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A 2017 Colorado Health Access Survey found:
5 percent — Douglas County residents who reported eight or more days of poor mental health in the previous 30 days.
Tri-County Health Department’s 2016 Community Health Assessment found:
5.9 percent — Douglas County residents who needed mental health care or counseling services but did not get them in that time during the past 12 months.
13.6 percent — Douglas County students in ninth through 12th grades who reported their mental health was not good on 14 or more days during the past 30 days.
14.1 percent — Douglas County students who seriously considered attempting suicide during the past 12 months.
A December 2016 health update from Tri-County Health Department with data from 2014 found:
6.8 percent — Douglas County residents who reported 14 or more days of poor mental health in the past 30 days.
42 million adults live with anxiety disorders.
16 million adults live with major depression.
6.1 million adults live with bipolar disorder.
2.4 million adults live with schizophrenia.
Anxiety disorders occur in 25 percent of teens ages 13 to 18 years old.
Mood disorders, including major depressive disorder, dysthymic disorder — described as low-grade chronic depression — and bipolar disorder, occur in 14 percent of teens ages 13 to 18 years old.
Source: National Alliance on Mental Illness, U.S. Department of Health and Human Services Office of Adolescent Health
Let’s Talk Colorado, launched in May, is a statewide campaign created by Tri-County Health Department and other partner organizations to combat the stigma of mental illness. In English and Spanish, Letstalkco.org defines mental health and stigma, as well as provides links to local and statewide resources.
The campaign also provides tips on how to talk about mental health, such as:
• Be nice.
• Keep in contact.
• Offer help.
• Keep the conversation moving.
• Don’t ignore it.
MakeItOk.org is a national campaign to combat the stigma of mental illness. On its website, visitors can learn about mental illness, answer a questionnaire on stigmatic behaviors and read about individual experiences with stigma. The campaign provides resources that can be used to teach, share, learn and speak about mental illness and stigma. Below are phrases the campaign recommends to use and to avoid when discussing mental health.
• “Thanks for opening up to me.”
• “How can I help?”
• “I’m sorry to hear that. It must be tough.”
• “I’m here for you when you need me.”
• “I can’t imagine what you’re going through.”
• “People do get better.”
• “Can I drive you to an appointment?”
• “How are you feeling today?”
• “I love you.”
• “It could be worse.”
• “Just deal with it.”
• “Snap out of it.”
• “Everyone feels that way sometimes.”
• “You may have brought this on yourself.”
• “We’ve all been there.”
• “You’ve got to pull yourself together.”
• “Maybe try thinking happier thoughts.”
Editor's Note: This report on the state of mental health in Douglas County, and the barriers that can prevent needed care, is the first in an ongoing series that looks at how mental health challenges and illnesses affect our communities. The next part will explore how social media is affecting our children’s emotional intelligence and self-esteem and their ability to cope with conflict. Subsequent focuses will include suicide; mental health challenges among seniors, families, employers and jails; and how substance and alcohol abuse exacerbates the issue.
Growing up in Highlands Ranch, Sydney Chapin, 19, had everything she needed: a nice home where she lived with her parents and younger sister, good schools, close friends, money to pay for a tutor or therapist if she needed one.
But she struggled.
In second grade, she was diagnosed with anxiety, a mental health condition that runs in her family. In ninth grade, when her mother battled stage-four breast cancer and Chapin took on the role of caring for her sister, she was diagnosed with depression. She had difficulty fitting in at a new high school. Her energy declined, as did her grades.
“Because you have the money to fix things, it’s kind of expected that it’s all OK,” Chapin said. “There is an expectation to do well by everyone.”
Today, with the help of medication and therapy, Chapin is successfully managing her mental health. She is a freshman at Metropolitan State University of Denver, studying psychology so that she can someday help people who have been in her shoes.
She is not alone in her struggle to maintain a healthy state of mind: One in five adults nationally lives with a mental illness. The number is the same for young people 13 to 18 years old.
That means, even in affluent, suburban Douglas County — with its $103,000 median income, family-friendly communities, safe neighborhoods and good schools — almost everyone knows someone who is struggling with some form of mental illness.
“There is no level of education or socioeconomic status or ethnicity or creed or age that is mental illness,” said Anne Mosbach, coordinator of the Douglas County Mental Health Initiative, a 37-member coalition studying ways to address the county’s mental health challenges. “Mental illness in Douglas County looks like it does everywhere — it looks like one in five people.”
Among mental illnesses, two are most commonly diagnosed: Nearly 42 million Americans live with anxiety disorders, the National Alliance on Mental Illness (NAMI) reports. About 16 million adults live with major depression, also the leading cause of disability worldwide. NAMI calculates that depression costs $193.2 billion in lost earnings every year.
Research has shown lower income directly correlates to poorer mental health.
“Income is a pretty good proxy for life circumstance,” said Dr. John Douglas, director of Tri-County Health Department, which provides health services to Douglas, Arapahoe and Adams counties. “In that respect, Douglas County looks better.”
But, he said, Douglas County has additional lifestyle challenges, such as substance abuse and binge-drinking, that impact mental health.
And mental health experts also have found no one is immune from society’s fast-paced, competitive, technology-driven environment. Stressors of work, pressure of academics, the emotional unrest caused by social media — combined with the stigma associated with mental illness and high costs of insurance and treatment — make it difficult to achieve a positive state of mental health, they say.
More: The cost of mental health treatment
“We just need to normalize that all of us have small or large, or a different variety of, behavioral health problems,” said Dr. Kaan Ozbayrak, chief medical officer at AllHealth Network, which provides behavioral health services to Douglas and Arapahoe counties. “It is as normal as having diabetes or high blood pressure. We should be talking about it more.”
Mosbach, who was a social worker for 10 years and a former director of internal therapists at the Douglas County jail, has noted the growing role that societal factors play in increasing stress among county residents. Particularly, she said, there seems to be more pressure on young people to succeed, as well as fear of what others perceive.
“There is a lot of pressure and high expectations of young people,” Mosbach said. “It comes from a good place, but I have noticed that a characteristic that might be different in Douglas County is high expectation and a lower margin of error for people.”
More: The stigma of mental illness and how to fight it
Statistics show the Douglas County School District is high-performing, outpacing neighboring counties and the state in several areas of academic achievements.
In 2016, DCSD’s graduation rate was 90.1 percent, according to the Colorado Department of Education. That was higher than the national rate of about 83 percent and Colorado’s rate of 78.9 percent. In the 2016-17 school year, every traditional high school in the district scored above the state average on the PSAT and SAT, according to standardized college test score results released in August.
Those are all praiseworthy accomplishments. But even with programs to help students handle stress positively, the pressure to perform well academically, combined with the nonstop buzz of social media, can cause anxiety in some students, said Wendy Strait, a counselor at Mountain Vista High School in Highlands Ranch.
“Kids typically look at academics as a way that they are performing in the world right now. That’s what they have as their window into who they are,“ said Strait, a counselor for 22 years. “When something doesn’t go right and there is so much pressure put onto things they can’t control, that’s when things get bad.”
Kevin Duffy, captain of detention at the Douglas County Sheriff’s Office, also points to the weight that high expectations, such as maintaining an affluent lifestyle, generate. That, coupled with what he describes as a “severe” lack of mental health resources, can create a stressful environment for many.
“We live in a very affluent, very safe county, but it is also a very, what I would call, a pressure,” Duffy said. “Kids are under a high pressure to succeed, our parents are under high pressure to maintain their lifestyle — you just see people that are going a million miles an hour just trying to stay ahead of the curve.”
Duffy, who has worked at the sheriff’s office for 28 years, said county jails mirror society. And in the Douglas County jail, 45 percent of inmates have a diagnosable mental illness, he said, adding that because Colorado has only one mental health hospital, in Pueblo, county jails across the state double as mental health facilities.
“Many of these inmates come from our community — and are going to go back to our community,” Duffy said.
Caused by a combination of genetic, lifestyle and environmental factors, mental illness is treatable. Yet only 44 percent of adults with diagnosable mental health problems and less than than 20 percent of children and adolescents receive needed treatment, says the U.S. Department of Health and Human Services.
A 2017 Colorado Health Access Survey conducted by the Colorado Health Institute, a research organization that provides data on healthcare in Colorado, found 5 percent of Douglas County residents reported eight or more days of poor mental health in the previous 30 days.
Of those people, 2.8 percent didn’t seek treatment for four main reasons: cost or insurance coverage, feeling uncomfortable discussing personal problems, difficulty getting an appointment and fear of someone finding out.
More: "If people are in crisis, they should't have to wait"
Tri-County’s 2016 Community Health Assessment found 5.9 percent of Douglas County adults needed mental health care or counseling services but did not get it at the time during the previous 12 months.
“Sometimes depression can be so severe that you can’t get out of bed or go to work,” Ozbayrak said. “It is very difficult at that point just to say, ‘Eat healthy, exercise and get over it.’ You do need professional intervention.”
The importance of addressing mental health shows in numbers, Douglas said. Suicides in Douglas County increased from 34 cases in 2010 to 57 cases in 2016, according to data from the Colorado Department of Health and a 2016 report from the Douglas County coroner.
“Douglas County is the healthiest county (physically) in Colorado but mental health is clearly not optimal,” Douglas said. “The suicide issue in particular is a concern in Douglas County, just like it is across Colorado.”
More: Douglas County's initiative to improve mental health
Statewide, the number of suicides jumped from 910 cases in 2011 to 1,058 in 2014. Colorado’s suicide rate that year was 19.4 per 100,000 residents, the seventh highest in the country, the Colorado Department of Public Health and Environment reports. The suicide rate in Douglas County, which has 328,632 people as of the 2016 U.S. Census, was 16.3 per 100,000 residents as of 2015, according to the Colorado Health Institute.
Tri-County’s 2016 Community Health Assessment found 13.6 percent of Douglas County students in ninth through 12th grades reported their mental health was not good on 14 or more days during the past 30 days. And 14.1 percent of Douglas County students had seriously considered attempting suicide during the past 12 months.
Duffy, of the sheriff’s office, said it seems as if suicide is “becoming more of an option” as people dealing with crisis become more overwhelmed and increasingly feel more hopeless.
“It seems like every year our completed suicide calls are rising fairly significantly, not only in Douglas County but throughout the state of Colorado,” he said. “Suicide is probably one of the biggest issues we are dealing with right now.”
However, mental illness doesn’t have to be fatal, said Andrew Romanoff, president and CEO of Mental Health Colorado, an organization that advocates for the prevention, diagnosis and treatment of mental health and substance-use disorders.
“We are trying to help more people understand that mental illness is not a character flaw or a figment of imagination, it’s a medical condition,” Romanoff said. “Mental illness doesn’t have to be a death sentence — it’s treatable.”
For Douglas County officials, two tragedies in 2013 and 2014 sparked a realization that residents with mental health issues were falling through the cracks.
In December 2013, a student at Arapahoe High School who lived in Highlands Ranch fatally shot a classmate before killing himself. The following year, a 15-year-old boy from Highlands Ranch shot and killed his mother, then fatally turned the gun on himself. Both displayed signs of mental illness, according to investigators.
Deputy County Manager Barbara Drake and other county leaders began to question how the county could better support people with mental illness and find ways to create a more integrated healthcare system, where mental health specialists were consistently more accessible to individuals. In 2014, Drake spearheaded the creation of the Douglas County Mental Health Initiative, whose 37 partner organizations meet monthly to discuss the county’s needs. Its goal is to find the gaps in services required by those with mental illness, streamline support by facilitating collaboration among local resources and start new programs to fill the holes.
“The idea of the mental health initiative was to really put forth that message that this is a community issue and it takes everyone in a community working together,” Drake said. “We wanted to look at where there were unmet needs. If we got people connected to mental health services, could we prevent people from falling through the cracks?”
Douglas County Commissioner Lora Thomas, who served as the county’s coroner from 2011-15, also encountered tragedies related to mental illness in the suicides of Douglas County residents, including some students at local high schools and middle schools. When her term as coroner ended in 2015, she started “A Night with the Coroner,” a nonprofit that raises money for suicide prevention efforts.
Thomas, along with fellow commissioners Roger Partridge and David Weaver, agree a strong community network is essential to improving care for residents.
“When people are not able to access or get the right kind of mental health care they need, bad things happen,” Thomas said, “and that hurts a community.”
Late last year and early this year, Douglas County experienced two more extreme tragedies, highlighting again the need for accessible mental health support and acceptance of mental health challenges as a daily part of life, officials of the county and public health departments say.
In November 2016, a mother from Highlands Ranch shot and killed her two young sons before shooting and killing herself.And in January 2017, another Highlands Ranch mother shot and killed her 10-year-old daughter and then herself. Law enforcement and family members said depression and anxiety played a role.
“There are a lot of stories out there,” said Drake, noting that each is unique to the person. “There is not just one story.”
Douglas, the executive director of Tri-County Health Department, praises the Douglas County Mental Health Initiative for being proactive and giving greater attention to the notion that behavioral health issues are part of human health.
“We don’t like to talk about it, we don’t like to admit it to ourselves, we don’t like to admit that our family members have it,” Douglas said. “Mental health issues can extract an incredible toll.”
But opening up to another individual about the accomplishments and struggles of everyday life is a significant part of maintaining mental health, Mosbach said. As is digesting the statistic that one in five people go through a mental illness, which Mosbach describes as “part of the human condition, not a flaw or weakness.”
“The best thing we can do as community members is to model that behavior,” Mosbach said. “Don’t force someone to open up, but model it, talk to them about how you are doing and show them that it is a safe space.”
Some of that role-modeling is coming from the county’s younger residents.
At Valor Christian High School in Highlands Ranch, a group of students is working on a photography project that depicts depression and anxiety. It will be presented sometime in January.
Sophomore Tabi Snowden, one of the group members, focused her research on self-harm, and with the help of her mother, Tami Snowden, interviewed three young girls who were or are cutting themselves to cope with depression and anxiety.
Tabi Snowden hasn’t experienced mental health problems or engaged in self-harm. But the topic interests her, she said, because a friend she cares about from middle school went through that experience.
“If we talked about it more,” she said of self-harm, “it wouldn’t be as scary.”
For Tami Snowden, her daughter’s project reflects a larger societal issue that makes itself evident in suburban communities of Douglas County and across the nation.
“We are such a busy society, we don’t have time for people,” she said.
Sitting in a Highlands Ranch Starbucks on a November afternoon, Chapin, a Rock Canyon High School graduate with a sweet smile, comfortably talked about how she manages her mental health. She makes herself get out of bed. She does yoga. She says no when she doesn’t want to do something. She writes.
“A lot of things that I can’t say to other people, I can put on paper,” she said.
She said she often feels that because she was raised in an area where having enough money is generally not a problem, there is a preconceived notion her mental health is supposed to be optimal and fixable.
“I’m privileged,” she said. “It’s hard to explain why I’m still depressed because to an outsider, I have everything. But it's not about physical things — it’s completely about my mind.”
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