Mental health workers in Colorado saw huge upticks in need for care. How are they adjusting? |

Mental health workers in Colorado saw huge upticks in need for care. How are they adjusting?

Peggy Sammons, director of the Craig Outpatient Program at Mind Springs Health, works in her office in Craig Wednesday.
Eliza Noe / Craig Press

Mask mandates have largely lifted. Lockdowns have ended. Vaccines are in broad distribution. While some would argue that the COVID-19 pandemic’s effect on physical health is trending in a positive direction, its impact on mental health is still a substantial concern in Colorado.

According to research from the Kaiser Family Foundation, during the pandemic, about four in 10 adults in the United States reported symptoms of anxiety or depressive disorder — up from one in ten adults who reported these symptoms from January to June 2019. In Colorado, 31% of adults reported symptoms of at least one of those disorders.

The Longevity Project to dig deeper on mental health

The Craig Press is holding an event titled The Longevity Project in which a panel and keynote speaker will address local and national mental health issues. The event is $10 to enter, Wednesday, September 22, from 11:30 a.m. to 1 p.m. Come learn more with us about this critical issue.

Moffat County is no exception

Jamie Fraipont-Daszkiewicz, advocate program and grants manager at Open Hearts Advocates, said that a large jump in need for mental health support has also been seen at Open Hearts Advocates. Between July 2020 and June 2021, clients in almost all categories of their care sky-rocketed.

Open Heart Advocates clients comparison
Type of client contactJuly 2020June 2021
Domestic violence151701
Sexual assault14177
Crime victim146215
Human trafficking11
Suicide attemptsData not available7
Homeless individuals/familiesData not available6
Nights of shelter59137

Fraipont-Daszkiewicz said that though this uptick is not solely because of stay-at-home orders or trauma from the pandemic (record-keeping practices were improved and community awareness of OHA’s services grew), case workers at the advocacy group saw more victimization during the last year and a half.

“Throughout this pandemic, we saw an increase in the severity and the frequency of victimization,” Fraipont-Daszkiewicz said. “We also saw a lot of people (in general). As it crossed over, the resiliency that people naturally have — the tools they have and the supports they have in place — became strained.”

Caseloads have been especially heavy for workers. When a normal caseload would typically be between seven and 10, advocates are now seeing numbers closer to 20 and above, and many are working overtime. When most of an organization’s funds are grant-based, “just hiring more people” is easier said than done, Fraipont-Daszkiewicz said.

“If you just started a grant that’s four years long, you don’t get to go back and be like, ‘Oh, hey. I need to hire four people. Give me more money.’ It doesn’t work that way,” she said.

Despite the fact that most mandates have been lifted and businesses and schools have reopened, Fraipont-Daszkiewicz added that it’s hard to know if things will ever go back to the levels that OHA saw before the pandemic.

“As things have been lifted, things aren’t the same, and they’re not going to be even lessened,” she said. “We stay very, very busy.”

Open Hearts Advocates continued in-person services throughout the pandemic, unlike many groups across the country that chose to operate only virtually, in order to serve clients in the best ways they could.

“It was interesting, as we thought we were going to see this a large uptick in the number of deaths by suicide, which we actually did not see,” Fraipont-Daszkiewicz said. “However, there was a large increase in suicide ideation and attempts, as well as a large increase in (overdose) deaths.”

According to state data, 12 people in Moffat County died by suicide in 2019 and 2020 (the most recent data available). That’s a couple more per year than the county saw over the previous 10 years, when four people per year died of suicide, on average. All 12 recent deaths were between the ages of 35-54, and eight of those, or two-thirds, were male. The 2019-2020 total is more than next-door Routt County, which has almost double the population.

But suicide isn’t the only harm caused by mental health concerns in the community.

As many as 90% of Open Hearts Advocates’ domestic violence caseload is substance-abuse related, Fraipont-Daszkiewicz said, and most of the time, that substance is alcohol. She said the group often sees substance abuse as a coping tool — especially during isolation. CDC data shows that March to May 2020 saw a large increase in overdoses, and according to the National Institute on Alcohol and Alcohol Abuse, feelings of social isolation can trigger depressive or other negative emotions that can push vulnerable alcohol consumers to abuse the substance.

Pandemic-related stressors aren’t the only concerns of mental health workers

“We realize that that is probably going to continue to increase, just because in Moffat County, we have other things going on besides COVID — (that will) affect and impact our community as a whole,” she said. “Those (substances) — due to lack of other tools and support in our area — are things that people have a tendency to gravitate toward.”

Because of the pandemic, OHA workers had to be creative to solidify long-term care for those who reached out for their services. With the world on pause for most of 2020 and part of 2021, remote mental health tools were key for many of those clients.

“We figure out telehealth providers for them — outside of ones locally,” Fraipont-Daszkiewicz said. “I’ve gotten people into different private companies that do mental health therapy online. We also work with people to create different support groups.”

This dramatic rise in cases has caused administrators at OHA to be mindful about the mental health of the case workers that keep OHA up and running. Fraipont-Daszkiewicz said self care for her staff has been one of her priorities as case numbers have risen across the board.

Working with difficult cases such as sexual abuse and domestic violence can take a toll on the emotional wellbeing of the staff, she said.

“(Self care) was just as much of a priority as our clients, and if we were doing these things for clients, we had to be doing them for ourselves,” Fraipont-Daszkiewicz said. “(We needed to be) checking in with people and working trying to find schedules and ways to give ourselves some time and ability to recover, which is hard to do when you’ve got everybody working 40, 50, 60-hour weeks.”

Elsewhere in the local industry, staffing levels are keeping up with the demand, though demand is increasing.

Providers at Mind Springs Health, which has provided services like therapy and counseling to western Colorado communities for almost 50 years, said they have also seen a rise in requests for services over the past 18 months, and it’s still going up. According to a spokesperson for Mind Springs, in the second quarter of 2021, the Craig office had an increase of 17% in clients seen over the same quarter in 2020.

Peggy Sammons, director of the Craig Outpatient Program for Mind Springs Health, said that while there has been a jump in clients asking for care, there is no waitlist to receive services, and staff members are not seeing oversized workloads.

“I don’t see a strain (on services),” Sammons said. “Of course, therapists need therapists, right? And we do take care of each other very well around here. Because we are fully staffed, a person could see a clinician one week and then our case manager, possibly.”

The increase in clients, Sammons said, is caused by various stressors over the past year, in addition to clients spreading the word about their services.

“I will say loss and grief issues (is what Mind Springs has seen the most), so many people lost loved ones over the last year and a half,” Sammons said. “We also saw a rise in co-occurring disorders and maladaptive coping strategies arise in substance abuse. Being under shelter-in-place, of course, causes depressive symptoms.”

Despite these trends, Sammons said the increased need for mental health services has been beneficial for de-stigmatizing the need for mental health services.

“I think others (involved in mental health services) helped say, ‘It’s just that simple. Let me help you make that call,’” Sammons said. “And our crisis workers are out in the community, also responding and helping others get services. I guess I’m hopeful that the stigma has decreased, so that people understand it’s just as important as your physical health and it should be treated together.”

Sammons added that though their office never closed or ceased in-person sessions, Zoom sessions were a popular option among clients. Within the Mind Springs network, there are over a dozen medical providers, and clients could come into the office to Zoom or speak with their doctor from home about medication management.

State officials are looking to ease the load

Elizabeth Owens, director of policy and communications at the Colorado Office of Behavioral Health (OBH), said that the use of telemental health services grew exponentially — from the service covering 1% of patients’ care to 61%.

“Certainly for the crisis line, we have seen a 37% increase in total volume since the pandemic,” Owens said. “We know that the crisis line is one area that has consistently seen a lot more volume.”

Owens added that, historically, there have been a lot of issues with the behavioral health systems. Improvements in recent years have helped — like Gov. Jared Polis’s Behavioral Health Taskforce, which formed in 2019. That taskforce produced a blueprint plan last September that outlined areas of reform within the behavioral health system within Colorado. As the taskforce was researching and putting together the blueprint, the COVID-19 pandemic arrived on the scene, “exposing some gaps and some opportunities” within the system, Owens said.

In that plan, the taskforce addresses complications in the behavioral health system — including access, affordability and administrative burden — and what potential solutions could be used to solve them. Owens said that the behavioral health system is often “incredibly confusing” to navigate especially when a patient has no prior knowledge or experience in getting mental health services.

“People just don’t know how to access behavioral health services in our state,” she said. “There are multiple different agencies that have some sort of purview over behavioral health. So it’s hard to understand how you access behavioral health services, and especially now (because) there’s private insurance, Medicaid (and) our office pays for some services.”

Preliminary data from OBH suggests that mental health services have increased between state fiscal year 2020 and state fiscal year 2021, as well as during the pandemic. There were 2,003,681 services reported to OBH in 2021 compared to 1,971,074 in 2020. Average monthly visits also ticked up during the pandemic: 165,178 between July 2019 and February 2020 compared to 165,833 between March 2020 and June 2021.

When it comes to affordability, long-term care can create issues for lower income patients. Owens said that the Office of Behavioral Health is working toward creating dialogue between clients and providers, similar to getting consumer feedback.

Federal dollars will (hopefully) reform the way Coloradans get help

“There were a lot of gaps in the system beforehand,” she said. “We knew that we had a lot of work to do to help people get services. Fortunately, we had a lot of great planning in our state — like Gov. Polis has directed resources toward this — and then through the stimulus dollars, we have more of an opportunity here to access it.”

Despite varying accounts of the level of strain in Craig, specifically, Owens said there has been a large strain on providers across Colorado as a whole, making workloads heavier for individual therapists, social workers and mental health care workers. She said even before the pandemic, this was an issue.

“(One issue was) not having enough behavioral providers and then also about having behavioral providers with the right kind of training,” Owens said. “For example, if you’re a person of color and you need specific therapy, your provider should be able to focus on racial trauma.”

To help ease the stresses of accessing long term care, Owens said the state of Colorado is spending $26 million on “care coordination,” which is intended to centralize infrastructure and create a single point of entry for those looking for care. Essentially, it’s a system that says to Coloradans, “If you need care, this is where you start.”

In addition to the $26 million going toward care coordination, another $18 million will go toward supporting the workforce of behavioral health providers — specifically to help people get into behavioral health careers like tuition incentives and online training, Owens said.

“It’s a difficult job to begin with, and certainly with the pandemic, most people are struggling or someone in their family is struggling right now, just because it’s been a horrible year and a half, so, that’s a lot of strain on clinicians,” she added. “I also think pay is something that we hear consistently as an issue, making sure that providers are adequately funded.”

Despite the current strain and gaps within the system, Owens said there have been some statewide plans that will work to help remedy some of these system-wide issues. She said by July of 2022, the state will have a Behavioral Health Administration.

“The money that we received so far from federal stimulus is helping us more quickly advance the goals through the Behavioral Health Administration and building a system where our goal is that all people can get services whenever they need,” Owens said. “There’s a lot of work to do.”

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