As the Summit County community processes the aftermath of an incident involving mental health issues where officers shot and killed an 18-year-old who police say pointed a weapon at officers, experts say young people need better access to mental health care to help prevent such tragedies.

Yet, demand for mental health services is higher than ever, straining the system in Colorado, which is already “one of the worst places in the country for accessing mental health care,” according to Mental Health Colorado President Vincent Atchity.

“What really ought to concern people in regards to their mental health is how difficult it is to access care if you’re a parent or you have a loved one who you’re worried about,” Atchity said. “That is the worst-case scenario because it is so hard to access care, and people often only recognize that when they are experiencing serious mental health needs.”

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Last year, the national branch of the nonprofit, nonpartisan advocacy group Mental Health America, ranked Colorado the worst state in the country for adults with mental illnesses and 37th overall for mental health care. 

While Colorado received better grades for youth mental health care, Atchity noted that the American Pediatric Association has declared a national emergency as rates of mental health challenges among children, adolescents and their families soar in the aftermath of the pandemic.

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“At the same time we’ve got a youth population in crisis, we’re kind of in a terrible spot where we have a larger-than-ever population of young people who need care and a larger-than-ever population of older people who also need care,” Atchity said. “Resources are scarce at each end.”

As adults with mental health challenges and issues with substance use are left with few places to turn, that also puts added stress on the services available to youths, Atchity said. The best hope for Colorado might be to get young people help now so that the system will be less burdened in a decade when they are adults, he said. 

“Everyone should be aware of that,” Atchity said, “and be more cohesive and aligned in calling for something more adequate in terms of access to care.”

Opportunities to improve

A monthlong wait was the first challenge Stacey Hervey, an associate professor of criminal justice at Metropolitan State University of Denver, faced when one of her own high school-age children experienced a mental health crisis.

This was before the pandemic, Hervey said, noting she lives in the Denver metro area, where there tends to be more mental health services than rural parts of the state. Even after her child finally got an appointment, two providers left their insurance network within two years, she said, requiring the family to start the process over more than once. Eventually, they had to settle for a provider outside of their network.

“Trying to get mental health care is extremely difficult,” Hervey said. “That’s why there is definitely a tie between mental health issues and getting intertwined with the criminal justice system.”

In the United States, one in five children ages 13 to 18 have or will have a serious mental illness, according to the National Alliance on Mental Illness, with 50% of lifetime cases of mental illness beginning by age 14 and 75% by age 24. The average delay between onset of symptoms and intervention is reportedly eight to 10 years.

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At the same time that symptoms of serious mental illness often emerge, young people are in a stage in their development where they need a peer group and support, according to Hervey, whose studies have focused on juvenile delinquency, education and bullying. Adolescence is also a time when young people are often introduced to substances, she noted.

Meanwhile, bullying, which can put added stress on young people’s mental health, has grown more pervasive in the internet age, Hervey said, and became especially acute during the COVID-19 pandemic, when youths were forging fewer face-to-face friendships.

“COVID left people very isolated during formative years when they’re supposed to be forming connections with other kids,” Hervey said. “It’s been really tough for kids to cope after COVID. Then finding access to mental health care — I think (the system is) overwhelmed not only by teenagers but by adults who are having increased needs for health care, as well.”

As the pandemic ignited a national emergency around youth mental health, it also exacerbated access to care, according Ray Merenstein, the executive director of the Colorado branch of the National Alliance on Mental Illness. 

Especially in rural parts of the state, like Colorado’s mountain towns, where mental health care was already limited, it became even harder to receive mental health services, Merenstein said. 

Without adequate access to mental health care and with limited beds for those who need inpatient treatment for mental illness and substance use, those who need help are instead ending up in emergency rooms and jails where the underlying issues don’t get addressed, he said.

“If someone is in a mental health crisis, and yet they don’t feel like they have a place to go, then we’re failing them because we haven’t provided enough options,” Merenstein said. “That’s my belief.”

Mental health and police

Across the United States, mental health is deeply intertwined in the criminal justice system. In Colorado, the Department of Corrections is the largest provider of mental health services in the state, according to the National Alliance on Mental Illness.

Meanwhile, over 2 million people with serious mental illnesses are booked into jail each year, and seven in 10 young people in the country’s juvenile justice system have a mental health condition, statistics from the national alliance state.

“We’re relying on police officers to deal with a lot more mental health issues than I think is fair for them to,” Hervey said. “Unfortunately, a lot of families don’t know what to do, so they call 911.”

But in America, interactions between people suffering mental health crises and police can turn deadly. Each year since 2015, police have shot and killed more than 1,000 people per year, according to an ongoing analysis by The Washington Post. Of those killed, almost one in four were experiencing some sort of mental health crisis, that data shows.

“The truth is, around much of the country, that the fatal response on the part of police — that is just bad management of the crisis where instead of de-escalating a situation and recognizing that someone has got a health crisis, police are overly dependent on that stupid tool on their belt,” Atchity said.

But that’s not necessarily true in Summit County, Atchity said, noting that the Summit County Sheriff’s Office “has a strong reputation for having its own clinical staff that joins the public safety officers in responding to crises.” 

Since its launch in 2020, the sheriff’s Systemwide Mental Assessment Response Team program, known locally as SMART, has been an “exemplary” model of how to respond to individuals with mental health issues, he said.

Merenstein agreed that officials in Summit County are better equipped to respond to mental health emergencies than those in other parts of Colorado and the country, but he said there is more work to be done.

The laws surrounding mental health interventions are complicated. Unless a person poses “an imminent threat of harm to themselves or others or is gravely disabled” officers can’t take them into custody for a formal mental health assessment, Atchity said.

“But all of that language is open to interpretation,” Atchity said. “And the ‘grave disability’ part of the law is rarely, if ever, invoked because it is so difficult to prove or establish.”

Merenstein said the laws around involuntary services from law enforcement are meant to protect an individual’s civil rights. But the law is “still a tightrope between civil rights and public safety” and often families feel left in the lurch without much recourse to get help for a loved one who is refusing services, he said.

“The system is still failing because we still have too many people in crisis and too many people on waiting lists,” Merenstein said. “If we can lessen the mental health crisis, law enforcement can go back to … being police.”

Making changes

While mental health care remains out of reach for many of those in Colorado and elsewhere in the country, progress is being made, Merenstein said. He pointed in particular to the Behavioral Health Administration that the Colorado government has formed specifically to oversee and coordinate mental health resources in the state.

The Behavioral Health Administration, which is expected to be fully operational by next year, will be the first time that the state has had a dedicated administration focused solely on mental health, Merenstein said.

“You can’t do it fast enough,” Merenstein said. “The strain is too big and those pressures — I think it’s like watching a pot that’s boiling over. You’re noticing it’s burning over. You pull it off the burner, it stops boiling over, but it’s still hot.”

Last year’s launch of the 988 suicide and crisis hotline should also help, Merenstein said, as once that nationwide service is fully up and running, it will be able to connect those in crisis with peer support.

The 988 hotline will also eventually be able to connect individuals with crisis-intervention teams, like SMART, rather than simply dispatch a police officer like a 911 call, he said.

Meanwhile, early diagnosis and preventative care must become more central to mental health care if Colorado is to get a grasp on the situation facing so many with mental illnesses, Atchity said.

“If we really had an adequate system of care, a lot of it would be early intervention preventive care, often earlier in life, so people’s needs could be identified when they begin to show themselves,” Atchity said. “Because if people can get their needs met when conditions are beginning to make an appearance, the longer-term prognosis for good outcomes is much improved.”

Public schools are one place where that kind of early intervention will be especially important, Hervey added. 

“Honestly, I would love to see more comprehensive care in schools,” Hervey said. “And then more diagnostics of mental health much earlier. It really needs to start in elementary school.”

Merenstein said the ultimate goal is to get people the care they need so traumatic and deadly incidents don’t keep happening.

“How can we provide all these 16-, 17-, 18-year-olds more options?” Merenstein said.