Rural Crisis Support ft. Colorado Department of Human Services

Announcer: Welcome to the Backyard Bounty podcast from heritageacresmarket.com, where we talk about all things, backyard poultry, beekeeping, gardening, sustainable living and more. And now here's your host Nicole.

Nicole: Good morning everybody. Thank you for joining us for another episode of Backyard Bounty. My name is Nicole and today I'm joined by Camille who's with the Colorado Department of Human Services and the Office of Behavioral Health. And today we're going to talk about a little bit of a different topic about how to support others or yourself that may be in need of some mental health services or maybe struggling with some substance abuse. And Camille, thank you so much for joining me today.

Camille: Sure. Thanks for having me.

Nicole: Of course. So generally we talk about chickens and bees and homesteading and stuff, so this is not one of our regular topics, but with the history that I've seen as a first responder and knowing that these services can be challenging for those that live in rural America, I thought it would be really great to talk about supporting others or yourself if you're having a crisis and where people can go to get these resources. So I assume that what we'll talk about today is predominantly for people living in Colorado.

Camille: Yes. Yeah, we can talk about our crisis services that are statewide and some of the interesting projects that we're working on to make sure that we're accessing folks that live in rural regions.

Nicole: Okay, great. So your with the Colorado Department of Human Services like I mentioned, but can you tell us a little bit more about your background and how you support the behavioral health side?

Camille: Sure. So I am a licensed professional counselor by training and had done private practice for almost 20 years before I left and went to the state. And then I worked in the state Medicaid program and now I oversee community behavioral health services though that's our crisis system around the state. We pay for substance use treatment and do a lot of technical assistance and capacity building to ensure that we have a robust continuum of substance use treatment services around the state as well as mental health services around the state. We contract with all the community mental health centers. So there is a community mental health center in every region of the state that covers all the counties. And then we also work with criminal justice involved populations and do a lot of work around prevention services as well.

Nicole: Great. So you guys have really a lot going on and it sounds like you were able to provide services to a large number of people.

Camille: Yeah, and if we don't provide the service directly, usually those services are oftentimes paid by commercial insurance and/or Medicaid. And so we really do a lot of just capacity building to ensure that there is providers, that have capacity and so right now we have a behavioral health task force that Governor Polis has taken on as a big initiative and we're really trying to understand where the gaps in service are, where do we need to put more resources and think through that continuum in a really meaningful way. So there's lots of opportunity for folks to participate in that, by giving public testimony. We're doing community outreach and having meetings with regions around the state on next weekend, spending the majority in Northwest Colorado in rural regions, understanding where the gaps are there. So if folks are interested, they can go to our state website and there's all sorts of meetings and opportunities for public testimony for folks if they want to weigh in on where they think we need more resources for mental health or substance use treatment around the state.

Nicole: That's great. And what is the website for that?

Camille: It's Colorado Department of Human Services Behavioral Health Task Force. I can get you the actual web address.

Nicole: Okay. Yeah, you can just send that to me later and I'll, and I'll throw it in the show notes.

Camille: Perfect.

Nicole: So I touched on this before, but in my history as a first responder, unfortunately I see a lot of people that are struggling with mental health, with substance abuse, with depression and then suicide and suicide attempts and successful suicide and it's really heartbreaking and my hope is that people that are struggling with these challenges can get the help that they need. I read a statistic on the CDCs website that said, "Suicide is highest in rural America and it's higher in rural America than urban", which I thought was somewhat surprising, but what are some warning signs that somebody might be struggling with one of these issues?

Camille: Sure. So I think that it looks different for everyone, but in general you want to look at changes in behavior, any verbalizations usually people will say something that may not sound overtly like, "I'm thinking about killing myself", but oftentimes, "I feel like I'm such a burden to my family or I feel like things are hopeless." Oftentimes there's been some sort of significant life event, a change in circumstances. So it could be job loss, economic stressors. It could be like, "I just broke up with my boyfriend or girlfriend or partner", even in adolescence all the way through the continuum and not seeing that there's any hope or light at the end of the tunnel and people will make verbalizations about, " I hope that I go to sleep tonight and don't wake up in the morning."

Camille: Those types of things should trigger some sort of additional questioning. Right? And when you question someone around, "Are you having thoughts of hurting yourself", or "Are you thinking about suicide?" You want to be that direct. You want to just directly ask the question. Sometimes I think people will approach it from, "You have so many great things going for you. You're not thinking about hurting, right?" And asking it in that way is setting them up to give you the answer that you want to hear, because it's an uncomfortable question to ask folks, but it really is about saying, "Are you thinking about hurting yourself? Are you thinking about killing yourself?"

Nicole: I imagine, this is probably somebody close to you. If not a friend, then maybe your significant other or a family member. And if somebody does say, yes, that they are feeling that way, that could be really scary or overwhelming. So what's the best way to respond to that and then to help somebody who is feeling suicidal?

Camille: Yeah. So if someone says, "Yeah, I am", usually they're pretty overwhelmed and oftentimes in my experience they'll usually will start to cry and get teary and oftentimes it's like a release and lifts some of the weight off of them. So really it's wrapping around that support and saying, "Okay, well, we're going to help you figure out what we need to do." Then it's making sure they get connected with professionals or treatment or resources. So the state we run... the statewide crisis hotline as well as crisis services. So oftentimes the majority of folks that we have calling crisis services are concerned family members or concerned friends, calling on behalf of another person. It's pretty frequent that that's why people call our crisis hotline.

Camille: So you can certainly reach out to the hotline and say, "This has just been my experience. They've just said, 'Yes, I am thinking about hurting myself'," and oftentimes they'll help you manage through that and give you the steps to get connected with the right set of resources. So our statewide phone number is 844-493-TALK, and there's also a text and chat line and all three of those are great ways to get someone connected with resources. So if our hotline does a brief assessment over the phone and believes that someone's at risk, then we have statewide teams around the state that will come out and do a face to face assessment and help get someone to the right set of services.

Nicole: Now is that something that if you are calling that line, either for yourself or somebody else, can you call in anonymously just to get some information?

Camille: You can call in anonymously and just inquire about, "This is what I'm hearing, this is what I'm seeing, what do I do in this particular case?" They're great at sort helping people navigate those types of questions.

Nicole: So especially in the rural parts of Colorado, there's not as many resources typically as maybe, Denver or whatever. So does this task force go out to those really remote areas?

Camille: They do. So we actually just brought up our new crisis contracts as a July one and so we have contractors all around the state. They look a little bit different. So if someone's in an imminent situation, they're actively suicidal and have a plan, then sometimes the hotline will say, "We need to make...", and they have access to means... say they actually have some sort of means in carrying through a suicide. Then in those cases we often go... 911 needs to help us manage that situation. But the vast majority of the time they send out a clinical team to come out within a couple of hours usually.

Camille: I think the two hours is our window for rural areas and we'll do a face to face assessment and really work through what's going on and then make recommendations about what needs to happen next. So sometimes people would need to go inpatient for a higher level of care and stay for a bit and get stabilized, get some treatments and medications. And oftentimes what ends up happening is they sort through a safety plan. They come up with some next steps and then they will coordinate services and make sure that that individual gets connected to supports in your region, wherever that might be.

Nicole: And what if somebody has some financial challenges? Are there fees associated with this?

Camille: Yeah, so in 2014 the legislature allocated 21 million and since then our budget has grown to about 35 million. So if a family does not have the coverage or the ability to pay for services that these services are paid for with state funds, we do ask that if someone has coverage that our providers build that coverage bill Medicaid or commercial insurance. But if there is not any resources in place, the service will be covered and picked up with the state resources.

Nicole: So it sounds like if somebody is struggling, as long as they can get in touch with you guys, it doesn't matter where they live, their financial ability, they're going to be able to get help and get support through their current crisis situation.

Camille: That's right. That's the whole point of the system is to make sure that we're impacting the suicide rate and we're making sure that folks get connected to services and that's the priority. The financial stuff gets worked out on the backend.

Nicole: Well, that's really wonderful. I know that there's so many people that could really use that, especially when they feel like there's nothing else. It's good to know that you guys are there.

Camille: Yeah. We really want to make sure that folks know that this services is there and it's available and if folks do not have the resources to buy into treatment themselves, this isn't a great way to get connected with services and let these teams really find the right set of services and resources for that individual that's in crisis.

Nicole: Are you guys able to provide services even for somebody that maybe isn't feeling suicidal but they're just struggling with some depression, like you mentioned, maybe they just broke up with the significant other. Can they just call and vent and get support through situations like that?

Camille: Absolutely. Yeah. So our crisis hotline that the... 844-493-TALK number, is staffed by both clinicians and then also individuals with lived experience that are trained to support individuals who may just need some ongoing someone to talk to. And so that's called our WARM LINE, so people can choose to get transferred to just get them support, once they dial into that number, they have a choice about which team they want to speak with. And of course if someone chose the WARM LINE and then it escalated and they needed to get connected with a clinician, there is that opportunity as well. And our state hotline has about over a hundred staff that work 24/7, seven days a week. And they're able to take calls whenever someone might be in crisis.

Nicole: Well that's wonderful. And what other services do you guys provide or can people access if they needed it?

Camille: Yeah, so the hotline also does resource and referrals. So lots of times folks are just calling because they're trying to locate a treatment provider, whether it's mental health or substance use, but they also can make referrals at the hotline and they have a pretty extensive list of resources. Additionally, each of our community mental health centers around the state have resources that we pay for those folks that might be uninsured or under insured. So that's always an opportunity is to reach out to one of the community mental health centers in the region. I can send you a list of those. There are 17 of them around the state that cover all 17 counties... all 64 counties... There are 17 that cover all 64 counties rather.

Nicole: Sure. Yeah, I can definitely put that information in our show notes too so that if anybody wanted to access that it'd be available for them.

Camille: Yeah. And then we also have managed service organizations, which our state is also divided up into other catchment areas. Our managed service organizations oversee funds to ensure that there's access to substance use treatment. So if someone is calling because they're trying to out locate a substance use treatment provider, they're a great resource as well as the hotline. The hotline actually has access to that information as well.

Nicole: So we touched earlier on depression and suicide, but if you have a loved one who's struggling with substance abuse, a lot of times people aren't very receptive to suggesting that they get help. Do you have any advice for people in that situation?

Camille: Yeah, so we also have done a lot of work. We have Opiate funding from the federal government that we've received for the last several years and we've really been working on scaling a model called CRAFT. And what CRAFT is, is a family model to help concerned family members or significant others, manage through a loved one who may be using substances. So it helps them teach the skills to talk to that loved one about how they're impacting them. It teaches them ways to support one another through any substance use crisis. And we have, I think over... I want to say 200 providers trained in CRAFT around the state and our managed service organizations can help direct families to those providers that really are doing support for the family as they try and help their loved one get connected to treatment when they're ready.

Nicole: That's really great that you are able to support not only the individual impacted by this but also the family because it's, also challenging for the family and I know that they can definitely use that expert advice and resource while they're supporting their loved one.

Camille: Yeah, we know that that's really stressful for families when they have a loved one that's using substances and it really teaches those skills about how to support in a healthy way as well as manage their own mental health through the process.

Nicole: Absolutely. And you mentioned earlier your task force, do you have any other resources or any other current projects going on?

Camille: We always have interesting projects going on. So with one project I think that is pertinent to this conversation is that we've been partnering with Colorado Department of Public Health and Environment who has the Office of Suicide Prevention and they have been looking at occupational subgroups that may be at risk of suicide. We know that rural regions and men between the ages of 35 to 60 are one of our high risk populations within Colorado. So we have partnered with the Colorado Department of Agriculture to produce them video and radio public service announcements that are targeting the agricultural community. And it promotes the hotline, that they are co-branded with the department of agriculture and our crisis services program and we've been doing a lot of information sharing at the State Fair, the National Western Stock Show, the Farm Show and the Rocky Mountain Farmers Union Conference.

Camille: So those PSAs will be public soon. We're trying to really help get those individuals that are in agriculture connected to resources as well. So that's a targeted project. And then some other models that we're really working on is a lot of partnerships with law enforcement. So we have almost 35 co-responder program brought up around the state. And what that means is that we have behavioral health professionals paired with law enforcement, so that they can respond to individuals that have a behavioral health emergency going on if they get routed to 911.

Camille: We believe that the co-responder model is a nice way to get folks connected to treatment as well because they have a behavioral health provider on board that can help do the case management, connect those to treatment and make sure that they get the right set of services rather than law enforcement needing to do that work when they're not trained and that's not their skill set. So it's a nice intersection and I think there's a ton of interest in it and we just continue to see lots of demand for co-responder models around the state.

Nicole: How do you know about how many people access your phone line per year?

Camille: I do. So last year in total we had about 163,000 callers to our Rocky Mountain Crisis Partners. And as of June of this year, just June alone, we had about almost 14,000 callers.

Nicole: Wow. And if anybody listens to this in the future, so this is for 2019 is our current year.

Camille: Yeah. As we've brought up these services, we're just seeing more and more mobile responses and we've seen our mobile responsive and community doubled since July.

Nicole: Well that's really great that people are taking advantage of this opportunity to get help.

Camille: Yeah. We see it as a really nice way to meet people where they're at and get them connected to the right set of services instead of relying them to go to a facility.

Nicole: Absolutely. Well this has been a lot of great, useful information, Camille, and I really appreciate you sharing all this with us and I hope that if anybody is looking for some help or any even just some information that they'll take advantage of this information available. And again, we'll put all of the links to the resources and put the phone number and our show notes so that people can access that as well. And Camille, I just wanted to thank you again for sharing this information with us today.

Camille: Absolutely. Thanks for having me and letting me share all of these resources for folks.

Nicole: Absolutely, and for those of you at home, thank you so much for listening to Backyard Bounty and we'll see you again next week.

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