Montezuma, La Plata and Archuleta counties. As a federally qualified health center, Axis services include primary care and dental care in addition to mental health, psychiatry and substance use treatment. 

Paul Reich, CMH community relations liaison, offered a brief presentation of the upcoming changes and said the merger is the result of the past two years of discussions between the organizations. He said CMH’s intent is to remain at both ends of Gunnison County, although the Crested Butte clinic is looking for a new location. “Our landlord has decided not to renew the lease,” said Reich. He said they want to remain a presence in town, and are looking for a reasonable option. 

CEO Shelly Spalding reviewed that the reason for the merger is a response to changes in healthcare in general. “The board of directors for both organizations came together and said, ‘let’s pool resources.’” She said she expects the merger to help both organizations offer enhanced services and “a deeper bench of practitioners.” She then quickly opened the discussion up to addressing commissioner concerns. 

Spalding asked for more context to county commissioner chair Jonathan Houck’s signature on a recent letter to Colorado governor Jared Polis expressing concerns about the CMH’s “lack of transparency, inequitable payment practices and failure to serve Coloradans with the greatest needs.”

Houck responded that he joined many other commissioners in signing the letter in December. He said he felt the geographic spread of the organization was challenging “and often creates access problems for folks. And with the desirability to have more services in our community, we struggled with having follow through with the program.” He used the example of providing services for the Gunnison County jail and how that did not work out as planned. 

 “I’m very happy to see that there’s more openness, societally-speaking, and more willingness to lean into mental health issues,” said Houck. “It’s as important as physical health, and we believe in that. But we are struggling with the accessibility of mental health services within our community and our concern is that a lot of these issues will continue to be issues.”

Houck said the six-county region is often centered around Montrose, and “for those of us that are out on the edges…it’s hard to be on the edge of that service.”

Spalding agreed that access is a big concern. She said that particularly in terms of crisis services, it is difficult to staff enough people in person, on location, for sparsely populated rural areas. 

“I am extremely concerned about what I think of as the middle class, upper middle class population,” she said, who have high deductible plans and have to pay for services out of pocket. “I don’t think we have enough providers in our community serving that particular population.”

Spalding said that the CMH, as a safety net provider, has a responsibility to serve individuals who are uninsured or underinsured as well as the Medicaid population. “I think over the years we have tried to provide service to some other populations and not in the greatest way. I think it is in our best interest to focus on those populations that we are required to help and try to do that well.”

Commissioners Liz Smith and Roland Mason echoed Houck’s comments. 

“The folks that are getting treatment at the CMH need to be able to trust that system,” said Mason. He said repeated changes had made that continuity of care challenging for people he has spoken with. Mason added that the local hospital system provides excellent services, and he would like to see collaboration increasing to expand that access.

All parties spoke in favor of supporting legislation to increase federal and state funding to the mental healthcare system, which could make a direct impact on the topics at hand.

“I want you to hear that although we’ve been critical, we are also trying to be actionable,” said Houck of Gunnison County’s support for such legislative opportunities. 

Spalding said she appreciated the comments and candid discussion. She also noted, “It moves around depending on what study you look at, but Colorado sits at 36th for federal funds regarding mental health programs…and 49th for state funding.”  

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