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How mass killers slip through Colorado’s fragmented safety net: “One of the great challenges of our time”

Assessing credibility of threats is difficult. Experts say state law, ineffective mental health holds must change.

Sarah Carlson and her son Odie place flower at the growing memorial where hundreds of flowers, balloons, signs and remembrances have been left for the victims of the mass shooting at Club Q in Colorado Springs on Tuesday, Nov. 22, 2022. (Photo by Hyoung Chang/The Denver Post)
Sarah Carlson and her son Odie place flower at the growing memorial where hundreds of flowers, balloons, signs and remembrances have been left for the victims of the mass shooting at Club Q in Colorado Springs on Tuesday, Nov. 22, 2022. (Photo by Hyoung Chang/The Denver Post)
DENVER, CO - DECEMBER 4:  Shelly Bradbury - Staff portraits at the Denver Post studio.  (Photo by Eric Lutzens/The Denver Post)DENVER, CO - NOVEMBER 8:  Elise Schmelzer - Staff portraits at the Denver Post studio.  (Photo by Eric Lutzens/The Denver Post)
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A man at Denver International Airport told his father he’d ram his truck through a gate, hijack a plane and shoot up the airport.

A husband promised carnage at his former place of worship.

A woman in east Denver vowed to open fire in a grocery store to make people listen to her.

An author published a book detailing gruesome killings.

A young person with bomb-making supplies pledged to be the next mass killer.

A Colorado Springs man threatened a mass shooting at a street fair.

In the last 15 months, three of those people acted on their threats. And 12 Coloradans died.

After those attacks, the three suspects’ prior threats loomed large — missed warning signs of impending tragedy. A year before authorities say a 22-year-old killed five in a Colorado Springs LGBTQ nightclub, a judge said the suspect was clearly planning an attack and it would be “so bad” if the person did not get mental health treatment.

Before a man shot and killed five in a targeted spree across Denver and Lakewood, a reader tipped the FBI and Denver police that his murderous novels might be a manifesto.

And before a man attempted to bomb a Jehovah’s Witness hall in Thornton on Christmas Day — and fatally shot his wife and then himself — a family member became so worried about his escalating anti-social behavior she asked the police to intervene.

None of it was enough to prevent bloodshed.

The failings in those cases have been well-documented. But a review of red flag filings and interviews with law enforcement and mental health professionals by The Denver Post shows people across Colorado regularly make threats of mass violence, and the safety net intended to prevent such attacks is a complex, fragmented system that pits personal freedoms against public safety.

Patchwork funding means some communities are better equipped than others to investigate threats of mass violence and to get help for those who need mental health treatment. Assessing the credibility of threats is difficult, messy work, and state law can make it hard for bystanders, mental health professionals and police to intervene until a situation becomes dire. Mandatory holds for people experiencing dangerous mental health symptoms are short-lived and too often result in a person being released back into society with few resources.

“That grey area where there’s not necessarily criminal charges, but how do we make sure this person doesn’t do something in the future — that’s the tricky situation,” said Denver police Cmdr. Paul Jimenez of the department’s strategic investigation bureau, which includes the counter-threat section.

Colorado doesn’t have a statewide, multidisciplinary threat assessment team, law enforcement and government officials told The Post. There is no overarching system to track a person’s threats or threatening behavior across jurisdictions and time — especially if that person is not charged with a crime.

Frustrated families are often left to advocate for a loved one, even as that loved one might pose a threat to them. And people fall through the cracks.

“This is one of the great challenges of our time,” 18th Judicial District Attorney John Kellner said.

Police crime tape is placed outside the scene of the mass shooting at Club Q in Colorado Springs on Nov. 21, 2022. (Photo by Helen H. Richardson/The Denver Post)
Police crime tape is placed outside the scene of the mass shooting at Club Q in Colorado Springs on Nov. 21, 2022. (Photo by Helen H. Richardson/The Denver Post)

Mental illness and mass violence

By the time Denver police officers responded to reports of a man claiming to have a gun and pushing an empty wheelchair at Denver International Airport in September, that man’s family had been trying to get him help for five months.

They weren’t surprised to hear that officers took the man to a hospital for an involuntary mental health assessment after determining he was unarmed but “acting highly erratic.” They weren’t surprised when he was released from the hospital and was back at DIA the next day. It wasn’t a shock when the man then called his father from the airport and threatened to carry out a mass shooting, to hijack a plane.

“Thankfully he hasn’t gotten to where he has hurt anybody,” the man’s sister said. “But it’s just terrifying. When someone is this far gone, unless this trajectory can be stopped, where is this going to end? You just don’t know.”

The man’s sister spoke to The Post about her brother’s long-term mental health issues with his permission, on the condition that neither sibling be named in order to protect the brother’s career. The 40-year-old man lives in rural Colorado and was diagnosed 20 years ago with bipolar schizoaffective disorder, which means he experiences episodes of mania — a high mood, with high energy and activity — coupled with delusions and a break from reality.

“My brother is a pretty normal person who is just plagued with his mind getting hijacked sometimes,” his sister said.

People who are mentally ill are much more likely to be victims of crime than perpetrators, and the vast majority of people with mental illness do not carry out mass violence, experts told The Post. But mental illness does often play a role in mass violence.

A study released in January by the U.S. Secret Service that looked at perpetrators of 173 mass-violence attacks in public spaces between 2016 and 2020 found that the majority of attackers experienced mental health symptoms, including depression, paranoia or suicidal thoughts, prior to or during their attacks.

In Colorado, several suspects in mass shootings have had documented mental health conditions.

The suspect in the Nov. 19 attack at Club Q in Colorado Springs had been prescribed medications used to treat schizophrenia, mood disorders and depression. The man accused of carrying out a mass shooting at a Colorado Springs Planned Parenthood clinic in 2015 has been consistently found mentally incompetent to stand trial. And the man who killed 12 at an Aurora movie theater was diagnosed with schizophrenia, as was the man charged in a 2021 mass shooting at a Boulder King Soopers.

The Secret Service study found that effective mental health treatment is part of mass violence prevention and that communities should work to ensure people who are in a mental health crisis can get the help they need.

But that’s easier said than done. People who need mental health care in Colorado must navigate a complex system that doesn’t easily share information between providers. And those who don’t want care — even though they need it — have to become a threat to their own safety or others before they can be helped against their will.

A disconnect between Colorado’s court system and medical system means some people who need help are never connected to care, said Andrew Sylvester, a psychiatrist at UCHealth.

There are only a handful of mental health courts across the state — courtrooms that are focused on helping people with mental illness who are accused of crimes. There are five such courts serving 10 counties in Colorado, according to the Colorado Judicial Branch.

Attorney Matt Landers speaks to Judge Susan Blanco at the Fort Collins courthouse during a day in 8th judicial competency court on Thursday, Dec. 15, 2022. (Photo by AAron Ontiveroz/The Denver Post)
Attorney Matt Landers speaks to Judge Susan Blanco at the Fort Collins courthouse during a day in the Eighth Judicial District’s competency court on Thursday, Dec. 15, 2022. The court serves as a central place where defendants facing mid-level felony charges are supported by a team of mental health professionals who work together with the judge, defense attorneys and prosecutors to reduce delays and restore defendants to competency. (Photo by AAron Ontiveroz/The Denver Post)

“You have a right to be mentally ill”

When the man who made threats at DIA is healthy, he’s a friendly, compassionate guy who is deeply dedicated to his family, his sister said. He holds down well-paying remote-work positions and keeps up romantic relationships. But when he’s sick, he becomes a different person: he uses a different name, changes his phone number to the 202 area code and dresses differently. He’s rude and entitled, and he shuns his family in favor of spending time in bars with acquaintances.

Over the last two decades, he’s had regular episodes of mania and delusions that can last weeks or months, his sister said. Once, he went five years without having an episode, his longest healthy stretch. In early 2022, life was good for him: new job, likable colleagues, new girlfriend.

“And then in May, he said to my aunt, ‘Something is wrong, my eyes don’t look right, I’m afraid I’m going manic,’” his sister said. “And within days, he was no longer himself. And then it lasted for six months.”

When he’s delusional, her brother believes he’s part of some grand plan, she said. He’s in the FBI, or he has to stop a global war, or he has a mission against looming dangers that he can’t quite articulate.

In 2011, he tried to break into the White House to personally warn the president of danger he perceived. “That did not go well,” his sister said with a laugh. Her brother was arrested and charged with assaulting a police officer.

The episode that hit him in May was the longest he’s ever experienced, his sister said. Over the years, he’s figured out how to recognize the signs of an episode early and get himself medical help. And he tried to last summer, she said.

He checked himself into the emergency room more than a dozen times, she said. Got inpatient help 10 times. But he’d often complain of something unrelated to his true problem once he got there, like foot pain, and he’d refuse antipsychotic medications — the only treatment that pulls him back to being healthy, she said. He always left the hospital as delusional as he was when he walked in, she said.

“He says it’s like fighting with himself,” she said. “He’s trying to get help, and then he arrives at the institution and the manic and delusional part of him takes over and he’s like, ‘No, no, no. We’re not going to let them do that.’ … It’s a battle. And it’s a battle where the further he goes into the delusion it appears to be harder and harder to get help.”

Last summer, she watched her brother repeatedly refuse the only effective treatments for his illness, she said.

“You have a right to be mentally ill,” his sister said.

Colorado law allows a person to be detained for 72 hours against their will in order to receive mental health care — what’s known as an “M1 hold” — but only if the person presents an imminent danger to themselves or others due to a mental disorder, or is so sick they can’t feed or care for themselves.

The patient must be evaluated within 72 hours. At the end of that time, the patient can either agree to receive ongoing voluntary care, be released with no further treatment or authorities can begin the court process of certification to force the person to undergo additional involuntary treatment, including involuntary medication. A person who has been certified can be held in a medical facility for care, or be released for court-ordered outpatient care, said Sylvester, the UCHealth psychiatrist.

In 2021, medical providers executed just under 36,700 72-hour M1 holds across Colorado, most for people who were considered a danger to themselves, according to statistics published by the Colorado Behavioral Health Administration. In about 1,450 of those holds, the person was considered a danger to others, according to the records. That same year, medical providers reported 4,500 certifications for longer-term court-ordered involuntary treatment.

“The standard to put someone on an M1 hold is very specific; Colorado wants to make sure people’s rights are not being violated,” Sylvester said. “…There has to be a specific target with a specific timeline demonstrating imminent harm… Vague threats — ‘I’m angry, I feel like hurting people’ — that is concerning. Very concerning. But without a specific threat, I can’t do anything about that.”

The laws around involuntary holds and certification were tweaked in 2022, with phased changes set to take effect on July 1 and in 2025. The new laws will allow police officers to take a person to medical treatment instead of jail even if a warrant is out for the person’s arrest, increase the required paperwork around involuntary holds, and give the right to an attorney to people going through the court certification process, among numerous other procedural changes.

Lawmakers initially proposed allowing relatives to seek a court order for involuntary treatment for a family member, but that proposal was cut out of the final bill.

The sister of the man who made threats at DIA feels family members need better tools to help their loved one with mental illness.

“If the family could provide information that today he bought a gun, then he will be secured,” she said. “But when we say, ‘He has this history and he’s in a delusional state,’ they say, ‘I’m sorry, there is nothing we can do.’ …You’re accepting a community threat and deferring to the rights of the mentally ill person to make decisions when they’re not mentally well enough to make decisions. What can we do? Not to get all the way to involuntary commitment just willy-nilly, but the pendulum has swung too far right now for meaningful interventions by family or the medical community.”

She and her frustrated family members called hospitals, told them her brother’s medical history, and explained what medication he needs, but the hospitals couldn’t act without her brother’s consent. Sometimes medical staff assumed he was homeless, she said, or that he didn’t have family support.

For her brother, the right to be mentally ill meant he got sicker and sicker until he eventually made threats of mass violence.

“Would he actually get on a plane and cause issues?” she said. “Would he actually bring a bomb? I don’t think so. I think of it as a plea for help. But you can’t know that as law enforcement. And I can’t know that, because he’s off in a different world.”

Early on in this summer’s episode, her brother ended up in Salida, and she convinced her father to pay for a hotel room out there for a few days, hoping it might help him to stabilize.

“It’s like throwing spaghetti at a wall,” she said. “At any moment, you’re like, ‘OK, what might work?’”

A few days later, her mom drove out to pick her brother up.

“And there he is with this crazy rifle, trying to get into the car, acting totally normal,” she said. Their mother had him put the weapon in the trunk, and, later, they took the gun from him and realized it was an Airsoft gun, though it looked real.

At the time, there was nothing barring her brother from buying a real gun. Even when sick, he presents well to strangers and can pass as well, she said. After he made the threats at DIA, Denver police asked for and received a temporary extreme risk protection order under the state’s red flag law, which barred him from buying or possessing any guns for 10 days.

He wasn’t arrested for making threats, but was charged with petty theft for taking a limo to the airport and then refusing to pay, as well as trespassing. Both charges were later dismissed, court records show.

The threats at DIA were the beginning of the end of his manic and delusional episode. He eventually was connected to the Denver Police Department’s co-responder team and to one of the state’s 17 community mental health centers. Staff there went through the certification court process to medicate him against his will, and he was given an antipsychotic injection.

Within two weeks, the man was back to himself, his sister said. Then he had to deal with the aftermath of the crisis: the criminal charges, a lost job, damaged relationships, unpaid debts.

“When he comes out of it he has inklings of what happened, but it’s like someone waking up from a bad dream,” his sister said. “You know some of these things happened, but you weren’t fully present for it.”

Once he’d been certified for involuntary treatment, he was barred from buying a gun under federal law, and Denver police did not pursue a permanent extreme risk protection order, which would have barred him from possessing guns for one year, on the grounds that it would be redundant.

Federal law prohibits anyone who has been involuntarily committed to a mental health facility from possessing a gun after being released. Most states also have similar or more restrictive laws on their books; Colorado is one of a handful of states that do not, instead relying on the federal statute, according to the National Conference of State Legislatures.

Boulder County Sheriff Curtis Johnson, far right, stands with other deputies and Boulder police officers as they listen to the presentation during an active shooter training for faith leaders at Boulder Jewish Community Center on Feb. 21, 2023. The U.S. Attorney's Office and other law enforcement agencies hosted a training for faith leaders about the threat of violence to houses of worship. (Photo by Helen H. Richardson/The Denver Post)
Boulder County Sheriff Curtis Johnson, far right, stands with other deputies and Boulder police officers as they listen to the presentation during an active shooter training for faith leaders at Boulder Jewish Community Center on Feb. 21, 2023. The U.S. Attorney’s Office and other law enforcement agencies hosted the training for faith leaders about the threat of violence to houses of worship. (Photo by Helen H. Richardson/The Denver Post)

“A difficult line to walk” for law enforcement

Every day, law enforcement officials in Colorado triage reports of possible threats. With each report, they have to determine how credible the threat is and how many resources to devote to investigating it.

Few of those investigations lead to arrests, officials said.

“There are a lot of very hateful, nasty things that are said but are First Amendment-protected material,” said Ash Thorne, supervisory special agent over domestic terrorism and weapons of mass destruction at the FBI’s Denver field office.

When evaluating a threat, investigators consider the specificity of the threat, whether the person’s rhetoric has escalated over time, whether there’s evidence that the person is making physical preparations to carry out their plan, and whether the person has a violent history.

But it’s nearly impossible to know which of the hundreds of people who are reported will follow through. In the January report on mass shootings, U.S. Department of Homeland Security officials wrote that most people who exhibit behaviors connected to mass violence will not act at all. Law enforcement has to determine who will act.

“If there is a committed individual who has a plan and who isn’t communicating their plan to do something — that’s very challenging to stop,” said Jimenez, of the Denver Police Department.

Investigators and prosecutors must prove that a threat is a “true threat” to pursue criminal charges in a case, U.S. Attorney for Colorado Cole Finegan said. That means they need to prove the person was serious about their statement and that it would cause a reasonable person to be afraid. Prosecutors don’t have to prove the person intended to carry out the threat or had the means to do so, but they must prove the statement wasn’t a joke, idle talk or an exaggeration.

“It’s really a difficult line to walk,” Finegan said.

United States Attorney Cole Finegan addresses members of the media during a news briefing at the Police Operations Center in Colorado Springs on Nov. 21, 2022, to deliver updates on the mass shooting at Club Q. (Photo by Helen H. Richardson/The Denver Post)
U.S. Attorney Cole Finegan addresses members of the media during a news briefing at the Police Operations Center in Colorado Springs on Nov. 21, 2022, to deliver updates on the mass shooting at Club Q. (Photo by Helen H. Richardson/The Denver Post)

The standard of what constitutes a “true threat” changes from state to state, with some states requiring judges and jurors to consider the speaker’s state of mind and intent when a threat was made. Other states — like Colorado — consider only the impact of the threat on a “reasonable person,” not the threat maker’s intent.

In a Colorado stalking case that’s going before the U.S. Supreme Court in April, the justices will consider how to define a “true threat.” The case stems from a man who sent unwelcome social media messages to a Colorado musician and implied he was watching the woman, was romantically interested in her and was frustrated when she ignored and blocked him.

Colorado courts found that the man’s messages were true threats. He was convicted of stalking and sentenced to 4.5 years in prison. But he appealed, arguing that his messages were protected by the First Amendment and that Colorado’s laws should consider a person’s state of mind when evaluating the legality of speech. The U.S. Supreme Court agreed to take up the question after the Colorado Supreme Court declined.

Criminal prosecutions for threatening behavior can be difficult, said Denver District Attorney Beth McCann. But when prosecutors do bring charges, they can use the court system as a way to push a person into getting mental health treatment or complying with probation in order to have their record wiped clean, she said.

“I prefer that kind of approach in these cases because if we have someone making that kind of threat, there most likely is some kind of mental health issue going on,” she said. “And sometimes it’s really a cry for attention and a cry for help, and if we can get ahead of that and try to provide a way for that person to get counseling and treatment, we are better off in the long run.”

In Colorado, prosecutors can charge people with menacing “if, by any threat or physical action, he or she knowingly places or attempts to place another person in fear of imminent serious bodily injury.” Under federal law, prosecutors can pursue charges if they can prove a suspect communicated a threat across state lines.

Between 2020 and March 2023, prosecutors across Colorado filed about 49,000 counts of menacing across about 15,000 cases, according to data provided by the Colorado Judicial Branch.

About 44% of the menacing charges were ultimately dismissed by prosecutors, the data shows. Defendants were found guilty in 20% of the menacing charges, the data shows. In another 22% of charges, no disposition had been reached by March 2, according to the data.

Criminal charges mean that police, probation officers and other criminal justice workers can follow up with a person and make sure their behavior isn’t escalating, Jimenez said. Otherwise, officers have no legal reason to keep track of them.

Criminal charges also often mean a protection order is entered against the defendant that bans them from legally purchasing a gun, said Kellner, the district attorney.

Sometimes prosecutors may not be able to pursue threat charges but will prosecute a suspect for other crimes and use the person’s threatening behavior to get a stiffer sentence.

But even if they don’t make an arrest, law enforcement officials often will try to intervene in other ways. Prosecutors in Denver will try to warn named victims of threats even if there’s not enough evidence to support a criminal prosecution, McCann said. Sometimes, the FBI will send agents to someone’s door to explain to them the seriousness of making threats and the potential consequences should they continue, Thorne said.

“People don’t have to go to jail for it to be a win,” he said. “There’s no one-size-fits-all solution.”

It’s impossible to quantify how many people would have acted had law enforcement not stepped in. Threats of mass violence prompted about 11% of all extreme risk protection orders filed statewide in 2022, a review by The Post found. Across 111 red-flag petitions, 12 involved threats of mass violence.

“Success for our section is when something doesn’t happen and nobody knows about it,” Jimenez said.

Some thwarted plots do make the news. Finegan pointed to the case of a Colorado man who was investigated for a plot to blow up a synagogue in Pueblo. The 27-year-old white supremacist told undercover FBI agents that he planned to start a “racial holy war” and purchased fake bombs from agents to blow up the temple. And in January, the FBI arrested an Evergreen man who threatened to commit a mass shooting at the FBI office as well as a local performing arts venue.

“When I started this job in December 2021, after the first few weeks I was just struck by how much violence there is in the country,” Finegan said. “I thought I understood that, but when you’re involved in these cases daily… the number of guns is astonishing. The crisis with drugs is terrifying. And just the amount of violent rhetoric that is in our state is really disturbing.”

From left to right Jeanette Vizguerra, ...
From left to right, Jeanette Vizguerra, Elena Klaver, and Miranda Encina, who described themselves as healers with a group called Comadres, hug one another in front of a makeshift memorial on Dec. 28, 2021, outside Sol Tribe Custom Tattoo and Body Piercing shop on Broadway where two women were killed and a man was injured in a shooting spree that spanned Denver and Lakewood. (Photo by Helen H. Richardson/The Denver Post)

“Relentless follow-up” needed

Every week in northwest Oregon, mental health professionals, law enforcement officers, prosecutors, advocates and others gather in the same room to talk about people who recently made violent threats across the region.

The experts discuss each case in detail: a man who lost a job and made threats to his boss, or a husband targeting his wife, or a college counselor concerned about a particular student’s behavior, said David Okada, a member of the team and president of the Association of Threat Assessment Professionals.

“The beauty of this system is that we are getting different perspectives,” Okada said. “…the idea is problem-solving as a team. Coming up with things we can do to help keep somebody from doing any further attacks.”

Twenty-seven different public agencies are represented on the Willamette Valley Adult Threat Advisory Team, including members from higher education, the juvenile justice system, veterans’ affairs, probation and parole. The group, which was established in 1998, serves a solely advisory role — any member can bring a case to the team, which then brainstorms ideas for de-escalation and makes suggestions to the originating agency.

It’s not a law enforcement task force, and it’s not led by mental health professionals or any one agency. It’s a system-wide collaboration for the region, Okada said. Cases sometimes come to the team before a person has been arrested or charged.

“Our leaders within our community have recognized our process as a good process to help solve problems,” he said. “So maybe people don’t understand what they are seeing, or it’s just kind of ominous. They’ll send that stuff to us.”

Multidisciplinary threat assessment teams are the gold standard for preventing mass violence, said John Hollywood, a senior researcher at the RAND Corporation who authored a report on preventing mass shootings.

But Colorado has no such team.

While many Colorado schools and universities have such teams and law enforcement agencies collaborate on such cases, there aren’t any multidisciplinary teams in the state that handle adult cases, law enforcement and state government officials said.

Hollywood reviewed more than 600 mass attacks — including more than 300 that were stopped — to find new prevention and intervention strategies. Multidisciplinary teams like the one in Oregon can follow peoples’ trajectories over extended periods of time and check in on them as needed.

“There needs to be relentless follow-up,” he said.

Arrest is almost never the next step and most incidents can be handled outside the justice system, he said. The Department of Homeland Security also supports the idea of such teams as a way to intervene before threats become so dire they require a law enforcement response.

On the Oregon threat assessment team, members consider how to connect subjects to counseling, financial support, mental health services or some sort of continued supervision, either through a mental health case manager or, if someone has already been arrested, through probation or incarceration, Okada said.

Much of the team’s work focuses on intimate partner violence, he said. They also handle threats of mass violence, though less frequently, and can help agencies develop safety plans for potential targets. On weeks when the team has no new recent cases to consider, they’ll either follow up on past cases or do training, Okada said.

In the absence of a formal multidisciplinary threat assessment team, professionals in law enforcement and mental health care should still build cross-disciplinary connections, Okada said.

One way that Colorado has created collaboration between law enforcement and mental health providers is through co-responder teams, which partner a mental health professional with police departments to handle police calls for service.

There are 27 co-responder programs across Colorado that are funded by the state’s Behavioral Health Administration, according to the department, as well as other programs not funded by the agency. The BHA spends about $6.6 million on the programs, pulling money from marijuana tax revenue and the state’s general fund.

The co-responder programs are located in 24 of the state’s 64 counties. In the 2020-2021 fiscal year, co-responders made 29,000 contacts with individuals in 80 communities, according to the BHA. Most of those contacts were during active calls, but also include follow-up contacts and referrals for additional care.

The Denver Police Department added a mental health clinician to its counter-threats section about a year ago to help complete threat assessments and help detectives understand mental health concerns, Jimenez said. The clinician can help people connect with services if there isn’t an arrest.

Other proposed solutions in Colorado include changing two state laws — one governing M1 holds and another the state’s red flag law — and increasing access to mental health hospital beds.

Thirty-eight days before the Aurora theater shooting in 2012, the shooter’s psychiatrist became so concerned by his homicidal thoughts that she alerted campus police at his school, the University of Colorado’s Anschutz Medical Campus, that he might be dangerous.

Aurora theater shooting makeshift memorial
A man writes on a cross at a memorial for the victims of the Aurora Theater shooting at the intersection of Sable Boulevard and Centerpoint Drive on Sunday, July 22, 2012. (Photo by AAron Ontiveroz/The Denver Post)

The psychiatrist didn’t, however, send the man for a 72-hour involuntary mental health hold — an M1 — because the law requires that professionals know about an “imminent” threat to the safety of others or the safety of the patient, and she didn’t feel his general homicidal thoughts met that threshold.

The “imminent” requirement in the law was scrutinized after the theater shooting, but ultimately not changed, said Frank Cornelia, deputy executive director at the Colorado Behavioral Healthcare Council.

“Some of that came from a lot of pushback from consumers who felt threatened about expanding the ability to take somebody’s civil liberties away,” Cornelia said, adding that whether to order an involuntary hold can be a tough judgment call for mental health providers.

Some providers interpret imminent to mean a specific threat with a specific timeline, while others take the term more generally, said Jen Bock, chief clinical officer for AllHealth Network.

“It doesn’t have to mean, ‘I’m going to kill myself in five minutes,’ right? It can mean, I want to die and I’m intent on killing myself without a specific timeframe,” she said.

McCann said the imminent danger standard makes it too difficult for mental health providers to order involuntary mental health holds.

“I think the term ‘imminent’ should be removed and can be substituted with another kind of word, like ‘substantial,’” she said.

The 72-hour clock starts as soon as someone is ordered for an involuntary hold, Sylvester said, even if there are no hospital beds available.

“Patients may sit in the ER for two or three days,” he said.

In general, the state needs more effective mental health holds that ensure people in crisis are released into ongoing care after they become stable or the 72-hour period expires, Kellner said.

“As a society, we moved away from institutionalizing people because of widespread abuses and scandals, but that move away left a large gap that really hasn’t been filled,” Kellner said.

State mental health hospitals are often overloaded and too full to accept new patients coming off 72-hour mental health holds, Sylvester said. Independent psychiatric hospitals usually have more open beds, but patients covered by Medicaid can be rushed out the door in those facilities because of the way the state insurance works: if a patient on Medicaid is held for more than 15 days in a calendar month, the state does not pay for any of their care, Sylvester said.

The idea behind the policy was to prevent private hospitals from keeping patients for longer than necessary, but it has created a situation in which hospitals must sometimes choose between discharging a patient prematurely or offering the care for free, Sylvester said.

“There is a push to make sure we are getting people out the door,” he said.

The 15-day policy is driven by federal guidelines, said Marc Williams, spokesman for the Department of Health Care Policy and Financing. Inpatient stays of over 15 days make up just 2.7% of all stays in psychiatric hospitals, he said in a statement.

“HCPF has engaged providers to understand their concerns and provide suggestions for how to address the financial impact related to lengths of stay over 15 days,” he said in the statement.

Colorado lawmakers are also hoping to expand the state’s red flag law. If SB23-170 is passed, licensed medical care providers, licensed mental health-care providers, licensed educators and district attorneys will be able to request that a judge take away someone’s guns. Under current law, only family members and law enforcement may do so.

“We need to get better as a society, we need to get better working with law enforcement at identifying threats, taking them seriously and getting them referred to the right authorities,” Colorado Attorney General Phil Weiser said, “and then making sure authorities know about and are comfortable using tools — most notably the red flag law — to save lives.”

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