By Allison Perry | Telluride
An Uphill Battle to Educate, Prevent and Treat Those Mental Health IssuesA ctor Robin Williams’ tragic and shocking suicide this year continues to have an impact. Because Williams was such a beloved public figure, his desperate final act forced many states, towns and individuals to put more focus on mental health and substance abuse issues, and to take a deeper look not only at causes, but at whether education, prevention and treatment methods are sufficiently available all over the country.
Here in western Colorado, San Miguel, Ouray and Montrose counties are not experiencing higher than usual numbers of people afflicted with behavioral health problems, but the region still faces many challenges in continuing to make progress. Mental health professionals in the area believe challenges can only be conquered with a bigger emphasis on making resources more available, increasing awareness, expanding treatment options, and focusing on prevention education – especially for teens and children.
HAND IN HAND: MENTAL HEALTH AND SUBSTANCE ABUSE
According to information provided by the Montrose Center for Mental Health, “At one time or another across the years of a lifetime, we all have something in common with Robin Williams. We all experience some form of depression whether it is just for a few hours, a few months, or perhaps for years. Most people with depression experience a lesser quality of life, many people with depression have problems with relationships and employment, and sadly many consider suicide.”
Ed Hagins, deputy director of the Montrose Center for Mental Health (MCMH), says one in four people nationally will confront a behavioral health problem during their life span, although this number can drop to one in five in any given year.
Within MCMH’s six county region, that rate remains consistent.
Indeed, many people do and will experience symptoms, bouts, or full blown incidents of mental illness, no matter the severity, each person will choose to deal with their feelings differently. Some will seek medical care, some will seek therapy and some will turn to substances ranging from legal forms like pot and alcohol, to more dangerous forms such as cocaine, prescription painkillers, benzodiazapenes or methamphetamine.
Director of Emergency Service at Telluride Medical Center, Diana Koelliker, believes there is a very clear association between substance abuse and mental health issues, and has she directly witnessed problems stemming from this hand-in-hand relationship in Telluride’s rural setting.
“We have definitely seen a high proportion of our transient population with both mental health issues as well as substance abuse issues,” Koelliker says, “and sometimes this combination lands them in the ER or, more often, in the hands of law enforcement.”
Despite the fact Telluride is one of only a few in the region that has approved retail marijuana shops on its streets, Hagins says substance abuse problems are not unique to Telluride. While he recognizes that pot culture has certainly become a big aspect of the Telluride lifestyle, also playing an instrumental role in how the town makes a living, Hagins says, “In Montrose we don’t have [marijuana] in the city, but it is still legal in the state, and we have all had to adjust to this, especially as treatment providers.”
Carol Friedrich, former Montrose County deputy director of Health and Human Services (who will also take over as Director of Social Services when Gerstle retires at the end of this year) has learned from her experiences that “Often, people who have mental health issues use substances to self medicate and to feel better. Instead of seeking treatment they use the more easily accessible substances, which treat the symptoms, but not the underlying cause.”
According to an online National Alliance on Mental Illness article on Dual Diagnoses, “Certain groups of people of people with mental illness (e.g. males, individuals of lower socioeconomic status, military veterans, people with more general medical illnesses) are at increased risk of abusing drugs…stimulants, and alcohol. Recent scientific studies have suggested nearly one third of people with all mental illnesses…experience substance abuse.”
Furthermore, the article finds that in addition to self-medication, substance abuse can also worsen an underlying mental illness, and, perhaps most troubling, can cause a person without mental illness to experience the onset of symptoms and in some scenarios, psychosis.
Gerstle and Friedrich both fear children can be severely affected by this worsening scenario.
“Kids are getting mixed messages,” says Gerstle, whose job requires him to work with people of all ages, including families. “And as far as children go, I think it’s important to delay experimentation as long as possible.”
While Gerstle emphasizes that alcohol and prescription drugs cause just as many, if not more health and social problems for the community than marijuana does, he believes that because kids are still developing physically and emotionally until they are 21, it is important to educate them about weed and all substance abuse while they are young, bringing to the forefront the fact that “Telluride life” is not real life.
“We live in a fairy land of substance use,” he says. “People come here to party and that’s what our kids see. I hope we see more government discussions about the mental health of our community and I hope that discussion will continue and strengthen so that we can bring some reality to the party atmosphere.”
Hagins possesses the same concerns for Montrose and Montrose County, where, although pot is not sold in retail shops, not enough education or awareness efforts have been devoted to making children better able to make healthy decisions about it.
WHERE ARE WE NOW?
The trifecta of addressing mental health and substance abuse is education, prevention and treatment, and while the region has been making leaps toward fulfilling each of these, there are shortcomings in all three that make it more difficult to combat the problem.
Both MCMH and the social services offices it operates in Norwood and Telluride offer services for both substance abuse and mental health issues, including referrals for treatment, facilitating placement, providing financial assistance and helping clients maintain a plan for when they have to wait for a bed in a long term care facility.
“We have a relationship with regional hospitals,” Hagins says, “and we are working with them on having respite rooms available for when people might not need hospitalization, or can’t get a bed at a hospital, but need somewhere to stay and some help with mental health professionals before they are released to their families or on their on recognizance.”
The problem, however, part of which is due to the nature of living in a remote region, is that all of the services a patient might need are not available in each town, and for those who need medical detox, long-term residential care, or rehab, Grand Junction or Durango are the closest places.
Additionally, both Hagins and Gerstle are in agreement that there is a lack of psychiatrists in the region.
“There is a psychiatrist in Telluride once a month,” Hagins says, and in Norwood twice a month, who are available for consult on an as-needed basis.” Hagins also noted that finding masters level behavioral health professionals has also been a challenge.
“It is a lot of work to sell people on moving to Western Colorado,” he says.
In addition, keeping up with insurance exchanges and Medicaid expansion has been difficult. “If you are looking for ‘regular’ treatment we have our bases covered pretty well,” Hagins says, “but specialty services, such as EDMR and modality, for example, may not be available here.”
Add to that the fact that obtaining certain services only provided by a bigger hospital or more equipped facility might require driving for one or two hours. Obtaining help might not be so easy in this region.
Part of the problem is funding.
“Colorado is at the bottom of the states for federal funding,” Gerstle said. “Not the very bottom, but in the lower portion.”
Despite being at the back of the line for federal money, in 2012 Colorado Gov. John Hickenlooper was able to secure almost $20 million in 2012 as part of his “Strengthening Colorado’s Mental Health System: A Plan to Safeguard All Coloradans” project, which has already been helpful in making changes.
According to Hagins, money from the program has already been used for a statewide hotline, which, in addition to the local hotline MCMH operates, will provide another mechanism by which people in acute and more long-term distress can seek help whenever they need it. Some of the money will also be used to provide more transport to and from care facilities that does not involve law enforcement, as it has historically.
Friedrich explains that MCMH has operated a local crisis hotline for quite some time, and both hotlines have different lines for those suffering from acute symptoms, such as feeling imminently suicidal, and those who need someone to talk to in less volatile situations. Staff who operate the emergency lines are not only trained in diffusing the situation, but can also dispatch mobile crisis teams when necessary.
Friedrich also mentioned the Coalition For Drug Free Montrose County, which includes an awareness and prevention committee, is attempting to bring awareness to the interplay between substance abuse and mental health issues in creating social problems, and to resources and outlets people can use when they need to reach out for help.
Although Friedrich supports the coalition’s objectives, she is unsure of whether an abstinence model is the best approach, and says that in the context of the state legalizing certain drugs, it is hard to strike the best balance for keeping people safe.
Hagins echoes her concerns.
“Harm reduction [rather than abstinence] is the best approach. It is tough because a lot of parents was abstinence, but if you want to turn a teenager off as quickly as possible, just mention abstinence. We know well enough now that this model doesn’t work. Parents need to connect with their kids, by approaching them with material that’s relevant.”
Gerstle is also in favor of harm reduction models, particularly in Telluride.
“I think the town of Telluride, and the county has the opportunity here to really become a model for an education, prevention and treatment plan” he says.”
Hagins, Gerstle and Friedrich are all in agreement that in order to continue to make progress in effectively addressing mental health and substance abuse issues, education, prevention and treatment must all go hand-in-hand, and that no one particular aspect is markedly more crucial than the others.
Although there is no crystal ball to gaze into, one big development that could shoulder some of the burden of treating and caring for mentally ill patients is the new medical center which will be built in Mountain Village in the next five years. At a public site selection forum hosted in Telluride this past August, Telluride Hospital Board Director Larry Mallard indicated that a mental health unit would be included in the new medical center.
If this happens, it would both increase available services in the area, and also potentially attract more sorely needed mental health professionals to the area.
Gerstle and Hagins noted the need for more psychiatrists in the area, a need Hagins plans on continuing to address. “We are actively pursuing psychiatric professionals,” he says. “And are continuing to hire to keep up with current needs.
“I’d rather be in a position to hire more people than turn people away.”
Hagins also notes that some of the money from Hickenlooper’s 2012 emergency services contract will be used to increase 24-hour, 7-day-a-week crisis response service in the state, and the region, some of which work in conjunction with the hotlines.
Friedrich believes that addressing the under-utilization of services, in particular the hotlines, by making people aware of the all the resources at their disposal and encouraging use of those resources would make a profound impact on getting people the help they need and too often do not know how to ask for, or how to obtain.
Gerstle was more focused on education when it came to future mental health care needs. “We need more prevention education, and the more research-based programs we have the better.”
While Gerstle believes prevention starts at home, he also stresses that the community in Telluride has to do a better job of facilitating prevention education, given the partying culture children are exposed to on a daily basis.
“Sometimes I think we stick our heads in the ground about some of the problems we create while we go about our work making this a resort town,” he says.
Hagins also emphasized a community role in education and prevention.
“It’s on Montrose’s radar to do more programs on substance use and awareness,” he says. “With a focus on pot use. We have grant money being made available for more education.
“Regardless of which approach is taken, whether it is harm reduction or abstinence all health care is a local issue, so we need to approach prevention with our children as a community issue. As a community we need to do more.”