The State Government's Moral Obligation to Address the Mental Health Crisis

The State Government's Moral Obligation to Address the Mental Health Crisis

Lindsey Wyatt

In 1948, the Universal Declaration of Human Rights (UDHR) was adopted and became pivotal, as it outlined fundamental human rights that must be universally protected by both governments and their people for the first time. One of the most important components of the UDHR is the right to health outlined in Article 25 that states, “Everyone has the right to a standard of living adequate for the health and well-being for himself and his family- including food, clothing, housing, and medical care,” (1). While the UDHR does not explicitly state mental health, modern research emphasizes that mental and physical health are deeply intertwined and must be treated comprehensively (2). Comparatively, the International Covenant on Economic, Social and Cultural Rights (ICESC) explicitly states “the right to physical and mental health.” It documents that governmental parties have an obligation to prevent and control epidemic, endemic, infectious, occupational, and other diseases, as well as create the conditions that would assure access to medical services and medical attention in the event of sickness. The government has an obligation to set up the conditions in which individuals can exercise their right to the highest attainable standard of both physical and mental health by implementing these standards (3).

The Mental Health Crisis

The State of Colorado is experiencing a mental health crisis due to an inadequate system of care. In their 2021 Health Access Survey Report, the Colorado Health Institute declared mental health a “Second Health Crisis.” The report also documented that about 24% of Coloradans have reported poor mental health-- a rate higher than ever before (4). This increase in mental health difficulties is not a new trend, as the Colorado Department of Public Health and Environment has documented an increase in suicides and overdoses both before and after the COVID-19 pandemic (5). Some more examples of the mental health crisis within the state are the widely documented opioid epidemic, rates of burnout, depression, and moral injury among healthcare workers, and increased suicidal ideation among school-aged children (6-8). Despite the clear and unequivocal need for expanded mental and behavioral health services, Colorado was recently ranked one of the worst for adult access to mental healthcare by Mental Health America’s 2021 Report (9). In many instances, individuals who do seek out help have been denied services or placed on lengthy waitlists by Community Mental Health Centers (CMHCs)-- leaving the most at-risk Coloradans without care (10).

The facts are sobering and can only indicate one conclusion: the state’s existing mental healthcare system is a blatant human rights violation. This violation shows where and how the government has failed to fulfill their historically recognized responsibility to set up the conditions in which an individual can exercise their right to health. While the violation has been noted as a national problem by President Biden, Colorado is bearing the brunt of this crisis (11-12). Our state’s system isn’t working. Therefore, if the goal is to achieve the healthiest Colorado, mental health must be integrated, considered, and supported in all policies.

The Government’s Obligation

The burning question is what exactly is the government’s obligation to meet these standards? Unfortunately, neither the UDHR nor ICESC have legal grounds for enforcement, but that does not mean they are not important. They are morally enforceable - there is still the expectation that governments engage in the necessary steps to ensure that individuals can exercise these rights. It is important to clarify that the government does not have the responsibility to enforce that an individual exercises their rights-- that is the freedom of the individual to choose. However, these documents explicitly state that it is the government’s responsibility to create the conditions that provide capacity for an individual to exercise these rights if they choose to do so (1,3).

Since Colorado is ranked one of the worst in access to mental healthcare and entities are denying services to individuals with some of the highest need, it is clear that the government has failed to create conditions for individuals to exercise their right to mental health (9-10). Legislators and government officials alike must recognize that at any given moment, each and every resident exists on a continuum of mental health. As they continue their roles within the state government, there is an expectation they will address mental health through their policies. This means legislators and government officials must actively demonstrate commitment to address this crisis through critical and intentional examination of the current system, acceptance of the system's strengths and weaknesses, proactive advocacy for change, and bipartisan collaboration that consistently puts citizens first.

Colorado State Government’s Plans to Address Mental Health

While the current situation seems bleak, not all hope is lost because the Colorado State Government has made efforts to address this crisis over the years. For example, in 2019 Governor Jared Polis directed the Colorado Department of Human Services to create the Behavioral Health Transformational Task Force (BHTTF) to gain insight into what transformational change would look like within the mental healthcare system.

One of the most notable accomplishments of the BHTTF was the unanimous vote to form the new Behavioral Health Administration (BHA) that will be the government entity responsible for mental health and substance use funding and programs within Colorado (13). This recommendation was effectively put into law through Governor Polis’ signature on House Bill 2021-1097 Establish Behavioral Health Administration (14). In addition, the current legislative session contains House Bill 2022 – 1278 Behavioral Health Administration, which outlines the standards that the BHA must implement by July of 2024. According to this bill, the BHA must implement statewide grievance, performance monitoring, safety net, licensing, and authority systems to regulate the state’s mental healthcare system (15). Hopefully, the launch of the BHA and their implementation of these standards will finally create a cohesive, person-centered mental healthcare system that is accessible, high quality, and easy to navigate.

What the Colorado State Government Should Do to Address Mental Health

While the BHA is an important start, it is not enough. The true effects of the BHA will not be noticeable for several years. This poses an important dilemma because of the magnitude of the current crisis. In order for residents of Colorado to truly be able to exercise their right to mental health and well-being, the Colorado State Legislature must enact and vote in favor of policies that have short-term and immediate impacts in addition to the long-term solutions to mitigate the current status of this crisis.

Additionally, it is integral to consider, prioritize, and elevate the testimony of those with lived experience when enacting policy. It is one thing to enact a policy that one “thinks” is best. It is completely different to achieve transformational change based on the experiences of those who have struggled to navigate and have been failed by the system. To do otherwise is reckless, dehumanizing, and ineffective. Oftentimes, individuals who end up utilizing mental health services within the existing system leave feeling invalidated and stigmatized, and those who have experienced a mental health crisis are released into unsafe conditions without support or access to followup care (16). This concern is frequently reflected among testimonies of support for bills such as House Bill 2022 1303 Increase Residential Behavioral Health Beds (17). Legislators have the duty to actively listen, critically analyze, and deeply reflect on the experiences of those who are in and have experienced a mental health crisis in which any level of intervention was needed. Once this occurs, effective and transformational change of the system will be achievable.

Finally, there needs to be more consistent data collection and reporting across entities and jurisdictions. The current mental healthcare system is extremely difficult to navigate due to the unclear role of different entities such as Community Mental Health Centers (CMHCs), Administrative Service Organizations (ASOs), Managed Service Organizations (MSOs), and Regional Accountable Entities (RAEs) (18), as well as the distinction between public and private services. While this is one of the goals outlined by the BHA, it is unclear how this is going to be enacted and enforced. There needs to be clearer, more tangible documentation on exactly how the BHA will accomplish their purpose. It is time for the government to lift some of the bureaucratic red tape that keeps residents in the dark and instead provide the opportunity for civic engagement that is consensual and informed.

Overall, the state is experiencing unprecedented rates of poor mental health due to a system that is a human rights violation (4). All individuals experience mental health across a continuum at any given moment, and the state government must create person-centered, holistic systems that acknowledge this spectrum. While strides have been taken, it is time to enact policies that address this problem immediately and provides the opportunity for individuals to exercise their fundamental human right to the highest attainable standard of mental health and well-being.