Just as battling mental health issues is not easy for many Routt County individuals, providing community mental health services is no easy task, especially with the added pressures of the pandemic.

Routt County has two large nonprofit providers who currently offer mental health care to lower-income patients enrolled in Medicaid or the uninsured.

These two agencies — Mind Springs Health and Northwest Colorado Health — cared for a combined 1,647 mental health patients in 2021, including 971 individuals at Mind Springs and 676 at NWCH.

“You take the two of us out of the picture, and there is a large percentage of our community who doesn’t have access to mental health services,” said Stephanie Einfeld, CEO at NWCH for almost four years.

Mind Springs and NWCH offer complementary mental health services. In general, Mind Springs specializes in serving crisis, acute or mentally ill individuals with persistent concerns, while NWCH helps patients with mental health screenings, setting up treatment plans and generally offers six patient visits.

Nonprofit mental health care providers in rural Colorado face numerous challenges. The limited number of professionals available in the industry, along with the high cost of housing in rural resort areas, increase the difficulties in hiring.

The number of patients seeking mental health care continues to rise due in part to the COVID-19 pandemic, as well as the gradual decrease in the stigma of receiving mental health care.

“Staffing across the valley continues to be challenging, especially in first responder positions — including mental health services,” said Brittney Wilburn, executive director of The Health Partnership in Steamboat Springs.

Einfeld said the agencies’ ability to provide the care needed was necessarily limited by the number of individuals providers on staff.

“We hire as best as we can, and we expand as best as we hire. But the barrier is finding licensed mental health providers in our rural area,” Einfeld said. “We do not have enough mental health providers in the state or nation to fulfill the demand of behavior services.”

Mental health care in Colorado especially suffers from shortages in geriatric and child psychiatry, as well as bilingual therapists, the program directors explained. Locally, Mind Springs serves some of those needs through telehealth appointments with therapists in other counties or with Spanish-speaking interpretation services, said Tom Gangel, operations manager at Mind Springs in Steamboat.

The administrative burden of serving Medicaid clients is also steep.

“The payment structure from Medicaid isn’t set up for us to thrive; it’s only set up for us to survive,” Einfeld said.

Mind Springs Health, systemwide, serves clients in 10 Western Slope counties.

Former Mind Springs CEO Sharon Raggio resigned earlier this month after an investigative series by the Colorado News Collaborative turned up concerns about how Colorado’s mental health safety might be failing some residents. However, local nonprofit leaders who work closely with Gangel and Program Director Gina Toothaker say the leadership team in Routt County is stable and well-respected.

Toothaker has served with Mind Springs for almost 27 years, including as director in Steamboat for 18 years, and Gangel has served with Mind Springs for 22 years.

“Local Mind Springs is a trusted long-term partner, and they continue to try to evolve to meet the needs of the community,” Einfeld said.

“I think we have amazing leadership in Routt County, especially people who are passionate about keeping people safe and healthy,” added Lisa Lorenz, executive director of Yampa Valley Autism. “In the incidences that we’ve had individuals in crisis related to autism spectrum disorders, including children and adults, Mind Springs was extremely responsive and provided immediate support for those individuals.”

Gangel noted the local leadership remains proud of the service provided in Routt County.

Quarterly client surveys conducted by health care analytics company Press Ganey reported that in third quarter 2021, the overall positive response rate from clients was 80.9%. Specific statistics include access to care — 76% rated good or very good — satisfaction with primary therapist — 82.8% rated good or very good — and overall assessment of care — 83.3% rated good or very good.

Toothaker said Mind Springs is happy to be fully staffed at this time in its two full-time crisis counselor positions, noting the counselors respond within two hours to crisis calls and try for a half-hour response.

“If somebody is in crisis in Routt County, it takes less than two hours to have a Mind Springs employee meet with them for an evaluation,” Toothaker said. “Primarily, those cases are suicidal or a mental illness with need for immediate help.”

According to Toothaker, patients on Medicaid, or those who are uninsured and pay on a sliding-scale basis, can receive an appointment through local Mind Springs within five business days currently.

Mind Springs saw the retirement of two long-term therapists within the past two years.

Carla Portigal, who had 32 years of experience, and David Reed, who had worked for 27 years, both reached the end of their careers recently, Gangel said. Locally, Mind Springs, with a current staff of 14, is advertising to hire four additional full-time or part-time employees for business services, case manager or clinician roles.

Einfeld said NWCH prefers a mental health team of five full-time and one part-time staff but currently is working at about half of the ideal staffing level due to therapists recently moving out of town or to other agencies.

Mind Springs in Steamboat is short two therapists to handle private insurance clients, so the wait time for new patients with private insurance can be up to three weeks, Toothaker said. To compensate, Mind Springs currently is recommending that private insurance clients who need more timely appointments ask their insurance providers for other therapist options, Toothaker said.

According to Medicaid contractor Rocky Mountain Health Plans and local directors, Routt County is likely home to about 10 additional private providers who accept Medicaid patients. However, the wait time for care can be longer than expected, because some of those providers work part time, carry a smaller case load or may not accept crisis cases, local providers say. Because not all local providers accept all forms of insurance, private-pay patients may be dissuaded by fees for counseling sessions that run up to $150 per hour, although sliding-scale fees may be available in some cases.

“Everyone I know has a waitlist,” said Beth Wendler, a registered psychotherapist in Steamboat. “A lot of people are looking for services and having an exceedingly stressful time right now.”

According to the nonprofit Colorado Heath Institute’s 2021 survey, 14% of residents in Routt, Moffat, Jackson and Rio Blanco counties talked to a doctor about their mental health in 2021, and 11% talked to a mental health specialist in the past year. That’s several percentage points less than the statewide statistics of 19% and 16%.

“We all understand that there is a huge demand, and we all need to work together to combat that,” Einfeld said. “The community is wonderful in supporting what we do, because they understand the valuable service we provide and the challenges in a rural area.”