Competency Process Testimony, September 2025

​In July, I was recognized as a 2025 Behavioral Health Administration Community Champion. I attended the event, determined to speak with Commissioner Smith and share my reality. Receiving the award was humbling, as there are many with whom I have found compassion, shared stories and resources. My reality, however, is that due to the overreach of HIPAA and the refusal of institutions to uphold Colorado statue as to the sharing of information; I am unable to participate in the care of my own adult child.

Autonomy is not a proxy for self-agency respecting deliberations in which anosognosia (or lack of awareness of one’s own illness) is a confounding variable. It is critical for this audience to understand that legal competency is not something that is merely “raised in court.” That restoration does not promote well-being or stability. Whatever your role as a panelist, legislator, or other participant—as part of the system—you are empowered with influence to change the course of another’s life. Competency challenges are exacerbated by the lack of accountability, responsiveness, and coordinated care. Families are fractured, embroiled in the churn. Competency further entraps an individual in carceral settings, increasing the risk of relapse, isolation, and time served—by months or even years.

 

Imagine your child is denied access to life-saving medication by their provider and cannot refill the prescription at another provider. From experience, you know they will be in active crisis in several days.

 

Imagine that health crisis results in criminal activity a week later, for which your child is sent jail, you are the victim of the crime—and can have no contact with them whatsoever.

 

The District Attorney reveals your child hasn’t eaten in days, is in isolation, screaming, refusing to dress or shower, and will be released on a Personal Recognizance bond to a Mental Health hold.
 

Imagine contacting the jail Mental Health team to explain the loss of medication, share background, current prescription information, and their behavior when not in active psychosis.

 

How does it feel to be so fortunate that the Lead actually answers your call, actively listens to you—asks clarifying questions, and while they can’t pass on information, responds with empathy and compassion?

 

Imagine feeling angry, and confused, knowing your child is gravely disabled and filing a motion to amend the protection order. The motion takes 4 months to amend, meanwhile— your child calls you to spring them from the hospital on their third mental health hold in 2 months—a total of 13 days. They take medication—just enough to terminate a 12.5-week pregnancy—all alone—and competency is raised by the defense.

 

Imagine feeling this sordid chaos may have been avoided if she had just received her meds.
 

What if during their 5th round of restoration, your child repeatedly relapses—becoming so sick that they are at the top of the waitlist for a bed at Pueblo?

 

Imagine feeling such relief and hopefulness that FINALLY meaningful and comprehensive treatment will begin!

 

How would it feel to learn that trauma-informed therapy, individual talk therapy, career counseling, or community engagement opportunities are NOT available to someone with pending charges. That competency restoration consists of coaching to memorize a deck of flash cards and parrot back answers.
 

Our story begins to change with court ordered meds. There is continued incremental improvement—flash cards memorized sufficiently—the evaluation passed. The defense files a motion to order a 2nd evaluation that is signed; however, our daughter is sent back to jail facing her 6th round of restoration where she refuses medication and worsens rapidly.

I advocate for court ordered meds. Bridges leadership becomes involved, creating space for staffing with me, then spearheading a staffing with the mental health team and others for strategizing and planning. Conversations begin to dismiss charges when a bed opens at Fort Logan.

After several challenges as to the dismissal of charges and 9th round of competency—she is admitted on a short-term certification to Centennial Peaks. After only two weeks, staff attempted repeatedly to release our child, unstable, unhoused, and without supports—claiming that her ability to feed herself and wash her own clothes met criteria for release. She was eventually safely transitioned to Fort Logan where she
resided up until one week ago—3 years and a couple months after this latest chapter of our journey began.

What can you do?

• Read more of our story here: https://www.comadmoms.org/stories/barbara 

• Strengthen opportunities to incorporate the voices of lived experience in the evaluation of laws/rules and their implementation.

• Revise Competency statute to promote well-being and stability, meeting Legal Competency as an intended benefit.

• Evaluate proposed and current laws to identify unintended consequences. For example, dismissed charges renders an individual ineligible to continue a relationship with Bridges of Colorado.

• Uphold the implementation and application of CRS 27.65.123 (Records).

• Approach every Bill and Revision as if your child’s life depends on it. Because it may.

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Barriers:

• Stigma. It is not a crime to live with a severe brain illness (SBI).

• HIPAA. The overreach of HIPAA hinders appropriate care. Our loved ones experiencing psychosis may be unable to share their history or other information necessary for crisis care.

• Criteria for holds. Individuals with SBI are frequently released from care prematurely; returning for crisis care within days.

• Disrupted care. Denial of access to antipsychotic medications without an alternative care plan must stop. “With no other illness do you fear going to jail after missing a pill.” Erin Brown

• Response time. In a crisis, ASAP does not mean 24 hours later.

• Wait times are further exacerbated by a shortage of competency evaluators.

• Lack of accountability. Probation is no deterrent without accountability. Noncompliance should be addressed swiftly and appropriately.

• Siloed entities. Communication flow and access to information is imperative to coordinated care. Many of us support our loved ones by researching options, initiating communication, and coordinating treatment or programming among several entities.  

• The definition of legal competency. Rote memorization of answers to competency evaluation questions on flash cards is of little relevance. Competency should include measures and metrics related to stability and proper awareness of one’s environment.

• Hopelessness and isolation. Communication and knowledge of less restrictive environments, or other goals to attain may incentivize a change in behavior.

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Bright Spots:

• Responsive and caring individuals and organizations.