Mental health – lots of problems, but not solutions

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When a group of mental health care providers got together last October, they started a process that will take years: identifying and solving the mental health crisis in Colorado Springs.

But now, the collaboration put together by Pikes Peak Community Health Partnership has the chance to get an infusion of cash from the state to address some pressing needs.

The ad-hoc group, divided into four committees, spent the past nine months exploring ways to divert mental health patients from the emergency room, improve access to care for people without insurance, enhance workforce development and navigate the complex mental health system.

What they found: Identifying the system’s endemic problems is one thing; fixing them is something entirely different.

Report after report highlighted specific areas where work, coordination and money are needed to fix the problems.

The overarching problem remains the same: Suicide rates and substance abuse are higher in El Paso County than in the rest of Colorado and higher than the national average – much higher.

“And this is not the place we want to be the highest,” said Dr. Sara Qualls, director of the UCCS gerontology center and one of the leaders of the effort. “The problem is particularly bad with teenagers, and the suicide rates among veterans is growing, even though there are many interventions for veterans.”

The state is providing a necessary boost, thanks to $20 million from the 2013 Legislature to create mobile crisis centers, shelters and hotlines to help people who need to access mental health services in places other than the emergency room. Local agencies are preparing to respond to the request-for-proposals to receive much-needed money for mental health programs in the Pikes Peak region.

More problems, fewer answers

Despite nine months of meetings, phone calls and surveys, the mental health community just now realizes the scope of work that needs to be done.

“I’m astonished by how little we know,” Qualls said. “We need to know how big the problem is, define the scope of the problem. And the lack of data is significant.”

The good news is that the first steps have been taken. The committees discussed ways to educate people on how to navigate the system, for instance.

“Basically, there’s a lot of fragmentation,” said Brenda Heimbach with Rocky Mountain Health Care Services, who served as chairwoman of one of the committees.

“People doing the same thing: the fire department, the police department, nonprofit organizations, hospitals. There are a plethora of services, but you need a secret decoder ring to navigate it. Not one group has a list — there are directors for just about everything, but nothing really comprehensive.”

Heimbach’s task force was charged with easing the process for people who need mental health services, whether they have insurance or not. The committee, wanting to narrow the large funnel of information into a relevant stream, found an answer in the Mental Health America website, www.mentalhealthamerica.net/go/help.

“We find that many people have other issues — social service issues — that are complicated by mental health problems,” she said. “We think they can call 211 (United Way’s hotline) for social services and use this website to find help.”

The website provides sliding-scale and pro bono help for people who don’t have insurance.

Larger problems remain: uninsured

And while one committee found a one-stop website, Brian DeSanti of Peak Vista Community Health Clinics said the committee had a bigger problem: how to address the needs of the uninsured. “We all struggle with this every day,” he said. “It was impossible to get our arms around a problem this large. It’s just an enormous task.”

So the group of five chose to take a stab at a single part of the problem: access to providers who can also prescribe medicine. Their first thought was that some providers – not necessarily psychiatrists – could provide pro-bono help to people who couldn’t afford insurance.

They ran into concerns. One provider said the need was too great, and doctors and nurses would be overwhelmed with requests. Others wondered about compliance issues and raised concerns about liability with malpractice insurance.

“Many providers liked the idea of providing pro bono services off-site,” DeSanti said. “But we still ran into issues of patient compliance. If we paired a talk therapist with every pro bono client, that might increase the patient’s compliance in taking medicine.”

Basically, the committee discovered too many barriers to move forward.

“It’s not bright news,” he said. “There’s just too much supply and demand. The issue is too big and the shortage is just huge.”

But if the access problem seemed insurmountable, the workforce development piece proved even more difficult to solve.

“Are there major gaps now?” asked Qualls. “Future gaps? What do we need to grow the workforce? There is just an absence of a universal view, and a local workforce survey failed epically. We know there’s a looming problem, but we don’t know how big it’s going to be.”

Qualls said more people were accessing mental health services as successful therapies are tried and as the stigma of mental health disease dissipates nationwide.

“We know that a significant number of local psychiatrists are retiring,” she said. “We know the training pipeline is inadequate for mental health. We know there aren’t enough teachers, so there aren’t enough slots.”

And there’s no way for nurses or other health care practitioners to retrain to cover the shortfalls.

“For instance, if I decided I wanted to dedicate the rest of my career to substance abuse care, I would have to go back to school and start over,” said Qualls, one of the nation’s foremost geriatric experts. “It’d be starting over at Day 1, and I’d have to go at least a year with no salary.”

Bright spot

One of the committees might have some much-needed help from the state in developing ways to keep mental health patients out of the emergency room, where they typically spend three-and-a-half days because there’s no other place to send them until they are stabilized.

The task force, headed by Fred Michel of AspenPointe, suggested a regional hotline for emergencies, a mobile crisis unit that would go to the patients instead of taking them to the emergency department, and a “mental health” shelter that would provide not only a place to stay, but therapeutic help as well.

The state has asked for grant proposals to fill the mental-health gaps. Proposals are due in five weeks, which leaves little time for providers to collaborate on the application. They’ll also have to reach out to behavioral health groups in Pueblo and Trinidad, because the Springs has been included in a geographic area that covers most of Southern Colorado.

“It’s going to be challenging,” said Kelly Phillips-Henry, COO at AspenPointe. “We have real funding issues in Colorado – and this isn’t going to be any different. It’s not enough money to do everything we want to do, everything we need to do.

“This is not going to be a cheap investment, and we’ll have to start the conversations with partners across the city to get this in place. We know there are groups that are interested in solving these problems, so we’ll be talking to them.”

One in five

The number of people who report having a poor mental health episode in the past seven days.

$317.6 billion

The amount spent every year on mental health in the United States.

8.2 percent

The percentage of El Paso County residents who suffer from major depression.

7 percent

The percentage of Colorado residents who suffer from major depression.

Suicide

Completion rate is higher in older adults, attempt rate is higher in teenagers.

More women than men attempt suicide; more males complete suicide.

Military veteran suicide rate: 50.5 suicides for every 100,000 veterans.

Colorado has the sixth-highest suicide rate, 40 percent higher than the national average.

(Source: Pikes Peak Community Health Partnership)