Sen Judy Amabile: When Psychosis Hits, Families Need A System That Works

We sit down with Colorado State Senator Judy Amabile to connect one family’s painful path through serious mental illness to the laws that decide whether people get treatment or get pushed into homelessness and the courts. 

We talk honestly about psychosis, stigma, and the hard policy choices behind civil commitment, Medicaid rules, and building enough beds to stop the cycle.
• Her son’s schizoaffective disorder and the road to diagnosis
• Early signs like paranoia and thought broadcasting
• Family anger and confusion turning into empathy
• NAMI Family-to-Family as a bridge to advocacy
• Why mental illness feels like the “no casserole disease”
• The jump from lived experience to writing policy
• Civil commitment and AOT as a contested safety net
• Competency waitlists and why they don’t equal treatment
• The “churn” between jail, hospitals, and the street
• Medicaid changes that allow longer inpatient stays
If you know someone who has a story to share, tell them to contact us at why notme.world.
One last thing, spread the word about why not me.

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Transcript

Welcome And Mission

SPEAKER_00 0:06

Welcome to Why Not Me, Embracing Autism and Mental Health Worldwide. Hosted by Tony Mirator. Broadcasting from the heart of Music City, USA, Nashville, Tennessee. Join us as our guests share their raw, powerful stories. Some will spark laughter, others will move you to tears. These real life journeys inspire, connect, and remind you that you're never alone. We're igniting a global movement to empower everyone to make a lasting difference by fostering deep awareness, unwavering acceptance, and profound understanding of autism and mental health. Tune in, be inspired, and join us in transforming the world one story at a time. Hi, I'm Tony Mantor. Welcome to Why Not Me, Embracing Autism and Mental Health

A Mother’s Lived Experience

SPEAKER_00 1:09

Worldwide. This is our special event, Crafting Justice, Empowering Autism and Mental Health through legislation. Joining us today is Senator Judy Amarbale. She's notably passionate about addressing serious mental illness, informed by personal experience, and has advocated for policies like involuntary care in extreme cases, a dedicated mental health tax. With a proven track record of coalition building and impact legislation, she continues to work tirelessly to address Colorado's most pressing challenges. She has a wealth of knowledge, and it's a pleasure to have her join us today. Thanks for joining us.

SPEAKER_01 1:47

Yeah, I appreciate you inviting me.

SPEAKER_00 1:49

Oh, it's my pleasure. I understand that you represent the people in Colorado.

SPEAKER_01 1:54

Yeah, I live in Boulder, and I represent Boulder Louisville Superior Gun Barrel in Naiwat.

SPEAKER_00 2:00

I understand that your journey to becoming a senator was so that you could help those with serious mental illness. Can you tell our listeners what led you down that journey to help others like you're doing?

SPEAKER_01 2:13

I have a son who has schizoaffective disorder. He was, he did fine, mostly fine through high school, but towards the end of high school, he started showing some signs of mental illness. He was um pretty heavy marijuana user, starting when he was in eighth grade. He really, we tried a lot of things to get him to quit, and we were not successful. And then in college, he deteriorated further. When he was about 23, 22, 23, he was diagnosed with schizoaffective, with co-occurring substance use disorder and also anxiety, depression. He pretty much has had every diagnosis you can think of. He has been briefly homeless on the street. He was uh at the homeless shelter in Boulder for about I want to say six months, maybe it wasn't quite that long. He got thrown out of there. And then he was criminal justice involved.

SPEAKER_00 3:08

Okay. Can you tell us what led to the involvement with the criminal justice system with him?

SPEAKER_01 3:15

Um, just doing crazy shit. Sorry, you probably can't use that on your podcast.

SPEAKER_00 3:21

Well, that's no problem. That's real life, unfortunately. It's just PG. Looking back, can you tell us some of the things you might have seen that now you look at and that was just a precursor to what was coming?

Early Warning Signs Of Psychosis

SPEAKER_00 3:36

Because I've been told many times that psychosis does evolve over a certain period of time within young men. What led you to believe that he might have had this until he got fully diagnosed?

SPEAKER_01 3:49

Well, I mean, he started being sort of disconnected from reality. Like he was going on study abroad in college, and he said to his dad and me, he was going to Australia, and he said, Did you guys know that Australia isn't even in America? And it was like, hmm. That's a very odd thing for this pretty well-educated person who's going to Australia to say, and then he had a lot of paranoia. He thought that some of his classmates were trying to hurt him. You know, his former high school friends were trying to hurt him. And then the final thing that he told me about was he said that people could hear his thoughts. And I Googled that. That's called thought broadcasting, and that is a hallmark of schizophrenia. And he did have also a lot of mood swings, mood disorder. So he would get super depressed. He did attempt suicide. I would say his suicide attempts were somewhat half-hearted, but nonetheless pretty scary.

SPEAKER_00 4:55

Yeah, I can just imagine. So through all this process, I mean, it's the big unknown. You just don't understand what's happening. You're only going by Google and what the doctors are telling you, but it's still very confusing. So, how did that affect your family?

Family Fallout And Finding NAMI

SPEAKER_01 5:12

Yeah. So it's a train wreck for your whole family, partly because everybody's mad at the person who's sick. And it feels manipulative. It feels like they're just not trying. Like it is really hard to understand what's going on and to have empathy and compassion for your own child, let alone his brothers. So I actually, and it sounds kind of cliche, but one of my sisters insisted that we take this class together at the National Alliance for Mental Illness. They had a class called Family to Family in Boulder. And it was incredibly eye-opening for me. Like I thought I'm pretty well informed. But sitting in a room for 12 weeks with a bunch of other people who had loved ones who had all kinds of different stories, but also some pretty similar stories. And seeing how angry people were at the beginning, and like looking at that and thinking, well, that seems like the wrong response. And then internalizing that and saying, Well, I'm I'm doing that too. That is what the class is kind of about is some education, then moving you to empathy, not just for your person, but for other people. And then finally to advocacy, advocacy for your person, and then also advocacy for others.

SPEAKER_00 6:33

When you came out of the class, how did it affect you? And then how did you move forward from it?

SPEAKER_01 6:40

Yeah, I mean, I definitely understood a lot more about the disease. I did have, I was able to get to a way more empathy, a place of empathy with my kid. He needed that, but also I really needed that.

SPEAKER_00 6:55

Yes, I can understand that because as much as it affects the person that's afflicted, it also affects the people that's around him. Then add to it if you don't have the understanding, or if you do have the understanding, it is still a difficult place to navigate through.

SPEAKER_01 7:13

Yeah, it's really, I mean, so the other thing is that you go, okay, I'm not alone. And what my what's happening in my family isn't unique. There are some unique elements, I'm sure, but it's happening to a lot of people, and then you don't feel quite so isolated either because it is very isolating. I mean, you know, they talk about, I haven't heard this in a long time, but it's the no casserole disease. So you tell your friend, oh, my kid is in jail. He had a psychotic break and pushed somebody down. They don't come over with a casserole. You know, they're just they don't have any idea how to respond to that. Or my kid's in the hospital. Just to be clear, my kid never was never in jail. He pled his case, he got probation, he never had to go to jail. He was in the hospital a lot. And again, they didn't come over with casseroles. Nobody sent flowers. It is really different. And also, people try to minimize it. Oh, he's fine, he'll be fine. I saw him the other day and he seemed fine. And they don't do that with other illnesses. You don't have to defend the fact that the person is sick. You know, people just accept what you tell them.

SPEAKER_00 8:24

Yeah, it's very much like I had a person on my podcast a few months ago, good-sized guy, very healthy. He says, if I tell them I'm autistic, they go, Oh, you don't look autistic. But he says, if I was to tell them I had cancer, they'd be going, Oh, how can I help?

SPEAKER_01 8:40

Yeah. Well, I mean, that also brings up this other thing in my head. People say, Oh, these schizophrenics. We don't say these cancers. He is a person who has schizophrenia. And it's a funny wordsmith thing. Like, I don't really love that, but it actually really sticks when people say that because he's not schizophrenic. He's my kid and he has schizophrenia.

From Advocacy To The Legislature

SPEAKER_00 9:09

So once you got through all this, what ultimately led for you to run and get into the Senate?

SPEAKER_01 9:16

Well, okay, so I was in the House first, just to be clear. I was in the house for four years. And so what led me to do that?

SPEAKER_00 9:23

Oh, okay, that makes sense.

SPEAKER_01 9:25

Well, it was probably a number of things, but Boulder decided to run a tax to build an alternative sentencing facility at the jail so that they could do work release. And I wrote an op-ed that said, why are we doing that? When the way to keep people out of jail is to build a hospital, a continuum of care so that we can actually help people get better. Let's take our tax money and build a hospital. The alternative sentencing facility tax passed with like 85% of the vote. So clearly, no one was on my team. I said, I'm voting no on this because it's the wrong thing to do. But a woman who had run mental health partners and who was involved with NAMI and the NAMI policy committee reached out to me, Phoebe Norton is her name, and said, Will you be on our policy committee? So I did that. We went around and met with all these different people, legislators and county commissioners and city council people. It did become really clear that no one, none of these people had this kind of experience. And then I got on the board of mental health Colorado. Went down there and said, Hey, I want to, you know, work on policy. Andrew Romanoff was running it at the time, and he kind of sussed me out and said, Well, you can be on our board. So I was on the board, but I also did get to work on policy. And that was really eye-opening and important to see how hard it is to even pass a simple change in policy and how many people are interested and how many different points of view there are on every little thing. So I did that just for a short while. And then I, I don't know, the seat was open. And I I testified on the red flag law in 2019, and I told this story about how my kid had said he wanted to get a gun so he could kill himself. And then I saw on his debit card that he had made a purchase, uh like a $10 or $15 purchase at the gun shop. And so his dad and I went running down there and we're like, what's happening? And they said, Well, your person was here and he's gonna buy a gun, and his background check didn't come back instantly. So this is the gun. And they showed us the gun and they said, We're just waiting for his paperwork to come back. We, you know, cried and carried on. And they said, Okay, we won't sell the gun. And they wrote on the paperwork not to sell it to him. But I wanted to tell that story. So I get down there and I'm waiting for five hours to testify. And it's my turn, I'm on a panel with some other people. And I said, Um, the committee members were getting some food. And I said, Well, I see you all got dinner, and I just want you to know that in the cheap seats back here, we didn't get any food. And Tom Sullivan, it was a joke, and Tom Sullivan said to me, Well, if you want to eat, you gotta run.

SPEAKER_00 12:24

You just brought up policies and how difficult it is. I've talked with senators and legislators as well as former U.S. House of Representatives, and you've got lived experience. Some of these people don't have, although some do. I would be interested to hear your perspective. Number one, how does that make a difference for you, even though you have the lived experience? You're having to deal with legislators that do not, they only hear from people that give them their perspectives. How do you bridge that gap for those that do not understand so that they can get on board and make legislation that will help everyone?

Civil Commitment And The System Churn

SPEAKER_01 13:09

Yeah. Uh it's hard actually. And also, I have my perspective. And so what I've figured out is that not everybody, even if they have lived experience, they don't necessarily agree about the way forward. So, for example, people who have who I've met along the way, who have, some of them have deep-seated mistrust for their family. And, you know, I come at it from the perspective of I'm trying to help. And the system is pushing me away at every turn. You know, I have hundreds of families that I've talked to, and there's a group called Mad Moms that's got 400 families now involved. And we all have this same experience, which is we're not allowed to participate in a way that would be more helpful. And nobody wants to talk to us until it's time to pay the bill and they realize the person isn't going to be able to navigate that, or until they just need somebody to come pick them up because they're releasing them from a hospital or that kind of thing. That's been incredibly frustrating. And then, you know, to have this other experience of people who don't want that. They don't want their family to participate. They feel like where they are is maybe their family's fault. So navigating that.

SPEAKER_00 14:27

A lot of states have what they call AOT. Is this something that is on your plate and you're trying to push and get changed as well?

SPEAKER_01 14:36

I've been beating this drum. I do work on a lot of criminal justice stuff, but I have been beating this drum about you have to have a good, solid civil system and a way to get people committed, short-term commitment, a way to have people go, even if they don't think they want to, to get treatment. So I've been working on all this criminal justice stuff, and we've been working on how to get people out of jail. But it's like if you get somebody out of jail, but you never get them care, they just come back. They just cycle in and out, in and out of this system. The answer, in my opinion, is to get them into care. And that might mean a civil commitment. You know, maybe it's three months, maybe it's three weeks. I don't know. It depends on the person. But we have to at least be open to the idea that somebody might need to spend months trying to figure out what the right medication is and getting stabilized and getting other things that might help them to get better, getting, you know, eating nutritious food and all kinds of things. So but I've made a little headway on that. The other day, one of the attorneys who I work with a lot said to me, Okay, you're right. I'm ready to work on that. You know, because the knee-jerk thing is that's just another way of locking people up. But I don't want to just throw people into poor houses. I want there to be good care. Because people who get good care get better. Not everybody, but a lot of people do. And also we have to admit that some people are never going to get better. They can't live out in the world on their own. And so we had to figure out something for them too.

SPEAKER_00 16:25

Yeah, that's a tough thing to acknowledge and admit. Sometimes, and most times, when you're dealing with the House and the Senate, they are always looking at bottom dollar, in other words, budget. How can they not see by not fixing this, or at least by not trying to fix this, that it's just going to cost the taxpayers millions and millions of dollars? And many times, if they can fix it, these people can be diverted to other places. And most always, the legal system will never see them again. How can we get that put in place?

SPEAKER_01 17:00

I mean, I'll just say, like here in Colorado, one of the big

Competency Waitlists And Short-Term Thinking

SPEAKER_01 17:04

things that we're dealing with is this competency wait list. So every year we have hundreds of people who are sitting in jail waiting for a bet at the state hospital to get their competency restored so that they can proceed with their legal case. Competency restoration isn't treatment for your mental illness, it's just a workbook. And as soon as you can parrot back what's in the workbook, you're good to go. And then your case can proceed. And we are under this consent decree because we got sued and we're spending $12 million a year on this consent decree. And the legislators have bought into this idea of we just have to make this competency wait list go away. So, you know, we put $80 million into beds, more beds, surge beds at private mental health hospitals to make the wait list go away. And what happened is we went from 450 to 250 and then 350, and we're headed back up to 450 because those same people and new people are just cycling around. And new people who are becoming sick, there's no civil system for them to get care before they ever get into the criminal justice system. Many of us were like, no, we should take half of the surge bed money and put it into civil beds. And then let's get people into that system sooner. And you know, we just couldn't win the day because everybody is just burdened with this short-term thinking. So if the benefits come down the road, I don't know if it's because we have term limits or like I'm not sure, but no one wants to wait to see what might come down the road. They just want a fix right now. And of course, that's an absurd way to go about it. And we're seeing now, of course, that it doesn't work. It didn't work for us. It wasn't the way. And I've been really trying to help people understand about what this cycling is, this thing that I heard a podcast out of Washington that was called the churn. And uh, if we don't interrupt this churn, we're not fixing anything. And now that we're looking at Medicaid dollars being reduced, it's just gonna get a lot worse. And we're gonna have a lot more people ending up in jail and in homelessness, and we're gonna have a much longer list for this state hospital.

SPEAKER_00 19:29

Yeah, and I heard, and I can't remember where I heard it, that decades ago we had X amount of beds, and it seems like each decade the beds are getting smaller and smaller in availability. And because of that, there are no facilities that are able to take the people that actually need the help. Then, because of that, they find ways to put them back on the street, so they wind up living on the street, in a homeless shelter, or unfortunately incarcerated. We have to find a way to educate these people. A lot of these people are, of course, our representatives, the ones that are elected and served to help our communities. It seems like it's a vicious circle to get them to understand, kind of like it's a vicious circle, that churn podcast that you just mentioned.

SPEAKER_01 20:18

Yeah. I think that there is, we are having a dawning awareness. Like California tried to do this care courts thing. I don't think it's been very effective. And I'm not exactly sure why, but we I did go with a group of people from Colorado to look at that. You know, they had a meeting with all these families and advocates. And the the families wanted involuntary commitment. And the advocates did not want involuntary commitment. So they ended up not having involuntary commitment. They have voluntary commitment and they've poured a bunch of money into that system, but I don't know that it's really helping or it's not helping in the way that people had hoped.

SPEAKER_00 21:01

Yeah, that's very tough. Without some sort of AOT, some sort of safety net, what do we do? Many times you will hear stories of people getting picked up by the police, taken to the hospital, then the doctors say that he's not a threat to himself or others at this point in time, so their hands are tied and they can't do anything. It's sad that their hands are tied because they may not be a threat to themselves or others at that point in time, but give them a few hours, a few days, or whatever time frame, and they could be. We need to find a way to help these people so that they don't wind up in that type of situation.

SPEAKER_01 21:41

Yeah.

Medicaid 60-Day Stays And Next Steps

SPEAKER_01 21:42

Well, okay, so this year we passed a bill. Right now in Colorado, if you are a hospital and you have somebody and you keep them and they're on Medicaid and you keep them for more than 15 days, you don't get paid for any of this day. So you you have to get them out of there before the 15 days are up. In order to get paid. And if the person is in three different hospitals for five or six days in each hospital, none of the hospitals get paid. And they don't even know the person was in a different hospital because we don't have good data sharing. But we got a waiver uh from the federal government from for Medicaid that says now going forward, a hospital can keep you for up to 60 days. So in this bill that we passed this year, it says it codifies this waiver that allows a hospital to get paid for up to 60 days. And it says if somebody's in your hospital on a short term, a three-day hold, an M1, you have to evaluate them for a longer term stay. And this year we'll maybe come back and say, at least one of the things you have to consider is their history. See if maybe they qualify. So how many times were they on an M1 hold? How many times were they in jail previously? Have they been homeless? Like these things should factor into this decision about whether you qualify. It shouldn't just be, you know, what's happening in that exact moment.

SPEAKER_00 23:09

Yeah, I totally agree with you 100%. So in closing, we've covered numerous things here, all very important topics. So this is a very broad question, one that might not have a perfect answer, but it has to be asked. So what do we do? We have many of the things that we talked about, plus the things that you brought up, and it seems like a lot of things are just so restrictive in helping these people, even if they're not asking for it, they still need this help. So how do we get past some of these barriers so that we can actually do what we're trying to do? And that's help people that need the help.

Beds And A Continuum Of Care

SPEAKER_01 23:51

Well, I mean, I'll just start with this beds, beds, beds. We need beds, and we don't have them. We have we need beds and we need a continuum of care. So we need hospital beds, we need transition to living homes, which Colorado just we are building some of those. We need group homes, we need supportive housing, all of that. We need this continuum of care so that somebody who has serious mental illness is getting cared for for the rest of their life in the way that is the least restrictive that they need. We do that with people who have diabetes or people who have severe autism or people who have, you know, heart disease. We take care of them and we help them and we give them what they need. And we need to do that with mental illness. Now, in terms of how do we find the money to do all of that, I don't know. I I get in my car at night and I think, what have we done? In the time I've been there, we've passed a lot of bills on this topic. And I'm not sure if we've helped anybody or not.

SPEAKER_00 24:56

Yeah, yeah, I get it. I was speaking with a member of the House of Representatives in Iowa just the other day. They passed a bill 100%. Everybody voted for it. Got to the Senate, it got killed. So now they have to wait till next year to reintroduce the bill again and hope that it passes. If there was one person that needed that passed, just one, then the Senate failed them.

SPEAKER_01 25:20

Yep.

SPEAKER_00 25:20

We have to find a way to get wins instead of losses.

SPEAKER_01 25:24

Yeah. Well, I'll tell you what, I have a pretty good track record of wins on the mental health stuff.

SPEAKER_00 25:30

That's great.

SPEAKER_01 25:30

And a big part of that is I've just been fortunate to work with people who are willing to come together. So the criminal justice stuff, the public defender's office, and the DA's office, they're legislative people, are reasonable people who want to get to a compromise, who would rather see something happen than nothing. So we've had good luck with that. But the knock it out of the ballpark big changes are really hard to come by.

SPEAKER_00 25:59

Yeah, yeah, that's understandable. Well, this has been a great conversation, great information. I really appreciate you taking the time to join us today.

SPEAKER_01 26:09

Yeah, thank you for taking the time to care about this.

SPEAKER_00 26:12

Oh, it's my pleasure. Thanks again.

Final Thanks And Listener Invitation

SPEAKER_00 26:21

Thanks for taking time out of your busy schedule to listen to our show today. We hope you enjoyed it as much as we enjoyed bringing it to you. If you know someone who has a story to share, tell them to contact us at why notme.world. One last thing, spread the word about why not me. Our conversations, our inspiring guest, the show. You are not alone in this world.