New behavioral health commissioner to target access to care, fentanyl

State officials behind an ambitious and daunting plan to create a new government agency for behavioral health have chosen a doctor who ran Crisis Services in Washington, DC, to lead the transformation.

Dr. Morgan Medlock

Dr. Morgan Medlock, a public health expert who most recently served as chief medical officer of DC’s Department of Behavioral Health, spent the first two months of work in Colorado visiting state psychiatric hospitals, clinics in community mental health and residential addiction treatment centres. . As Colorado’s first behavioral health commissioner, she reports to Governor Jared Polis and is responsible for what has been described as the most monumental overhaul of mental health care in the state in decades.

The Colorado Sun caught up with Medlock amid a legislative debate over how to spend $450 million in ‘once in a generation’ federal coronavirus aid to reform mental health care and addiction treatment in the Colorado, as well as legislation that will set the rules for the new behavioral health administration.

The new office will assume responsibility for more than 100 mental health and addictions programs that are now spread across at least four state agencies. By 2024, the office should create a statewide complaints system where the public can report abuse or lack of access to care, and should expand services, especially in communities remote, in accordance with the law.

Medlock, who is part of the faculty of Massachusetts General Hospital Center for Law, Brain and Behavior and was a clinical psychiatry fellow at Harvard Medical School, spoke to The Sun about her plans to restructure the system, tackle the crisis in children’s mental health and help Colorado emerge from the fentanyl epidemic.

She plans to hire a Child and Family Advisor, as well as a Deputy Equity Commissioner. In addition to a medical degree, Medlock holds a master’s degree in divinity and public health.

Building the Ideal Mental Health System

Medlock said his first priority is to make sure people know where to go for treatment, which requires help from libraries, homeless shelters, doctor’s offices and more.

“We need to have a strong gateway to treatment, a single gateway, and we need to develop that through unique pathways. As we think about what this front door will look like, it will have a digital component where people can get help. You should know that you can walk to certain places, be it shelters or libraries, schools, and receive help and advice to access these resources. We need to combine digital solutions with human solutions.

After focusing on the “front door” of care, particularly for people in crisis, Medlock said she would move on to improving long-term services for people in the system.

“We need to do the same analysis across the continuum of care and think about it in terms of intensive services, outpatient support, etc., housing support. But as we build the continuum of care, we focus on the front door.

Strengthening the workforce is another key priority, as is setting up a complaints system so people can seek help from the new behavioral health administration when they cannot. find treatment or when they receive inadequate care, she said.

“Any system must be publicly accountable. And when people don’t live the results they deserveand are dissatisfied with care, they should be able to rely on us as BHAs to help them resolve grievances and concerns.

Opioid Abuse Research at Howard University

Before working for the Department of Behavioral Health in Washington, Medlock was director of community engagement and new program development for the College of Medicine at Howard University, a historically black private university in the capital.

“I was really responsible to be an architect of strategy and to open new doors for the treatment of opioid use disorders to our community, and in particular to marginalized communities,” she said. declared. “It was my job to travel to DC, and especially to Wards 7 and 8, where we have the highest opioid overdose rates, and to meet with community members, religious leaders, people with lived experience, nonprofit trustees and talking about how we have a comprehensive strategy to reduce opioid overdose deaths in these communities. This work was also part of the policy work I was doing on the Mayor’s Opioid Death Review Committee.

The review panel sought “analysis of the root causes of opioid-related deaths, determining what policy solutions were needed to support those at risk of overdose. We also analyzed the skyrocketing use of fentanyl in Washington, DC, which has unfortunately become a matter of national significance and crisis.

Reduce arrests of people with mental illness

After joining the DC Department of Behavioral Health, Medlock focused on reducing arrests of people with mental illness and creating other ways to help those in crisis instead of charging them with crimes.

During his tenure, the city reduced criminal charges against people in behavioral health crisis, including having mental health professionals — or co-responses — join police on some calls, a- she declared. Several, but not all, Colorado law enforcement agencies use co-responders. She intends to use her experience to help people who have experienced trauma feel comfortable accessing care to help shape policy in Colorado.

“We have taken steps to work with national consultants on this issue to complement the training and empowerment of our staff, to think of an individual in crisis as still a person and not a diagnosis. Not just a filler.

“Even if individuals are in crisis, that doesn’t mean they can’t contribute to a common decision on next steps and what they do to heal. You also have to think about housing, you have to think about transportation needs, you have to think about the context of a person’s life, and especially the economic context of a person’s life. And for our work in DC, that became extremely important when we thought about how populations moved around when it came to housing and economic policy.

Responding to the fentanyl crisis

Overdoses of fentanyl, a powerful synthetic opioid, have exploded in Colorado over the past two years. Most pills currently sold on the street that look like OxyContin or Xanax are counterfeit and contain fentanyl. Last week, a Colorado Springs woman was arrested for selling the little blue pills near a high school, where a student overdosed and died at her desk.

Medlock, who was part of the DC Hospital Association’s Opioid Task Force, said finding new ways to deal with the epidemic was among his top priorities. First, she wants to build a system where people who need mental health treatment or addiction treatment walk through the same doors to receive treatment in one place, instead of the current, fragmented setup. .

This undated file photo provided by the Phoenix Division of the United States Drug Enforcement Administration shows a close-up of sky blue pills containing fentanyl. (Drug Enforcement Administration via AP, File)

“The Behavioral Health Administration wants to integrate these two parts of the system, and we do this intentionally through our administrative structure. This question is of crucial importance. And when you add the lens of the pandemic and the hopelessness and the rise in anxiety and depression and suicidality that have all increased during the pandemic and then you include the pre-existing opioid crisis, things are really at a disastrous level. The BHA is ready to step in and integrate our approach for people in addiction crisis. »

Hiring a Children’s Mental Health Counselor

Medlock said she plans to hire a senior child, youth and family counselor who will develop strategies to help children in mental health crisis. For starters, Colorado needs more psychiatric beds for children so they don’t have to travel out of state for treatment, she said. The governor intends to spend federal funds from the American Rescue Plan Act to create new neuropsychiatric beds for children.

“Many of our children who are now displaced out of state are those with neuropsychiatric needs and intellectual or developmental disabilities,” she said. “And so I really want to commend Governor Polis for prioritizing this issue so that we can get more beds online for our children, and so their families and parents don’t have to deal with to move their children out of state to receive life-saving care.”

The exterior of Children’s Hospital Colorado in Aurora, photographed October 18, 2019. (John Ingold, The Colorado Sun)

“Fairness cannot be overstated”

Medlock, who was vice chair of the American Psychiatric Association’s Council on Minority Mental Health and Health Disparities, said she had received approval from the governor’s office to initiate a search for a deputy commissioner focused on the fairness and efficiency of the system.

“I can’t say enough about the fairness. We want the work we do to be effective across the continuum of care and we want it to be equitable across the lifespan. Children and young people currently deserve more than what we are providing, and we know we must do better. We know racial inequities in behavioral healthcare need to be addressed, we know we need a fairer system of care for people with disabilities. And so fairness cannot be overstated.

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