By Amelia Stern
Behavioral health issues, especially anxiety, alcohol use, and substance use disorders, rose dramatically as a result of the COVID-19 pandemic, and experts predict the numbers will only continue to rise — specifically in the San Luis Valley, where there are serious barriers to accessing much needed mental health care services.
According to the most recently published Colorado Health Access Survey (CHAS) conducted by the Colorado Health Institute (CHI), more than 24 percent of residents living in Alamosa, Conejos, Costilla, Mineral, Rio Grande, and Saguache Counties reported poor mental health, but only 16 percent talked to a mental health care provider about their struggles.
“Where the most acute shortages are in the San Luis Valley are around emergency services,” says Emily Johnson, Director of Policy Analysis at the CHI. “There are no crisis walk-in centers, no emergency psychiatric services, and only one mobile crisis unit in Alamosa.”
There are few outpatient options either, with the San Luis Valley Behavioral Health Group catering to thousands of patients residing in an area larger than the state of Massachusetts. “We’re the only community mental health center in our region,” says Kate Jack, Director of Communications at the San Luis Valley Behavioral Health Group. “We have an 8,000 square mile service area which makes it difficult to reach all the different individuals scattered throughout,” she says.
But that’s not for lack of trying. According to Jack, if someone requires services but doesn’t have a vehicle, patients can rely on their transportation department to get to and from appointments. “We can even have our transportation office bring them an iPad to use for telehealth sessions,” she says. There’s also a mobile medication assisted treatment (MAT) unit, internally called the ‘mobile health on wheels,’ with a nurse, a peer-specialist, and a telehealth provider from Denver on board. “We park the unit at public service entities around the Valley that are more central to where people live. We try to meet client’s where they’re at and get them the services they need,” she says.
The San Luis Valley Behavioral Health Group lies in an area where a large number of individuals fall below the poverty line. “In Colorado, about 11 percent of the population falls below that poverty threshold but in the San Luis Valley, it’s 17 percent,” says Jack. “A large percentage of our patients are on Medicaid and we have a sliding scale fee so we don’t turn anyone away for lack of ability to pay.”
Yet even with solutions to transportation and cost barriers, Johnson reports that 11 percent of women, 16 percent of men, and 35 percent of young adults reported that they didn’t get mental health care in the San Luis Valley when they needed it.
“With Medicaid, it’s not necessarily hard to pay for care but it’s hard to find a doctor to give it to you,” says Johnson. “More than half of the people who reported they didn’t receive mental health care when they needed it said the reason was that they couldn’t get an appointment.”
Part of the problem stems from a lack of providers in the area, not just in number but in their diversity. “It’s really hard to get psychologists to move to rural areas,” says Johnson. “Not only are there not that many providers in the first place, but there’s a much lower chance you’ll find someone you have that rapport or shared identity with.”
Johnson points to peer-support specialists as an underutilized resource in rural areas that struggle to attract providers. “There’s an interesting project being done outside of the Valley called the Confess Project where barbers are trained in mental health first-aid. These people have long conversations with a lot of young men who tend to experience the most stigma around mental health. We can get a lot out of these non-licensed supports as well,” she says.
According to Johnson, some people may even feel more comfortable reaching out to these informal supports than to a licensed mental health professional. “For people who don’t get mental health services in the Valley, it’s more often stigma related concerns than it is about cost or other barriers,” says Johnson. “One way to get around these concerns is by going to your primary care provider. That way, people don’t have to worry about their car being recognized outside of certain mental health specific buildings,” she says. But according to Johnson, only one in five residents reported speaking to a primary care provider about their mental health in 2021.
The Behavioral Health Administration (BHA), a new cabinet within the Department of Human Services, was created last year to address some of these behavioral health challenges in Colorado. According to their website, implementation is underway and is expected to be a multi-year, phased project that includes ongoing partner and community engagement.
“We’re working closely with state representatives to make sure these legislative changes are continuing to meet and serve the unique needs of our patients,” says Jack. “Behavioral health is a community effort. It’s important to put the community back in community health centers,” she says.