Consumer and Family Affairs

For many people, the subject of mental illness is surrounded by mystery and fear. Mental health consumers and their supporters often have many questions about mental health treatment. They want to know the role of the mental health center, how to understand the symptoms and diagnosis, what to expect from treatment, the part family and friends can play as supporters in treatment, how to handle relapses and other emergencies, and what practical living issues confront consumers and families.

The NRBH Office of Consumer and family affairs is here to help consumers and families receiving services from NRBH with these issues. Consumers and families can call or come in to the Office of Consumer and Family Affairs to discuss concerns, ask questions, pick up information or borrow video tapes. Call (970) 347-2367 to make an appointment.

The Office of Consumer and Family Affairs has an information guide that gives basic information and helpful tips for consumers, parents, families and friends. Much of this information is also available in this website. Just click on the subject listed below:

BASIC SERVICES

Your first appointment is called an "intake". That means we'll get more details about what is going on with you, fill out required paperwork, and evaluate what you tell us. You will need to bring proof of insurance and proof of income with you.

ASSESSMENT - An assessment and mental health evaluation is the first step toward identifying problems and finding the best ways to treat them. A mental health professional will do this evaluation. It is important to share information about your own and family mental health history, living situation, medical problems and current condition. A preliminary service plan will be developed and a Care Coordinator assigned to you.

SERVICE PLAN - Your Service Plan is the map for your treatment. Your Care Coordinator will work with you and other people you wish to include to set goals for treatment and plan how to meet those goals.

Goals may be short term such as:
• Stabilize the body from the trauma of a psychotic break or episode
• Learn about the mental illness
• Find ways to cope with symptoms

Long-term goals may include:
• Making community living arrangements
• Participating in recovery based psycho-social rehabilitation programs
• Trying education/vocational training/employment programs
• Gaining skills for community living
• Learning about community resources

Over time, your service plan will change to meet new circumstances and needs.

MEDICATIONS - Medications can help control the active symptoms of many mental disorders. If it appears medications may help you, you will be given an appointment with a psychiatrist. If medications are prescribed, you will want to learn their names, functions, dosages, therapeutic benefits, side effects and risks. North Range provides nurses and medication groups that can help you understand these things.

OUTPATIENT TREATMENT- Most clinical treatment and medications checks occur in the office of the psychiatrist, nurse, clinician or care coordinator/case manager. Your Service Plan may describe other places for treatment activities, such as residences, Assertive Community Treatment offices, Adult Recovery offices, clubhouse, drop-in center or other locations in the community.

INPATIENT TREATMENT OR ACUTE TREATMENT UNIT (ATU) - A 24-hour setting may be recommended during periods of acute symptoms. Inpatient treatment may take place in the psychiatric unit of a local hospital, at the state hospitals, or at the ATU in Greeley.

• Short-term - usually at the local hospital for emergencies or ATU for most periods of stabilization
• Long-term - usually at the state hospital for very serious emergency cases or those involving multiple problems, co-occurring disorders and the need for a more secure environment

For descriptions of specific programs see the NRBH Program Descriptions.

HANDLING AN EMERGENCY

A crisis is not always an emergency. State law says that an emergency is when, as a result of mental illness:

1. a person may be a danger to him or her self
2. a person may be a danger to others
3. a person can't take care of his daily needs

Actions you can take:
If the situation is an emergency, the following actions can be taken by you or a family member or supporter:

• Call the NRBH 24-hour crisis phone line! Telephone: (970) 347-2120 The on-call crisis team member will evaluate the danger and explain the options and resources available.



• Go to the emergency room of a local hospital where you can be examined by a physician and be medicated and/or hospitalized. North Colorado Medical Center, 1801 16th Street, Greeley, Emergency Dept. Tel: (970) 350-6244



• Call the detox center at Island Grove Regional Treatment Center, Greeley. Tel: (970) 356-6664



• Call the Police Department! If the person is gravely disabled or potentially dangerous to self or others and is unwilling to go to the hospital for help, the police can usually sign for involuntary treatment (hold and treat) and transport the person to the hospital.



• Use 911 or contact your local police department or sheriff's office: Greeley Police Department (970) 350-9600 Weld County Sheriff's Office (970) 356-4015

INVOLUNTARY TREATMENT

• Police
• Physician (M.D.)
• Licensed psychologist
• Registered nurse (R.N.)
• Licensed clinical social worker
• Licensed counselor or marriage and family therapist with special training
• National Park Ranger
• A family member can go to probate court to ask for a hold

1. 72-hour Hold and Treat - This enables a person to be held involuntarily for a period of 72 hours, or three days, for evaluation and treatment.
2. Five Day Alcohol Hold - If alcohol use/abuse is involved, the person can be held for five days at a detox center for detoxification and evaluation.

If symptoms are apparent in a brief evaluation by police and the person is unwilling to go to a professional, family members may petition the civil court system to order an evaluation.

• Short Term Certification is for three months and can be extended for an additional three months.
• Long Term Certification is for six months and can be extended for six month intervals.

The person who is certified has the legal right to contest certification through a court hearing.

PRACTICAL ISSUES FOR FAMILY MEMBERS

1. Ask your relative or the staff members working with him/her to obtain a release of information if you want to be involved in or informed of the treatment and services.
2. Discuss concerns and observations with those treating your relative. If you have concerns or questions about treatment, talk with the therapist or case manager as well as your relative.
3. To best help your relative and to keep the family intact, learn about the specific mental illness and develop coping strategies. Recognize that the situation is extremely stressful for all family members.
4. Take care of your own physical and mental health if you are a caregiver.
5. Be supportive of your relative to promote hope for the future, but consider the safety and well-being of the whole family and set limits on behavior when appropriate.
6. Participate in family education and support groups. These are a resource for information and referrals as well as sharing and caring.
7. Find and use the many community resources that can help you and your family members.

• How could a loved one have a mental illness?
• How can I help him/her? What do I do? Where can I go for help? Why doesn't he/she respond?
• Why is this terrible thing happening?
• What did I do wrong? Why do I resent that person for his/her behavior?
• Why can't it go away? Why can't somebody do something?
• Why isn't there anyone who can understand these awful feelings?

NAMI-WELD COUNTY
This is a group of family members who have a relative with a mental illness, people with mental illnesses (consumers), professionals and other interested supporters. Regularly scheduled meetings provide a setting for education and support with others who really understand what it's like. Membership is open to all who are interested. NAMI sponsors local education classes: Family to Family for family members of adults and Visions for Tomorrow for parents of children and adolescents. Monthly NAMI meetings are held:
          the third Thursday of each month at 7:00 p.m.
          Greeley Recreation Center Room 203
          651 10th Ave., Greeley
Contact person: Bernie Bliss (970) 353-5918 or blissbj@cs.com
NAMI-Colorado Tel. (303) 321-3104 Help line: 1-888-566-NAMI (6264)

EDUCATION RESOURCES ABOUT MENTAL ILLNESS

For detailed, specific information about mental illnesses, treatments, research, medications and other information, check national websites. A list is available at the State of Colorado Website, Mental Health Services Home Page: http://www.cdhs.state.co.us/ohr/mhs. Click on Information Resources - Websites to National Organizations

For a detailed reading list check the state of Colorado Website, MHS Home Page. http://state.co.us/ohr/mhs Click on Information Resources- Schizophrenia and Mood Disorders Bibliography.

WELD COUNTY COMMUNITY RESOURCES

WELD COUNTY DEPARTMENT OF SOCIAL SERVICES - 315 N. 11th Avenue, Greeley, Colorado (970) 352-1551 - County Assistance including AND (Aid to Needy Disabled), TANF (Temporary Assistance to Needy Families), Medicaid, food stamps and emergency assistance.

SOCIAL SECURITY ADMINISTRATION - 5400 11th Street, Suite A., Greeley (970) 353-2192 - For federal assistance through SSI, SSDI, Social Security and Medicare

GREELEY HOUSING AUTHORITY - 315 N. 11th Avenue, Greeley (970) 353-7437

WELD COUNTY HOUSING AUTHORITY - 315 N. 11th Avenue, Greeley (970) 352-1551 - Takes applications for subsidized housing for low-income individuals, families and people with disabilities

COLORADO RURAL LEGAL SERVICES - 1020 9th Street, Greeley (970) 353-7554 - Legal assistance for individuals with a low income

STATE DIVISION of REHABILITATION - (970) 352-5180 - Vocational rehabilitation assistance to individuals with disabilities

COMMUNITY HEALTH CENTER - 1028 5th Avenue, Greeley (970) 353-9403 - Medical and dental care for low-income families (takes Medicaid)

MONFORT CHILDREN'S CLINIC - 100 N. 11th Avenue, Greeley (970) 352-8898 - Medical care for low-income children and adolescents

ISLAND GROVE REGIONAL TREATMENT CENTER - Island Grove Park, Greeley
Detox - 1140 M Street, Greeley (970) 356-6664
Outpatient - 1260 H Street, Greeley (970) 351-6687
Detoxification, evaluation, residential and outpatient treatment for alcohol and substance abuse problems

LEGAL CENTER for PEOPLE with DISABILITIES - 455 Sherman Street, Suite 130, Denver. Tel: 1-800-288-1376 - Federally funded protection and advocacy for people with disabilities: civil rights, access, abuse or neglect, denial of educational services, housing discrimination, and inpatient rights violations

CONSUMER RIGHTS

Colorado laws and regulations around consumer rights in treatment are contained in C.R.S. 27-10:101 - 125, also referred to as "27-10" statutes. Complete information can be found on the state website. www.state.co.us/ohr/mhs. Click on 27-10.

1. To be treated with respect and dignity.
2. To receive services which are suited to individual needs in the least restrictive setting, in keeping with available resources.
3. At your request and at your expense, to get a second opinion.
4. To have a service plan established for your treatment with your participation.
5. To have your service plan reviewed every 6 months by the professional clinical staff assigned to supervise and implement your treatment plan.
6. To have the professional person in charge of your treatment explain the procedures and medications that will be used, including the benefits, risks, and side effects; to be given information regarding alternative treatment procedures that are available.
7. To refuse the services offered to you, unless an emergency exists or a court order is in effect.
8. To have your treatment and medical records kept confidential except when release of such information is authorized by law.
9. To see your records or have them shown to any person that you designate in writing according to Colorado law. You may be denied access to your records in limited circumstances. If you are denied access to your records, you have the right to know why and the right to appeal this decision.
10. To complain or grieve about the services you are receiving or a rights violation. No retaliation can be made against you for complaining.
11. To receive assistance from the consumer representative or an independent advocate in making a complaint, and to receive a copy of the complaint procedure.
12. To understand the risks and benefits of experimental programs or research and to refuse to participate in such programs.
13. To be given the names and professional status of the staff members responsible for your care.
14. To have these rights explained to you in a language you understand best.
15. Any other rights guaranteed by statute or regulation.

Medicaid recipients have additional rights under federal and state Medicaid Rules. These rights, along with Medicaid Grievance and Appeals Processes, are available in the NBH Medicaid Consumer Handbook and the Help Guide for Consumers with Medicaid. For complete information check at state website http://www.state.co.us/ohr/mhs.

Consumers who do not have Medicaid can receive information about the non-Medicaid Complaint Process in the NRBH Help Guide for Consumers without Medicaid.

CONFIDENTIALITY

In addition to Colorado laws requiring a release from you before information can be given to others, other laws about confidentiality are contained in the federal HIPAA (Health Insurance Portability and Accountability Act). These regulations protect the privacy and the rights of persons with mental illness in many areas of life and treatment.

What can family members of an adult do when there is no release signed due to impaired thinking, stigma, incapacity during an episode, or personal choice?

The most important action for relatives and supporters is to ask for a signed release of information when the individual is not under stress or in an impaired state.

However, the State of Colorado recognized that families need information at times when a release has not been signed. State "27-10" statutes allow information to be shared with family members in two situations if informed consent is not possible. One situation is to relieve family anxiety if the person doesn't come home when expected because of hospitalization; the other is to allow access to information that a family needs to more effectively help that person.

Family members can be told of a hospitalized patient's location upon request and if such information would not be detrimental to the patient. If denied information, family members can get assistance from Colorado Mental Health Services for location information.

Family members involved in the care of a person with mental illness can be given information about the patient's diagnosis, prognosis, medications, side effects and general treatment without a signed release, if the mental health professional determines that the person is too impaired to make a good decision, and it is in the person's best interest for the family to know what is going on. This applies to inpatient as well as community treatment.

FINANCIAL ISSUES

Family Responsibility for payment for services:
Parents are expected to be responsible for treatment costs of their child(ren).
Departments of Social Services with custody of a child, however, can arrange for Medicaid, which will pay for medically necessary treatment and medications.

The family is not responsible for payment for any treatment, emergency or on-going, if the individual is an adult. When an adult develops a mental illness and is incapable of making important decisions for him/herself, the family often assumes the responsibility to pursue options and seek the best possible treatment for that individual. If the illness is likely to need treatment for a long time and medical insurance is not available, application for public benefits should be considered.

The State of Colorado does offer health insurance plans for both adults and children with low incomes. See link to state website.

North Range Behavioral Health, hospitals and other mental health service providers will require proof of insurance coverage, Medicaid card, Medicare card, or other guarantee of payment before giving treatment, except in an emergency. Individuals with low income and no insurance may be eligible for reduced fees. Proof of income is required.

GETTING PUBLIC BENEFITS
If a person is so severely disabled that he/she is unable to work, he/she may be eligible for financial assistance. The most common federal programs for financial assistance are:

1. SSI - Social Security Income (for people who have never worked)
2. SSDI - Social Security Disability Income (for people who became ill after working enough qualifying work periods.)
3. OTHER SOCIAL SECURITY - Children of disabled, retired or deceased parents may be eligible for benefits.

Rules of eligibility are complicated. For information and to make an application contact the Social Security Office at 5400 W. 11th Street, Suite A, Greeley. (970) 353-2192

If the first application is denied, the applicant may go through an appeal process. While waiting for a decision about qualifying for benefits, funding and assistance is available through the County Department of Social Services. Emergency resources for food and shelter may be given. Apply at Weld County Department of Social Services, 315 N. 11th Avenue, Greeley. (970) 352-1551

If the individual is unable to manage his/her Social Security funds, a representative payee may be designated. This may be a parent, other family member, or an agency like the local mental health center.

NOTE: Any form of financial assistance should be checked out to see how it may affect SSI or SSDI. For example, if the individual lives with the family, Social Security or Social Services may reduce the benefits due to the contribution of the family toward basic support. The Social Security Office prints booklets on benefits and limitations. Also check with the Legal Center for People with Disabilities, 1-800-288-1376, your attorney or bank about discretionary trusts, or the book Alternatives by Mark Russell.

INSURANCE
Those who are eligible for SSI may qualify for MEDICAID. Contact the Department of Social Services Office, 315 N. 11th Avenue, Greeley. (970) 352-1551

Check out all the ways of becoming eligible for Medicaid. Medically necessary mental health services and medications are a benefit of Medicaid. North Range is a Medicaid provider of mental health services.

Those eligible for SSDI may qualify for MEDICARE. Contact your local Social Security Office, 5400 11th Street, Greeley. (970) 353-2192

Medicare does not include medications as a benefit, and requires co-pay for mental health services.

FAMILY INSURANCE AND INDIVIDUAL INSURANCE
If medical insurance is available, it is important to prolong coverage as long as possible.

The benefits for treatment of a mental illness that medical insurance provides depends on whether the insurance policy or health plan is regulated by the State of Colorado (i.e., HMO) or by a self-insured organization. Check with your employer to find out what type of plan you have.

• schizophrenia
• bipolar disorder
• clinical depression
• schizo-affective disorder
• panic disorder
• obsessive compulsive disorder

You should report violations of the law to the Colorado Division of Insurance 303-894-7499.

GUARDIANSHIP OR CONSERVATORSHIP
If a person is not competent to handle his/her own affairs, legal responsibility for financial and business transactions may be assigned to another person by a civil court. If you need more information or assistance, legal aid services are available in most communities for people on limited incomes or call the Colorado Guardianship Alliance for more information 303-423-2898.

DISCRETIONARY TRUST FUNDS
Families concerned about long range financial issues should obtain competent legal advice. Leaving an estate in a will could cause the loss of other benefits. A person on SSI or SSDI, for example, cannot receive substantial gifts or have substantial assets. Financial support beyond subsistence needs can be arranged through a Discretionary or Special Needs Trust Fund, but there are rigid rules. Check with a bank, an attorney or The Colorado Fund for People with Disabilities 303-761-4900 about a special needs trust.