If he’d been in Colorado Springs, chances are he wouldn’t have gotten even that much help.
That’s because mental-health experts say healthy communities should have one psychiatrist for every 10,000 residents. In a perfect world, El Paso County would have 64 licensed doctors qualified to treat and medicate someone like Holmes.
Instead, there are a mere 14 private-practice psychiatrists in the city, many of whom are nearing retirement age.
“It’s the elephant in the room,” said Dr. Julie Sanford, chief medical officer at Peak View Behavioral Health, a recently opened psychiatric hospital seeking to stem the gap between providers, beds and the people who need their services.
“It’s just tremendous — and the hospitals closed their psychiatric units. We lost 26 beds when St. Francis closed their unit (in 2010), and we were full the day we opened here.”
The access problem leads to grim statistics. According to local mental-health experts, Colorado Springs has the second-highest suicide rate in the nation, only behind Las Vegas.
“For a community this size, that’s staggering,” Sanford said. “It’s just sad.”
The military isn’t the cause for the high suicide rate, she said. Those statistics are separate from the city’s numbers.
“We live at a high altitude, and there’s some correlation there,” she said. “But we also have a lack of providers, a lack of beds and a lack of coordination of care. Colorado is a very poorly funded state for mental health.”
Billie Ratliff, a social worker who supervises mental-health evaluations at Memorial Health System, says her staff of 18 evaluates more than 500 patients a month, with shifts every day, all day. About 220 of those need full evaluations and additional psychiatric services.
“We do see psychosis, all different types,” Ratliff said, “people in acute psychiatric crisis, some very violent patients, some who have attempted suicide and are now very calm.”
Ratliff says her department is among the state’s busiest because it handles patients regardless of their ability to pay. But once they’re stabilized, what happens next?
“There are just so few places to send people to be stabilized,” she said. “There are so many gaps in service, particularly if you don’t have insurance or are under-insured.”
Colorado Springs has three psychiatric hospitals: Peak View, AspenPointe and Cedar Springs. All three are nearly always full, and Peak View is the only one that accepts geriatric patients. The state runs two hospitals, but the bed count is low. The Springs only has access to 18 beds at the state-run mental health hospital in Pueblo.
“Mental-health needs are expensive,” Ratliff said. “But other communities manage much better than we do.”
That’s because other cities have set up a community health center model, and Colorado Springs doesn’t.
“We just don’t have the resources,” she said. “We need to have a continuum of care — a primary care doctor, a therapist and a psychiatrist. We need to treat the whole person.”
Instead, in Colorado Springs, primary doctors are left caring for seriously mentally ill patients, prescribing medicine and sending them to therapists. Most will never see a psychiatrist until they are at a crisis point. And then, they end up at Peak View or Cedar Springs. In some cases, they have to travel to Denver for help.
“We see people here from Goodland, Kansas,” Sanford said. “We’ve had them from as far away as Del Norte. This isn’t just a Colorado Springs problem. It’s a statewide problem.”
Mental-health services are easier to access for people with insurance, said Charlene Coffin, social worker at Penrose-St. Francis Health Services.
“But the state Legislature provides very little funding for treatment and care,” she said. “It’s inadequate for patients with no payer source. Really, access to care is very problematic for those patients.”
That lack of access leaves the city grappling with many problems that could be solved with the right treatments, said Lori Jarvis-Steinwert, executive director of the Colorado Springs chapter of the National Alliance on Mental Illness.
“Right now, they’re talking about panhandling downtown,” she said. “Do you know how many of those men are mentally ill? Statistics show that it’s about 80 percent. Dealing with access to care will cure the downtown problem.”
Transportation issues also exacerbate the problem. Since many people struggling with mental illness can’t drive and are on disability payments, they rely on buses to get them to the grocery store, to doctor visits, to therapists.
“Cuts in busing mean these people can’t get what they need,” she said. “They can’t get medicine, they can’t get care. It’s all connected. And it all leads to the problems we have in Colorado Springs.”
Jarvis-Steinwert is all too familiar with the problems accessing care, navigating a confusing system and trying to get help for someone in crisis. It’s why she joined NAMI and took on an advocacy and education role.
She has a child dealing with a mental illness. And that personal insight led to knowledge of a different sort of problem for people who confess their sickness to co-workers, bosses and friends.
“There is still just a stigma,” she said. “We occasionally ask people to talk about their struggles and their successes. And people are still too scared to do it. They’re worried about the backlash.”
NAMI’s mission is to erase that backlash, she said. The goal is to educate and support families and to advocate on their behalf.
“This is just a biochemical imbalance in the brain,” she said. “People with cancer don’t get blamed. People with mental illness shouldn’t either.”
The organization has been around since 1983, and was started by parents whose children were released from the state hospital. There was a movement in the 1980s to “de-institutionalize” those with mental illness because psychiatric medicine was considered strong enough to curb the strongest impulses, she said.
“Those parents were overwhelmed,” she said. “Their kids came home and they didn’t know what to do. They just released them from the hospital with no real plan how to teach them to function in the community. Parents didn’t know what resources were available, and they didn’t know how to access them.”
The over-reaching problem is that there’s no equity for mental health, said Nancy Braney, vice president for health services at AspenPointe, a nonprofit dedicated to providing both in-patient and out-patient help for people with mental illness and physical disabilities.
“I think of this as a national problem,” she said. “There’s not equality for mental health. It’s expensive, but everyone agrees that there’s not enough attention being paid to mental health.”
Today, there are few places for long-term psychiatric stays. State facilities house people who have committed crimes and are mentally ill, but that’s a different ward than most people go to. Mostly, patients spend about two or three weeks — at the most — at a facility.
“Our job isn’t to keep them here,” said Peak View CEO Gary Miller. “We see them when they’re in a crisis, and then we stabilize them. Give them medication, get them connected to other help once they leave.”
Peak View also sees people on an out-patient basis, providing psychiatric services to all ages of adults. Starting in January, it’ll open a child and adolescent wing to serve patients as young as 4 years old.
When finished, Peak View will have 92 beds, making it the area’s largest facility. It will also be the Springs’ only facility providing electro-convulsive therapy to patients who are suicidal or suffering from depression or bipolar disorder.
“It’s only available with the recommendation of two psychiatrists,” Miller said. “And it’s available on an outpatient basis. We believe this is a critical need — the two in Denver are the only two in the state — there’s a six-month waiting list. When you need a service like this, you can’t wait six months. That’s like waiting six months to have an appendectomy when you need one. These people need help now.”
The therapy works like this: people get anesthesia as they would for surgery, and the treatment stimulates the brain until it convulses. The brain then resets, and often, the chemical imbalance is erased.
Mental-health experts realize that there’s a serious problem with access, coordination of care and available resources.
That’s why all the local stakeholders — from AspenPointe to NAMI to local hospitals, city and state officials are meeting Oct. 5 for a summit. Penrose-St. Francis’ Coffin is positive it will result in changes for patients and providers.
“I think we’ll have so many more answers about how to fix the problem,” she said. “We’re coming up with subcommittees to work on issues that come up during the summit.”
They’re not stopping there. The group plans another summit next spring to gauge progress.
“We’re not leaving it to chance,” Miller said. “We’re going to come back and make sure it doesn’t get lost, that it’s not just another one of those discussion groups where nothing happens.”
Braney said the group hopes to bring attention to mental health, especially to state policy-makers.
“One in five adults will deal with some sort of mental illness in their lifetimes,” she said. “Finding ways to coordinate and use limited resources will help reach as many of those people in need as possible.”