Coloradans are increasingly ending up in hospital emergency rooms when they are in severe mental health crisis, yet once they’re stabilized and sent home, most never follow up with therapy.
Colorado Crisis Line: A statewide hotline. 1-844-493-8255, or text TALK to 38255.
About 70% of people don’t see a therapist after an emergency visit, a statistic that mental health advocates blame on a confusing system and a lack of guidance available to patients.
But what if trained listeners — the same ones who answer suicide hotline calls — called people after they checked out of hospital emergency departments and talked them through the process of finding a regular therapist?
That’s the premise behind a Colorado program that has expanded to 73 hospitals statewide and recently partnered with a nonprofit that provides free counseling sessions to young people who don’t have the means to pay for it.
The “Follow-Up Project” began almost a decade ago as a pilot program with a few hospitals, including UCHealth University of Colorado Hospital. By piecing together funding through a variety of grants, the state’s Office of Suicide Prevention was able to stand up the program in 2018 with eight hospitals. It now includes 73 hospitals, both in cities and in rural towns, and follow-up specialists have called more than 19,000 patients.
The latest federal grant allowed the suicide prevention office to partner with the Second Wind Fund, which since 2002 has paid for therapy sessions for young people up to age 19 who are at risk of suicide. Now, the crisis specialists who make the post-hospital follow-up calls can offer not just guidance on how to find a therapist who is accepting patients, but link patients with the nonprofit that can set up and pay for those appointments.
Rocky Mountain Crisis Partners, which answers Colorado’s crisis services hotline and calls to the nationwide 988 suicide hotline dialed in Colorado, has a team of 25 people dedicated to the Follow-up Project. A patient who has been discharged from a hospital emergency department gets a call from a specialist within 24 hours, then one weekly call for the next month or so.
The risk of dying by suicide is heightened in the weeks and months after a person visits a hospital in mental health crisis. Studies have found that 22% of suicide deaths happened with 30 days of a hospital emergency visit, while 40% happened within one year of a trip to the emergency department.
There’s proof the Follow-Up Project is helping. Based on surveys after six months and a year, people who participated in the program were less likely to have returned to a hospital or walk-in crisis center. This means that ongoing therapy has helped them manage their anxiety and depression and they are less likely to end up in a crisis that requires emergency care, said Melody Keown, manager of the program for Rocky Mountain Crisis Partners.
The program’s origins go back to 2011, when Rocky Mountain Crisis Services began answering the state hotline. Staff answering the hotline soon began making follow-up calls to people who had called in crisis, and a few years later, the pilot program began with University Hospital, thanks to a grant received by the state suicide prevention office.
“When you are discharged from an emergency department, there is a lot of information thrown at you and a lot of instructions,” Keown said. It’s often too much to digest, and then people feel overwhelmed about trying to set up ongoing therapy. Staff who make the follow-up calls try to empower patients with information, as well as push them, gently, to stick to the plan, she said.
They say, “We will call you next week and see how that worked out,” Keown said. “Not only are they encouraged and informed, but they are held accountable and have to answer that phone next week. It’s not done in a judgmental way. It’s support, to see if they followed through.”
The first call lasts up to 30 minutes, and the average length for the subsequent weekly calls is 15 or 20 minutes. Patients at any time can opt out of the program, which is free. “We try our hardest to actively listen and understand everybody’s story,” Keown said.
The program specialists won’t make appointments for anyone, but instead encourage people not to give up if it takes awhile to find a therapist who not only accepts their insurance but is taking new patients.
“A long wait time for a first appointment is a pretty common experience right now,” Keown said.
Before she worked for Rocky Mountain Crisis Services, Keown went through the experience of trying to navigate a “big disconnected system” when one of her children needed mental health care. Her son’s doctors recommended he go to an intensive outpatient program, yet the wait list was nine months long.
“I was going to have to keep him safe on my own and get him in therapy that he didn’t want to go to,” she said. “If we had known there were other support options out there, we might not have felt as lost.”
The Follow-Up Project, which has served up to 8,000 people per year, is for children and their parents as well as adult patients. In the past year, the program connected with 133 parents of children up to 9 years old, and more than 2,500 young people ages 10-24.
“For the majority of people, there’s an increased suicide risk after a suicidal crisis,” said Lena Heilmann, director of the state Office of Suicide Prevention, which is part of the Colorado Department of Public Health and Environment. The project is based on the “caring contacts” model, which has shown that people are less likely to die by suicide if they have someone check on them.
“Someone to check in with that person who’s been suicidal, or experiencing a mental health crisis, to just offer support and care without anything demanding or providing therapy, but just caring contact,” said Heilmann, who was drawn to her career because she lost her sister to suicide.
The new partnership with Second Wind Fund puts more focus on children and teens. Suicide is the leading cause of death for young people in Colorado, with recent data showing one in five high school students has considered suicide. The state suicide rate for children and teens ages 10-18 is one of the highest in the nation, although the rate has remained steady since 2016.
The nonprofit provides 12 free therapy sessions to young people up to age 19 who do not have insurance or who are underinsured. With the new partnership with the state, the goal is to expand the free therapy program to people up to age 24. The latest grant, from the federal Substance Abuse and Mental Health Services Administration, provides $735,000 each year for five years.
The plan is to expand each year for five years until young people up to age 24 can access the free therapy sessions, Heilmann said.
More than 8,000 young people have received mental health help from Second Wind in the past two decades. The fund has received 750 requests just since July — the highest number in the past five years, said Chris Weiss, the fund’s executive director.
Parents and caregivers who are concerned their child may be experiencing thoughts of suicide can find immediate, free and confidential help through Colorado Crisis Services at 1-844-493-TALK or by texting “TALK” to 38255.