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Andrew Romanoff was once the speaker of the Colorado House of Representatives. Now he's the CEO of Mental Health Colorado, an advocacy group looking to improve conditions for people with mental illness.
The difference between working with lawmakers and people with mental illness?
“Mental illness is treatable,” Romanoff said.
Romanoff painted a broad picture of the challenges facing mental health providers and their patients in Colorado at a meeting of the Littleton Kiwanis Club on March 28.
Perhaps 250,000 people in Colorado alone suffer from “severe” mental illness, Romanoff said, and about a million Coloradans live with a diagnosable disorder or substance abuse.
Of those, roughly 60 percent aren't getting the care they need.
“If only half the population with cancer got treatment, there would be a national outcry,” Romanoff said.
Mental illness is a big driver of homelessness and imprisonment, Romanoff said, dating back to the trend toward “deinstitutionalization” in the 1950s and 1960s, when large, state-run mental health hospitals were closed down or greatly reduced in size, pushing patients onto the streets or into jails.
“The biggest source of treatment in Colorado is the Department of Corrections,” Romanoff said. “It's the most expensive way to treat mental illness, and the least therapeutic. There are more than 5,000 inmates in our state and local prisons with severe mental illness, but only a quarter as many hospital beds.”
People tend to think of this as a sorry fact of life, Romanoff said.
“This is a decision we've made, though,” Romanoff said. “There's no law of nature, no divine commandment or act of God saying to use your criminal justice system as a warehouse for people with mental illness. This is a choice we've made because of the laws we've passed and the budget priorities we've made. It's the kind of choice we can change.”
Romanoff said addressing shortages in care will require a multifaceted approach, starting with identifying why people who need mental health care don't get it.
Roughly half of people with mental illness show signs by age 14, Romanoff said, and three-quarters show signs by 24. Prevention and intervention are key, he said.
“We should be doing more to engage family members, to train teachers to spot symptoms, and enact mental health screenings for kids in school like we do for hearing or vision,” Romanoff said. “We should also equip schools with social workers, psychologists and counselors. We only have half as many as we need.”
A biennial state survey spelled out more barriers to care, Romanoff said: More than half of those who needed mental health care but didn't receive said they couldn't afford it, and almost as many said they didn't have insurance or didn't think their insurance covered it. A third said they couldn't find a provider, and a similar number said they were worried what people would think if they found out.
The insurance and monetary barriers are frustrating, Romanoff said.
“We've spent the last 20 years passing laws telling insurance companies they have to provide equal coverage for mental health as they do for physical care, and provide adequate networks of mental health professionals,” Romanoff said. “But those laws are useless unless you enforce them. We don't need to pass another law saying we really meant it the first time. We should say we'll enforce what we've got.”
Improving conditions for people with mental illness is a matter of life and death, Romanoff said, because people suffering from severe mental illness have significantly reduced lifespans, and because Colorado has one of the higher suicide rates in the nation.
Getting the state to allocate more money to mental health care will prove crucial, Romanoff said.
“It costs money to treat mental illness, but it costs a whole lot more to ignore it or criminalize it.”
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