A therapist with Montezuma County’s Social Services department came before the county commissioners Nov. 26 to call for more to be done to provide behavioral and mental health support to local residents.
“In Montezuma County we are severely lacking in providers and programs to serve our increasingly high-need area,” said Annie Diaz, a mental-health therapist for the Child Welfare Department of Social Services. She was reading from testimony she gave before the Colorado Behavioral Health Task Force in October.
The increasingly diverse county has a poverty rate of 15.2 percent, the 14th highest in the state, she said. And the county has the fourth highest suicide rate, more than double the statewide average.
But finding help and treatment for mental- health and behavioral-health problems is very difficult for residents because there are so few providers available, Diaz said.
Axis Health System is the only community mental health center in the county. As of last October, she said, they had unfilled openings for two full-time child and adolescent providers and four adult providers.
Axis has a very high turnover rate, Diaz said, “in part because individuals either relocate to Durango or are living there already.” Diaz came to Montezuma County in 2015 and worked two years for Axis, then began working for the county.
“I worked there for two years and I was one of the longest-acting staff at Axis,” she said, adding that such a rapid turnover makes it difficult for clients to even develop a relationship with a therapist. “When I worked there [at Axis], I frequently felt overwhelmed with a high case load [of over 100 clients] and the inability to see people with enough regularity to make any significant difference in their lives,” she told the commissioners.
She added that she was the only bilingual Spanish provider, and she often saw Native American clients relying on family members to translate for them.
In addition to Axis, she said, as of last fall there were numerous unfilled openings for providers at other places:
- Four Corners Youth Clinics at Dolores and SW Open School campus had had an open part-time position since June but no licensed applicants;
- Moguan Behavioral Health Center, a new organization on the Ute Mountain Ute Reservation, had two unfilled openings for therapists as of October;
- The Dolores Re-4JA School District had unfilled openings for an elementary school counselor and a secondary-school social worker.
Other schools in the county are reportedly fully staffed, Diaz said, but the smaller ones often don’t have a school counselor. Instead, they rely on licensed clinical social workers and psychologists from San Juan Board of Cooperative Education Services (BOCES) who travel through the county.
“We are spread very thin,” she said.
She called for a number of measures to improve mental-health resources in the community, including incentives for providers to live and work in Montezuma County such as salary increases, more local, culturally relevant training opportunities for providers, more psychiatric services, and more conversations with community members regarding ideas for improving services.
Diaz said she’d spoken to several foster/ adoptive parents, caregivers and their families, and quoted one who said, “There truly is a frightening shortage of qualified mental health professionals for this area, especially for low-income families. You can’t be seen right away unless you’re in crisis and you can’t get appointments reliably afterwards. For kids in the community, unless they are already in the system or have experienced such significant trauma it can’t be ignored, there is practically nothing.”
Diaz added, “The work that I do inspires me every day. I feel truly honored to work with amazing and resilient children and their families who are trying, against all odds, to recover from often times generations of poverty, substance abuse and trauma.”
She quoted a line from Dr. Seuss: “Unless someone like you cares a whole awful lot, nothing is going to get better, it’s not.”
County attorney John Baxter commented that, “A lot of these things the commissioners can’t do anything about.”
But Diaz said she was asking for further discussions on allocations of resources, devoting more to mental health, hearing more from the community, and encouraging people to come in and talk about their ideas to the commissioners.
“Today I was just hoping to have this continue to be a conversation because it is a problem for our young people and people of any age,” she said.
Commissioner Larry Don Suckla asked how many kids are being left out of treatment. Diaz estimated half of those in need.
“A comment one of the parents made is you can’t get help for people that are on that line but not in full-blown crisis,” she said. “People at the edges of depression… they get sent to the side.”
Social Services Director Gina Montoya said 100 percent of their clients receive services. “She [Annie] is talking about the whole community, in terms of people not being served by social services because there’s not enough providers,” Montoya said.
Montoya said one local school suspended a 5-year-old boy in kindergarten “because they couldn’t get a provider at Axis.”
She said one teen had said he will not go back to Axis because ‘they keep changing the provider on me’.
“We serve our clients 100 percent,” Montoya said, “but there’s going to be a time when Annie’s going to say ‘enough is enough’.”
Baxter said the situation is a national issue. “I don’t know that Axis has a better retention record in La Plata County,” he said. “Maybe it’s easier in Denver or a metro area. My impression of Axis is they have a very high turnover, period.”
“It’s a big problem,” Diaz said. “It doesn’t get solved by one thing or another. We need to continue having this conversation.”
The commissioners voted 3-0 to approve Montoya’s request for an FTE for social services for a 24/7 suspected child-abuse hotline. Later they asked Axis spokesperson Haley Leonard Saunders, who was at the meeting, if she had comments.
Saunders said she agreed that “there is a provider shortage in general.”
“There’s 12 open positions county-wide between us and the tribe and other agencies,” she said. She also agreed there is a high turnover at Axis and in the county.
“We are a training ground. They get their license and they leave,” Saunders said.
She said at Axis, “We try to make sure that people are paired up with somebody right away.” However, that depends on what insurance a client has.
Saunders said it takes two to three hours to get someone ready for their first actual counseling session at Axis because they have to fill out a form with 63 questions.
“It’s not easy to be a client trying to seek services,” she said, adding that private providers don’t have the same intake forms and paperwork.
Commissioner Jim Candelaria said for most people, if they have to wait two hours and fill out paperwork to see a doctor, “You have already lost them.”
During the public-comment session later, M.B. McAfee of Lewis said although the situation might seem impossible, it needs attention.
“When we started the shelter a long time ago it seemed like the homeless situation in Cortez was impossible,” said McAfee. “People were dying on our streets… As we grew it became clear there were so many people needing a shelter, meals, safety, and eventually inspiration to carry on on their own. In a small way the shelter grew.”
She suggested the commissioners use their leadership to “try to address some of the mental-health and substance-abuse issues” in the area.
“If the county would spend the money to get other people like Annie here – make this a star place where behavioral health providers would want to come and work,” she said.
She said the county has money for more mental-health providers. She called for increasing ways to attract providers.
But Commissioner Keenan Ertel disagreed. “You know what the attraction is, what I heard from the police at a meeting the other day?” he asked McAfee. “The Bridge. The Bridge [the homeless shelter in Cortez] is an attraction for homeless vagrant people… because they have got a wonderful, beautiful, brand new facility for them to get into for nothing.”
He said the Bridge’s clients “go to the churches for their free lunches during the day and they spend all their money on dope and booze.”
He and McAfee then got into an argument that ended when Ertel repeatedly indicated her time was up. The commissioners had implemented the use of a new timer run by Candelaria that indicates when a speaker exceeds three minutes of public comment.
McAfee’s time had indeed ended, but after it ended, Suckla asked her a question, which led her to keep talking.