In September 2019, UCHealth announced a five-year, $100 million investment in behavioral health services. The commitment aimed to address a widening health care gap caused by growing rates of anxiety and depression, suicide risk, and substance use disorders, along with a shortage of providers and other barriers to care. Six months after the announcement, the COVID-19 pandemic hit, sending both medical and behavioral health needs soaring.
The problem remains. But more than three years after its announcement, the UCHealth investment has produced concrete programs to address it throughout the state. The solutions include:
- Integrating primary and behavioral care in dozens of clinics
- Connecting patients by video to behavioral health services
- Expanding the number of inpatient psychiatric beds
- Developing a pipeline to bolster the behavioral health workforce
- Pairing behavioral health professionals with local law enforcement to assist people in crisis
The original $100 million commitment has grown, thanks to philanthropic donations matched by UCHealth, said Vice President of Behavioral Health Elicia Bunch.
“We are positioned to significantly exceed the initial investment, based on the expansive services that we have [launched] and are expanding and will continue to expand,” she said. At the current pace, she projected the total investment over the five-year period will reach more than $150 million.
The initiatives address a variety of patient needs, but they have a common purpose: making more behavioral health services available to a greater number of people, Bunch added.
“Our overall mission from a behavioral health access perspective has been to remove barriers to care,” she said. That means not only making behavioral health services more available, but also breaking down the stigma often attached to mental health issues and ensuring that they are treated as an essential part of medical care, she added.
One stop for primary and behavioral care
The need to address the often intertwined medical and behavioral health needs of patients with minimal delay is a key part of the UCHealth strategy. In 48 of its primary care clinics, licensed behavioral health specialists and medical providers and staff share space and collaborate on patient care. Two other clinics will do so soon, Bunch said. The behavioral health specialists include counselors, family therapists, social workers and psychologists, with support from psychiatrists at all locations.
Since the program launched early in 2020, the clinics have handled some 74,000 behavioral health visits, with the numbers rising steadily each year, Bunch said. The integrated approach improves patients’ access to care, she added.
“When a primary care physician makes a behavioral health referral, there are so many barriers to finding a provider in the community who is accepting new patients and is geographically acceptable,” Bunch said. “We know that when therapists are actually located inside the primary care practice, the likelihood that they will access care and connect with a professional increases dramatically.”
A video visit solution
Not every patient with behavioral health needs is seeing a therapist in an integrated primary care setting. The UCHealth Virtual Behavioral Health Center links patients anywhere in the system to licensed therapists for an evaluation and assessment of the level of care they need. Care coordinators then work to connect patients to the appropriate services they need throughout the state, Bunch explained.
“A significant percentage of Coloradans live in areas with a shortage of behavioral health professionals,” she said. “Being able to connect with a professional through the Virtual Behavioral Health Center has been a significant way to address that shortage.”
UCHealth recently created another remote bridge to care with its Virtual Intensive Outpatient Program. It’s designed to fill unmet needs for specialty services throughout the system and state, Bunch said. The sessions target:
- Anxiety and depression
- Dialectical behavior therapy
- Adolescent issues
- Co-occurring substance use disorders and mental health conditions
- Complex grief and trauma
Bunch added that the Center for Dependency, Addiction and Rehabilitation (CeDAR) at UCHealth University of Colorado Hospital on the University of Colorado Anschutz Medical Campus provides behavioral health services for patients admitted primarily for substance used disorders. UCHealth Mountain Crest Behavioral Health Center in Fort Collins offers mental health and substance use disorder treatment for both adults and adolescents.
The COVID-19 pandemic and its aftermath also imposed heavy stress on UCHealth employees. Many faced mental and behavioral health challenges as a result. UCHealth responded with First Call, which connects employees to individual therapy, psychiatric consults and support sessions. Between December 2020 and January 2023, the First Call program provided nearly 7,000 such sessions.
“We know that through the pandemic, the general population has had increasing rates of anxiety and depression,” Bunch said. “Health care workers have even higher rates than the general population.” Meeting these employees’ needs is vital, not only for the individuals, but also to ensure that they are able to provide the most effective care for patients, she stressed.
Building inpatient capacity
A severe lack of inpatient psychiatric beds is another key barrier to addressing behavioral health needs in Colorado. Bunch noted that UCHealth screens patients for suicide risk in its emergency departments and inpatient medical care units. The goal: identify at-risk individuals who need access to an inpatient psychiatric bed – a commodity in short supply in Colorado and around the country.
“It is very difficult to find these beds and ensure safe care and psychiatric treatment for patients,” Bunch said. “The need for additional inpatient capacity is a driver for our behavioral health investment.”
A 40-bed inpatient psychiatric unit for adults is slated to open this summer in a third University of Colorado Hospital inpatient tower now being constructed. It will include 20 beds to treat a variety of mood disorders, including anxiety and depression, often accompanied by risk of suicide. Another 20 beds are for “high acuity” patients with severe psychiatric symptoms, such as psychosis, who also pose a risk of harm to themselves and others. In addition, an interventional psychiatry clinic adjacent to the inpatient unit will provide an additional site for electroconvulsive therapy for patients with severe depression and other disorders that resist standard medications and psychotherapy.
Bunch noted that UCHealth worked closely with the University of Colorado School of Medicine’s Department of Psychiatry in planning the new unit. Clinicians from the department will deliver psychiatric services in both the inpatient units and the clinic, she said.
In northern Colorado, UCHealth plans to expand the number of inpatient beds at Mountain Crest Behavioral Health Center from 41 to 50 as part of a move from its current location to UCHealth Poudre Valley Hospital in Fort Collins. The move is targeted for completion in 2025.
Seeking behavioral health helping hands
The investment in behavioral health care extends beyond the walls of UCHealth’s clinics, emergency departments and hospital rooms. In El Paso County, Aurora and Fort Collins, behavioral health professionals work with local law enforcement in a “paired responder program,” Bunch said. The teams work together on calls arising from individuals experiencing a possible mental health crisis. The aim: connect people in distress with behavioral health services as an alternative to time in jail or an emergency department, she noted.
Bunch also acknowledged that UCHealth’s behavioral health expansion will demand a large and well-trained workforce. The Colorado General Assembly recognized that need statewide with passage of Senate Bill 22-181. The act required the Behavioral Health Administration (BHA) “to create and implement a behavioral health-care provider workforce plan,” which BHA formulated and released in September 2022.
The details include funding for the Colorado Department of Labor to create an entry-level apprenticeship program for “young people who have an identified passion to explore a behavioral health career pathway.”
UCHealth is contributing to the behavioral health bolstering effort, Bunch said. “As part of our expansion of behavioral health services, we have invested a lot of time and attention into a strategy for workforce development. Our ability to expand access to care is certainly dependent on our capacity to hire high-quality mental health professionals.”
She pointed to the UCHealth Ascend Career Program as a key pillar of the approach. Ascend supports education for people pursuing health care positions, including those in behavioral health. “We are also developing partnerships within our communities to provide career pipelines,” Bunch said.
A holistic approach to care
UCHealth’s heavy investments in behavioral health care are necessary to comprehensively meet patients’ needs and improve their outcomes, Bunch concluded.
“There is lots of data on the ‘why’ for integrating behavioral health care with medical care,” she said. “Patients with chronic medical conditions respond much more effectively to medical treatment when their behavioral conditions are treated.” Bunch cited a statistic from a 2014 study that put the need for integrated care in stark relief.
“Fifty percent of people who died by suicide saw a medical health provider within 30 days of their deaths,” she said. “Our investment addresses the opportunities we have to intervene.”