Several Douglas County administrators sat on one side of a large rectangular table. The deputy county attorney was a few seats down, near a deputy from the sheriff’s office. Representatives from area hospitals, public health departments, rehabilitation centers, nonprofits and churches filled other seats. Some people presented; others listened and threw around ideas.
They were at a monthly meeting at Douglas County’s administration building in Castle Rock to brainstorm how they could better serve residents with mental illness. And they were from among the 37 organizations that make up the Douglas County Mental Health Initiative.
“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,” said Barbara Drake, Douglas County’s deputy manager who led the creation of the mental health initiative.
The mental health initiative started three years ago, after multiple tragedies shook communities in Douglas County. In 2013, Karl Pierson, 18, fatally shot 17-year-old classmate Claire Davis before killing himself at Arapahoe High School in the neighboring Littleton school district. Pierson lived in Highlands Ranch. In 2014, a 15-year-old boy, also from Highlands Ranch, shot and killed his mother, then turned the gun on himself.
“Those were the things that made us say, ‘Can we do better than this? What can we do? We think this is indicative that there are people that are falling through the cracks,’ ” Drake said.
Collaboration is ‘night and day’
The initiative aims to create an integrated mental healthcare system, educate the public on mental health resources and make navigating the healthcare system easier for people with mental health challenges. Partners include the Douglas County School District, the district attorney’s office, Tri-County Health Department, AllHealth Network, The Rock church in Castle Rock, private psychiatric facilities such as Highlands Behavioral Health in Highlands Ranch, local law enforcement agencies, area hospital systems and other public health, nonprofit and private resources.
From what Andrew Romanoff of Mental Health Colorado has seen, the initiative is the only program of its kind in Colorado. Similar efforts are underway, he said, pointing out that other communities have teamed up law enforcement and mental health professionals as Douglas County is doing in one of its programs.
But the initiative is different in that it is “encouraging local officials to prioritize prevention and early intervention instead of criminalizing,” said Romanoff, president and CEO of Mental Health Colorado, a mental health advocacy organization. “Douglas County is consistent with everything we believe and everything research shows and everything the rest of Colorado ought to be doing.”
For the Douglas County Sheriff’s Office, the mental health initiative provides partnerships that help treat and reintegrate mentally ill inmates into society.
Two of four mental health clinicians in the jail are from AllHealth Network, made possible by a grant from the state’s Jail Based Behavioral Health Services (JBBS) Program, which supports county sheriffs in providing resources for inmates with substance use disorders and co-occurring substance use and mental health disorders. Arapahoe/Douglas Works! Workforce Center provides job training and employment opportunities for inmates.
“It’s night and day compared to when I took over the jail in 2014 — the amount of collaboration and partnerships we have, the services we are giving the inmates,” Kevin Duffy, captain of detention at the sheriff’s office, said of the mental health initiative’s impact.
Developmental Pathways, a nonprofit agency that serves people with developmental disabilities and their families, is better able to provide resources for and identify more individuals with a co-occuring mental illness and intellectual disability.
Before the initiative “we were all in our own silos,” said Bob Ward, the organization’s vice president of case management and quality assurance, of the partners. “It broke down those silos and created a better understanding of what resources were available in the community.”
The initiative’s discussions and identification of gaps in resources and community needs have led to the creation of three programs to date that serve residents experiencing mental health challenges.
Project Upstream is a prevention program that offers families ways to get help for children with mental health concerns, even if they haven’t met thresholds for intervention set by the more formal evaluation systems. If a school has exhausted resources it may recommend the family participate in Project Upstream and, with the family’s permission, refer the child to the program.
A family meeting would be arranged with Project Upstream at the school, where a representative with the program would discuss the family’s strengths and weaknesses and recommend concrete next steps.
In a second program, a mental health navigator, described as a conduit for continuation of care, contracts with the mental health initiative to assist the County Attorney’s Office in working with individuals and families of individuals who have severe substance abuse or mental illness. The navigator helps 14 clients per week access ongoing treatment and provides support for the families.
The third program is a community-response team — consisting of a law enforcement officer, a paramedic, a mental health professional and case manager — that models a public health program in Colorado Springs called CARES. The service connects individuals to mental health services and prevents the overuse of jail and emergency departments, Drake said.
For example, the initiative looked at seven individuals in Castle Rock who generated more than 100 combined 911 calls in 18 months. To health care professionals, that can signal the person isn’t getting the outcome he or she needs by using the emergency system.
Since the pilot’s inception in May, the community-response team has served 327 individuals. From May to August, 65 percent of 911 calls to which the community-response team responded were treated in place, 8 percent were treated at an area hospital, 14 percent at psychiatric units, 3 percent at a detox unit and 3 percent at a family support center, according to Douglas County’s website.
None were taken to jail.
Because of its success, the mental health initiative plans to roll out a second team in early 2018.
There is not a typical call for the community-response team, said Anne Mosbach, coordinator of the mental health initiative.
Calls may come from an individual or the family of an individual who is contemplating suicide, from an individual who is struggling with substance use disorders or from a chronically mentally ill individual who is “experiencing disruption in their lives as a result of the symptoms of their behavioral illness,” Mosbach said.
Until the individual is connected to the appropriate services, the community-response team follows up in person.
“Coordination means somebody is going to check in with you and make sure that you called someone,” Mosbach said. “It’s reaching out to people to make sure that they are getting connected.”
Paving the way for the future
For Sheryl, whose last name is being withheld for privacy reasons, the community-response team has been a blessing.
Her brother, who lives in Castle Rock, was diagnosed with schizophrenia in his late 20s, she said. He doesn’t take his medication regularly, Sheryl said, because he doesn’t like the way it makes him feel.
On his medication, his mental illness is manageable. Off of it, his behavior is “aggressive and belligerent,” said Sheryl, her brother’s legal guardian. Her brother has been in jail in Douglas County since August on misdemeanor charges, she said.
Thanks to the community-response team and the mental health navigator, Sheryl, who lives in North Dakota, has been informed on her brother’s progress and whereabouts since May.
Before “there was no coordination between entities,” she said, “no central location.”
Leaders of the mental health initiative hope that the community partnership paves the way for mental health treatment and becomes a model for other cities and counties.
“Our hope is that these different responses — that we are finding are much more effective and are producing better outcomes — become the foundation and way we do things in the future,” Drake said.
“Eventually it will be the way things are and not just an initiative.”