IT WASN’T RAINING ON THAT DAY LAST JULY, BUT IT MIGHT AS WELL HAVE BEEN. JUDY, 68, WAS BORN AND RAISED UNDER COLORADO’S BLUEBIRD SKIES, AND LATELY SHE FELT TOSSED AROUND IN A TORRENTIAL, UNRELENTING STORM THAT ONLY SHE SAW. IT WAS OFTEN LONELY AND BLEAK. AND NOW IT WAS FRIGHTENING: SHE COULDN’T FIND HER SON.
HER MICHAEL.* HER TROUBLED, TALENTED THIRD CHILD, WHO WASN’T A KID ANYMORE. HE WAS 42, YET SHE COULDN’T STOP THINKING OF HIM AS HER BOY. NOT WHEN HE NEEDED HER SO MUCH. NOT WHEN SHE FELT—KNEW—THAT NO ONE IN THE WORLD CARED ABOUT WHETHER HE SURVIVED MORE THAN HER. NOT THE COPS. NOT THE THERAPISTS. NOT THE HOSPITALS.
She’d check in with him by phone several times a week. Usually they discussed mundane stuff, simple conversations that let her touch base and get a sense of what he was feeling. Lately, he’d been feeling a lot, probably too much. In truth, he’d been doing terribly. He’d moved into his own apartment and over the past few months had lost so much weight she thought he might have an eating disorder. He was even more antisocial than normal. He said he’d been talking with his neighbors, but she knew those conversations were just the voices invading his mind. That was Michael’s reality; how could she convince him something so vivid was imaginary? How much would she fight if another person told her to distrust her own thoughts and instincts? That something about her was off? That the voice that says “go talk to that person” is actually a schizophrenic delusion?
She had to try to help Michael see when his brain shifted between reality and an alternate world. She’d done it before. With a slew of help—psychiatrists, ER doctors, counselors, social workers—she’d gotten him on medication. He hated the side effects, especially the inevitable weight gain. Even worse, Michael was an artist, a painter, and a poet. He was convinced the prescriptions dulled the edge that allowed him to feel and create. Plus, the voices reassured him, he was fine. He didn’t need help.
So he’d quit the meds, just like before. And when he spun out of control, Judy picked him back up, just like before. Because that’s what she does. For the past 15 years, she’s worked as an elder-care provider, helping seniors manage their twilight years. As Michael’s caretaker for many more years, though, she’s had the opposite mission: to ease her youngest son back into life, and, most important, to not let him die before she does.
Judy knows the statistics. Michael is 11 times more likely than the rest of the population to be a victim of violence. He is expected to die 25 years earlier than his three siblings, not just because of higher rates of suicide or an accident, but because American options for mental health patients are so dismal he might as well live in a third-world country.
Some days, it seems like neither Michael nor his mom live here, in Colorado. They inhabit a separate world dealing with what professionals call a “no-casserole” disease. If your son is mentally ill, neighbors don’t bring over cheesy concoctions for you while he’s in the hospital. Co-workers don’t organize fund-raising drives to find money for treatment. Friends don’t stop by to walk the dogs or fold the laundry. Mental illness is the biggest cause of disability in the United States. Yet the National Institutes of Health (NIH) reports that of every dollar spent on research, less than one cent goes toward severe mental illness. By contrast, 25 cents is allocated for AIDS and cancer research.
That’s why Judy so often feels alone in this battle. And when Michael didn’t call that day in the middle of the summer, when he didn’t answer her calls, she knew something was wrong. She phoned a few places, including the Mental Health Center of Denver (MHCD), where Michael was a client. Eventually, she climbed into her gold minivan and drove to his apartment to make the landlord let her in. When she saw Michael’s car parked outside the building, she knew what she’d find on the other side of his door.
THE NEXT TIME YOU’RE at a grocery store, or a bank, or a restaurant, look around. In Colorado, statistically speaking, one out of every 12 people suffers from a severe mental illness such as bipolar disorder, schizophrenia, post-traumatic stress disorder, or dissociative personality disorder. Now, take another look: At some point, one in four of them—maybe even you—will experience anxiety, bouts of depression, obsessive-compulsive tendencies, or other behavioral health issues.
Although these all are treatable diseases, when most people think of mental illness, a very different stereotype emerges: mug shot images of mass murderers, such as the gunman who killed 12 people at the Washington Navy Yard last September 16. Or the man in Tucson who killed six people and shot U.S. Representative Gabrielle Giffords in the head in 2011. Or James Holmes, who allegedly killed 12 people and injured 58 more in Aurora in 2012. As deplorable and incomprehensible as these shootings are, they provide an image of mental health that’s sensationalized and incomplete. These violent incidents are extreme examples of mental health care system failures, the results of treatment having not been sought or maintained. They shift focus away from early diagnosis and therapy—the kind of interventions that might prevent such atrocities—to what do we do now?
That was the dilemma Colorado faced last legislative session. Within hours of the Aurora shootings, Governor John Hickenlooper convened politicians and behavioral health experts to discuss gun control, mental health, corrections, and homelessness, and he demanded a legislative response. The legislated result was a convoluted, sometimes misguided, package of bills that included gun-control legislation to limit magazine capacities and changed background checks for private gun purchases. Another bill proposed the creation of a state or national list of people who had been held in a hospital longer than 72 hours for mental health reasons, but an odd-bedfellow mix of mental health advocates and pro-gun lobbyists halted it. Other legislation explored the possibility of holding mentally ill people in hospital limbo for up to a week before they could enter the legal system, where they would be entitled to due process and access to an attorney. The American Civil Liberties Union quickly stepped in, and that one didn’t pass, either.
The efforts reflected the governor’s emphasis on gun control and public safety. The trouble is, the numbers don’t support the widely perceived need to protect “us” from the mentally ill. Only three to five percent of violent crimes are committed by people with serious mental health diagnoses. This is where the discussion in Colorado and beyond (by last summer, most states had addressed some kind of new mental health legislation) becomes uncomfortable: Severely mentally ill people not in treatment are six times more likely to commit violence than those who are. Forcing people into treatment might be the most reliable way to prevent Aurora-type incidents. But punishing a group of people for a crime that might be committed quickly starts to sound like herding Japanese into internment camps during World War II or the forced sterilization of prison inmates, acts that are both unconscionable and unconstitutional.
Instead, Colorado legislators focused on what they could do: prevent and provide. They passed a broad $25 million initiative to completely restructure the state’s crisis system to focus on the majority of mentally ill patients, rather than on the sensationalized minority. This included a statewide hotline—much like Denver’s Metro Crisis Line, a 24/7 phone number that connects people to mental health assistance—to ensure that struggling people in eastern Colorado’s Last Chance have access to the same expert care as those in LoDo.
In addition, the state will build several community-focused crisis care centers to help move psychiatric patients out of emergency rooms and into facilities designed to address the difference between a broken mind and a broken hand. And in one of the bolder plans, Colorado would create mobile crisis teams that could respond, like 911 paramedics, to someone in the throes of a mental health crisis, such as contemplating suicide. Similar programs elsewhere have reduced hospitalization rates by eight percent.
Critics called the infusion of funds too little, too late. Others disagree, including Lisa Clements, director of Colorado’s Office of Behavioral Health for the Department of Human Services. She runs the state’s public mental health efforts, a system that includes two hospitals—in Fort Logan and Pueblo—nine specialty clinics, 17 community mental health centers, and more. “It is a huge investment. It is the largest behavioral health investment that we have made as a state for—ever,” she says. “I would not minimize that in any way. But we have not invested for years, and so we have a lot of catching up to do.”