Colorado counties break from psychological well being supplier Thoughts Springs
Editor’s note: This investigation is part of the ongoing “On Edge” series about Colorado’s mental health by the Colorado News Collaborative, the nonprofit that unites more than 160 communities and news outlets to ensure quality news for all Coloradans. The series title reflects a state that has the nation’s highest rate of adult mental illness and lowest access to care, and the fact that state government is on the edge of either turning around its behavioral health care system or simply reorganizing a bureaucracy that is failing too many Coloradans.
Summit County is hurting.
The suicide rate in this mountain community of 31,000 is higher than Colorado’s, which is one of the highest in the nation. And locals say almost everyone here has known someone — or several someones — who ended their life:
A beer brewer. A prominent businesswoman. A bird-watching construction worker. A knitter of fabulous afghans. High school and middle school students.
A girl who was a baby when immigration officials deported her mom. Her name was Vanessa. She was 11.
“It has been a very personal public health crisis for us, and it is devastating,” says Summit County Commissioner Tamara Pogue.
She and other local leaders have tried to reduce risk factors in a county where the cost of living is high, wages low, the hospitality and outdoor industries’ workforces young, hard-partying, transient and separated from support systems. They have sought to combat mental health stigma, which nearly 64% of residents here cite as the reason they don’t seek counseling or other treatment.
Now they are trying to root out what they see as two other threats to the community’s mental health:
“F%#@ing Mind Springs, for one thing,” says County Sheriff Jaime FitzSimons, whose jail — like many others — is full of people with untreated behavioral health conditions. “And that f%#@ing snake oil saleswoman who runs it, for another.”
Mind Springs Health, led by CEO and President 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 are failing to serve the most vulnerable Coloradans. Mind Springs stands out among them for intense community disappointment about access to and the quality of its care. Nowhere is that disappointment expressed so bitterly and publicly than in Summit County.
OTHER STORIES IN THIS SERIES:
More:Colorado’s mental health safety net is failing some. Reforms could fix or further problems
More:Colorado has $450M to fix its mental health system, but it won’t work without workers
Frustrations here are so high that 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 with Summit County. 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 counties 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 question the safety-net provider and 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 s#@t 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.
If you’re experiencing a mental health crisis, call the Colorado crisis hotline at 1-844-493-TALK(8255). There is no wrong reason to reach out.
Her family unsuccessfully sued the sheriff’s department, one of its officers, and Danielle Wood, the Mind Springs clinician who had evaluated her. During a deposition, the family’s lawyer asked Wood 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,” Wood said.
Wood 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 claimed that Bickford’s husband had told her his wife had improved in the hospital and was not suicidal.
Travis Bickford winces when reading Wood’s testimony.
“It’s hard enough that I lost my wife, that Trent lost his mom because we were desperate to get Jackie help and these f%#@ing 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 Colorado News Collaborative reached out to Wood and asked if she could provide any written notes of her claimed conversation with Travis Bickford. A Mind Springs spokesman says Wood declined to do so or to comment on his allegation.
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’s OK,” he tells his dad. “I know.”
‘Please don’t call Mind Springs’
Summit County’s sheriff at the time, John Minor, announced his resignation to become police chief in Silverthorne a few weeks after Bickford’s suicide. Commissioners appointed FitzSimons, a commander in the department, to replace him until voters elected him to the office months later in 2016.
He inherited the legal aftermath of Bickford’s death — 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,’” FitzSimons says.
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 to people in crisis at any hour to help stabilize them so they don’t end up in more expensive emergency rooms. Assistant County Manager Sarah Vaine says she 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, writes, “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.
Gwen Eller, a school counselor in Mesa County, adds that she and her colleagues were told by the school district not to count on Mind Springs’ mobile crisis unit in a crisis.
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’s 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.”
FitzSimons says his officers would respond to a call about a person actively trying to end their life and phone Mind Springs’ mobile crisis team for support, as was their protocol. “They’d ask our deputy if he took their gun away and the deputy would say yes, and they’d say well, then there’s no need to send their people out because the problem had been solved.”
Raggio says her organization responds appropriately to crises as needed, but she declines to discuss any particular incident raised in this story.
The CEO, 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 with the Colorado News Collaborative, she has mentioned the multiple business innovation awards the organization has won from industry groups.
“So I care deeply about community mental health,” she says.
“We’ve done a lot of good things,” she adds. “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 county are questions the center can’t or won’t answer. Entire programs seem not to exist. Spanish-language services are sorely lacking, even in areas with high immigrant populations.
“Mind Springs is a black hole,” says Pogue, the Summit County commissioner.
“We don’t know where the money goes or how it is being spent,” adds Beth Melton, a Routt County commissioner with similar concerns about Mind Springs. “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 social services, 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’s 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’s a lie,” says Sarah Vaine, the assistant Summit County manager.
In response to our initial investigation published earlier this month, Mind Springs’ spokeswoman Stephanie Keister 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.
“If I owned a used car lot, I’d hire Sharon,” says FitzSimons, who slams Mind Springs for creating programs he says don’t deliver.
“For some reason our state just gives them the money to keep doing it.”
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.
Spanish speakers, whose cultures have especially high stigma around mental health, have an even tougher time accessing care at Mind Springs. In paperwork the nonprofit filed to receive state contracts, it describes its treatment as “culturally responsive.” Yet, Mind Springs usually does not have fluent Spanish-language providers in most of its clinics, including those in communities with sizable immigrant populations such as Summit, Eagle and Routt counties. Sources in all three say the bilingual clinicians it has hired typically don’t last longer than a few months.
Mind Springs cites a statewide behavioral health workforce shortage for its difficulty finding and keeping bilingual care providers.
Fernando Almanza, a 911 dispatcher and school board member in Eagle County, says that stigma, in addition to Mind Springs’ lack of bilingual care, have dissuaded Latinx residents there from relying on the center:
“It’s not trusted in the community, to say the least.”
Trust in Mind Springs’ home county of Mesa also is low. In two separate 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. We could not locate any of the clients who provided those positive testimonials.
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.
Building Hope says that, in less than three years, it 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. Those are with 71 mental health care professionals independent of Mind Springs, many of whom are bilingual. Building Hope has been working to train those clinicians on how they can qualify to accept Medicaid reimbursement from the state. That training defies decades of efforts by Mind Springs and the Colorado Behavioral Healthcare Council, the trade group for community mental health centers, to limit the number of private Medicaid care providers they see as competition.
Revenues from Summit County’s mill levy also have allowed Building Hope to fund a program offering medication for addiction; pay for peer support counseling, which research shows can be more successful in communities with high levels of stigma; and staff teams of mental health coordinators to “concierge” or sherpa people through various stages of treatment, to advocate for them with Mind Springs’ staff, and to help them find a bed in a psychiatric ward, if needed. Finding a local placement is important because Mind Springs’ hospital in Grand Junction is three hours away and often full, and generally doesn’t treat children.
“People who have been screwed over 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.
Community leaders initially had feared the public would balk at having to pay twice — through federal and state tax dollars, then the local mill levy — for mental health safety-net care. Now, residents there seem to agree that the community cannot “be held hostage with substandard care,” says Vaine, Summit’s assistant county manager. She 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, Sheriff 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.”
If Summit County leaders have been the most vocal critics of Mind Springs, leaders in nearby Eagle County have — far more quietly — been the most aggressive in breaking off from the center.
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.
Shroll says his county chose to avoid the kind of slow, painful split that has made Summit County have to fight for its share of state and federal mental health dollars.
“We haven’t gotten into the weeds with Mind Springs like other counties — you know, adversarial,” he says.
“We wanted a quieter divorce,” adds an Eagle County official who asked not to be named to avoid further tensions with Mind Springs.
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.
Raggio says she has a great relationship with Eagle County officials and initially denied knowing anything about their plans to split from Mind Springs.
“You’re the only person I’ve ever heard that from. Am I misinformed? I don’t know what to say about it,” she said in August. By that point, sources inside and outside her organization tell the Colorado News Collaborative she had been having conversations about the break-up and how to respond to it for at least six weeks.
Months later, Raggio put out statements welcoming the new center and announcing that she will be retiring this spring. The two developments are unrelated, she said in November before turning the conversation once again to the industry awards Mind Springs has won.
Officials in all but one of the eight counties remaining in Mind Springs’ coverage area have said that political and economic factors make it unlikely their voters would pass a tax to pay for mental health services the center is supposed to be delivering. The one exception is Pitkin County, where Aspen is located.
Meanwhile, Mesa County has been researching ways to possibly end some of Mind Springs’ contracts there.
“We’re trying to determine which is the best path forward. We definitely are looking at creating some programs — maybe detox, maybe crisis care — that would meet the need that remains unmet,” says Rowland, the Mesa County commissioner. In the meantime, she adds she would like to see Mind Springs “focus on improving the system rather than on talking about their awards.”
Routt County has been changing some of its contracts with Mind Springs from a flat fee to an hourly rate so, as Commissioner Beth 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’s just say, and I’m trying to be diplomatic, that a lot of work needs to be done,” he said over the summer of Mind Springs in particular. He will not be there to help make reforms because he will be resigning in February.
At his home in Summit County, Travis Bickford says Coloradans cannot wait for state bureaucrats and lawmakers to resolve their “infighting and politicking and b-s’ing” about mental health policy, especially while the pandemic is still adding to the reasons people are spiraling into crises.
“People need help now, yesterday, six years ago. How many suicides … should it take to fix things?”
On the wall of his living room, Bickford keeps two framed photos of his late wife, Jackie. One is from their wedding day and the other from the last day their family of three spent together. He often pulls that photo down to look at it more closely and think about what was and what could have been. He tries, hard, to cut through the anger and hurt about her death and let himself feel what it is to just miss her.
Email Susan Greene at [email protected]
This story is part of a statewide reporting project by the Colorado News Collaborative called On Edge. The 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. Our intent is to foster conversation about mental health in a state where stigma and a lack of access run high. To learn more about COLab, visit colabnews.co.