That was the community climate in Colorado Springs in 2001. Pikes Peak Mental Health (PPMH) decreased its detox bed availability because of funding cuts. Yet throughout this crisis, much community dialogue occurred and a new model was born.
For behavioral health agencies to transform into quality-leading community players, new approaches and tools for building interagency trust and overcoming embroiled politics are a must. But how do you do this when behavioral health is misunderstood, mistrusted, and often viewed as an afterthought? What follows is the approach taken in Colorado Springs and the lessons we learned.
In 2001, the PPMH board directed the CEO and senior staff to “fix the detox problem.” Programming had been funded partially by the state with the expectation that communities also would provide funding. At that time, 60% of the Detoxification Center's financial support came from the Colorado Division of Alcohol and Drug Abuse, 6% from the local county commissioners, 11% from the city, and 23% from the center's humanitarian foundation, a grants- and resource-related division of the community mental health center.
Funding was in jeopardy, and the board did not want to increase dependence on PPMH's foundation dollars because detox operations were accumulating net losses of close to $1 million per annum. At the board's direction, the CEO and COO met with leaders at community agencies, city government, and county government to address the urgent funding need and announce the detox bed decrease. They were skeptical that PPMH really needed to decrease beds so significantly, and they questioned PPMH's motives. There were many questions about PPMH's finances and unsolicited media attention, all with a flavor of mistrust. The barriers in obtaining a financial commitment from the proposed collaboration seemed to stem from two main points:
strong value judgments about helping the substance abuse population, opting for the “drunk tank” alternative (a holding area with no treatment) as opposed to a therapeutic treatment approach; and
a belief in the community that PPMH was fiscally responsible for substance abuse care for the community as a whole, and allocated dollars should be managed more effectively.
Without additional financial commitments, PPMH had to significantly reduce capacity from 24 to 8 detox beds in June 2001 and change programming from a modified medical detox program to a social detox program. This resulted in ER overcrowding, more law-enforcement responses to inebriated people on the streets, and business leaders’ complaining about intoxicated people downtown. Everyone wanted to know why PPMH had decreased bed availability—and how PPMH was going to solve the problem.
Stage one: Bringing the community onboard. PPMH recognized it had the community's attention and hired a respected local consultant to initiate a task force to clear the air and develop community solutions. PPMH invited all community stakeholders, and many did participate. Initially, many questions were raised about PPMH's finances and detox services.
Each group or agency evaluated the problem as it related to its specific situation and offered correlating solutions. For example, law enforcement wanted a drunk tank without treatment components, and hospitals wanted intoxicated individuals removed from their ERs. The task force often focused on each agency's funding commitments, and finding solutions was made more difficult because of three factors:
an overall mistrust of the mental health center and a belief that the task force's initiation was self-serving;
agencies' blaming each other for the problem; and
weak communication and undeveloped relationships across the task force.
By this point we had learned several lessons:
PPMH had to be transparent and willing to open up and expose the organization to build trust. Thus, PPMH shared its detox financial information with the community, and this went far in easing mistrust.
Solid data were critical in addressing mistrust and facilitating communication, and PPMH shared its client numbers and outcomes data.
Mission had to drive staff behavior. The CEO was continuously visible and delivering the message. This helped anxious staff live through the community's scrutiny and delivered a consistent message about PPMH's interest.
Stage two: Identifying solutions. To move the task force toward decisions and solutions, a smaller group of decision makers was formed, comprising two hospital CEOs, a local psychiatric facility's senior administrator (which also provided detox services), the assistant director of county government, a city intergovernmental liaison, PPMH's CEO and COO, and the deputy police chief.
The new task force brought in an independent consultant to facilitate planning. A local hospital, Penrose-St. Francis, secured a grant for a planning study to identify and develop a long-term, financially viable continuum of care for detox services. Penrose also offered a staff member to serve as group facilitator.
The task force needed to identify:
the community's needs specific to a continuum of care for substance abuse;
a care model to meet all service users’ needs;
financial options; and
methods to secure fiscal commitment.