Mental health -- and care options -- in Colorado remain 'distressing' after years in survival mode

Jan. 29—Colorado no longer ranks as the worst state in the nation for the prevalence of mental illness and access to treatment for adults, a spot it held in the 2022 State of Mental Health in America report.—

The recently released 2023 report from Mental Health America places Colorado at 45th of 50 states and the District of Columbia for prevalence and access among adults.

The improvement is negligible, said Vincent Atchity, president and CEO at Mental Health Colorado, an affiliate of Mental Health America.

"The numbers jigger up and down for both adults and children — it's the nature of this data," he said. "Colorado reliably ranks down in the bottom third of the country."

The data provides a snapshot in time and lags real time, Atchity said, noting that the 2023 report uses statistics from 2019 and 2020, which accounts for just the first nine months of the COVID-19 pandemic.

The effects of the pandemic on mental health are only now fully manifesting, he said, and entering the new year, the mental health of Coloradans continues to be concerning.

"There's still a generalized, intensified increase in levels of anxiety and depression across the board," said Dr. Eric French, D.O., who owns Mind Spa Denver in Greenwood Village, an outpatient psychiatric and psychology clinic.

"People are still cleaning up after what happened between 2020 and 2022," he said. "Many people hunkered down in survival mode and pressed through and are now realizing how deeply this is impacting them. It's becoming more of a trauma situation."

And people seem uncertain about how to move forward, French said, which raises increases unease and creates a sense of hopelessness.

Anyone who's recently sought the services of a psychiatrist, psychologist, therapist or counselor knows there's an ongoing shortage of providers, said Lori Jarvis, executive director of the Colorado Springs office of the National Alliance on Mental Illness, or NAMI.

"Wait times are long, and many are not accepting new patients," Jarvis said.

Many people are waiting 30 to 60 days for an appointment, Atchity said.

Even then, "You may get your foot in the door, but what are the odds of connecting with a provider who understands your circumstances and can provide you the support you need?" he asked.

That's particularly the case for LGBTQ+ people, Black, Hispanic and other people of color, rural residents and asylum seekers, Atchity said.

Coloradans also are more isolated than residents of states with denser populations, Atchity said, and access to treatment in rural areas can be nonexistent, forcing people to travel to larger cities to receive care.

Despite the state's strong economy, according to indicators such as employment, and the state's high national rankings for the education levels of adults, "we can't seem to close the gaps for mental health access," he said.

"It's imperative that we create a pipeline of care," Atchity said. "The state of mental health in Colorado is distressing."

'Grateful for the trend'

Youth have fared better in recent years on the State of Mental Health rankings, moving from 13th best in 2022 to 11th best in the 2023 version.

The report studied numbers of people with any mental illness, as well as those with serious thoughts of suicide, and substance use disorder in the past year. Also figured into the rankings were people who did not receive treatment for mental problems, or uninsured or had other cost-prohibitive factors and unmet needs.

Colorado's overall ranking, which takes the status of children and adults into account, shows improvement over the past few years, moving up from 47th worst nationwide in the 2021 report to 37th in 2022 to 30th in 2023.

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While Colorado's numbers are "still not great, we're grateful for the trend," Jarvis said.

New methods being employed to address the lack of providers and workforce shortage, such as using peer specialists and nurse practitioners, are helping expand services to meet the demand for treatment, she said.

Her organization's peer support programs that are run by people who have a mental disorder or who have an afflicted family member, "are being recognized as a good way to support mental health needs when someone is struggling," Jarvis said.

Other help is on the horizon, but some will take years to materialize.

The state is applying for a planning grant from the Safer Communities bipartisan gun-control legislation Congress passed last year to develop more certified community behavioral health centers, Jarvis mentioned.

And the six-month-old Colorado Behavioral Health Administration is working furiously to meet the requirements of new legislation intended to overhaul and reform what's been identified as a broken and fragmented system, staff members said at the agency's first monthly virtual town hall on Jan. 25.

With an overall goal of meeting the behavioral health needs of all Colorado residents, the new system of governance at the cabinet level — meaning its commissioner is a direct report to Gov. Jared Polis — is tasked with creating better access, affordability, workforce support, whole-person care, accountability, and local and consumer guidance, said Stacey Davis, a licensed clinical social worker with the BHA.

Progress has been made, officials said. State lawmakers allocated $450 million from federal pandemic relief funding to add beds, crisis response, care coordination, justice diversion, community gaps, workforce and youth programs. COVID-relief money also helped build capacity for the new national 988 crisis hotline and increase responders.

The Behavioral Health Administration will release next week a strategic plan that will cover the next three years, staff members said. The document will outline where the administration is and where it's heading.

A frequent complaint is that people are being turned away for services, said Tom Miller, director for the administration's quality and standards division.

Regulatory restructuring and revisions will stop that from happening, he said, by developing a "safety net system," in which people are not rejected for lack of ability to pay or because of the level of their acuity. Also, a new "cafeteria style" format of licensing is in the works, in which providers will be able to pick and choose endorsement areas of specialty on top of baseline services they offer.

New legislatively driven rules, which number 300 pages now, should be completed by June 30, Miller said.

Behavioral Health Administration Service Organizations need to be set up by July 2024 in regions statewide to help with patient care coordination, reduce confusion for patients, manage services and ensure families can initiate and access the kind of behavioral health care they need, speakers said.

A plan for establishing a statewide grievance and performance monitoring system also must be submitted by July 2024.

Virtual public town halls will happen monthly throughout this year, with the next one scheduled for 3-4 p.m. on Feb. 22. Registration is at https://bha.colorado.gov.

Some problems seem nearly impossible to fix.

Insurance companies not reimbursing mental health providers as a rate that can sustain their practices and not covering patients' care — even though mental health benefits are part of their insurance, are ongoing challenges, French, the doctor, said.

"The cost of care has to come down," he said. "Most outpatient practices have had to increase their rate of seeing patients in the course of an hour, so you're in and out and the patient doesn't feel heard."

At that point, "You find the quality suffers or you may not want to pursue mental health care" at all, he said.

He encourages people to remain strong, adopt a clean diet, regular exercise, optimization of sleep and mindfulness practices that focus on the here and now.

Such activities decrease stress, French said, recommending that people intentionally make time in their schedules for such practices.

"If people are beginning to experience feelings of hopelessness or thinking things would be easier if they weren't here anymore or having active suicidal thoughts, please reach out to someone," he said. "Let someone know things are getting to that point. We need to find ways to get patients access — their lives depend on it."

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