Officials say mental health clinic is failing Colorado mountain towns, where suicide rates are above average

By Susan Greene, Colorado News Collaborative

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 are low, and the hospitality and outdoor industry workforce is 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’re trying to root out what some see as another barrier: Mind Springs Health, the private, taxpayer-supported 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 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.

That disappointment is expressed bitterly and publicly in Summit County, where local officials, including the sheriff and county commissioners, say the center provides substandard care, that its mobile crisis team regularly does not show up when needed, and that it fails to publicly account for its spending of taxpayer money. 

In 2018, Summit County voters passed a tax measure to fund mental health care and an alternative to Mind Springs. 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 entirely and joining nearby Eagle County’s new community mental health center because Mind Springs refuses to acknowledge its failures and state officials have not intervened. 

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 provider and eye ways to take control of their own care. 

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 like ours 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. Read more stories…

Mind Springs Health CEO and President Sharon 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.” 

A wife’s death

Travis Bickford doesn’t want to hear it. Raggio’s words will not bring back his wife, who took her life while in the county jail, where Mind Springs provides mental health care. 

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. 

Because she was talking about ending her life, Travis 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 in a condition “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 decided not to bail her out, assuming she — and their son — 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 the baby 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, Jackie 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, according to a deposition in a lawsuit filed by her family. 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. Mind Springs would not comment on the matter. 

“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 Jackie Bickford’s suicide. Commissioners appointed Jaime FitzSimons, a commander in the department, to replace him. FitzSimons was elected sheriff a few months later.

He inherited the legal aftermath of Jackie 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 after 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.” The mental health center did not provide any specific numbers about how often the mobile unit responds or declines to respond to calls. 

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

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. 

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 his department’s 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 according to 2018 tax documents, cites a lack of state and federal funding and a maze of red tape as challenges for Mind Springs. In defending the organization, Raggio repeatedly recounted the story of how she led it 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. She touted the multiple business innovation awards the organization has won from industry groups.

“So I care deeply about community mental health,” Raggio 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”

County officials are highly critical of what they say is a lack of transparency about how much tax money the center receives for its programs, what it spends in each county and how many people it employs in each county. 

“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.”  

According to its most recent publicly available tax filing, for 2018, Mind Springs reported receiving $13.5 million in Medicaid and Medicare funding and $11.4 million from governmental agencies for its programming.

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” during interviews, repeatedly has said her organization does not keep its electronic records in a way it could figure out how much it spends per county.

In response to the Colorado News Collaborative’s 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. 

Fernando Almanza, a 911 dispatcher and school board member in Eagle County, says the stigma surrounding mental health care, in addition to Mind Springs’ lack of bilingual care, have dissuaded Hispanic residents there from relying on the center.

“It’s not trusted in the community, to say the least,” Almanza said. 

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. 

Building hope

Summit County businesswoman Patti Casey took her life 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 services they said 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.

Money from Summit County’s mill levy also has allowed Building Hope to fund a program offering medication to treat 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,” said Vaine, Summit County’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.”

Vail Hospital starts alternative to Mind Springs

If Summit County leaders have been the most vocal critics of Mind Springs, leaders in nearby Eagle County have been the most aggressive in breaking off from the center.  

Eagle County in 2017 passed its own mental health tax, but 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 plans to 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.

Leaders in Summit and Eagle counties now are working 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.

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 Melton, the county commissioner, describes it, “we actually pay for services that they’ve actually provided.” 

In six months of interviews, no one — except for Sheriff FitzSimons — called for Colorado’s community mental health centers to be dismantled. 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 when asked about Mind Springs in particular. He will not be there to help make reforms because he will be resigning in February. Nor will Raggio, who says she plans to retire this spring. 

Email Susan Greene at susan@colabnews.co

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.