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It’s easy to look at many Coloradans—with their fit, athletic bodies—and see the proverbial picture of health. Unfortunately, that image doesn’t always provide a complete portrait. Mental health issues are rarely visible, but they’ve long been prevalent among Centennial Staters. Colorado’s suicide rate in 2019 was 22.1 per 100,000 people, compared with an average of 13.1 for the entire country. Locally, 15 percent of teenagers ages 12 to 17 and 8.5 percent of adults reported having a major depressive episode during that same year. And 15.3 percent of residents said they had poor mental health—a number that sat at 9.9 percent just four years earlier. “Colorado wasn’t winning any prizes for mental health care,” says Vincent Atchity, CEO of the nonprofit advocacy group Mental Health Colorado.
Then 2020 happened. And 2021 hasn’t exactly been a pick-me-up either. Tiny though SARS-CoV-2 may be, it has had an outsize effect on everything, including our emotional well-being. It has triggered anxiety and depression, ballooned fears, and forced us to isolate ourselves from one another. Kids missed out on major developmental milestones. Adults lost their jobs. Businesses shuttered. Graduations, weddings, births, funerals—nothing was celebrated or mourned appropriately. Furthermore, the pandemic has persisted for much longer than most of us initially thought it would. We’ve been living in a world on pause—and we’ve labored to deal with it mentally.
“Since [March 2020], the number of people exhibiting signs of stress and anxiety has gone through the roof,” Atchity says. “Opioid and alcohol use has risen. There have been increased incidents of domestic violence. Things got worse.”
Although the gradual return to some sense of normality this summer has helped ease COVID-19-related stress, mental and behavioral health specialists say we are only beginning to understand the repercussions of the past year and a half. “I see it as being like a tsunami,” says Dr. Jason Williams, a pediatric psychologist and director of operations at Children’s Hospital Colorado. “I don’t think it has hit the shore yet. There are going to be major trailing mental health effects in our society.”
That’s especially concerning considering that the state’s current health system isn’t set up to deal with the number of people who will likely need help in the coming months and years. Over the past five years, Colorado has consistently ranked in the bottom half of states in terms of providing access to mental health care for its citizens, according to Mental Health America, a nonprofit dedicated to addressing the needs of people living with mental illness. According to medical experts, the state is also lacking in mental health professionals trained to treat depression, anxiety, substance abuse, and other behavioral health issues.
With a theoretical wave of pandemic-induced mental health conditions surging toward them, Centennial State health care organizations, along with state and local governments, are racing to change a system that has long prioritized physical needs over mental well-being. To better understand the problem, we asked local experts to explain who is experiencing the most significant struggles and what is being done to help them in Colorado.
By the Numbers
Three numbers that are indicative of our deepening melancholy.
55: The percentage by which calls and texts to Colorado Crisis Services increased in 2020 over the previous three years. In October alone, 24,821 people made a request
30.8: Percentage of Colorado adults who said they experienced symptoms of anxiety and/or depression at some point during spring 2021.
59: The percentage by which fatal drug overdoses increased in Colorado during 2020, compared with the average for the previous five years. Health officials say isolation brought on by the pandemic was a contributing factor in the massive jump.
How the Pandemic Affected Coloradans Differently
Few were left unscathed by the pandemic, but some Coloradans suffered disproportionately. We asked the experts to explain who—and why.
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Communities of Color
Dr. Sammie Moss knows how taboo it can be to ask for help in some communities of color. “My wife is half Hispanic, and she always makes the point that people in the Latinx community don’t want to admit they’ve seen a therapist,” he says. “Being African American myself, I’ve found it is similar in that community.” Moss, a psychiatrist at Kaiser Permanente, along with his colleagues, had been reaching out to local organizations that work with underserved groups to make them aware of mental health care services before the pandemic.
But after March 2020, limited in-person contact made it even more difficult to connect with communities of color. In the instances in which Moss had success doing so (most of the time via telehealth), it was clear to him that his minority patients had been suffering. People of color were experiencing unequal financial hardships and had seen far more family members and friends die of COVID-19. In other words, historical inequities were exacerbated by the public health crisis. Now, Moss says, “I am seeing a disproportionate lack of return to normalcy for my underserved groups, who were the hardest hit during the pandemic. They’re recovering slower.”
In her 23 years as a working psychiatrist, Dr. Patricia Westmoreland has watched the pressure on women, particularly mothers, continue to mount. “We all want to be able to fulfill our dreams in terms of work,” Westmoreland, the psychiatric residency program director for HealthOne, says. “But that hasn’t taken away from the responsibilities that we have at home.” The pandemic further stressed that push-and-pull dynamic. Many mothers became the primary teachers for their kids during distance learning, even if that meant altering work schedules or quitting the workforce altogether.
Others had to continue going in to work, leaving them with the near-impossible task of finding—and paying for—childcare for children who would’ve otherwise been in school. “I had a patient who was pregnant and took a job at a daycare, which she was overqualified for, because that was the only way she could get free childcare,” Westmoreland says. Add in increased instances of domestic violence during the past year and an uptick in substance abuse, and experts are worried about what comes next for moms. Says Westmoreland: “We’re certainly going to see some major mental health problems from all that.”
Around one in every three people who contract COVID-19 exhibit neurological or psychiatric conditions within six months of infection, according to a study published by the Lancet medical journal in April. Those who survive the disease have also been more likely to develop anxiety and mood disorders than people who catch the flu or other respiratory tract diseases. Physicians, like UCHealth’s Dr. Thida Thant, have long studied—and treated—patients suffering mental health side effects from neurological diseases, such as Parkinson’s.
It’s likely COVID-19 can also affect people’s brains (doctors are still trying to understand how), but Thant, a psychiatrist, believes there’s more to the mental challenges for some. “I compared it for some patients to the HIV epidemic,” she says. “There’s a general societal fear. The health care providers don’t know what to do. Patients don’t know what to do. Other people don’t know if it is safe to be around them. I think some people felt depressed, not necessarily from the physiological impacts, but from those weird life changes after getting sick.”
The COVID-19 Generation
Colorado youth are experiencing mental health problems at unprecedented rates. The mental health care system can’t accommodate them.
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The list of major events 18-year-old Ashley O’Day feels like she missed because of the pandemic is long. “I didn’t get a prom. I didn’t take the SAT. I couldn’t get my license for like four months after I was supposed to,” she says. Instead, O’Day, who graduated from Jeffco Virtual Academy in May, spent almost all of 2020 completing homework assignments online and casting about for other ways to fill the repetitive days. She rarely saw friends and stopped going to therapy because she didn’t like virtual counseling. “It’s hard being alone with your thoughts all day, every day,” she says. “I lost a sense of self and purpose.”
O’Day is far from the only Colorado kid grappling with the emotional downsides of distance learning and social isolation. In fact, emergency mental health visits to Children’s Hospital Colorado (CHC) were up 90 percent this past April compared with the same time in 2019. Suicide attempts were the leading cause for those ER arrivals, and at the time, the CHC hospital system, including facilities in Highlands Ranch, Broomfield, and Colorado Springs, had up to 24 kids waiting for an inpatient psychiatric bed on most days. The influx of kids in crisis led a panel of experts from Children’s to declare a pediatric mental health state of emergency in May of this year.
“Our kids have run out of resilience,” CHC chief medical officer Dr. David Brumbaugh said at a town hall announcing the heightened level of concern. “I’ve never seen anything like the demand for mental health services that we’ve seen at Children’s in the last 15 months.”
CHC is furiously adding resources to address the issue. By March 2022, it plans to increase the number of available inpatient psychiatric beds from 18 to 26, as well as bump up patient capacity in its eating disorder unit from 12 to 20. Hiring more mental health professionals is also high on the to-do list. But those changes won’t fix the underlying issue. “If we are building more acute beds, we’re losing the battle,” says Dr. Mike DiStefano, chief medical officer for CHC’s southern region. “We need to be intervening prior to the crisis.”
In order to reach more kids before emergency situations arise, Brumbaugh says behavioral health care needs to become a ubiquitous part of the medical system. “Unless we understand and begin to think about behavioral and physical health as being completely related, and dependent on each other, we are doomed to fail,” he says. Potential changes include making mental health evaluations part of annual physicals, having more behavioral health specialists on staff at primary care clinics, urgent cares, and in hospitals, and employing more counselors at schools who can help with psychological concerns, like how school nurses deal with physical ones.
Those additions would create opportunities for check-ins that could prevent a catastrophe. A pediatrician could notice during a routine checkup that a 12-year-old who is developing dangerously low self-esteem from being bullied needs to see a mental health colleague. A 17-year-old would have a place to vent about college entrance essays and work through fears about the future. Making such changes may sound simple, but Brumbaugh acknowledges it will require significantly more funding from health care organizations and governments, as well as time to train enough mental health professionals, to make them all a reality.
In O’Day’s case, being encouraged by her counselor to join the Mental Health Youth Action Board at Children’s, a program that encourages Colorado high schoolers to find ways to raise awareness about mental health issues, kept her from spiraling. She started a mentor group at Jeffco Virtual that helped freshmen navigate a weird year. The work encouraged a realization she hopes more people her age will have. “Mental health struggles,” she says, “don’t have to be as scary as they sound.”
Asking For Help
If you need help with substance abuse problems…
Visit cowellnessrecovery.org, a resource from the state’s Office of Behavioral Health that walks you through what treatment might look like and how to pick a provider that best suits you.
If you are an older adult looking for connection…
Reach out to the Telephone Buddy program, which is funded by the Colorado Gerontological Society and connects people ages 60 and up with volunteers who will call to check in one to two times a week.
If you are trying to understand what your health insurance might cover…
Call the Colorado chapter of the National Alliance on Mental Illness Law Line at 303-321-3104 to get free guidance on topics such as Medicaid.
What Are the Solutions?
Innovation in mental and behavioral health care is key. We explore four potential solutions Colorado groups have introduced.
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The Problem: Acute physical symptoms can be caused by underlying issues with mental well-being, but treatment often only focuses on immediate bodily complications.
Possible Solution: HealthOne opened one of the country’s first urgent care facilities with behavioral health outpatient services on-site this past May in Littleton. The behavioral health side of the practice will be mostly used for group counseling, not unlike the services offered at the health system’s other wellness clinics. If someone comes into urgent care with a prolonged stomachache, though, the on-call nurses and doctors can ask a mental health professional next door for a consult. That way, they can treat both the stomach problem and the anxiety that might be causing it.
Expert Take: “People keep trying to silo emotions from physical health,” says Cindy Meyer, the chief operations officer for HealthOne’s behavioral health services. “This helps us figure out what is going on with feelings that may be triggering something else.”
The Problem: If primary care doctors are concerned about a patient’s mental state, they likely aren’t trained to treat the issue—or don’t have a behavioral health specialist nearby who can help.
Possible Solution: In 2020, UCHealth added mental health professionals at 33 of its 60-plus primary care clinics. At Greeley Medical Center, for example, the internal and family medicine providers can easily refer patients who may be wrestling with poor sleep or showing signs of an eating disorder to Rachel Slick, a behavioral health clinician with an office in the same complex, to understand if those problems might be related to psychological issues.
Expert Take: “When you say you want to refer someone to someplace else, there’s questions about things like insurance,” Slick says. “It’s much easier to say, Hey, I have someone right down the hall, who I trust, and can help with this.”
The Problem: A deficiency of mental health professionals means people who need care can’t always find it.
Possible Solution: In 2015, Centura Health realized many of its physicians were battling burnout. So, the health system created a program that has since trained 100 or so doctors to recognize when colleagues are struggling and to provide emotional support for them, including referring them to licensed professionals when necessary. These peer support groups became especially useful during the pandemic as providers dealt with trauma from caring for COVID-19 patients. Centura wants to expand the program, and other health systems, like SCL Health, are looking to establish similar initiatives in other professional fields.
Expert Take: “Sometimes it is as simple as connecting with individuals and validating what they’ve been through,” says Dr. Caryn Baldauf, an internal medicine specialist who was part of Centura’s program.
The Problem: It’s challenging for many people to make time to visit a therapist’s office in person.
Possible Solution: In late March 2020, the CARES Act provided $200 million in funding for health care groups to set up the technology infrastructure needed for telehealth. As such, virtual appointments via video chat became the norm during the pandemic for a range of medical specialties. A final hurdle to the proliferation of telehealth was getting private insurers to cover the costs of therapy and counseling over video chat, which many have begun to do.
Expert Take: “It isn’t a perfect solution,” says local therapist Whitney Kearney, “but it is helpful for people who struggle with social anxiety and may be apprehensive attending in-person programs, or people with transportation barriers. Pre-pandemic, these services might not have been an option for some.”
Changing the Way Colorado Thinks About Mental Health
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Mental Health Colorado CEO Vincent Atchity has long found it difficult to get people to care about his cause: providing adequate resources for people’s psychological welfare. However, he believes the pandemic has forced us all to pay better attention to how our minds affect our overall well-being. Be that as it may, Atchity also thinks it’ll take more than that newfound recognition to change the way Coloradans access care.
5280: Had there been any recent, meaningful progress made to fix Colorado’s broken mental health care system before March 2020?
Atchity: Some changes had been made, but it wasn’t necessarily the best situation. We were near the bottom of most rankings for mental health care. We didn’t have enough resources for the number of people who needed help. I think the most notable change was in 2019, when Colorado passed the [Behavioral Health Care Coverage Modernization Act], which basically said insurance companies have to cover behavioral health costs on par with how they cover physical health, things like surgical costs. We still have some struggles implementing it, but that was an important step.
Have you seen the pandemic shift people’s thinking about mental health?
There has been a lot more talk about how we need to overhaul systems in order to move our culture away from being a punitive one to one that intervenes supportively for people. The historical approach has relied on crisis intervention at the last possible minute. We’ve got this backlog of adults who have fallen through the cracks and are costing us endlessly in terms of their use of emergency services and processes in the justice system. We’ve got this huge homelessness problem. We’ve got opioid abuse and overcrowding in jails. We’re realizing we could identify mental health issues that cause some of those things earlier.
What’s the biggest hurdle to providing supportive care?
Fifty-six percent of Coloradans who need mental health care don’t get access to it. Fifty-six percent. We don’t have enough psychiatrists and mental health professionals to support all the needs in this state. People are waiting sometimes two to three months for that first appointment—and mental health needs are many times more urgent than that. The providers are also often not culturally competent enough to be able to engage vulnerable populations, like immigrants and people of color. Consequently, patients often have a bad experience and don’t return. So much of this starts with a workforce problem.
How do we fix that?
There is a terrible lack of financial incentive for people to go into mental health services. Many people pay a lot of money to get advanced training and come out not making very much money. I think we need to look at things like student loan repayment or covering the cost of additional training. The adequate workforce doesn’t come overnight. If we are going to be dealing with all sorts of mental health issues because of the pandemic, we need to have more public messaging about informal ways to support those around you.
So, what can we feel good about going forward?
The introduction of the new 988 number. Congress and the Federal Communications Commission approved that to go live in July 2022. The expectation is when you call that number, you are calling for someone who is in a mental health crisis and needs assistance. Kids are going to learn the 988 number just like they learn 911. It’s symbolic of the type of broader recognition we need for mental health.
Statewide Efforts to improve Colorado’s Behavioral Health Services
Local leaders have said that improving behavioral health services must be a priority. We mapped out some of the ways they plan to deploy resources to help in the coming months.
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“An estimated one million Coloradans live with a behavioral health condition, and we know the compounding traumas of last year have only worsened [things]. We need a system that can deliver timely, affordable, and responsive services.” —Governor Jared Polis
Polis and Colorado Democrats committed to spending $400 million from the latest COVID-19 federal relief package on mental and behavioral health solutions. At press time, specific details about how the money would be allocated remained limited.
Behavioral Health Administration
Polis signed a bill in April to create a government entity that manages all the state’s behavioral health initiatives. The Behavioral Health Administration (BHA), which will begin operating in July 2022, was designed after a task force found that Colorado funded 75 different behavioral health programs that were part of 10 different state agencies. “People didn’t know where to go for care,” says Robert Werthwein, the director of Colorado’s Office of Behavioral Health.
“Now more than ever, we need to consider the behavioral health impacts of all of our policy decisions, and we need to take behavioral health concerns as seriously as we take physical health,” said state Representative Dafna Michaelson Jenet after introducing several bills focused on behavioral health in the Colorado General Assembly this year.
Rapid Mental Health Response for Colorado Youth
This bill, approved in June, will give every Colorado child the opportunity to take a mental health screening online within the next year and, if needed, be referred to an in-network mental health provider.
“Every person, family, and community is touched by these behavioral health issues. That’s why it must be a priority for our city. We can end the stigma and get people the treatment they deserve.” —Mayor Michael Hancock
The Denver Department of Public Health and Environment released a plan in April for how to improve behavioral health care in the Mile High City. Goals include creating more services that can be easily accessed by all citizens and keeping people experiencing behavioral health crises out of jail.
Stigma Reduction Campaign
After conducting a citywide survey, Denver’s Office of Behavioral Health Strategies plans to begin running targeted marketing efforts next year that make specific communities and groups aware of mental health services that might be useful to them.
This midsize Winnebago began traveling the city in 2020, providing resources like mental health screenings and distributing Narcan—a medicine that can be lifesaving during overdose situations—to historically underserved regions, such as Montbello and Lincoln Park.
Behavioral Health Solutions Center
The 24/7 facility, which opened its doors this past May in Sun Valley, offers referral-based crisis services, temporary housing and assistance transitioning to community living, and treatment options for mental health and substance abuse issues.