Former workers describe a long practice by the Grand Junction-based Mind Springs Health of intentionally writing bogus patient evaluations. The three departments tasked with regulating Colorado’s mental health safety net system failed to notice the allegedly falsified reports during a recent multi-agency audit of the center, and over years of lax oversight.

“You’ve got to wonder how closely these so-called regulatory agencies are really looking,” said Sunny Sullivan, one of 29 current and former Mind Springs workers who came forward to tell the Colorado News Collaborative (COLab) what they see as legal and ethical breaches.

State officials say they offer considerable leeway in how forms are filled out, but Sullivan and five other former workers say their supervisors had them and their colleagues fill out mental health assessments of patients they knew little or nothing about and hadn’t actually evaluated. The whistleblowers, who were not trained in behavioral health care and had no clinical licenses or experience at the time they worked for Mind Springs, say their bosses also told them to:

• Make up diagnoses for patients to justify treating them
• Diagnose certain patients with disorders they did not have in order to qualify them for costly, Medicaid-funded treatment they did not need
• Show progress among all patients they were assigned to assess – including those whose symptoms had not actually improved – because state funding for the center hinged partly on the success of its treatment

Mind Springs’ longtime CEO Sharon Raggio and two of its other top executives resigned following a Colorado News Collaborative investigation about access to and quality of the center’s care. Interim CEO Doug Pattison and the center’s spokeswoman had not returned multiple emails and phone calls over several months about these latest allegations before the deadline for this story.

The former workers’ accounts span from 2012 to 2021, suggesting that falsifying records wasn’t merely a one-off or occasional mistake.

“I’m no legal expert, but I’m pretty sure what we were doing was fraud,” says former case manager Amy Jensen, who estimates she took part in doctoring at least 1,000 patient assessments between 2014 and 2018.��“I’ve wondered how long it could go on without anyone at the state bothering to do something about it.”

Mind Springs is one of 17 regional community mental health centers statewide that have long made up the core of Colorado’s safety-net system, serving people in 10 Western Slope counties.

The Behavioral Health Office long has required the centers and other mental health care providers complete evaluations called Colorado Client Assessment Records, or CCARs for short, for each person receiving Medicaid or other publicly funded care. One CCAR must be filled out upon intake for treatment and another when treatment has ended. Care providers must submit additional CCARs for clients in long-term therapy and for psychiatric patients who are medicated or hospitalized long-term.

From a policy perspective, the evaluations help state agencies track who’s getting state and federally funded mental health treatment and the extent to which it����ap helping. The state also uses aggregated data from the reports to inform lawmakers about the efficacy of Colorado’s overall mental health safety-net system. The clarity of that picture depends on the accuracy – and truth –��of the information providers like Mind Springs submit.

From a clinical standpoint, the mere mention of a CCAR form can trigger groans among care practitioners who often complain the assessment and other mandatory state paperwork take too long to complete. Because the need for publicly funded mental health care services far exceeds the number of clinicians available, the people most familiar with patients’ cases and who are most qualified to assess them often are slow to fill out the reports. That leaves backlogs of CCARs that need to be completed and submitted to the state in order for a provider to get paid.

At Mind Springs, whistleblowers say they were typically asked to fill out the CCAR after the patient was long gone from treatment or discharged from Mind Springs’ psychiatric hospital. And so they typically filled in clients’ diagnoses blindly, often guessing they had conditions such as general anxiety disorder, major depressive disorder, or schizoaffective disorder. Sullivan – then a team leader in the hospital admissions office – says her supervisor told her and her staff to write in “adjustment disorder” under the reasoning “that everyone has trouble adjusting to something, so nobody would be questioning that diagnosis.”

Mind Springs’ objective, as whistleblowers tell it, was speed, not accuracy.

“They said just put down your best guess, and fast,” says Sarah Mackie, who also worked in hospital admissions. “I had no sense of who these patients were. I had no clue how they would (have) answered these questions about themselves. And I had no idea what I was doing.”

“I had zero business – zero, zero, zero – diagnosing people,” adds Jenifer Hector, another former employee of the admissions office.

Each of the whistleblowers says she was encouraged to work on CCARs whenever she had downtime on a shift. Some were called in to work evenings or weekends to complete hundreds of the assessments in Mind Springs’ backlog. Supervisors referred to those occasions as “CCAR parties,” says Hector, who estimates she completed about 700 of the questionnaires in one year alone, 2015. “You just sat there, put your head down and did nothing but fill out those forms.”

The single mother of seven says she told her supervisors “I don’t want to do this” and “I’m not comfortable… messing with the state of Colorado and funding.”

To her many objections, she says they had the same response:��“That I didn’t have a choice.”

Jensen, the former Mind Springs case manager, also struggled with signing her name to phony assessments of people. She says supervisors assured her the assignment was legal and urged her to stop raising objections.

“They had us flat-out making stuff up, then came down on us for asking if it was legal or even ethical,” she says. “I felt like I was in the Twilight Zone. Like, am I nuts? Why does everybody think this is OK?”

Four of the five whistleblowers say supervisors instructed them, when working on a client����ap discharge evaluation, to answer all 25 questions about mental health symptoms at least one number lower in severity than the corresponding number on that client����ap intake CCAR. Mind Springs’ goal, they say, was to document that clients had improved from its treatment, whether or not that was actually true.

“We’d ask can we go read their treatment plans or their charts, and they’d say no, just mark them better, just mark them a point or two lower on all the questions,” Hector says.

Mental health care records are protected under HIPAA, leading the state to refuse the Colorado News Collaborative’s requests for CCARs submitted by Mind Springs and for certain data gleaned from them.

“What this means to people who needed help really bothers me. I hate to think of how many people weren’t getting the right treatment because of that,” says Reggie Bicha, who ran the Human Services Department under former Gov. John Hickenlooper.

It was under Bicha’s leadership that the state started to hinge its exclusive contracts with community mental health centers partly on their performance. Bicha’s behavioral health staff worked with each center to set quality improvement goals it had to meet to receive its monthly reimbursements from the state and renew its annual contract.

In fiscal year 2016-2017, for example, “improvement of symptom severity” was one of Mind Springs main performance goals. The state was only able to monitor progress through CCAR data.

In fiscal year 2017-2018, Mind Springs stood to lose up to $257,000 in state funding if it failed to show that symptoms of its adult clients’ depression were becoming less severe in the first six months of treatment and that the severity of those symptoms eased by 50% within a year. CCARs were key in demonstrating progress.

The often cash-strapped center had other possible reasons to falsify client assessments, including a program that gave centers the opportunity to earn extra funding if they “exemplify(ied) extraordinary performance.” That statewide pot was small at first, at only $50,000 in fiscal year 2016-2017, but by fiscal year 2017-2018 had grown to $3.9 million.

As Bicha tells it, a program that had real potential of boosting Mind Springs’ cashflow may have backfired.

“The intention of our performance management was to understand problems, hold ourselves and our partners more accountable and to drive better results for the people of Colorado,” he says. “A system that has contractors gaming it flies in the face of all of those priorities.”

Whistleblowers point to other incentives at play.

Jensen, for example, recalls being assigned to evaluate clients serving parole with a community corrections company that partnered with Mind Springs. She says two of her supervisors and one member of upper management instructed her to diagnose every one of those parolees with a substance abuse disorder, regardless of whether they had a history of substance abuse. The diagnosis ensured that each parolee would qualify for a Medicaid-funded intensive outpatient program that brought in money for Mind Springs.

As a private nonprofit, Mind Springs is not required to disclose how much it made from its partnership with the company.

The Colorado News Collaborative’s investigation into Colorado’s mental health safety net focused not just on troubles at Mind Springs, but also more broadly on state agencies’ longtime failure to regulate community mental health centers.

Shortly after those stories appeared in at least 30 partner news outlets statewide, Gov. Jared Polis’s administration announced the state was conducting an audit of Mind Springs with three state departments would be involved.

The Colorado Department of Public Health & Environment found “zero deficiencies,” its records show.

The Department of Human Services found Mind Springs failed to report 40% of “critical incidents” such as botched prescriptions, violence, injuries, patient escapes and staff wrongdoing within the required 24 hours, and to provide patients being released from its hospital with the proper paperwork for continued treatment. It also found data submission errors, but falsified client evaluation was not among them.

The Department of Health Care Policy and Financing – which controls the Medicaid funding that makes up most of community mental health centers’ budgets – announced Thursday that it found Mind Springs has been using various auditing methods and statistics that allowed it to expand its government revenues without expanding its services. It also found a need for Mind Springs to simplify its complex corporate structure and to improve the quality of its care.

As part of the audit, nobody from the three state departments reached out to any of the 29 current and former Mind Springs workers who at that time started contacting the Colorado News Collaborative about practices at the center.

The whistleblowers hold little faith in state audits.

“Mind Springs Health was audited all the time. We saw auditors in and out of that place and they never seemed to see what we were seeing, or even ask us. It makes me wonder if they even took their jobs seriously or if they simply ignored possible issues of fraud,” Sullivan says.

For months this winter and spring, the Human Services Department downplayed the relevance of allegations about falsified CCARs, saying state law gives leeway in how mental health providers fill out state reports. A spokeswoman, who since has left the department, emailed in March that state policy “does not dictate the physical location in which CCARs must be filled out and in most cases does not specify who can fill out a CCAR.”

“OBH Rule does not require an assessment to be performed in person… or by a licensed individual,” Maria Livingston wrote. “OBH staff routinely review CCAR data in line with the CCAR Data Reporting Policy as part of regular licensed/designated-provider site visits and reviews. The review involves checking to see if CCAR data is incomplete or missing.”

She would not say whether the reviews also look for accuracy.

Medicaid officials at Colorado’s Department of Health Care Policy and Financing also had little interest in whistleblowers’ accounts of falsifying CCARs at Mind Springs when the Colorado News Collaborative asked about them in the winter. Since then,��Rocky Mountain Health Plans, the company the Department of Health Care Policy and Financing pays to manage Mind Springs’ Medicaid contract launched an investigation into possible waste, fraud and abuse.

Then the Department of Health Care Policy and Financing began its own internal review. Most recently, the Human Services Department said it also is launching an investigation into the accuracy of Mind Springs’ CCARs, among other things.

“I worry this is a disingenuous PR move,” says Jensen.

Adds Sullivan: “I hope this time they actually take their investigations seriously.”

This story is brought to you by COLab, the Colorado News Collaborative, a nonprofit coalition of more than 170 newsrooms across Colorado working together to better serve the public. Learn more at

This article has been updated to correct the spelling of Jenifer Hector’s name.

The organization, one of 17 regional community mental health centers that receive millions of dollars each year in public funding, has been at the forefront of criticism as policymakers look to revamp Colorado’s behavioral health safety-net system.

Mind Springs, which serves residents from Summit County to Mesa County, was the subject of a recent Colorado News Collaborative investigation that found local officials — including the Summit County jail — were ending contracts with the mental health center. Public officials and local residents said the center has failed to help needy people in mental health crisis and that its leadership was not publicly accounting for how it spent tax dollars.

The mental health center gets public funding, mainly from the state Medicaid program, to care for needy people who are covered by Medicaid, are underinsured or lack insurance.

The Colorado Department of Health Care Policy and Financing, which oversees the Medicaid program, confirmed the site review of Mind Springs, acknowledging that it had sent state investigators to Mind Springs’ offices in western Colorado. Two other state agencies — the Colorado Department of Human Services and the Colorado Department of Public Health and Environment — are participating in the audit.
The review will look for signs of fraud, waste and abuse, as well as adherence to health and safety standards and financial transparency, according to a joint statement from the three departments.

Mind Springs public relations director Stephanie Keister said the review is “not an investigation.” Instead, she said the center is “collaborating and working closely” with the three state agencies to “develop opportunities to enhance care” in the community.

“We’re looking forward to this joint process and the outcomes,” she said, via email.

The “joint site review” comes after community complaints about Mind Springs reached the state level, according to the statement from the three state departments. The audit is intended to produce a list of “opportunities and obligations” for Mind Springs to address, state officials said.

Mind Springs has multiple clinics in its coverage area, which includes Summit, Eagle, Garfield, Grand, Jackson, Mesa, Moffat, Pitkin, Rio Blanco and Routt counties. It also provides mental health services in jails and schools, and runs West Springs Hospital in Grand Junction, the only psychiatric hospital on the Western Slope.

Mind Springs CEO and President Sharon Raggio had planned to step down in June but resigned this month following the Colorado News Collaborative investigation.

“With the negative press recently, she felt that by resigning sooner she could allow the organization to focus on positive change that will truly help our communities, versus the negative rhetoric surrounding her personally,” Keister said.

Doug Pattison, the organization’s chief financial officer, was named interim CEO following Raggio’s resignation. In his first week, he is “focusing on transparency” and has been meeting with local county commissioners and community leaders to provide information about funding sources and services offered by Mind Springs, which offers mental health therapy and addiction counseling.

Colorado’s 17 community mental health centers receive $437 million per year in tax dollars and have come under scrutiny recently from lawmakers and behavioral health officials who have questioned the system’s lack of oversight. The centers, now facing severe worker shortages, are serving fewer patients than they were before the coronavirus pandemic began, a period in which the demand for mental health services has escalated.

In the Mind Springs region, Summit County voters passed a tax measure in 2018 to fund mental health care and an alternative to Mind Springs. Since then, the county has ended three Mind Springs’ contracts and is working to end its relationship with Mind Springs.
Summit County hopes to join the new community mental health center in Eagle County, called Eagle Valley Behavioral Health. The center was started by a $60 million investment from the local nonprofit hospital, Vail Health, because local leaders said Mind Springs was failing to keep up with the community’s mental health crisis.

The findings of the joint state review of Mind Springs will be made public when the review is complete, state officials said.

Reporter Jennifer Brown can be reached at jennifer@coloradosun.com or��303-589-0175 .��This investigation is part of the “On Edge” series about Colorado’s mental health by the����of which The Denver Post is a member.

“(Expletive) Mind Springs, for one thing,” says Sheriff Jaime FitzSimons, when asked about the threats to mental health in Summit County. “And that (expletive) snake oil saleswoman who runs it, for another.”

Mind Springs Health, led by CEO Sharon Raggio, is the private nonprofit responsible for providing behavioral health safety-net services in Summit and nine other Western Slope counties: Eagle, Garfield, Grand, Jackson, Mesa, Moffat, Pitkin, Rio Blanco, and Routt. It is one of 17 regional “community mental health centers” statewide that long have been responsible for inpatient hospitalization, intensive outpatient treatment, outpatient psychiatric care, counseling, and other forms of treatment for Coloradans on Medicaid or who are indigent, underinsured, or in crisis.

A recent Colorado News Collaborative investigation found that many of those mental health treatment centers fail to serve the most vulnerable Coloradans, aided by a system that creates a financial incentive to take on fewer ill people and charge higher costs, while also protecting them from competition.

Communities served by Mind Springs are among the most frustrated. Nowhere is that disappointment expressed so bitterly and publicly than in Summit County.

In 2018 voters passed a tax measure to fund mental health care, even though it meant they are essentially having to pay twice for similar services. Since then, local officials have worked with the state to end three of Mind Springs’ contracts. And now they are going a step further by severing ties altogether and joining nearby Eagle County’s new community mental health center because leaders in both say the state cannot — or will not — fix problems with Mind Springs.

The split marks the first of its kind in the 50-year history of Colorado’s mental health safety net system, and is prompting other Mind Springs’ communities to eye ways to take control of their own care.

Raggio, in a series of interviews over several months, has not addressed specific reasons for public discontent, telling the Colorado News Collaborative, “I don’t believe in litigating issues in the media.”

“It makes me sad that anybody would feel that they got less than adequate services from our organization,” she says. “It makes me sad that people have such negative things to say.”

The new mom

Travis Bickford doesn’t want to hear it. Raggio’s words will not bring back what he says Mind Springs — from its clinics to its hospital to its services in the county jail —��took from his family.

His wife, Jackie Bickford, 31, had a history of depression and alcohol addiction when she sought treatment at the Mind Springs office near their home in Breckenridge in 2016. She was experiencing severe postpartum depression after the birth of their son, Trent, a few months earlier. The clinic prescribed medication that her husband says seemed to make her more depressed and “turn her into a zombie.”

“The doctors there just handed that … out like it was candy. They would chastise her for overusing the medicine, but then keep refilling her prescription.”

Because she was talking about ending her life, he and his father-in-law had her committed to the Mind Springs-owned West Springs psychiatric hospital in Grand Junction. He says his wife returned home after about 10 days “far worse” than when she went in: “Constant crying, depression, abusing medicine, drinking vodka.”

He was at work one day in April 2016 when a nurse called their home for a wellness check. Police responding to the nurse’s concern found Bickford drunk and semi-conscious with her infant son nearby, and arrested her on suspicion of child abuse and neglect.

Her family made the tough decision not to bail her out, assuming she — and Trent —��would be safer if she were in jail where Mind Springs had a contract to provide mental health services. She threatened to kill herself if he was removed from her care, so the jail clothed her in a smock that kept her from hurting herself and put her on a 24/7 suicide watch.

Within a day, Bickford persuaded a Mind Springs clinician to clear her to move off suicide watch and into a regular cell among the jail’s general population. Four days later, she killed herself.

Her family unsuccessfully sued the sheriff’s department, one of its officers, and the Mind Springs’ clinician who had evaluated her. During a deposition, the family’s lawyer asked the clinician whether, in retrospect, she wished she had not cleared Bickford to be taken off of suicide watch.

“No,” she answered.

“Why is that?” the lawyer asked.

“Because I did what was presented to me during her evaluation. She was not suicidal at the time,” she said.

The clinician called Bickford’s suicide an “impulsive decision,” even though records show she had been suicidal for weeks and even the day leading up to it. She also said Bickford’s husband told her his wife had improved in the hospital and was not suicidal.

Travis Bickford winces when reading the testimony.

“It����ap hard enough that I lost my wife, that Trent lost his mom because we were desperate to get Jackie help and these … people didn’t do their jobs,” he says. “But to sit here knowing this woman blatantly lied to justify her wrongdoing, to have no recourse after we made it perfectly clear Jackie was suicidal and tried like hell to make them help her, well, that takes crazy to a whole new level.”

The clinician, through a Mind Springs spokesman, declined to comment or provide any written notes of the conversation with Travis Bickford.

Trent Bickford, now 6 and with no recollection of his mother, walks into the room and sees his father crying during an interview. He climbs on the kitchen counter and grabs a paper towel to wipe away the tears.

“It����ap ok,” he tells his dad. “I know.”

“Please don’t call Mind Springs”

FitzSimons became sheriff shortly after Bickford’s death and inherited the legal aftermath — and county residents’ deep distrust of their community mental health center.

“When we’d come across people experiencing crises, they’d half the time say, ‘Oh my God, please don’t call Mind Springs. I won’t talk to them. They’re horrible,’” says FitzSimons, whose jail — like many others — is full of people with untreated behavioral health conditions.

He and other Summit County officials grew especially impatient with Mind Springs’ mobile crisis response unit. The state-funded program is supposed to dispatch a mental health specialist at any hour to help stabilize people so they don’t end up in more expensive emergency rooms. Assistant County Manager Sarah Vaine inquired about the program when noticing the number of ER visits wasn’t dropping, only to be told by a Mind Springs supervisor in Summit County that the organization was urging clients to go to the ER because it didn’t want to risk the safety of its mobile response team members.

Mind Springs’ spokeswoman, in response, wrote, “There is a delicate balance between a crisis worker’s personal safety, and responding appropriately to a crisis in someone’s home.”

Officials and private mental health care providers in five other counties within Mind Springs’ service area also describe their local mobile crisis response units as unresponsive.

Raul De Villegas-Decker, a clinical psychologist in Grand Junction, where Mind Springs is headquartered, says the unit there would call the primary care practice where he worked asking what it could do for someone in crisis.

“It was almost laughable — not the call you would expect from the very people who are paid to know how to handle crises,” he says.

Even Mind Springs’ own staff members say they have problems getting the units to show up.

“There’s typically nothing mobile at all about our mobile crisis team. It����ap just basically a call center. And when you call, they act almost like you’re inconveniencing them,” says a Mind Springs clinician who asked not to be identified for fear of being fired. “Here you have someone who is literally at the lowest point of their life, and they’re reaching out or having someone else reaching out for them, and what are we offering them? Nothing, which is terrifying.”

Raggio says her organization responds appropriately to crises as needed, but declined to discuss any particular incident raised in this story.

Raggio, who made $312,331 in 2019, cites a lack of state and federal funding and a maze of red tape as challenges for Mind Springs. But more often than not the former licensed professional counselor keeps returning to her own history leading Mind Springs from the verge of bankruptcy with “three days’ cash on hand” in 2008 to building a psychiatric hospital in 2018 and women’s recovery center in 2020. In almost all her interviews, she mentions the multiple business innovation awards the organization has won from industry groups.

“We’ve done a lot of good things,” she added. “I know there are naysayers and that makes me sad. I think we all want the same things and can achieve more working together.”

“A black hole”

Mind Springs’ critics, county officials, former clients, even its own employees say that it’s not just mobile crisis units that seem to be MIA.

How much tax money the center receives for its programs, what it spends in each county, how many people it employs in each are questions the center can’t or won’t answer.

“Mind Springs is a black hole,” says Summit County Commissioner Tamara Pogue.

“We don’t know where the money goes or how it is being spent,” adds Beth Melton, a Routt County commissioner. “It seems to me that we should have an understanding of what services are being provided in the community.”

Mesa County Commissioner Janet Rowland, who has a background in mental health care, also has questions about how Mind Springs is using state and federal tax dollars. She says Raggio keeps giving different explanations for barriers to care. “I’ve heard money’s an issue. I’ve at other times heard capacity or staff or state rules and regulations are the issue. We haven’t gotten to a real answer about what����ap getting in the way.”

Raggio, who refers to herself as “an open book,” repeatedly has said her organization does not keep its electronic records in a way it could figure out how much it spends per county.

“That����ap a lie,” Sarah Vaine, Summit����ap assistant county manager says.

In response to CoLab’s initial investigation published earlier this month, Mind Springs’ spokeswoman contradicted Raggio, saying her colleagues do in fact keep records by county and would make them available for review. As of this writing, she has not provided them.

Alex Wolfe, a 22-year-old Summit County resident, has spent years cycling in and out of treatment for borderline personality disorder. In 2018, he did a stint in Mind Springs’ psychiatric hospital from which he and his mother say he was released on the condition that he attend a certain kind of therapy group offered only at 5:30 p.m. each Wednesday.

“I went in at that time. They said come back next Wednesday. I went in again. They said there’s no such group,” he says.

Trust in Mind Springs’�� home county of Mesa also is low. In two Mesa County surveys, one to residents and one to health care providers, respondents warned people to stay away from the center.

One provider wrote, “The saying is, you might as well commit suicide than go to Mind Springs because they will drive you to it.”

The Colorado News Collaborative interviewed more than 100 people about Mind Springs. The only praise came from someone who works in its hospital and from three self-identified clients who appeared in one of the organization’s marketing videos. CoLab could not locate any of the clients who provided those positive testimonials.

Building hope

Prominent Summit County businesswoman Patti Casey took her life by suicide in January 2016. By that year’s end, so had 12 other county residents, a pattern that prompted Casey’s family to launch a mental health care nonprofit in her memory.

Building Hope quickly drew widespread support for its mission of reducing mental health stigma, increasing access to treatment for Spanish — and English — speakers, and addressing other local behavioral health challenges. Community members rallied around that mission and proposed a mill levy to pay for mental health services Mind Springs wasn’t providing.

In less than three years, Building Hope has used about $2 million in revenues to help more than 1,800 county residents who either don’t have insurance or have a deductible they can’t afford to pay for up to 12 therapy sessions.

“People who have been (harmed) so badly by the system just needed to have their health honored the way we do for other people who are sick,” says Jennifer McAtamney, Building Hope’s executive director.

Vaine, Summit����ap assistant county manager, last year kicked Mind Springs’ detox program out of a county-owned building, then ended Mind Springs’ contract for that service and worked to prod the state to fund a different nonprofit to run it.

Likewise, FitzSimons has ended Mind Springs’ jail and mobile crisis response contracts and replaced them with programs of his choosing. “At first, we didn’t know we could say no to Mind Springs,” FitzSimons says. “But now I’ve got sheriffs all over the state calling to learn how to break from community mental health centers that aren’t getting the job done.”

Following Summit����ap lead, Eagle County in 2017 passed its own mental health tax — on marijuana sales. Responding to what County Manager Jeff Shroll says are the same problems other counties have experienced with Mind Springs, his county then went a step further by forming its own community mental health center, called Eagle Valley Behavioral Health. The new nonprofit is a subsidiary of Vail Hospital, which will likely build a psychiatric hospital as well as a shorter-term overnight facility to stabilize people in crisis. It will include a team of clinicians co-responding to crises with law enforcement, a detox program and all the other safety net services expected by the state.

Leaders in Summit County are now working with those in Eagle County and with state behavioral health administrators to fully split from Mind Springs and join the new center.

The creation of the state’s 18th community mental health center — the first new one in several decades — challenges the status quo of Colorado’s mental health safety net system. The new center will not be joining the Colorado Behavioral Healthcare Council, the powerful trade group that represents all other centers throughout the state in contract negotiations and has lobbied against proposals requiring competitive bidding for mental health contracts and more transparency and accountability among the centers. Its creation also will take tens of millions of state and federal tax dollars annually out of Mind Springs’ pocket.

Meanwhile, other counties are also taking action. Mesa County has been researching ways to possibly end some of Mind Springs’ contracts there. Routt County has been changing some of its contracts with Mind Springs from a flat fee to an hourly rate so, as�� Melton tells it, “we actually pay for services that they’ve actually provided.”

In six months of interviews, no one — except for Sheriff FitzSimons — called to dismantle Colorado’s community mental health centers. But, as the state prepares to launch a new cabinet-level department overseeing mental health care this summer, Melton and officials from counties across the state have been asking for laws and policies to make the centers more transparent and accountable.

Colorado’s Office of Behavioral Health Director Robert Werthwein has been outspoken about the need for those changes. “Let����ap just say, and I’m trying to be diplomatic, that a lot of work needs to be done,” he said of Mind Springs in particular. He will not be there to help make reforms because his department announced earlier this month that he will be resigning in February.

Susan Greene can be reached at susan@colabnews.co.

This investigation is part of the�� “On Edge” series about Colorado’s mental health by the Colorado News Collaborative. “On Edge” reporting is supported by the Carter Center’s Rosalynn Carter Fellowship for Mental Health Reporting as well as by the Benjamin von Sternenfels Rosenthal Grant for Mental Health Investigative Journalism. To learn more about the

Updated 6 p.m. Dec. 22, 2021 This story has been corrected to report that Eagle County passed its mental health tax in 2017, not 2018. That was before, not after, Summit County, which passed its tax in 2018.

But as the coronavirus pandemic gripped Colorado, the vacancies started to climb, first into the teens and then the 30s and then to 50 by the end of 2020. Just as the Jefferson Center was growing alarmed, the pace of the resignations picked up even more. By March, a year into the pandemic, the community mental health center was down 105 workers, about one-fifth of its clinical workforce.

The center has only started to catch up from the hit it has taken in the nation’s “great resignation.”

“We had 75 and 90 and then 102 and 105, and we’re back to about 90,” said Kiara Kuenzler, president and CEO of the Jefferson Center, which has offices in Lakewood, Wheat Ridge, Evergreen, Conifer and Black Hawk.

The workforce shortage extends beyond Jefferson Center to all of Colorado’s 17 regional community mental health centers — the safety net for people without insurance, on Medicaid or who can’t afford to pay for private treatment. The centers combined have 1,092 job vacancies, according to data collected by the centers’ trade group. That includes 233 administrative jobs and 859 openings for clinical workers, or 16.4% of the total clinicians.

The shortage means therapists at the centers are overburdened with patients, that people wait weeks or even months for an appointment, if they get one at all, and that in the midst of a mental health crisis brought on by the isolation and stress of coronavirus, the centers are seeing thousands fewer patients now than they were before the pandemic began.

Some in the industry consider it a reckoning. After decades of low pay, the centers have become a training ground for inexperienced mental health workers, and now many of those workers either burned out or moved on to better-paying jobs. They’re walking away from community mental health clinics to work in hospital systems or they’re signing on with telehealth startups where the pay is better and they can work from anywhere in front of a computer screen.

The 90 help-wanted postings at Jefferson Center are not a wish list or a new goal based on a growing community need for behavioral health care. They represent the clinicians who’ve quit in the past year and a half, Kuenzler said.

Case managers with a bachelor’s degree start out as low as $37,698 at Jefferson Center, working their way to a mid-level salary of $43,369. A mid-level licensed counselor with a master’s degree earns $63,242 and a mid-level clinical psychologist with a doctorate is paid $84,862.

That����ap far below what any of those professionals could earn working for a hospital network or one of the private-equity backed telehealth companies that have ramped up services during the past two years. Switching jobs often means a $20,000 jump in pay.

Kuenzler has heard all the reasons over and over during exit interviews throughout the last year.

The workers are tired, worn out from trying to help folks with a complex set of issues that might involve criminal justice and homelessness and child welfare. They’re tired of the paperwork, required by state and federal government insurance programs. ��It����ap now much easier to work from home, spend more time working with patients and less on paperwork, and earn bigger salaries.

“It����ap just really hard work,” said Kuenzler, a licensed psychologist. “During the pandemic, when everything is hard, if there is an opportunity for your work to be a little less hard, then people are choosing that. They’re taking stock in what����ap important and what they value.”

Each clinician at Jefferson Center typically sees about 150 patients in the course of a year. With 90 of them gone, that����ap about 13,500 patients who didn’t get an appointment, Kuenzler said. “It has a huge impact on our ability to serve our community.”

The center served about 34,000 people each in 2018 and 2019. Last year, that dropped to about 28,000, partly because of the staffing crisis and partly because of the logistics of the pandemic. While emergency crisis centers remained open, many counseling appointments moved online. Jefferson Center set up “telehealth kiosks” in various spots — including libraries and homeless shelters — where people could log into an appointment using a laptop.

Now, clinicians have outpatient caseloads reaching 100, an unhealthy shift from pre-pandemic times when the center considered 75-80 the upper reaches of the limit.

“We can’t just keep piling onto our clinicians,” Kuenzler said.

As a result, instead of getting an appointment with a psychologist or a therapist, a patient might instead get a phone call from an outreach worker.

The turnover rate among community mental health care workers was 30% in 2021, about double the rate of other mental health workers, according to the trade organization, called the Colorado Behavioral Healthcare Council. The council blames the problem on decades of inadequate rate increases from the state Medicaid system, and is asking the legislature next year for a 5% boost.

The reimbursement rates the state pays to individual clinicians in private practice are far lower even than those paid to mental health centers. Centers, however, say they need higher reimbursement rates than therapists in private practice�� to cover the costs of operating 24/7 crisis services, case management and community education courses.

Colorado has $450 million to fix the system, but not without workers

Colorado policymakers have what many have called a “once-in-a-generation opportunity” to improve the behavioral health care system in the form of $450 million in federal coronavirus relief aid that Gov. Jared Polis has tagged for mental health.

But no amount of money will fix a broken system unless there are enough workers, which is why a task force responsible for recommending ways to spend the money has focused much of its time on the workforce crisis.

In Salida, for example, the local community mental health center is building the area’s first 24/7 crisis intervention center. The new unit is on target to open in the spring, but here’s the problem: it will need 28 full-time employees. And Solvista Health, the local mental health center, is already trying to fill 16 vacancies for clinicians.

“Detox work is hard. Acute treatment is hard,” Solvista CEO Brian Turner said. “Supporting people 24/7, that is very difficult work and it pays very poorly, generally.”

At Southeast Health Group, the community mental health center for Lamar, La Junta and Rocky Ford, current job postings include multiple therapists, youth therapists and peer specialists. The pay listed in the peer specialist job posting starts at minimum wage: $12.32-$14.69 per hour.

And the Mental Health Center of Denver, which has had an easier time filling vacancies and already pays more than other centers across the state, announced an “unprecedented” raise for its staff last week. All staff will earn no less than $24.04 per hour, or $50,000 per year for a full-time employee.

The Denver center, with multiple locations in the city, has 160 job openings. In nearby Aurora, the Aurora Mental Center has 78 vacant positions, or 18% of its staff.

A task force working on recommendations about how best to spend the $450 million and help create a new Behavioral Health Administration has keyed in on the workforce shortage. Casey Wolfington, senior director of community behavioral health at Eagle Valley Behavioral Health and a task force subcommittee member, said she was optimistic about the state’s potential plans.

One idea is a student loan repayment program in which federal coronavirus aid would pay off a chunk of a mental health clinician’s college debt each year they stayed on the job. Eagle Valley already has such a program, and the loan payments continue as long as the worker stays in the community — even if they switch jobs but stay in mental health.

Other ideas include funding for scholarships so that clinicians can easily seek master’s and doctoral degrees.

Growing the pipeline could include programs that allow people to get advanced degrees without moving to a city with a major university, either through online programs or partnerships with smaller, far-flung campuses. The University of Denver, for example, offers a master’s degree in social work through Colorado Mountain College in Glenwood Springs. Wolfington is advocating for the state to offer universities some of the coronavirus relief money to set up similar programs statewide.

The task force in particular wants to find ways to recruit first-generation college students, graduates of rural high schools, first-generation immigrants and students who are Black, indigenous or Spanish-speaking. Kuenzler, with the Jefferson Center, predicts that even with the new incentives, it will take at least five or 10 years to increase the behavioral health provider pipeline. Besides student loan forgiveness and new graduate programs, she wants to see Colorado policymakers decrease the administrative burden for providers who have complained for years that they must produce duplicative paperwork required by federal and state law.

COVID “turned a problem into a crisis”

The demand for behavioral health care has skyrocketed during the pandemic, resulting in overflowing emergency departments at hospitals, including Children’s Hospital Colorado, and even longer waits than usual to see a therapist, and way longer, still, to see a psychiatrist. Youth mental-health emergency room visits jumped by 70%, and calls to the statewide crisis hotline rose by nearly 40%.

To fill the gap, hospitals are expanding mental health programs — and hiring workers away from community mental health clinics.

UCHealth, for one, is in the midst of a $150 million push that includes expanding “tele-psych” and “tele-social work,” and embedding psychologists and social workers inside its network of primary care clinics. The hospital system has hired about 100 behavioral health workers in the last couple of years and now has 68 vacancies for social workers, counselors, psychologists and other mental health workers.

The hospital’s midpoint salary for a clinical social worker, at $76,814, is about $27,000 more annually than the average pay of a social worker or counselor at a Colorado community mental health center, according to the centers’ trade group.

The good news is that people — more than ever before — are seeking therapy, likely a result of decades of work to destigmatize mental health care. But concerns about an insufficient workforce circling for the last 20 years are now at perfect-storm levels, said Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing in Washington, D.C.

“It does seem like COVID has turned something that had been a problem into a crisis,” he said. “Everybody I talk to says that their biggest problem right now is finding staff. There is all this money and they want to expand programs, but people are struggling to keep up with current staffing challenges.”

Vincent Atchity, president of the advocacy group Mental Health Colorado, said the gritty work of community mental health care got even tougher during the pandemic. So much of it is “driven by the instability of life,” intractable problems including a lack of housing, unemployment, and family issues that continue for generations. The “burnout factor” is intense, even in normal times.

“There is a different level of satisfaction in the work when you don’t solve somebody’s problem,” he said. “You see them over and over and over again and you don’t have that sensation of cure or remedy. People’s distress is hard to solve.”

Atchity doesn’t want Colorado to put the federal dollars into a system that����ap broken, and is hopeful that policymakers will instead find ways to fix it, as well as increase the value of workers willing to help those who need it most. One obvious fix is integration. Despite talking for decades about combining mental and physical health care in this country, it hasn’t yet happened.

“The industry is so slow to realize how foolish they are,” he said. “Why is it the Mental Health Center of Denver? Why not just be The Health Center of Denver? You can get a mole checked or see a psychiatrist.

“It����ap a darn shame to pour money into that system.”

Reporter Jennifer Brown can be reached at jennifer@coloradosun.com or 303-589-0175. This investigation is part of the “On Edge” series about Colorado’s mental health by the of which The Denver Post is a member.

“Tell them, just tell them I don’t need help so stop it,” he grumbled to no one in plain sight.

The voices in Vinnola’s head can be so loud, so constant, he figures everyone can hear them. Chronic paranoid schizophrenia and an addiction to shooting up whatever he can find to still the voices have landed the 29-year-old Denverite in emergency rooms, psychiatric wards and jails so many times that his mother stopped counting.

Crisis after crisis, Janet van der Laak had to push the Mental Health Center of Denver to provide care for her son instead of finding reasons to deny it. Each time the center dropped him from treatment, Vinnola lost more faith in seeking help. And the more faith he lost, the harder his mother pressed.

“What kind of safety-net system blows off the hardest cases?” van der Laak once wrote in a note to herself. “Giving up on Matt, giving up on anyone in crisis should not be an option.”

The Colorado News Collaborative spent six months investigating a state behavioral health system that turns away some of the most vulnerable and at-risk Coloradans in crisis, with no recourse from state officials. We zeroed in on the 17 community mental health centers that are paid more than $437 million a year in tax dollars to serve as the core of Colorado’s safety net.

We learned that Colorado, the state with the nation’s highest rate of adult mental illness and lowest access to care, has been giving those centers non-compete contracts and a privileged rate status for nearly 60 years, without meaningful oversight.

Our investigation shows that the centers – most now facing workforce shortages – collectively have treated fewer clients during the pandemic than before it, despite skyrocketing mental health needs. At the same time, more than half the centers have been sitting on liquid reserves of $10 million or more. Denver’s center kept more than $40 million in liquid reserves while its clients faced record-long wait times for care.

COLab also found that, starting long before the pandemic:

• The state’s payment system inadvertently created a financial incentive for the centers to take on fewer ill people and charge higher costs, while also protecting them from competition.
• The centers have been charging taxpayers up to 17 times more than independent Medicaid providers for the same services, but with little transparency about the expenses those rates are based on.
• Several centers, including those in communities with sizable immigrant populations, have had no Spanish-speaking care providers.
• And some centers have been paid for programs they’ve not provided, with no pushback from the state agencies funding – and charged with regulating – them.

We learned that some of these and other questionable practices stem from a long record by the centers’ powerful trade association of pressuring the state to avoid reforms that would ensure greater transparency and accountability.

Even now, as Gov. Jared Polis’s administration is poised to launch a new cabinet-level department to carry out those reforms, we’ve found that state government, at the urging of the trade group, is backpedaling. Months before the new Behavioral Health Administration even launches in July, state officials already have ruled out key ways of regulating the centers more closely. They also have all but scrapped what was supposed to be a top safety-net priority for the new department: Stepping in when the centers fail clients like Vinnola and trying to catch them before they hit bottom.

Colorado’s “safety net”

The community mental health movement took root in the 1960s when President John Kennedy called to deinstitutionalize people with mental illnesses. Private nonprofits popped up around Colorado to offer the mental health services – and, eventually, addiction counseling – needed to keep people out of hospitals and in their communities.

Those organizations eventually became the 17 regional community mental health centers (CMHCs) the state has relied on for more than a half-century to treat Coloradans who are indigent, on Medicaid or underinsured and can’t pay for private treatment, and to stabilize people in crisis. They are each contracted to provide inpatient hospitalization, intensive outpatient treatment, outpatient psychiatric care, counseling, and other forms of assistance to residents of the counties they’re responsible for serving.

The centers have helped generations of people throughout Colorado, especially those with less complex mental health needs. According to the state, they collectively served 158,911 clients in the fiscal year ending in June.

“Colorado is lucky to have the system it has built with such a strong network of CMHCs,” Doyle Forrestal, CEO of the centers’ trade group, the Colorado Behavioral Healthcare Council, wrote in an email.

Still, we found vast disparities in the quality and speed of the centers’ services.

Last summer, a Greeley resident with severe depression could see a psychiatrist within a few weeks of calling the center there, but someone just as depressed in Rio Blanco or Moffat counties had to wait nine or 11 months, respectively, for the same kind of appointment, if Mind Springs Health – the center serving those counties – agreed to schedule one at all.

Multiple sources say at least four of the centers are providing addiction counseling by staffers who aren’t certified to counsel addicts. We spoke with people who either work in or with three centers that rely on clinicians with no pediatric training to prescribe medications to kids. Clients of four centers told us their clinics are so slow to renew prescriptions that they tailspin biochemically as they wait. And we found centers serving six communities with high immigrant populations that have no bilingual clinicians, leaving Spanish and other non-English speakers virtually iced out of care.

Annie Diaz of Cortez treated about 80 clients as a counselor for Axis Health System – so many, she says she struggled to remember their names and problems. “I did the best that I could under the circumstances, but it wasn’t my best and it wasn’t good enough,” she says.

Some centers’ staffers describe pressure to drop their toughest cases.

A former case manager at Mind Springs in Summit County says administrators made her stop treating an acutely ill client earlier this year because he made inappropriate racial comments. She says she objected because she knew he had no other support system, but complied for fear of losing her job.

The client ended his life shortly after.

“I blame myself for that every single day,” says the case manager, who quit right after his suicide. She asked to remain anonymous for fear the client����ap death will hurt her career.

Mind Springs cited privacy reasons for refusing to discuss the case.

Emma Harmon, a single mom and Medicaid recipient in Durango, called Axis Health System when she was so depressed she was thinking about suicide several times an hour. She says the center made her wait six weeks for an intake appointment, then three more to meet with someone for a treatment plan. She asked to see a psychiatrist in the meantime, but was told he was busy. Her mother took her to the hospital, which released her because she hadn’t actually hurt herself.

Axis’ spokeswoman would not comment on Harmon’s case.

“I was on the brink of death – so, so close to killing myself, and they said ‘You’re fine’ and never followed up with me,” Harmon says. “The way things seem to work there, you’d actually have to have killed yourself before they’d meet with you.”

A rainy day

Colorado Behavioral Healthcare Council, the centers’ trade group, represents them in negotiations with Colorado’s Department of Health Care Policy and Financing, which provides about two-thirds of their public funding through Medicaid, and with the Office of Behavioral Health, which provides approximately the remaining third through a complex web involving 18 state agencies and more than 75 programs. The state has handed the centers decades of automatic contract renewals despite long-standing local concerns about their services.

Commissioners in most of Colorado’s 64 counties have over the years complained that their law enforcement and human service officials end up handling mental health crises when the centers fail to do so. Parents raise their hands at support group meetings to describe the desperation of having to send teenagers experiencing psychotic breaks across the state because there were no adolescent psychiatric beds open near them. Some people with severe depression are limited to two or three therapy appointments, but prescribed drugs indefinitely, with little follow-up.

State mental health officials have long been aware of these and other problems.

“The centers and the state have been failing people,” says Robert Werthwein, director of the Office of Behavioral Health, which will morph into the Behavioral Health Administration when the new department launches in July.

The Council – whose members pay an average $66,000 in dues annually – has, in the meantime, spent years lobbying and litigating to limit the number of independent contractors the state authorizes to receive Medicaid dollars.

“The centers pretty much have a corner on their local markets and don’t want competition,” says Byron Pelton, a Logan County commissioner and member of the state task force aiming to increase access to behavioral health care.

The Council also has pushed to preserve its members’ favored Medicaid reimbursement rate status with the state. The Mental Health Center of Denver receives $592 in Medicaid reimbursement for an hour of counseling, for example, compared to the $91 Medicaid pays an independent clinician for the same service. And the Denver center receives $818 for an hour of crisis intervention compared to the $47.50 an hour paid the private provider.

Those reimbursement rates are based on a formula – developed by the centers’ trade group in conjunction with the state – that divides a center’s overall expenses for any given year by the total number of services it provided the year prior. The higher a center’s spending and the lower the number of times it treats clients, the more money it will receive through Medicaid reimbursement. The methodology effectively creates an incentive for centers to be less efficient with their spending and to limit or even refuse clients care.

“It is hard to imagine how that formula is in the best interest of Coloradans, especially when there are so many people waiting for care,” says Nancy VanDeMark, former director of the Colorado Office of Behavioral Health who now works as a consultant.

North Range Behavioral Health in Greeley and Mental Health Center of Denver have the lowest and highest reimbursement rates among the 17 centers, respectively, according to cost reports submitted to the Department of Health Care Policy and Financing. Greeley charges Medicaid $228 for an hour of counseling compared to Denver’s $592 for an hour of the same service.

MHCD says it needs the higher rates to bankroll the array of programs the centers are required by contract to provide and to subsidize others that don’t make money, such as food pantries and homeless shelters.

Forrestal, the Council’s CEO, refused multiple requests for an interview. In a series of email exchanges she said comparing the centers’ reimbursement rates to those of independent Medicaid providers is unfair because centers offer a greater “depth and breadth” of services. Besides, she wrote, “Behavioral health has been significantly underfunded, and without (the Council’s) efforts to secure additional funding, there would be no new money for (the centers) to expand services or build new programs.”

The trade group recently hired the state’s assistant Medicaid director, Laurel Karabatsos, as a consultant only months after she left the Department of Health Care Policy and Financing (HCPF), and she has been attending meetings with that agency about changing the future payment methodology. Karabatsos has not sought an opinion from the state’s Independent Ethics Commission about whether that job breaks the state’s revolving-door ethics law prohibiting state employees from taking jobs in industries they regulate, and HCPF sees no conflict of interest.

The centers have received far more public funding since Colorado enacted Medicaid expansion in 2013, and watchdogs say some are wasting it with inefficiencies and other questionable spending.

According to a cost report it filed with the state that serves as the basis for its reimbursement, the Aurora Mental Health Center spent 48 cents on administrative costs for every dollar it spent on care in 2020. That����ap in sharp contrast to North Range Behavioral Health in Greeley –��the most efficient of all the centers statewide – which in the same year, records show, spent 8 cents on administrative costs for every dollar spent on care.

Kelly Phillips-Henry, CEO of the Aurora center, attributes her vastly higher administrative costs partly to updating technology, including the systems required to convert to telehealth care.

Former state Human Services director Reggie Bicha long has frowned on an overuse of mental health funding for things rather than people. He points specifically to the aquaponics greenhouse at the Mental Health Center of Denver’s Dahlia campus, which recirculates water through fish tanks and garden beds.”

“It����ap a wonderful little concept,” he says. “But from an organization that was constantly saying they needed more financial resources, I wasn’t seeing nearly that kind of creativity put into fighting severe mental illness, reducing suicide rates, keeping people out of hospitals and jails and institutions.”

The $15.6 million Dahlia campus is funded partly through the center and private donations, but mainly through Denver Urban Renewal Authority bonds.

For the union representing workers at the Denver center, it is a sore point that CEO Carl Clark made $819,340 in 2019, including $331,583 in bonuses. That����ap 10 times more than an average clinician there earns. Clark defends his earnings, noting his pay is set by his board, not by him.

He made upwards of two and a half times more than the $301,337 average total compensation for CEOs of community mental health centers in Colorado in 2020, our analysis of financial disclosures found.

The Denver center’s audited financial report also shows it sat on $41 million in liquid assets in 2020. Clark says his board likes to keep sizable reserves on hand as a “rainy-day fund.”

Since the pandemic hit in 2020, Denverites have faced the longest-ever wait times for care as pandemic-related depression and anxiety rates skyrocketed. And Denver’s is not the only center sitting on reserves. Nine others kept at least $10 million in liquid assets last year while their wait times also grew and the state plummeted to the bottom of national ranking for access to care.

“If the CMHCs are not willing to reinvest their reserves to expand access to care now, then when?” VanDeMark asks.

As the pandemic gripped Colorado in early 2020, the centers halted most of their services temporarily, then moved to telehealth. Yet, they still managed to treat more patients in that fiscal year ending in June 2020 than they did the following fiscal year when the statewide caseload dropped by 7,200.

The Council attributes the decline to what Forrestal calls a “dire behavioral health workforce crisis,” which she writes has left more than 1,000 job vacancies among its members.

“There simply is not enough workforce to meet demand.”

Union members counter that the center could retain more staff by raising salaries far more significantly than it has –��and by using bonus pay for executives like Clark to do so.

Leaving holes in the safety net

Despite the workforce shortage, the Council has fought a proposal that the soon-to-be-launched Behavioral Health Administration offer “care coordination” –��regional teams to work with some of the hardest-to-serve clients to make sure they’re not dropped from the centers’ care and don’t otherwise fall through the cracks. The proposal was meant to help people like Vinnola whom centers commonly refuse to treat if they have pending criminal charges, or show up high or delusional or are otherwise hard to manage.

The trade group has sought to block the proposal, saying the centers already coordinate care for their clients and that the state stepping in to do so could divert funding away from their own services. The Council’s opposition comes after it has spent years fiercely opposing attempts to add “no reject, no eject clauses” to centers’ contracts preventing them from refusing to serve the sickest clients or dropping clients who are difficult to serve.

The Council has an unlikely ally in Vincent Atchity, president and CEO of Mental Health Colorado, the leading statewide group advocating for people with mental health challenges. On the task force responsible for recommending reforms, Atchity voted against making care coordination a priority for the new department as what he calls “an attempted appeasement of the (centers) that objected strongly to” it. He describes his vote as “more about diplomacy than actual opposition.”

The no-voters were outnumbered by task force members who supported prioritizing care coordination as perhaps the most important aspect of a reform package the state has made a point of branding “Putting People First.”

Nevertheless, a state report released in early November outlining how the new department will function does not, in 109 pages, mention the kind of hands-on care coordination the task force approved. It instead lists detailed plans for what officials call “care navigation”– ways to help the public on the phone or online find behavioral health providers.

Werthwein –��who until this fall was a vocal proponent of providing care coordination – �� at first said his office intentionally left plans for it out of the report because details about how to staff and fund it “have not yet been worked out.” In that same interview, however, he called the omission “an oversight” and insisted the new department will be prioritizing hands-on care coordination and will revise the report accordingly.

But so far, the so-called “care coordination working group” Werthwein’s office has gathered to address the issue has made no mention of plans for person-to-person care coordination. Instead, the group is focused only on making the state mental health care system more user-friendly technologically.

At least for now, there is no significant plan recognizing that sometimes the centers fail people, and when they do, somebody ought to step in and keep those people from free falling.

What we don’t know

Werthwein’s Office of Behavioral Health says it does not know how many indigent Coloradans the centers are serving or how many people with private insurance policies that don’t cover mental health care the centers are allowing to pay on a sliding scale.

State officials also say they don’t know what happens to tax dollars centers receive for services they end up not providing. The Center for Mental Health in Montrose, for example, was paid to set up a mobile crisis program in the six counties it covers. For logistical reasons, that program didn’t serve San Miguel County. County Commissioner Hilary Cooper spent months trying to figure out where money for her county’s piece of that program went.

“They showed me a bunch of fancy budget slides and explained that it����ap really too layered and complicated for someone like (me) to understand, and in the end, I got no answers,” she says.

The Center’s CEO, Shelly Spalding, did not, in response, indicate where her organization spent that money.

“I think we’re transparent. But maybe other people don’t think we’re being transparent enough. Maybe things are being lost in translation,” she said.

Summit County officials say they could not get an answer from Mind Springs Health about what it did with state money it was supposed to spend on a detox program there, which it shut down without telling them. They also say that, despite years of questioning, Mind Springs has never said how much in public funding it was –��and should have been��– spending in the county.

CEO Sharon Raggio told them, and us, that there is no such information because Mind Springs does not track services or spending per county, but rather more generally in the 10 West Slope counties it����ap responsible for covering.

“It����ap like a frigging ridiculous mystery when you ask about it,” says Assistant Summit County Manager Sarah Vaine, who refers to Raggio as “a liar” and to Mind Springs as “The Mob.” “The way the state contracts work and the way the money flows is so confusing. And I think the community mental health centers benefit hugely from that confusion because it makes it harder to hold them accountable,” Vaine adds.

The centers also benefit from their status as private 501(c)3 nonprofits, which, unlike government agencies, are not subject to open records laws. Federal tax law makes it so the centers can – and do, as we’ve discovered in our reporting – refuse to provide information about how they spend public funding beyond the few financial disclosures required by the IRS and state.

Voters in several counties, including Summit, have over the past five years passed tax measures to pay for mental health services they say they aren’t getting from the centers. And one, Eagle County, is for the first time in the 60-year history of Colorado’s safety-net system breaking off from its center, Mind Springs, to create its own – one that officials there say will be more responsive to their residents. Eagle County’s will be the only center in the state that won’t be joining the trade group.

County governments have spent years urging state government to reform Colorado’s safety-net system so taxpayers don’t have to double-pay for services. They embrace the creation of the Behavioral Health Administration, which is supposed to give county governments and the public “a better sense of the dollars flowing into their community, and the outcomes resulting from those investments,” according to a state report released in November.

Still, many county officials worry the new department will not be able to monitor centers closely enough because it still won’t have control over their Medicaid contracts. That responsibility will remain within the separate Department of Health Care Policy and Finance (HCPF).

“If no single agency is actually responsible for these pieces, we fear there won’t be real oversight and we’ll just see a repeat of what we have now,” says Gini Pingenot of Colorado Counties Inc., a consortium of county governments.

County governments specifically have urged the state to audit the centers’ finances and conduct performance audits to make sure they are complying with contract requirements and not being double-paid by the multiple state agencies and programs that fund them.

There are no plans for the new department to do so, despite state officials’ insistence that it will prioritize making the centers more transparent and accountable.

Bicha, the former state human services director, notes there long has been “significant political pressure” from the trade group not to monitor centers that closely.

“The Council has a tremendous amount of influence,” he says.

Free falling

Before it sought and received lawmakers’ approval to create the new department, the state Behavioral Health Task Force heard more than 200 Coloradans statewide testify about the mental health reforms they want –��and desperately need – from state government.

Matt Vinnola’s mom was one of them.

Her son was in jail at the time in 2019, awaiting a competency evaluation after having been involuntarily hospitalized eight times in a year. The Denver car saleswoman had come, she said, as “Matt����ap mom, advocate and voice.”

Janet Van der Laak wanted to know why she could make a routine doctor’s appointment for her husband, but not an appointment at Mental Health Center of Denver for her adult son who is delusional, unable to remember his birthday or home address, and so sick he doesn’t always know he is sick.

She wanted to know what families like hers are supposed to do when the centers drop their loved ones from treatment.

She wanted to know what the centers are doing with hundreds of millions of tax dollars if not treating severely sick people like her son.

“MHCD dropped him… How do you drop someone who’s gravely disabled? How do you deny someone services like that?” van der Laak asked the task force. “We’re leaving out a huge, vulnerable population that we’re not treating.”

The Mental Health Center of Denver’s Clark says privacy laws keep him from discussing Vinnola’s case. “Could things have been dropped? It����ap possible for them to have been dropped,” he says, adding that if a client is not seeking care for himself, the center “need(s) to focus on someone who wants treatment.”

Five months after van der Laak’s testimony, one of her older sons, Aaron Ruiz, ended his life in March 2020.

Relatives say the family had not been aware of Ruiz’s mental health challenges, and had been focused on Vinnola’s for the 10 years since he developed symptoms of paranoid schizophrenia.

Five months later, Van der Laak took her life by suicide. She was 49.

Vinnola has been plummeting since his brother’s and mother’s suicides, both of which took place while he was home. He had a long jail stint last fall and winter, and for about seven months now, has been living on the streets, off his medication and untreated.

When time allows, his father goes looking for him. He searches Denver’s homeless encampments and drives by the condo where van der Laak used to live. The neighbors there sometimes spot Vinnola strung out and sleeping on the sidewalk out front.

Susan Greene can be reached at susan@colabnews.co. Freelance reporter LJ Dawson contributed to this report.

This investigation is part of the�� “On Edge” series about Colorado’s mental health by the Colorado News Collaborative. “On Edge” reporting is supported by the Carter Center’s Rosalynn Carter Fellowship for Mental Health Reporting as well as by the Benjamin von Sternenfels Rosenthal Grant for Mental Health Investigative Journalism. To learn more about the Colorado News Collaborative, visit

Soon enough, the nurses-slash-best friends from Grand Junction found themselves with matching chihuahua-print leggings and matching hoodies with fleece-lined pockets in which they carry their matching chihuahuas. Then came the matching housecoats they exchanged for Christmas last month – the softest they could find, and also the dowdiest.

“They’re the zip-up kind, long and baggy for when we’re grumpy and cold, and they are ugly and fuzzy and amazing,” Carpenter swoons.

She, 38, and Humphrey, 37 have been facing the stresses of the pandemic and family challenges as mothers of school-age children, as nurses, as volunteers, as women overwhelmed at times by their own anxiety. The kitsch of their matching loungewear has become not only a way to bring some levity to a heavy time, but also an expression of support when one or the other feels like crawling out of her skin.

In a year when nearly everyone’s mental health has been shakier than usual, they feel especially grateful to have built a friendship that is also a safety net.

“We’ve become comrades in arms,” Humphrey says. “This would have been so, so much harder without Laurel to go through it with.”

The two met about a decade ago and grew closer after the 2017 death of a mutual friend whose children Carpenter has raised along with her two own. Each was already juggling their kids’ schedules with a full-time bachelor’s-in-nursing program – from which they both graduated last month – and full-time jobs, most recently providing in-home nursing care to former uranium workers.

COVID made things even harder. Both have been tutoring their kids when they’ve attended school digitally and volunteering for a new nonprofit, Mutual Aid Partners, that serves unhoused, poor and elderly people hit by the pandemic in Grand Junction.

They’ve been offering free nursing services in two motels where Mesa County is housing COVID-positive people who are also homeless. They check on guests’ physical and mental health while delivering hot dinners and food for the next day’s breakfast and lunch, reminding them it����ap not safe to leave their motel rooms. Though both have had doors slammed in their faces, they agree the mutual aid work beats waiting around for someone else to fix the world.

They share extra PPE when they can find it. They share updates about motel guests who’ve been hospitalized for COVID or disappeared to feed their addictions. They share concerns about the elderly patients at their day jobs whose lungs, compromised from years of uranium exposure, are especially vulnerable.

One of Carpenter’s patients recently complained about her mask, yelling at her to “get that damn rag off your face.” He died of COVID shortly after. Another patient had a surprise visit from relatives who refused to wear masks around him. And 10 months into the pandemic, one of their fellow nurses is still insisting that mask requirements are useless.

“We, as nurses, are accountable for protecting these fragile patients from danger. It����ap all on us to keep them safe, and it����ap freaking scary,” Carpenter says. “When I’m having trouble handling it, Melissa offers a second reserve of emotional resilience to draw from.”

With help from Carpenter’s husband and Humphrey’s partner, each family supports the other by offering to cook and care for her children while she is at work, volunteering or needs a few hours to herself. The two couples are in constant touch about which kid is behind on homework and which is bouncing off the walls.

Humphrey grew up with an anxiety disorder that leads to panic attacks, which have been extra severe this year.�� Carpenter doubted the panic attacks were that bad — until she recently started experiencing her own.

“It����ap horrifying and I’m sorry, so sorry I didn’t recognize that,” she tells Humphrey.

Humphrey grew anxious a few weeks ago when unable to reach her partner, who had left his phone in the car while shopping. Her relief shifted to anger and back for a few hours until reaching out to Carpenter, who reminded her of a lesson she knew well from therapy: Others are not responsible for your anxiety.

Carpenter, for her part, says she has intense guilt on long nursing shifts away from her kids and anxiety that her teenage daughter may not admire her. Humphrey will occasionally prop her up by listing her strengths as a mom. Generally, though, she is careful not to try to fix her friend’s feelings, but rather acknowledge them and say, “Yep, you’re a stress case, that����ap just true.”

“These are things our partners don’t understand and… Melissa is part of the system that keeps me afloat – having a whole entire human being beside me who knows what I’m feeling in real time, and seamlessly hands me the tools or words I need to make it,” Carpenter says.

“Sometimes, it just helps for one of us to look at the other and say, ‘You’re not going to die,’” Humphrey adds.

And sometimes their mutual aid entails just sitting together, cross stitching in silence. They sewed their latest joint creation earlier this month after the mob of insurgents stormed the U.S Capitol. Humphrey stitched an “F,” then two more letters for the one-word design, and Carpenter finished the piece with a “K.”

The pair has been wondering lately if they’re crazier than most people, or if they’re just more open about it. Yes, they agree, to both questions.

They also wonder if and when a time will come when, as they both hope, their loads will be lighter, things will be easier and there’s not so much to kick themselves for and worry about. Until then, they assure themselves that they have each other – and their new housecoats.

If you’re struggling, help is available on Colorado’s crisis hotline. Call 1-844-493-TALK(8255)

This story is part of the ongoing series On Edge, intended to foster conversation about mental health in Colorado. It is brought to you by COLab, the . Reach Susan Greene at susan@colabnews.com

On its face, the answer seems clear: He’s a paramedic. But he was careful, thought himself well-protected, thought that if he did catch COVID, he’d knock it right down. “Up until the point I got sick, I felt invincible,” he says.

McGinnis, 51, is a self-described Type-A guy, a don’t-show-weakness hard charger. He’s been a paramedic for 30 years, nearly all of that for the Alamosa Ambulance District. Almost no one is a paramedic for 30 years. It����ap a churn-and-burn profession, the work physically and emotionally taxing, though McGinnis has developed the required survival skill of compartmentalization. He speaks matter-of-factly of drug overdoses and alcohol poisonings, of car wrecks and heart attacks. He cannot count the number of lives he has helped save.

“You’re basically right in the hot zone,” he says. “It����ap fast action. You have to be quick at decision-making and it����ap rewarding when you make a difference … It has gotten to me at times — I’ve sucked it up and dealt with situations — but I enjoy what I do. I’m pretty well known for doing what I do. At this point in my life, I don’t know what else I would want to do.”

McGinnis got sick in late October. His only daughter was marrying that month and he’d narrowed his world to the job and home. So, he figures it must have been work.

The probable answer still does not stop him from questioning, from trying to make sense of an ordeal from which he cannot seem to escape.

“I still ask myself every day, how, where, when and what could have I have done differently.” He tells himself that if he knew for certain he could have some peace.

“It would have given me my life back if I could have avoided it,” he says.

McGinnis nearly died of COVID-19. Memories flash: Standing in his driveway in his underwear on a 20-degree night trying to bring down a 105.3-degree fever, his wife bathing him with ice, resisting her pleas to go to the hospital because he intended, hell or high water, to walk his daughter down the aisle in just a few days. He thought he could gut it out.

“My stubbornness nearly killed me.” His body refused to bend to his will.

Flashes: Being zipped inside what he calls an Ebola bag, “basically a body bag with a window,” for plane transport from the San Luis Valley Hospital to a Colorado Springs hospital. Eight days in the COVID unit.�� McGinnis did not want to be intubated, but his chest X-rays showed white where black should be. All white. COVID-19 pneumonia. He could not get more than one or two words out at a time. “So, I sent my wife a text and told her she would need to come up with a plan because I was a dead man.”

More flashes: Laying there thinking of everything left undone, bank account numbers running through his head along with bills needing to be paid, his heart breaking because he did not get to see his daughter married and he was certain he would never meet his future grandchildren.

The docs finally hit him with powerful steroids, he says, and he dodged the ventilator and began to recover.

When McGinnis describes his experience now, he deploys words like “titrate,” “BIPAP,” “O2 sats,” and “high-flow oxygen,” the vocabulary of a medic talking about a patient. Language that distances him from what he has been through because as accustomed as he is to witnessing trauma, he finds it difficult to acknowledge his own.

Still, he cannot compartmentalize this experience and he chokes up when he recalls his wife calling him after he texted her. “You need to fight.” She promised to buy him a Mustang and in his retelling of that call, his emotion gives way to a grin: “That����ap not the reason I fought, you know, but I did. Haven’t got the Mustang yet.” He chokes up again recalling all those he loves waving signs upon his return home on Halloween. His daughter papered the garage in signs. “Out of the way, I get my daddy back today.”

McGinnis rode that tide of jubilation for a week or two. But a hoped-for November return to work pushed into December and then into January. A recent chest X-ray showed little improvement. “That����ap depressing. What do you do?”

For now, he needs to remain on oxygen.

This suspension is intolerable for a man accustomed to motion. It is too many hours on the living room couch, watching video after video: how to build airplanes, how to fix cars, here’s some people hunting, some people fishing, some people metal detecting on a beach.

“Heck, I was a pilot,” he says. “I’m a really outgoing person. But this has been life-changing for me.”

McGinnis is having trouble sleeping and has been stress-eating.

“I have been going out a little more, dragging an O2 bottle around, but I don’t want my world to revolve around sitting on a couch and watching YouTube videos.”

McGinnis has started pulmonary therapy. He’s putting in treadmill time at home, though that����ap slow-going. He tinkers in bursts with the 1929 Model A roadster he’s building. A work radio, basically a walkie-talkie, in his bedroom crackles out ambulance calls, keeping him connected.

But he says the hospital, which manages the ambulance department, recently warned him that if he can’t report to work by March, he could lose his job. McGinnis is determined to find his way back.

If you’re struggling, help is available on Colorado’s crisis hotline. Call 1-844-493-TALK(8255)

This story is part of the ongoing series On Edge,��intended to foster conversation about mental health in Colorado. It is brought to you by��.��Reach Tina Griego at��tina@colabnews.co

��

��

The 43-year-old news junkie could feel his body tense and cynicism rise with each tweet about COVID deniers, the president����ap false assurances, and the politicization of a national and global catastrophe.

“I noticed this sense of hopelessness coming over me, like everything was messed up,” says the Denverite who, when not tracking the online blow-by-blow of American politics, works in medical imaging at a Denver hospital that was, and still is, slammed with COVID cases.

Zayatz was overcome with a kind of disillusionment known as “moral injury.” It is a feeling that transcends politics and partisanship, a realization that what you thought you knew about people, including people you love, and about the nation has been turned on its head. It����ap something like disappointment, but also disorientation, and it has a way of making you doubt everything, including yourself.

The 2016 election of a man Zayatz sees as a “farcical bully with a tough-guy act” caused him to start losing trust in people, he says. “It made me feel like I didn’t know anybody, even my family and some friends…. It really ruined my view of our country. It harmed my view of humanity and just made me feel alone.”

He understands that plenty of conservatives and Trump supporters, including those who stormed the U.S. Capitol on Wednesday, may also feel morally injured. It����ap just that “they may not frame it in those terms,” he says.

His relationship with his conspiracy-theorist brother back East has grown strained since 2016. And he stopped speaking to a close friend here in Denver whom he says gloated to Zayatz’s wife when Brett Kavanaugh was confirmed to the Supreme Court.

As nurses and doctors Zayatz works with fell sick with COVID and some of his patients were dying, Trump’s downplaying of the pandemic made things worse. What he calls the audacious “me-me-me-ness” of people not wearing masks infuriates him, as does the president����ap ongoing lie that he won re-election.

“I mean how could people swallow those things so willingly and eagerly with no regard for facts or the truth? Well, that just blows my mind,” he says. That more people are not freaking out has caused him to question himself.

He finds himself sitting at his laptop, hour after hour, scrolling through Twitter and other sites, monitoring the smallest developments. He doubled his relatively low dosage of Zoloft – a widely-used antidepressant and antianxiety medication –��during the election season to help take the edge off his anger and anxiety. Without the prescription, he says there’s “a feeling in the back of your head that if somebody cuts you off in a car, you take it five times harder.”

He lowered the dosage after the election. That has been enough to sustain him through two months of doom scrolling about Trump denying the outcome and speculation about whether there will be a peaceful transition of power.

He had hoped to try to break the habit this winter, but says this isn’t the time because “We’re watching treason unfold in our country right now.”

“… I’d miss too much by turning it off. How could I not watch? I need it,” he says, then pauses.

“Listen to me. It really does sound like a sickness.”

This story is part of a statewide reporting project from the����called��On Edge that is intended to foster conversation about mental health in Colorado.��This project is supported in part by the Rosalynn Carter Fellowship for Mental Health Reporting and a grant honoring the memory of the late Benjamin von Sternenfels Rosenthal. Reach Susan Greene at susan@colabnews.co

If you’re struggling, help is available on Colorado’s crisis hotline. Call 1-844-493-TALK(8255).

He was “full of rebel spirit” in a town of kindreds and so he never left. He grew up with Breckenridge, jumped into the restaurant business in ‘81, married Cathy, his wife of 27 years, had three kids, became a city councilman.

Forty years passed. Time gave him no more preparation for 2020 than it had given anyone else. It certainly didn’t prepare him for the drumbeat of anxiety, the worry, the weight of responsibility that comes with being a family man, businessman, councilman in a ski town during a global pandemic.

He was forced to temporarily close his restaurants, Hearthstone and Mi Casa. He cut staff from a seasonal high of 150 full- and part-timers to 15, wondering whether he was abandoning them and how they would survive. He contemplated kissing his retirement goodbye, almost certainly postponing it with two high schoolers and one college sophomore. COVID took dear friends. And, worst of all, 2020 claimed Toby Gard.

“Toby committed suicide,” Carleton says, and for a while he can’t say anything else. “He was a friend of my kids. He was 16 and no one saw it coming.”

A little more than a week later, another Breckenridge teen, a freshman, killed himself. Then two more high school students attempted suicide, Carleton says.

That mountain communities tend to have higher suicide rates is neither a solace nor an explanation. “It is a mystery to all of us,” Carleton says, “how did this get started?”

The deaths and attempts have commanded him to think hard about mental health.

“I ask myself – how am I taking care of myself during these times? And am I really? … I know a lot of it is this mountain community where I live.”

He counts himself lucky to be able to soak in the surrounding natural beauty, or play hockey with a motley group in which income, occupation and politics don’t matter.�� His work keeps his plate and heart full, allowing him to help people and to witness the generosity of individuals and nonprofits keeping locals fed and housed.

But there is also this: About 5,000 people call Breckenridge home and that means always seeing the way your friends and neighbors are connected to you because their stories and yours have intersected again and again. So, Toby is not just Toby who played hockey with your son. Toby is also Heather’s son and Heather is Tinker’s daughter and good ol’ Tinker came out here in the ‘60s, a hippie, living in a cabin, Heather born in the back of a Rambler station wagon. And these stories, they fix you to a place and to a people and when the connection breaks down somewhere, it can be felt everywhere.

Connections broke down this year. Some people needed and still need help. So, he talks to his 17-year-old twins, Toby heavy on his mind because he would have turned 17 on Dec. 19. “We just talk about how we’re feeling because I felt a lot of guilt, still do, you know. … I keep asking, ‘What did I miss as a parent, a friend?’ and wearing the community hat, ‘What did we miss?’”

“…We all realize that we have to do more every day, every week, every year, we need more funding, we need to overcome the stigma. We are trying, but we have a lot of work to do.”

He wonders what happens to a place built on fearless rebel spirit in a time of so many rules. He thinks about it as a parent of active teens, as a councilman in a town both reliant and wary of visitors, as a restaurant owner with employees who need to be paid — and protected.

He thinks hard about trade-offs: His kids went to a small Halloween party that turned into a big Halloween party that turned into a spreader event. He and Cathy gave them a talking — Carleton the father and Carleton the council member both present — but he acknowledges that doing what����ap best for your kids and community is not so easily deciphered these days. A party with 40 kids crosses a clear line, he says, but smaller groups, “we’re not saying no to that.”

He and other parents weigh the instinct to lock kids down against the desire to allow them the kind of freedoms that drew them to the community in the first place.

“Teenage children, I don’t believe, were made to be quarantined. If, all of sudden, you snap your fingers and you take away their sports and you take away their interaction with their friends in person and it all goes to their devices, you know, that����ap not healthy at all. They’ve gotten parts of their youth — in their short lives, it����ap huge pieces of their youth — that you have just ripped away from them.”

This story is part of a statewide reporting project from the called On Edge that is intended to foster conversation about mental health in Colorado. . This project is supported in part by the Rosalynn Carter Fellowship for Mental Health Reporting and a grant honoring the memory of the late Benjamin von Sternenfels Rosenthal. Reach Tina Griego at tina@colabnews.co

If you’re struggling, help is available on Colorado’s crisis hotline. Call 1-844-493-TALK(8255).

She knew already what it was to be separated from the people you love whether that separation comes by virus or by war. And she knew, too, what it was to live with uncertainty and powerlessness.

But the anxieties of 2020 for her became magnitudes greater on Nov. 3. On that day, as Americans and much of the world awaited election results, civil war flared again in her family’s home country of Ethiopia and her grandmother and two aunts went missing in the shelling. In the days since, the isolation that has marked this year for so many has taken on a new meaning for her: much of her family is still unreachable and her grief is invisible to most Americans who know nothing of Ethiopia and the trauma of its wars.

“I swear to God I know I look like that crazy woman who is screaming about this terrible dream and everybody’s like ‘What is wrong with her?’ I feel like I’m in a psych ward yelling, but nobody can hear me.”

Birhanemaskel was born at a�� refugee camp in Sudan after her parents fled bombing of their native Tigray in northern Ethiopia under a military dictatorship. Her immediate family moved to Colorado in 1982, when she was an infant but her grandmother and extended family have been living back in Tigray since the dictator was toppled in the early 1990s. That is, until last month when a feud between Ethiopia’s federal government and local Tigrayan leaders prompted Prime Minister Abiy Ahmed to bomb the region again, inciting a civil war that has killed civilians and forced more than 50,000 Tigrayans to flee.

Since the disappearance of her grandmother and two aunts, Birhanemaskel, 39, has been calling the cell phones she bought them, which go straight to busy signals without even ringing. She has been checking her Twitter feed every few minutes.

She keeps seeing posts that refugees have little food or water as they walk west toward refugee camps in Sudan, some reportedly collapsing, even dying of exhaustion along the way. She keeps hearing that Ethiopian soldiers are raping Tigrayan women and shooting or beheading Tigrayan men, leaving their bodies in the road for fellow refugees to step over. She keeps imagining she is walking in their shoes.

“As long as they’re missing, I can’t sleep, can’t focus, can’t enjoy anything because I keep having the most awful thoughts about what����ap happening to them,” she says.

She is experiencing what clinicians call “vicarious trauma.”

But vicarious does not express how close it hits home, this civil war in a country where she has never officially lived, yet has defined so much of her life. It is the place, she says, that makes her “most full.” And yet the trauma her relatives are now enduring is a trauma they and her parents lived through four decades ago – and the third siege on the Tigrayan people in her grandmother’s lifetime. That story explains why her grandma, whose home was bombed in the ‘70s, hates loud noises. It explains why her parents met in a refugee camp and emigrated to the U.S. with a promise to themselves and their kids: “Never again.”

“This is literally my own story, the story of why I’m here. It����ap just horrific how history repeats itself, how it comes full circle, how my people are continuing to be devastated,” she says.

Vicarious does not describe the experience of having to stop thinking of herself as an Ethiopian American, but rather as a Tigrayan American virtually overnight Nov. 3. “There’s no way that my country could bomb my family like this,” she says.

Vicarious does not account for how on edge she feels, how irritated she is by the post-U.S.-election chatter on the talk radio her husband listens to every morning, how short-tempered she has become with their two youngest kids, ages 4 and 3, whose care her mother helps with.

“Thank God for that because I can’t be present with them and just forget about it, so I just sit in my car and scroll my phone for news about Ethiopia. This has consumed my entire life. Every minute. And I don’t know how to stop that.”

Birhanemaskel, who gave up her Ethiopian passport to become a U.S. citizen, would not be allowed into the country at this point. So she applied weeks ago for an emergency visa to tour the refugee camps in Sudan, partly so she can help tell Tigrayans’ stories on social media, but mainly to search for her family, or at least find out if they’re still alive. She will fly east when her visa arrives, which could be any day now, and daydreams about spotting them immediately in the camp where she was born.

Her mother – who lived in that camp for several years and knows what she’s heading into – has begged her to stay here with her kids.

Birhanemaskel knows she is risking COVID exposure and a lack of medical care in Sudan, and a long quarantine when she returns. She also knows that posting refugees’ stories could put her at risk of getting blacklisted by Ahmed’s government and forbidden from seeing her family if the civil war ends and if they survive and if they return, once again, to Tigray.

Those possibilities, however unbearable, seem preferable to further neither-here-nor-thereness. From the comfort of her home in Denver, she says, she cannot pretend she isn’t caught in this war.

“When I weigh just sitting here against what if that happens or what if I get COVID, it doesn’t even compare. I just can’t stay here doing nothing much more.”

Her decision to make the trip became easier last week when, after hundreds of attempts, her grandmother finally answered her cell phone.

“We talked for only a minute. She was terrified. The only thing she would say is ‘I’m in hiding, we’re rationing water, and where’s my daughter, you’ve got to find my daughter.’”

“Who could say no?” Birhanemaskel says. “I have to try because my mind is the hardest place to be.”

This story is part of a statewide reporting project from the called On Edge that is intended to foster conversation about mental health in Colorado. This project is supported in part by the Rosalynn Carter Fellowship for Mental Health Reporting and a grant honoring the memory of the late Benjamin von Sternenfels Rosenthal. Reach Susan Greene at susan@colabnews.co

If you’re struggling, help is available on Colorado’s crisis hotline. Call 1-844-493-TALK(8255).