Douglas County officials map barriers to civil commitment, pilot direct-admit pathway

Douglas County clinicians, sheriff’s office staff and the county attorney’s office on Sept. 11 outlined how involuntary mental-health pathways — M1 evaluations, emergency commitments and civil certifications — are meant to work and where the system breaks down, citing bed availability, handoffs between agencies and overlapping criminal competency rules.

Why it matters: County officials said the obstacles limit the use of involuntary pathways for people in crisis, especially people experiencing homelessness, and described pilots and court-focused reforms intended to reduce repeated emergency-room visits and arrests.

All Health Network clinical director Britney Lemon explained the street-to-certification process, saying it “starts with an M1. You can't end up on a certification without starting with an M1.” She described the flow as: a co‑response or HART team encounter → an M1 for imminent risk → transport to a facility with an embedded psychiatric evaluation team (PEPs or HCAT) → possible placement in a crisis stabilization unit (CSU), acute treatment unit (ATU) or inpatient unit (e.g., Fort Logan, Pueblo) and then evaluation for a short‑term certification.

Lemon said short‑term certifications require an evaluation by a psychiatrist or psychologist and that “certifications need treatment,” meaning a receiving provider must have an intake and treatment plan in place before accepting the certification to avoid a patient being discharged and lost to follow‑up. She also described pickup orders used to bring people to evaluation when repeated outreach has failed and urged use of pickup orders as a preventative tool.

Laura Cincone of Douglas County Human Services (Mental Health Collaborative) said the county began mapping the civil‑certification process in 2023 to identify gaps and that stakeholders have prioritized two operational fixes: a direct‑admit pilot with partners including All Health, CRTs and AdventHealth Porter (which has an inpatient psychiatric unit), and clearer processes around pickup orders and reasonable use‑of‑force language.

“We've been chipping away at that list of solutions,” Cincone said, describing monthly meetings for the pilot and noting the effort’s goal is to “expedite the process and get someone … into a placement as fast as possible” while avoiding emergency departments when safe and feasible.

Valerie Brewster, senior assistant county attorney, described ongoing legal work to manage overlaps with criminal competency proceedings. She said criminal competency provisions (which she cited in transcript as “Colorado revised statute 16 8.5111”) and civil certification statutes under Title 27 have different legal standards and that the county attorney’s office has sought and obtained a seat at a newly forming competency court MOU so civil‑side attorneys can communicate with criminal‑court stakeholders.

“We are the only county in the state that is doing that,” Brewster said of the county attorney’s office being invited to participate in the competency court process, adding that the county is also exploring ways to secure civil evaluators who will complete evaluations in the county detention facility so civil commitments can be pursued for some detained individuals rather than relying solely on criminal competency pathways.

Officials said other practical obstacles include rapidly changing bed availability (they update statewide bed lists but must still call facilities during an evaluation), and inconsistent familiarity among detox and behavioral health facilities with emergency‑commitment paperwork and processes. County and provider leaders said these are the reasons some people cycle repeatedly through emergency rooms and jails.

County leaders also described work toward a civil specialty docket modeled on assisted outpatient treatment (AOT) programs used elsewhere: a court‑supervised, treatment‑focused pathway intended to improve engagement for people who struggle to follow through because they are unhoused or hard to reach. The new judicial district (JD‑23) is developing competency and related dockets; Cincone said the competency court must be in place by July 2026 and that the civil‑court project is being coordinated to align with those timelines.

Next steps noted at the meeting included continuing the direct‑admit pilot, refining pickup‑order language to clarify reasonable use of force, recruiting or training civil evaluators willing to work in the detention facility and coordinating with state legislative efforts around competency/commitment rules.

Ending: County staff and partners asked for ongoing coordination with HART, CRT and jail reintegration teams and urged providers and law enforcement to exchange contact information to speed case‑by‑case coordination.