When Drew Dummit’s mental illness worsened in 2017, he was admitted to Mind Springs Health in Grand Junction, the largest behavioral health services provider on the Western Slope.
Three days later, staff deemed him stable enough to go home.
Soon after, Dummit’s hallucinations worsened, he attempted suicide twice and began assaulting his mother, Sandra Sharp, more severely and frequently.
“If I could have afforded inpatient care at the time, he would have gone,” said Sharp, who lives in Denver.
But the type of care Dummit needs is expensive. Sharp was quoted about $30,000 per month when she looked for help for her son in 2017 at several inpatient care facilities.
Over the past decade, Dummit has struggled to get the care he needs, because his parents simply cannot afford it.
Dummit has Medicaid, Sharp said. But the insurance plan doesn’t cover long enough stays in inpatient care and it doesn’t cover all of the medications Dummit needs.
For many Colorado families struggling to balance their budgets, the cost of mental health care is increasingly out of reach. In some cases, young Coloradans find their private insurance doesn’t cover the cost for services that address their mental health and emotional problems.
Text “HelpLine” to 62640 to connect with a specialist who can provide support, information and resources to people with mental health concerns. To talk with a National Alliance on Mental Illness HelpLine Specialist, call 800-950-6264.
Low reimbursement rates from insurers have pushed many mental health care providers to only accept clients who can afford to pay out of pocket. And those who can’t afford private pay can face long wait times at the clinics that do accept their insurance.
These hurdles can be so difficult and expensive for a person with an untreated mental health condition to navigate that it’s causing some to forgo care.
The trend, mental health professionals and people with mental health conditions said, is creating devastating effects for Coloradans struggling to get care, their loved ones, their neighbors and the economy.
Sandra Sharp’s son, Drew, pictured at numerous snowboarding competitions, skateboarding and attending a Congressional Youth Leadership Council. Drew, who is now in his early 30s, has schizophrenia. He had his first psychotic break two weeks into starting college. He was 19 years old then, and has since cycled in and out of hospitals, sometimes experiencing homelessness for weeks. (Olivia Sun, The Colorado Sun via Report for America)
The high cost of mental health care
The high cost of mental health care has long influenced who can get the care they need and who cannot, perhaps since its origin, said Vincent Atchity, president and CEO of Mental Health Colorado.
When it originated, for example, psychotherapy was mostly accessible to wealthy Americans who could afford to pay hundreds of dollars per hour to those professionals, who would spend hours examining their life experiences to identify root causes of distress and discomfort, he said.
“It’s always been kind of a culture of the rich,” Atchity said, “and for folks who are not rich but also not poor, there still are these access issues because what your insurance will cover is so limited in terms of what’s accessible and you could sign up for care and it could take you months to get in there.”
In 2022, the median payment a Colorado patient and their commercial insurer paid to a mental health provider for a 60-minute outpatient psychotherapy visit rose to $107, up from $79 in 2018, according to a data analysis by the Center for Improving Value in Health Care.
The median cost of an hourlong psychotherapy appointment
The median price Colorado Medicaid paid for the same service was $89 in 2018 and increased slightly to $93 in 2022.
The median reimbursement rate a Colorado patient and their commercial insurer paid for an outpatient psychiatric diagnostic evaluation was $104 in 2018 and $114 in 2022.
The median reimbursement rate Colorado Medicaid paid a mental health provider for the same service in 2018 was $108 and $107 in 2022 per visit.
A sample of about 60,000 visits at Colorado Psychiatry Center showed patients paid on average $71 in 2019 for a mental health visit and their insurer paid the remainder of the cost, said Dr. Ron Morley, medical director at the practice, which serves children, adolescents and young adults age 5 to 25 in Denver and elsewhere on the Front Range.
In 2020, the average price for the patient dropped to $52. In 2021, the average price was $43. In 2022, the average price rose to $63. And in 2023, the average price for a visit was slightly higher at $64, according to the center.
The average amount patients paid for a mental health visit
Patients’ insurers paid the remainder of the cost.
“The changes are because of changes in deductibles and co-pays, which vary over time,” Morley said. “Over the last several years, this has gone up a lot after being brought down by COVID.”
At the Colorado Mental Health Hospital at Fort Logan — one of two state psychiatric hospitals serving people with severe mental illness and offering court-ordered inpatient restoration treatment — the daily cost of a bed to the Colorado Department of Human Services was $1,013 in 2023, up from $868 in 2018 and $802 in 2014, according to a spokeswoman for the Colorado Department of Human Services.
The average length of stay there was 24 days in 2018 and increased to 95 days in 2023, meaning, the average person’s length of stay cost $20,832 in 2018 and cost the state $96,235 last year.
At the other Colorado Mental Health Hospital, in Pueblo, the daily cost to the state for a bed was $1,476 in 2023, up from $808 in 2018 and $830 in 2014. The average length of stay increased from 108 days in 2018 to 152 days in 2023, meaning, the average length of stay cost $87,264 in 2018 and cost the state $224,352 in 2023.
What patients pay varies widely and is sometimes covered by Medicaid or private insurance. No patient is denied admission to the state hospitals because of their ability to pay, the spokeswoman said.
A bigger bill for people with behavioral health concerns
People with behavioral health conditions tend to have higher health care costs than those who don’t, according to a report by Milliman, a risk management, benefits and technology firm.
People with a behavioral health condition had an average annual health care cost of $12,272, about 3.5 times higher than Americans without a behavioral health condition, who paid about $3,552 per year, according to the report, which included 21 million people age 2 to 64 who had commercial health insurance coverage for the entire year in 2017.
From 2009 to 2019, spending for mental health treatment and services increased 52% nationwide, while the U.S. population increased 7% in that same period, according to Open Minds, a business solutions firm helping health and human services organizations.
In 2019 alone, national spending on mental health services such as therapy, medications and stays at psychiatric or substance use rehabilitation facilities totaled $225 billion and accounted for 5.5% of all health spending, according to the organization.
But even with all the spending, Coloradans are still struggling to afford and access the mental health care they need.
More than half of all people with a mental health disorder in the U.S. did not receive any treatment in the past year, according to a 2021 analysis by NAMI Colorado.
Of the 328,000 adults in Colorado who did not receive needed mental health care, 37% said they were not seen by a provider because of the cost, according to the analysis.
Meanwhile, Coloradans are nine times more likely to be forced out of network for mental health care when compared to primary health care, according to the NAMI analysis. And almost 65% of Coloradans ages 12 to 17 who have depression did not receive any care in the year before the survey was compiled.
In 2022, Dummit was living at an assisted living facility, where he wasn’t receiving sufficient care. Staff eventually evicted him because they said he disrupted other residents when he screamed and paced around the facility during psychosis from schizophrenia, his mother said.
Sandra Sharp attends a statewide virtual support meeting of family members of adults with serious mental health conditions Jan. 17. The weekly virtual group has about a dozen others, all seeking more access to quality mental health care. The same day, she reviews a House bill regarding the sharing of patient health care information between institutions and family members. (Olivia Sun, The Colorado Sun via Report for America)
“And so he walked off,” she said. “What neighbors say is they saw him walking down an alley, he jumped a fence into a person’s yard, he played with a dog there for about 30 minutes, he followed the dog into the person’s home, put the owner’s clothes and jewelry on, had something to eat and drink and then the police arrested him.”
Dummit was arrested in August 2022 for burglary, and has been incarcerated at Denver County Jail awaiting trial since then in a pilot program with 12 beds for people with severe mental illness, who were on a long waitlist for the state’s psychiatric hospital.
He has a team of mental health specialists, he’s been on medication since his first week there, his hygiene has improved and he reads books again, his mother said.
He faced up to 26 years in prison but recently entered a plea agreement that ends his sentence on March 29.
“People in Colorado who are dealing with a severe mental illness, if they don’t have access to pay out of pocket for residential care at whatever level they need, their option is to be arrested,” she said. “But they need to be arrested for a felony, because with a misdemeanor, they don’t get enough mental health help. You go through stages as a mom, and eventually, you realize you’re not going to get help for them unless they get arrested.”
But Sharp said her dilemma will not be over when Dummit is released from jail. He will still need inpatient treatment and she still will not be able to afford it, she said.
Colorado’s unmet needs
Colorado ranked far below the national average, or 48 out of 51 of all states and Washington, D.C., for its percentage of adults with a mental illness who reported an unmet need for treatment, according to the 2022 State of Mental Health in America Report, which uses 2018 and 2019 data, the most recent accurate data available.
Percentage of adults with a mental illness who report unmet needs
Across the country, 24.7% of all adults with a mental illness reported they were not able to receive the treatment they needed. According to Mental Health America, this number has not declined since 2011.
In other words, nearly 1 in 3 Colorado adults with a mental illness could not get the mental health care they needed, according to the report.
Almost 46% of people who were asked why they weren’t able to get mental health treatment in Colorado said it was because they couldn’t afford it, according to the Substance Use and Mental Health Services Administration.
Colorado also ranked far worse than the national average, or 40 out of 51 states and Washington D.C., for its prevalence of young people ages 12 to 17, who had private insurance that did not cover mental health treatment, according to the Mental Health America Report.
Insurance
The 2008 Mental Health Parity and Addiction Equity Act works to ensure that people seeking mental health and substance use disorder treatment do not face greater barriers than others seeking care for medical and surgical conditions.
In 2019, Colorado codified parity into law, and since then, it has had additional capacity and enforcement options. But despite the law, people seeking behavioral health care still face greater barriers than those needing medical or surgical treatment.
When compared with other states, Colorado had the sixth highest rate of out-of-network care for behavioral health office visits versus primary care office visits, according to another Milliman research report.
In 2017, the same year Dummit was admitted to Mind Springs Health in Grand Junction, more than half of the people receiving behavioral health services at residential treatment facilities nationwide were paying out of pocket, according to the Milliman report.
Low reimbursement rates for mental health providers is also driving those professionals into other specialties and causing them to not accept insurance — further complicating a shortage of behavioral health care workers.
In 2017, 17% of behavioral health office visits were to an out of-network provider compared with 3% of primary care providers and 4.3% of medical/surgical specialists, according to Milliman.
The growing demand for mental health services, a shortage of mental health providers and an increase in out-of-network participation means people with higher incomes are able to afford care.
Mental health and substance use disorder care must be covered in health insurance plans in Colorado and across the country under requirements from the 2008 Mental Health Parity and Addiction Equity Act and the Affordable Care Act of 2010.
“Where that gets challenging is whether or not you can find a provider who can meet your needs in-network with your insurance company and that is something we’re looking at and we really want to mitigate the reasons why providers don’t take insurance,” said Cara Cheevers, director of behavioral health programs at the state Division of Insurance.
In 2020, the division found some insurance companies were overcharging consumers for co-pays, coinsurance and deductibles, anywhere from a few dollars to thousands. Those companies were “massively fined,” she said, and consumers who were overcharged received refund checks. “There’s still a lot more work to do and we know that.”
While the division mostly works to address and reduce consumer harm, the health care provider’s experience is also crucial to consider when closing health equity gaps, Cheevers said.
There’s still a lot more work to do and we know that.
— Cara Cheevers, director of behavioral health programs at the state Division of Insurance
The division has launched a complaint portal to track and identify trends and issues that make it hard for providers to participate in commercial insurance. The agency also publishes commercial insurance resources for providers to increase their likelihood of taking insurance and to help reduce the number of Coloradans paying for care out of pocket.
The division is also working to increase health care affordability, drive down premiums and ensure people can access affordable, quality health insurance products, she said.
“Mental health care can be a serious economic justice issue and we want to make the reasons why providers don’t participate in local markets no longer a problem,” Cheevers said. “People pay a lot for insurance and they should be able to use it to get mental health care too.”
Community implications of unmet care
The implications of forgoing mental health care are vast and numerous for the person struggling and others in the community.
Untreated mental illness often worsens and the person could be at risk of losing their job, housing and close relationships, said Ray Merenstein, executive director of NAMI Colorado.
The resulting isolation and reduced quality of life can increase their risk for self-harm or suicide and can cost them more financially, over time, if they’re seeking more expensive care at an emergency room or if they’re increasingly taking unpaid sick days, he said.
Another consequence of untreated mental illness is a depressed economy, he said.
As Coloradans appear to be heading into harder times amid growing inflation, and as millennials and younger generations who care about mental wellness age and become leaders across the state, it will become even more important to meet people’s mental health needs at a lower cost.
“It sounds terrible to say it, but there may need to be more self-reliance and team-reliance as the viable solution to a population facing scarcity of care and dominance of crises,” Atchity said. “I’m concerned that people who need care and aren’t getting care aren’t making a practice of doing other self-care things and that’s where I feel like there’s an opportunity for us.”
Maintaining a healthy diet, staying hydrated and movement — especially outside in the sun — are fundamental to maintaining good health, Atchity said, but clinicians rarely include these suggestions in a patient’s health plan.
“Another key thing in your toolkit is engagement and connection with people who you feel a sense of belonging and acceptance,” he added. “Even a five-minute phone call and a couple texts with your personal safety net can shore up your sense of strength and well-being.”
Charts by Danika Worthington