Colorado Community Mental Health Centers Survey

Disability Law Colorado

Disability Law Colorado is currently collecting stories regarding the provision of or denial from services at Colorado’s Community Mental Health Centers, including Crisis Stabilization Units, Community Clinics, or Acute Treatment clinics.  The information you share on this form may be used to anecdotally support a report, complaint, informal discussion, or other method of attempting to resolve systemic concerns related to services.  However, please note that by submitting this form to Disability Law Colorado, you are not requesting direct legal services.  Disability Law Colorado will therefore not be analyzing your case for purposes of offering or providing individual representation.   Instead, Disability Law Colorado will be reviewing the stories you share to determine if there are fact patterns that potentially support a systemic resolution, as discussed above.  Disability Law Colorado may share fact patterns without a release, but your personally identifiable information will not be shared without first obtaining a signed release from you or your parent/legal guardian.  Additionally, we may reach out to you for more information based on your response.  If you have questions or concerns, please call our office at (303) 722-0300 or visit our website at www.disabilitylawco.org.  Thank you!
1.Name
2.Email
3.Phone Number
4.Disability(ies)
5.Name of Problematic Facility or Organization
6.Date of Incident Giving Rise to Your Story
7.County of Residence
8.County of Facility
9.Are you currently working with an attorney or advocate?
10.Have you or a family member been denied services at a Crisis Stabilization Unit in a Community Clinic or Acute Treatment Unit?
11.What is the age of the person who was denied services?
12.Have you or a family member been denied behavioral health or mental health services due to a lack of bed space availability or skilled staff?
13.Have you or a family member been denied behavioral health or mental health services due to a lack of skilled providers who work with dual diagnosis patients (mental health disorders & intellectual and development disabilities)?
14.Have you or a family member been told that an agency is unable to provide services based on the fact that you or your family member requires assistance with activities of daily living (ADL)?
15.Is there anything else that you would like to share?