State audit reveals problems and progress at mental health centers
Mind Springs, the embattled community mental health provider for 10 Colorado counties, will have to change how it prescribes potentially dangerous drugs and do more to ensure it’s meeting local needs, a state audit released Thursday concluded.
In a briefing for Western Slope officials and reporters Thursday, the directors of three state agencies outlined a plan to improve care at Mind Springs, which is responsible for mental health services in Eagle, Garfield, Grand, Jackson, Mesa, Moffat, Pitkin, Rio Blanco, Routt and Summit counties.
It operates outpatient clinics and the West Springs Hospital.
The 22-page audit report was put together by the Colorado Department of Health Care Policy and Financing, the Colorado Department of Human Services and the Colorado Department of Public Health and Environment.
It found Mind Springs, the subject of a series of investigative reports by the Colorado News Collaborative, hadn’t entirely fixed prescribing practices that could put patients at risk of overdosing.
The Department of Health Care Policy and Financing, which runs the state’s Medicaid program, will require Mind Springs to use a tool meant to flag risky prescribing decisions. It also mandated that Mind Springs change its board to better reflect the community; attempt to fill vacant clinical positions; offer services in Spanish; track if people seeking help actually receive it; and make a plan to close any gaps between services the centers offer and those their communities need.
The Department of Health Care Policy and Financing found that Mind Springs was following the state’s financial reporting rules, but those rules weren’t guaranteeing good service to communities and are being updated, Executive Director Kim Bimestefer said.
“We need Mind Springs to be successful,” she said. “It has improved, but there’s a lot of work to do.”
Mind Springs officials, who received the findings about two hours before the public unveiling, didn’t respond publicly on Thursday.
The Office of Behavioral Health, under the Colorado Department of Human Services, found Mind Springs wasn’t always reporting harm to patients promptly; may not have gotten clients’ input on their care plans; didn’t set clear goals for treatment; didn’t properly assess what level of care clients needed; and failed to meet other requirements that it document clients’ care and progress. It reported Mind Springs has already addressed most of its concerns.
The Colorado Department of Public Health and Environment’s portion of the audit looked at whether Mind Springs failed to protect patients’ rights. It didn’t find enough evidence to draw conclusions.
The agencies reported they decided to do a combined audit after hearing concerns from local leaders and receiving 47 complaints about Mind Springs following a separate investigation in spring 2021. Bimestefer said she wasn’t satisfied with Mind Springs’ response to their concerns last year, but the interim CEO and new board members seem committed to making changes.
“It’s a lot easier to address something when you have a willing partner,” she said.
The latest audit followed several years of increasing concerns about Mind Springs. Summit and Eagle counties are ending their contracts with Mind Springs and setting up their own mental health center because of concerns about a lack of transparency around the organization’s use of taxpayer money; widespread distrust in their communities; and an alleged refusal to send response workers to assist people in crisis.
Mind Springs said it has to navigate a “delicate balance” to ensure its workers’ safety.
In April 2021, a whistleblower raised alarms about potentially unsafe prescribing at Mind Springs. Rocky Mountain Health Plans, which has a state contract to manage Medicaid benefits in western Colorado, found some patients received high doses of drugs that could cause an overdose, even if they had a history of addiction or were at risk for suicide. A wider review in December found potentially dangerous medication decisions in 128 out of 472 medical records.
The December review had also found people in need were struggling to get appointments; clients were disproportionately likely to be admitted to a hospital, but less likely to get followup care than in other regions; Mind Springs’ leadership didn’t have a plan to deal with gaps in services; and its board wasn’t representing the community.
The state health department launched a separate investigation in June, following a complaint West Springs Hospital’s board wasn’t ensuring patients received quality care. The department wasn’t able to say if that happened or not, but did find the hospital wasn’t properly assessing patients when they came in or connecting them to follow-up care when they left. It also found problems with discharging patients again after another complaint in February.
Some of the concerns with Mind Springs reflect problems with the entire behavioral health system, Bimestefer said. Clients and former employees of other mental health centers have also reported long waits for services, and that some centers had staff working with populations they weren’t trained to handle, such as children or people with addiction.
A raft of mental healthrelated bills this session, increased federal and state funding for care, plans to write performance requirements into centers’ contracts and centralizing work in the new Behavioral Health Administration will help to increase access to services and improve accountability, Bimestefer said.
“There’s never been a transformation like this,” she said.