For Emma Harmon, it was the six-week wait for an appointment. For Kyra Bass, it was her therapist moving away. And for Layla, who asked that her last name be kept private, it was learning to keep feelings quiet.
The barriers to mental health care in rural Colorado have existed for years, but access has become even more urgent as demand for services rises during the coronavirus pandemic. La Plata County’s main mental health service provider, Axis Health System, says it has programs ready to meet people’s needs.
But some patients and providers are concerned.
“Our health care system is flawed. A lot of people don’t seek treatment because they can’t afford it,” said Bass, a nurse in La Plata County. “People get discouraged and don’t even bother.”
Statewide, about 38% of adults reported symptoms of anxiety or depressive disorder in October, according to the Kaiser Family Foundation. About 28% of adults who reported symptoms had an unmet need for counseling. In 2017 and 2018, 21.5% of adults reported a mental illness, the foundation said.
In Southwest Colorado, Axis Health said crisis calls have increased from January to October 2020, and outpatient behavioral health services have seen more demand.
Barriers to care can often be unique in rural areas, said Michelle Mills, CEO of the Colorado Rural Health Center.
Statewide, health institutions might be underfunded, and stigma is “alive and well,” Mills said. It can be difficult to find a provider that takes the right insurance – or find a nearby provider at all.
“It’s just really hard to have all the right specialties that we need out in rural communities readily available for people. That’s a big issue,” Mills said.
In La Plata County, there are no inpatient mental health beds for minors – which means they must travel to Grand Junction or the Front Range, she said.
“It would be great if the state could put some more money toward that. Of course, we’re facing budget issues at the state level,” Mills said. “Our country, in general, needs to figure out a way that we can connect the head to the body in terms of care.”
When Harmon of Durango was suicidal in 2018, she knew she needed to seek care – fast. But her intake appointment at Axis Health System was six weeks away; therapy, 10 weeks.
She was critical of Axis. Once she got into care, it wasn’t what she needed – health professionals with checklists rather than person-centered care, she said. The care available, specifically the type of therapy available and having appointments every other week, didn’t fit her needs.
“I don’t think anyone there wants to harm anyone, but they are, and they harmed me,” Harmon said.
In 2018, Axis Health had a provider shortage, which has been resolved, said spokesperson Haley Leonard-Saunders.
Leonard-Saunders could not provide current average wait times because they vary depending on a person’s insurance and provider wait time, she said. Sometimes, people can see someone the same day, or in 10 days, she said.
In an email to Harmon, another spokesperson said it can take two to four weeks to schedule a nonemergency mental health appointment.
Concerned that people would be deterred from seeking care because of barriers, Leonard-Saunders urged people to call anytime. For emergency help, people can call the 24/7 Axis Care Hotline. A clinician will answer during business hours, and there can be a 15-minute delay after-hours.
“We completely understand that waiting for your appointment can be really difficult, especially when you’ve made a decision to seek behavioral health care,” said Stacie Russell, chief behavioral health officer. “That’s why we want to make sure you know that there are options.”
For Harmon, a new job and better insurance allowed her to seek care with a private therapist.
“It was when I got my work insurance when my life really turned around,” she said.
Layla, a Durango resident, grew up being told not to talk about her feelings. When she started private therapy in 2019, it was hard to build trust – it took her three months just to tell her therapist the main reason she was seeking treatment.
“I feel like I’m one of the fortunate ones who was able to access a good therapist and get some of the help that I needed,” Layla said.
But Layla changed jobs – and insurance providers – in early December, which threw a curveball into her therapy, she said. She had finally found a therapist she liked and trusted, but what if her new insurance wasn’t accepted? Without insurance, each appointment could cost more than $100.
“If they do take it, it’s going to be a big sigh of relief,” Layla said.
If not, she said she’d have to start over.
When Bass moved to Durango in 2019, her primary care referral took two months to reach Axis Health and an additional month for Axis to contact her.
“We need to not take so long. People take a while to finally admit they need help because mental health has such a stigma, still,” Bass said. “People won’t seek treatment until they’re really bad, then it’s three months until they can see someone. That’s not OK.”
When she did start therapy at Axis, it was going well. Then her therapist moved. The only other provider that matched her insurance wasn’t a great match for her.
“It’s hard, when you’re creating this bond with a person, to have to start over,” she said.
In October, she was suicidal and without professional support. She didn’t feel comfortable reaching out to her second therapist at Axis, and she didn’t know of many other community resources because she was new in town.
She was in crisis, and fortunately, she said, someone close to her knew the right numbers to call.
“Not everybody has that,” Bass said. “I want people to understand that lack of resources in the community leads to crisis.”
Now, she is seeing a therapist at Mercy Family Medicine. She urged people who are seeking care to keep looking, even beyond recommendations from primary care providers.
“Advocate for yourself – which I know is hard when you’re in a mental health crisis to advocate for yourself,” Bass said.
La Plata County organizations have launched campaigns encouraging people to seek help when they needed it and collaborations to start new programs in recent years after high youth suicide rates shocked the community.
Axis Health, which has served one in 10 people living in Southwest Colorado, is ready to accept new patients, including minors. It started offering telehealth appointments in response to pandemic-related public health measures. It even hired technology support staff to help people access teletherapy.
During the pandemic, it offered free support, like a community counseling assistance program and a parent and caregiver support group. It also increased access to medical and mental health support for Fort Lewis College students.
Harmon helped launch a support group for survivors of suicide attempts. Other groups, like Celebrating Healthy Communities and Rainbow Youth, raise awareness about support resources.
Based on her experiences, Harmon said therapist turnover needed to be addressed. Bass focused on making sure resource lists are easy to find so people know their options. Layla encouraged people to ask for recommendations.
Layla said stigma almost stopped her from seeking treatment. Her advice to others: “Never give up. And don’t let what other people might think of you stop you.”
smullane@durangoherald.com
How to find support
Community groups, providers and others offer a variety of resources to for those seeking help.
Community Counseling Assistance Program:
This Axis Health System Program connects people affected by the COVID-19 pandemic to resources, services and support. Call (970) 828-6004.
Free Virtual SMART Recovery:
This group, facilitated by Axis Health, is open to all ages and will meet virtually at 10 a.m. Mondays and 1 p.m. Tuesdays. Contact Axis Health for Zoom login details.
Emergency resources
24/7 Axis Care Hotline:
247-5245.
Colorado Crisis Services:
(844) 493-8255 or text TALK to 38255.
National Suicide Prevention Lifeline:
(800) 273-8255.
Nacional de Prevención del Suicidio:
(888) 628-9454
Options For Deaf and Hard of Hearing:
(800) 799-4889.
Veterans Crisis Line:
(800) 273-8255.
Crisis support for LGBTQ youth:
(866) 488-7386.
Non-emergency resources
Let’s Talk:
Heartbeat Survivor Group:
https://www.heartbeatsurvivorsaftersuicide.org/
Second Wind Fund:
