The Gazette and KKTV recently co-hosted a Community Conversation on the crisis in mental health care in Colorado. More than 250 people showed up at Studio Bee in the Pikes Peak Center on a Wednesday night in June to listen to four panelists discuss solutions for better mental health care in Colorado Springs and the state. The conversation came amid a series of special reports by The Gazette in recent months detailing acute problems with mental health care, with hundreds of thousands of Coloradans unable to access care in a hard-to-navigate system thatâ€™s unaffordable or inaccessible.
The Gazette has found that hospital emergency rooms are the first stop for mental health crises, and that jails and state prisons have effectively become warehouses for the mentally ill.
In addition, the state has too few psychiatrists and psychiatric beds to meet demand, and many parents struggle to find help for their children â€” a problem that has led some to seek care in other states.
Over and over, questions by readers and viewers submitted for the forum sought advice for stemming the tide of suicides in the Pikes Peak region, for improving mental health services in schools and for making care more affordable, even as insurers balk at covering many services.
Here is an edited and condensed transcript of the discussion among state Sen. Bob Gardner, R-Colorado Springs; El Paso County Coroner Leon Kelly, who is also a board member of the local chapter of the National Alliance on Mental Health; Vincent Atchity, executive director of The Equitas Project, which works to disentangle mental health care and prisons; and Rebecca Berghorst, associate medical director of children and adolescent programs at Cedar Springs Hospital.
Anchor Don Ward of KKTV moderated the forum, first asking each of the panelists for a few opening remarks.
Kelly: It may be a little odd to have the coroner here to talk about solutions. Iâ€™m not usually at the solutions end of the equation. But I do have a unique perspective. And weâ€™ve got challenges ahead and those challenges are going to need data to help us make decisions. And unfortunately, when we talk about mental health and where weâ€™ve failed, that data is going to come out of the coronerâ€™s office. My belief is thatâ€™s where we fail most spectacularly in this community is between agencies, the continuum of care, from the beginning of where initial symptoms are seen to shuttling them through the process of their illness. We have great things happening in this community, we have great agencies and groups and dedicated people. But thereâ€™s definitely room for those groups to work together, to work on the overall system.
Atchity: Not many Americans understand that jails and prisons are our largest psychiatric facilities. â€¦ a great deal of that mass incarceration is driven by mental health needs â€¦ the justice system does very little to support anybodyâ€™s mental health outcomes.
Berghorst: We are all trying to help families, and nobody is doing anything wrong. The kids are not acting out because they want to. We [at Cedar Springs] also want to help in the continuity of care, so we are building programs to try to meet that need.
Gardner: We have legislatively done a great deal on mental health over the past two to three years; at the same time, we have a great deal more to do.
Ward: You worry sometimes about the gap between a [mental health care] plan and implementation. What are you seeing there that could be done to make sure that goes smoothly?
Gardner: Our K-12 system is a place for young people, and is kind of the first line where mental health problems are spotted, and we need to focus more mental health resources there.
Atchity: Jails are not the right place for people to be taken when their health needs are a much higher magnitude of order greater than their criminality or any threat they pose to public safety. Jail becomes the pathway for where to take somebody when they are in crisis.
Ward: And that becomes a cycle, of course, they get out and then go right back in?
Atchity: Well, nobodyâ€™s mental health gets better in jail. They are serving a life sentence 30 days at a time.
Gardner: Once someone is released, the question of services is a real problem. When someone is released, how do we make sure housing is available, how do we make sure Medicaid services are available, all of that is a challenge weâ€™re going to have to keep working at. I like to think we are doing better, I hear some stories that we are, but then I walk down the hall, and someone grabs me and says we havenâ€™t solved that problem yet.
Atchity: Weâ€™re not there. But there have been some legislative successes over the past three years. I think the awareness is key.
Kelly: There has been progress in this community. CSPD has three units of crisis intervention law enforcement officers trained. We didnâ€™t have that in the county. But an officer can recognize that this is a mental health crisis and not a criminal one, but if you donâ€™t have a place to take that person, what happens next? Ultimately, they are going to end up in a jail.
Ward: Is that where we need to go with this, more of everything, and better coordination between all of it?
Atchity: Yes! As long as all weâ€™re doing as a community is focusing on folks who are at that acute state of crisis where weâ€™re getting first responders involved, weâ€™re always going to be in crisis mode. As a community, we need to be thinking a little bit longer term. And think about what weâ€™re doing preventatively, starting in early childhood, to support peopleâ€™s healthful development at all the critical stages of their lives, so that people know how to support each otherâ€™s mental health.
Ward: How can we get more psychologists and social workers and trained counselors in the schools?
Berghorst: Well I think there are some projects in place to get crisis evaluators in there. I know that in D-12, where my kids went, it was Safe-To Tell, trying to get that in there so students can feel like they can let others know when they are dealing with a crisis. But itâ€™s also opening up and training the teachers, theyâ€™re at the forefront. The kids go to them, they talk to them. They talk to the teachers. We need people on the front lines who have their ears and eyes open. Kids donâ€™t commit suicide in a silo. They reach out. They reach out on social media. They reach out to their peers. We need to make it safe to let others know. I think thatâ€™s the answer, because we have a whole arsenal of eyes and ears to help these kids.
Atchity: We can all be doing a better job as community members of being eyes and ears on each other, and each otherâ€™s children. One of the other critical issues is the workforce shortage issue. Weâ€™ve got a national shortage of people going into mental health professions. We need to get ahead of that somehowâ€¦ weâ€™ve got a nationwide shortage of psychiatrists and counselors.
Ward: You mentioned substance abuse as a sidecar to this whole issue. What can be done about that?
Berghorst: We get in this conundrum, where we get a patient admitted that had substances on board. Yet they also have their mental health history. What we are often told, first they need to go to substance abuse treatment, and then they get there and they say they are suicidal. Substance abuse treatment centers say nuh-uh, they need to go to inpatient.
The insurance says, nuh-uh, weâ€™re not paying for that, itâ€™s substance abuse. Weâ€™re really caught in the in between.
Gardner: There are a lot of Catch-22s in this business, and itâ€™s just astounding to me, the numbers we encounter. That sort of siloing where statutorily it doesnâ€™t fit. We have to take on those legislative challenges, the regulatory challenges, sometimes theyâ€™re systemic challenges. By that I mean even a lot of well-meaning legislators go to tackle a problem, and we find resistance in one segment or the other.
Ward: What can we do to get more services available? What can we do to get this going?
Atchity: This [Community Conversation] is the kind of thing that needs to be happening everywhere, because itâ€™s going to take pressure from the public and from constituents to demand shifts in our system to provide greater levels of access.
Kelly: I would agree. There are people in this room tonight who are running for office. And this needs to be your No. 1 issue, what you talk to people about. The change is going to come from the community. Iâ€™ve been in this community for 15 years and Iâ€™ve never heard people talk about this. Weâ€™ve never had these kinds of conversations before.
Ward: Is that part of the problem, by the way? The stigma?
Kelly: It is. Thatâ€™s the issue. Itâ€™s not that we invented mental illness in the last 30 years. Weâ€™ve had it since the beginning of human civilization, and how did we handle it? We handled it by pretending it didnâ€™t exist and not talking about it. When a family member ended her life, we didnâ€™t talk about it. How has that worked out for us?
Atchity: Not only did we not invent mental illness, itâ€™s not like itâ€™s rare. Thereâ€™s not a family in the world that isnâ€™t touched by mental health struggles. Itâ€™s sort of a collective silence that weâ€™ve imposed on ourselves. We may be approaching an important tipping point in the way the whole culture views these matters.
Ward: What is the state doing to make mental health care more affordable?
Gardner: One of the things that makes it so expensive is that itâ€™s not covered. And you have a lot of systemic issues in the insurance industry about what is and is not covered. The mental health parity bill is at least our attempt to hold insurers responsible and make sure those who do have health insurance are covered.
Ward: A gentlemen in the audience says he has a son who was addicted to opioids for eight years and he says it took him almost all of that time to figure out where to go to get the help he needed. And he wonders if it wouldnâ€™t be good to have some sort of clearinghouse to get that help immediately?
Berghorst: We [at Cedar Springs] try to build those community partnerships so we can tell people where to go. But building one central hotline is probably a great idea.
Ward: Is there a one-stop place where you can get that information?
Berghorst: Not that I am aware of.
Gardner: We have done a lot about doing whatâ€™s commonly referred to as a navigator for assistance with intellectual and developmental disabilities care. Weâ€™ve got to have a system where people can find the help quickly. It shouldnâ€™t be that difficult.
Ward: Whatâ€™s the bottom line message to families tonight?
Kelly: We focus on mental illness as either youâ€™re well or you have a mental illness. But thatâ€™s not the reality. The reality is that itâ€™s just like physical health. We donâ€™t wait until youâ€™re on deathâ€™s door to try to do something about living a better life. And thatâ€™s what we need to do, we need to focus on raising kids with resiliency and community attachments and the ability to weather things in life.
Itâ€™s not about taking away obstacles in life, itâ€™s about empowering kids and giving them tools to overcome it. It should be about how do we raise kids to not get to that point.
Ward: What can parents do tonight to get themselves more involved in the conversation and the issues of mental health among their children?
Kelly: I think you need to treat your kidsâ€™ mental wellness the same way you treat their physical wellness. You ask them how they are doing. You need to be involved in their life. You make sure youâ€™re spending as much time nourishing and nurturing the mental and emotional well being of their lives as you do paying attention to their sports.
And when you see that your kid is having challenges, you deal with them then, and you understand that you didnâ€™t do anything wrong and they didnâ€™t do anything wrong. If your kid twisted their ankle, you wouldnâ€™t blame it on them, right? This is the same with mental wellness. This is where we need to go.
Berghorst: Put down the cellphone, shut off the TV, get involved in your kidâ€™s life. Know what theyâ€™re doing, know what theyâ€™re on their cellphones doing, get more aware. Itâ€™s kind of hard, I have five boys and they were always one step ahead of me. Replace one hour a day with just face-to-face communication. Because we know that when we touch or have eye-to-eye contact, our feel-good hormones increase. Just one hour a day, because we get so busy in our lives. Start with one hour.
Gardner: I think if youâ€™d asked me four or five years ago what is one of the major crises of our state and our community, I probably wouldnâ€™t have put this one at the top five. Today, I would.
Ward: I would like a minute or so of closing statements from each of you.
Berghorst: Thank you for allowing me to come on this panel. I think it is such a huge issue that we are all tackling and it is so heartening to see everyone here trying to tackle this problem, and I know that with all the hearts invested in this it can only make a difference.
Atchity: Thank you so much for your interest and commitment for making a difference. Make your voice heard. Let your elected officials know that you have higher expectations when it comes to access to care issues and when it comes to workforce issues â€¦ and if you are experiencing a crisis, or someone you love is experiencing a crisis and youâ€™re in that intervening place of responsibility, beware when you call 911 that you get an appropriate response. Make sure you are articulate about the help you need. And insist on a healthcare response.
Kelly: We certainly have a lot of challenges in this community, and whether your issue is homelessness or substance abuse or â€¦ jails or the safety of our community or access to healthcare, all those things come back to be mental wellness and mental health. And so, as we look forward to what we want to do about it, the folks that are in this room and the agencies you represent, theyâ€™re going to have to be the ones that continue to put the pressure on the folks that make the decisions. This canâ€™t be the tragedy of the week that we all move on from. If we want to make real change in this community, it has to be because we continue to demand it. â€¦ Thanks for inviting the coroner and not being afraid.
Gardner: For the most part, none of us stand up for election and say let me talk to you about mental health. We stand up and talk to you about taxes or government or health care generally, but never, â€˜Let me talk to you about the really tough issues of mental health, about how do we deal with access, how do we deal with affordability, how do we deal with the problem with our jails having so many people with mental health problems.â€™ But once people are elected, the reality is, my colleagues on both sides of the aisle overwhelmingly, to a person, want to do what is best and right for our communities.
Reach out to them, let them know this matters, let them know this is a crisis. And that affects how I look at legislation, it affects how I vote on limited resources for innumerable problems… Because it is of interest to the community, because it is something that we need to deal with as a crisis, we will make a difference and response. So youâ€™re making a difference.
Thank you for being here this evening to make that difference.