Colorado Behavioral Health Administration hobbled by turmoil | Subscriber Content

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Staff defections, personnel clashes and delays in legislatively mandated reforms have troubled the new Behavioral Health Administration, a state department launched just over a year ago to fix Colorado’s tattered safety net for the mentally ill that one study ranked the worst in the nation.

Dr. Morgan Medlock

Dr. Morgan Medlock

The new department was supposed to be the key to improving the abysmal rate of access to care in Colorado, which still fails to provide adequate services to the mentally ill despite spending $1.5 billion annually on more than 120 mental health service programs spread across 13 state agencies and the judicial branch.

Instead, sharp divisions in the Behavioral Health Administration hobbled its ability to fulfill its mandate, according to a review of staff emails, legislative testimony and interviews.

The top three officials at the department clashed so severely that the head of the new department complained in emails that the other two did not trust her, and they resigned. They returned to work after Gov. Jared Polis replaced their boss late last month with an interim appointee.

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Those departures were part of an exodus of employees to hit the new state department. Since July 2022, 27 people have resigned from the Behavioral Health Administration, roughly equivalent to a quarter of the 116 people working there. Several employees who have worked there or who still are employed there say the department is drastically understaffed.

One current employee, who did not want to be identified due to fears of retaliation, said the department should nearly double its staffing given the long list of tasks and breadth of the overhaul it is supposed to achieve.

“We probably have 15%, maybe 20% of the people for the positions that have been created,” the employee said.

“The fact that we even go to work is amazing,” the employee said. “People are tired. They work all the time. If you have certain things that need to get done and deadlines, you can’t not do them.” The employee added that all the turmoil at the agency and fluctuating leadership “hurts your soul.”

The department is the target of ongoing investigations by the Colorado Civil Rights Division and the federal Equal Employment Opportunity Commission.

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State officials won’t say what is being investigated, though two people familiar with the inner workings of the department said a personal assistant to the former head of the department submitted age and disability discrimination claims after she was pushed out after clashing with others there.

A staff survey conducted by the Colorado Department of Human Services also documented deep dissatisfaction over the work environment at the BHA, with 55% of the respondents stating their job stress was unreasonable and nearly half of respondents stating they viewed senior leaders at the department as ineffective.

Meanwhile, the state’s mental health providers are disgruntled that officials at the Behavioral Health Administration did not promptly distribute all the $190 million in federal American Rescue Plan Act money they received last year to improve access to mental health care.

Officials at the BHA only recently awarded $150 million of that money in grants, nearly two months later than originally expected. An employee of one of the providers said that even though the money has been awarded, the contracting process still has been “a long, arduous byzantine process.”

The delays will put providers in a rush because all the federal money must be spent by the end of December 2024, said one provider employee, who asked to not be identified due to the sensitivity of the issue. In addition, the state still hasn’t developed a plan to sustain programming once the one-time allotment of federal aid is spent, according to that person.

The Behavioral Health Administration also won’t meet the original deadlines state lawmakers set for rewriting licensing standards for providers and for establishing a new oversight network that was supposed to coordinate and improve access to care. A redrafting of the regulations regarding involuntary commitment procedures for the mentally ill also has been pushed from a deadline of this July to a year later in July 2024.

“The part that concerns me is that the BHA is supposed to actually deliver care one way or another to people who desperately need it,” said state Rep. Judy Amabile, D-Boulder. “But it began to feel like they were mired in administrative mumbo-jumbo and having conflicts over what direction to go in rather than being a streamlined organization that knew where they were headed.”

HEADSHOT Judy Amabile

State Rep. Judy Amabile, D-Boulder

During one legislative hearing last month — this a week after the head of the Behavioral Health Administration, Dr. Morgan Medlock, was replaced — state Sen. Jim Smallwood, R-Parker, lamented that it appeared the fledgling department already was moving away from overseeing and running all mental health programs in the state.

Department officials said during the hearing that they planned instead to coordinate services and improve communications among state agencies because they feared moving programming under one department would take as long as seven years to do and would not be effective.

“I’m disappointed that the vision that I was sold does not sound like it is coming to fruition,” Smallwood said. “I really thought our state was ready to take a different step and was moving in a different direction and would have a lot more coordinated effort.”

Jim Smallwood 2017

State Sen. Jim Smallwood, R-Parker

Polis late last month announced he was replacing Medlock, the person he appointed just over a year ago to lead the BHA as the state’s first behavioral health commissioner.

Polis appointed as interim commissioner Michelle Barnes, the executive director of the Colorado Department of Human Services, to replace Medlock. The governor is searching for a full-time replacement. Medlock, who did not return telephone messages seeking comment, had previously been chief medical officer for the Department of Behavioral Health in Washington, D.C., before her appointment in Colorado.

While Medlock’s removal has been applauded by leaders at key advocacy groups for the mentally ill, legislators and county officials, it also has generated criticism from her allies. Supporters of Medlock say she struggled for clout and was subjected, as an African American woman, to racial insensitivities, even by other members of the governor’s cabinet despite Medlock often rising at 3 a.m. to begin her day.

“I saw it play over and over again, where she’s young; she’s Black; she’s smart, and people genuinely (felt) uncomfortable about that,” said Maureen Maycheco, who was promoted by Medlock from a role as communications director at the department to one of two deputy commissioners at the department. “They would challenge her in ways. Other cabinet leaders would like yell and scream on the phone, and Dr. Medlock would say that doesn’t seem appropriate, and people would be like, ‘Oh, oh well, you’re challenging me.’”

She added that Medlock, as a new outsider, unsettled some in the state because she didn’t always cater to titles and influence and instead valued reaching out to those most in need of services.

“Dr. Medlock started saying, ‘I’m so happy that you’ve been doing behavioral health for 30 years, and you’re a doctor who now serves on XYZ board and donates thousands of dollars. That’s great,’ Maycheco recalled. “’I’m also going to talk to this person who is in recovery, who lives in their house and has two children with serious mental illness.’ People genuinely did not like that.”

After Polis replaced Medlock, Maycheco resigned from her position as deputy commissioner in charge of system equity and effectiveness. She said that when Medlock first promoted her, two other key members of the executive leadership team at the department gave her the cold shoulder. She said Medlock continued to enhance her role at the department, going so far as to install Maycheco as the top person in charge when Medlock left town last month to speak at a conference.

By the end of the Monday that Medlock returned from that conference, Medlock was gone from the department, telling Maycheco she no longer worked there. Maycheco said she was excluded from meetings discussing a path forward and resigned.

“I resigned because I had a panic attack,” Maycheco said. “I was crying and shaking in the office. This was all too much for me, and I was being excluded and disrespected.”

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Medlock during her tenure championed the needs of minorities in the state, whose leaders argue the state historically has marginalized their mental health needs. Her sudden departure prompted a blistering email on Thursday to Barnes, the new interim commissioner, and other staffers at the BHA, from Racquel Garcia, a member of the Behavioral Health Administration Advisory Council, a 20-member group of appointees that helps the BHA form policy.

Garcia questioned in the email whether Polis and other state officials were just checking “their diversity box by inviting people of color and culture to the table? Were we just for show?”

“Because of the racialized trauma my dad has experienced he often tells me to be quiet and go on about my way,” Garcia said in the email. “Tuesday, he didn’t say that. Tuesday, he told me to use my voice, but I can’t help but think that I’m speaking for him today.”

Barnes wrote back to Garcia that she wanted to build “mutual trust” but cautioned that “there are certain topics I cannot discuss,” adding, “I hope all of you choose to stay as advisory council members.”

“You each were chosen for a reason and your voice and experience is important to guide our work,” Barnes said in the email.

Others welcomed the change in leadership at the Behavioral Health Administration, stressing that they’d heard of staff defections during Medlock’s tenure.

“We were concerned to hear reports of staff leaving the BHA in significant numbers, from program staff to executive leadership — many of whom left without another job lined up,” said Vincent Atchity, the president and CEO of Mental Health Colorado, the leading statewide group advocating for people with mental health challenges, in a letter to Alec Garnett, Polis’ chief of staff.

“Some of these individuals were longtime public servants with whom we worked for many years and know them to be tireless mental health advocates in addition to their roles as state department staff,” Atchity continued in the letter. “These staff departures were particularly concerning because we began to see issues regarding the ability of the BHA to meet expectations and legislative deadlines and impacts on statewide programs.”

Resignations at the department during Medlock’s tenure included Summer Gathercole, the deputy commissioner of operations; and Andrew Rauch, the department’s chief of staff, both of whom did not return requests for comment. They agreed to remain with the department after Polis replaced Medlock. Rauch now plans to take a six- to eight-week sabbatical before returning full-time, according to people familiar with his plans.

Emails obtained by The Gazette show that, at one juncture in February, Medlock lamented to Rauch after one contentious meeting that she doubted he trusted her.

“It reminded me of a difficult dynamic that has also developed between you, me and Summer,” Medlock wrote in the email to Rauch. “I feel we have actually not recovered from that fateful meeting in September, where I was surprised by a meeting agenda that developed in my absence.”

She concluded: “I think your vacation is well-timed, and when you return, I would like to share some reflections on co-management boundaries, and how those topics impact trust.”

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Rauch, in another February email to division directors, referred to how a recent meeting with them “took a direction that we were not expecting that resulted in some heated conversations.” He promised he would strive to set a better standard in the future.

Gathercole and Medlock in other emails clashed over Gathercole’s request that Medlock refrain from contacting her on Sunday mornings.

“My request was about setting expectations in not being available on Sunday mornings unless there is an emergency,” Gathercole wrote to Medlock in a Jan. 13 email, adding that she would be working in the afternoon and evening on most Sundays, but planned to hike or meditate in the mornings. “We have all been working long, hard hours for months — after hours and on weekends. For my own mental health, I need to carve out a bit of time each week where I am comfortable walking away from my work phone/computer and knowing that is OK not to be available.”

Medlock in a Jan. 23 email said her contacts of Gathercole on Sundays had been rare and stressed that “some agency risks have developed as a result of our infrequent communications.”

“Thus, it is my recommendation that we do not reduce our communication, and I will continue to reach out to you as deputy commissioner when I have needs,” Medlock continued in the email. “I will do my best to communicate in advance about needs that may be urgent and impact weekend availability.”

In another February email, Medlock said to her leadership team that she still had not addressed the group following a recent contentious meeting, and that “it takes me a while to process information that may be emotionally charged.”

Medlock in the email referred to a staffing retreat months earlier during which a management facilitator report found the team split between two leadership cultures.

Roughly 36% of the team gravitated to a culture of dominance that rewards independence, decisiveness and results while disliking hesitation and foot-dragging, she said. In contrast, about 45% of the team favored a culture of conscientiousness that rewards accuracy, attention to detail and dependability while disliking exaggerated enthusiasm, she added. Medlock put herself in the conscientiousness camp.

Atchity, in the letter to Polis’ chief of staff, described the interim appointment of Barnes as “prudent and thoughtful” given all the turmoil.

Despite the leadership change, widespread concerns persist at the General Assembly over the pace of a statutorily required overhaul to Colorado’s system of providing mental health care that new state laws required the Behavioral Health Administration to undertake.

Legislators bowed to reality and in April, nearly a week after the release of Medlock, agreed to push back six months the deadline for an overhaul of the state’s licensing standards for mental health providers. Legislators originally mandated that the BHA complete by this July a total rewrite of those regulations, which also would transfer licensing duties to the BHA from the Colorado Department of Public Health and Environment. Lawmakers now are requiring the BHA to complete that task by January 2024.

In addition, legislators delayed for a year the deadline for creation, required by state law, of a new network of Behavioral Health Administrative Services Organizations. The BHA’s creation of that network was supposed to improve access to mental health care in Colorado, which one study found was the worst in the nation amid rising wait times.

That 2022 study by Mental Health America, a national nonprofit that advocates for improvements in behavioral health care, found Colorado had the nation’s highest rate of adult mental illness and lowest access to care. A more recent 2023 study by the nonprofit found modest improvements, with only six states — Utah, Alabama, Oregon, Arizona, Wyoming and Kansas — now having worse access to care than Colorado amid high rates of adult mental illness.

Another major concern revolves around what type of network for coordinating care the BHA will create. Stakeholders reported that, during public meetings, they’d been told new coordination offices would be set up in regions throughout the state that would include walk-in services, according to legislators. Then those stakeholders later learned that there likely would only be one office for coordinating service, and it would not offer walk-in services.

State Rep. Dafna Michaelson Jenet, D-Commerce City, said part of Medlock’s downfall involved giving mixed messages.


State Rep. Dafna Michaelson Jenet, D-Denver

“One of the complaints that I got was that she would say one thing in a stakeholder meeting to appease stakeholders, and then she would turn around to her team and do the opposite and do something totally different,” said Michaelson Jenet. “The team was worried that they would then have to go talk to the stakeholders, and then stakeholders were off the rails upset. Something needed to happen.”

A key employee at one mental health provider, who did not want to be identified because the provider does business with the state, said the big question now is whether the remaining leaders at the BHA will remain introspective instead of boldly putting in places needed reforms.

“I think whatever happens, it will require a strong leader who has a vision and is able to take information that has been gathered and hit the ground running and trust in staff and trust in stakeholders and counties,” the provider said. “And really move forward quickly because time’s running out.”

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