About 13% of Mesa County residents who need mental health care don’t receive it, according to the 2023 Colorado Health Access Survey.
About half of respondents said the cost of treatment was a barrier to seeking treatment, while nearly 75% said not being able to get an appointment was a barrier to seeking treatment.
Similarly, Mesa County has been designated an area with a severe shortage of health care professionals for nearly two decades.
“Even those in the field don’t know where to start,” says Hari Nurnberg, a therapist and executive director of the Counseling and Education Center. “If I don’t know, it’s no wonder other people don’t know either.”
She added that the shortage of mental health professionals not only means a significant number of people don’t get the care they need, but it can also affect the outcomes of those who do receive treatment.
“We need more options so people can choose. Right now it’s like, ‘Oh, you got a reservation, lucky you, great, keep it,’ and what happens if you don’t like it? Are there options so you can shop around?”
Nurnberg said many people who want to become counselors or social workers lack the financial resources to get all the necessary education — high school, bachelor’s degree, master’s degree and clinical training — and that a lack of supervision, especially among social workers, makes it difficult to complete clinical training.
Nurnberg added that while online therapy services have been helpful for some and a big force in reducing the stigma around mental health, they have also exacerbated the staffing shortage. She said it’s becoming harder for physical providers to compete with the ability to work virtually and customize their caseloads while still receiving a full salary with benefits.
In theory, these online services could make therapy more accessible to a wider range of people, but Nurnberg said that’s not always the case in reality.
“A lot of these programs don’t work well with high-risk populations, like people who are suicidal or who have complicated home situations,” Nurnberg said. “Some work well, but a lot of them don’t serve those populations, so we end up with fewer clinicians to help our communities and truly invest in our communities.”
Aside from a shortage of general medical providers, there are few choices between outpatient and inpatient care/hospitalization. Having an intermediate option provides more options, especially for people who need the comprehensive services offered in hospitalization but cannot or do not want to give up work and other life responsibilities for an extended period of time.
One example is intensive outpatient placements (IOPs), which are daytime treatment programs that allow patients to return home in the evening. IOPs and similar models typically offer case managers, medication providers, peer support, and extensive therapy (much like inpatient treatment), but allow patients to become more independent and connect with the outside world.
Solutions and Initiatives
A partnership between local mental health office Foundations for Families and online therapy service Charlie Health means teens and young adults can now access a virtual intensive outpatient therapy program in an accessible, confidential and safe environment.
Aaron Jimenez, co-owner of Foundations for Families, said programs like Charlie Health’s IOP allow local people to get the mental health treatment they need without having to wait months for a therapy appointment or end up hospitalized. Jimenez added that having options is especially beneficial for young people, because they’re more vulnerable.
“As a parent, I understand the sentiment of, ‘Well, this is the only option. If I wait six months, someone might make a terrible decision based on their mental state, their hormones, their emotions at the time, so maybe hospitalization is the best option,'” Jimenez said. “Of course, that comes with a lifetime of stigma and a lifetime of bad experiences for the child.”
But Jimenez said because IOP is virtual, there’s no guarantee that youth who use it will be able to fully participate in a safe and confidential environment. He added that the virtual aspect of the program makes it harder to ensure clients are physically showing up and engaging with the mental health services they need.
In response, Foundations for Family partnered with Charlie Health to provide a space for adolescent clients to talk freely and privately while ensuring engagement and safety through case manager supervision (from a separate area). If transportation is a barrier, clients can also ask the program’s case manager to provide transportation to and from the IOP.
Other initiatives focus on addressing the shortage of mental health professionals, like CEC’s Internship and Supervision Program, which provides students pursuing a master’s degree in counseling or social work with an internship required for their degree, as well as the opportunity to complete post-graduate supervised practicum hours.
CEC currently has four supervisors who supervise and monitor up to 16 interns and trainees at a time. Upon completing the program and their supervised hours, trainees are eligible to work as counselors or social workers depending on their academic track. They are also eligible for student loan forgiveness through the Colorado Health Services Corporation and Public Service Loan Forgiveness Act if they continue working for CEC.
Nurnberg said that while it will take years, bringing in more licensed therapists and social workers could have a noticeable impact on the shortage of service providers and supervisors. Meanwhile, service providers are increasingly hiring peer support workers to fill staffing gaps.
The Colorado Department of Healthcare Financing and Policy defines peer support as individuals who use their experiences to provide empathy and practical solutions to patients. These individuals can also work in addiction recovery if they obtain certain certification, but otherwise only need a high school diploma or GED.
Nurnberg said Colorado has seen a recent surge in paraprofessional jobs as the state’s Medicaid system began reimbursing providers for services, which could ease staffing costs and the burden of recruiting more highly educated workers.
Nurnberg said there is a lot of pessimism about closing the mental health care shortage both nationally and locally, but that everyone can contribute to the effort by supporting the CEC and similar resources.
“Some people want to help but don’t know if they can. We think mental health is too big an issue, but there are agencies, communities and people in this region that are working on it,” Nurnberg said. “Supporting those agencies and those people is how we solve part of the mental health crisis in our community.”
“Everyone has the power to affect this change.”
Financial assistance
The main factor preventing local people from getting the mental health care they need was lack of access to services, with nearly half of respondents citing cost as a reason. Some programs may be able to help with the costs of mental health care, especially for young people. Eligibility is not guaranteed. EAP: Employee assistance programs are an increasingly common employer-sponsored benefit. They typically provide employees with short-term mental health counseling and referrals if further mental health care is needed. According to the International Association of Employee Assistance Professionals, more than 97% of large U.S. companies (5,000+ employees) offer EAPs even if their employees don’t have company health insurance. Conversely, on average, less than 10% of these employees take advantage of the programs. “I Matter” Program: Through the state-run initiative, Colorado students under the age of 18 (or under 21 if receiving special education services) can receive up to six free therapy sessions and be put in touch with a case manager if they need additional care. According to the program’s website, signing up online takes just 10 minutes and no insurance or other paperwork is required. Second Wind Foundation: This non-profit program connects young people 19 and under with licensed therapists who meet their specific needs and offers 12-20 free sessions to approved applicants. Applications can be made online through a referral. Referrals must be made by the young person themselves, a parent/guardian, or a youth mental health professional. Victim Compensation Fund: State programs may help with the cost of mental health services and many other costs directly related to crime. Funds generally assist victims of crimes that have resulted in death or physical, mental, or emotional injury. Eligibility depends on several prerequisites and factors, such as the crime being officially reported or supported by a forensic examination. Applications must be made through the district where the crime occurred. For more information, visit the Colorado Department of Criminal Justice Office of Victim Programs website. {related_content_uuid}4669a343-f1f1-4fa4-816f-7104c125143c{/related_content_uuid}
