By Diane Carman
Jeannie Ritter has insisted for years that when it comes to grappling with tough public policy issues, “all roads lead to mental health.”
It started as a clever quip, but “really, it’s the truth,” said Ritter, mental health ambassador for the Mental Health Center of Denver and Colorado’s former first lady.
It was this stark realization that propelled Mayor Michael Hancock to name former city auditor Don Mares to become the first director of behavioral health strategies for Denver.
“It was the Jeannie Ritter effect,” Mares said.
It’s the first position of its kind in the nation, so Mares has the exhilarating, terrifying responsibility of designing the job from scratch.
Mental illness is hardly a new topic for him. Mares worked on health care and mental health issues when he was in the state legislature from 1989 to 1995, and he served on the advisory board for the City of Denver’s employee assistance program when he was city auditor from 1995 to 2003.
On a personal level, Mares has been influenced by his brother, Fred, a Pulitzer Prize-winning journalist, who has spoken openly about his experiences with depression and severe anxiety disorder. Together the brothers have advocated for greater attention to behavioral health challenges.
“I hit the ground almost sprinting,” said Mares, who left his job as CEO of Mental Health America of Colorado in January to establish the office.
“I’m trying like the dickens to ensure my program is nimble and limited in numbers. Like a nonprofit, we’ve got to get things done in partnership” with other agencies and organizations, Mares said. “I don’t see myself creating a big bureaucracy.”
In many ways, the bureaucracy already exists through programs such as Denver’s Road Home (the program to address homelessness), the Office of Crime Prevention and Control, a variety of programs through Denver Human Services, and the drug, sobriety, mental health and recovery courts.
But despite these efforts, intractable behavioral health problems continue to plague the community. Roughly 5,000 people in Denver are homeless; an estimated 18 percent of the more than 2,200 inmates in the Denver County Jail are mentally ill; and substance abuse cases flood the city’s emergency rooms and detox facilities daily.
The total cost is hard to quantify, but the numbers that have been calculated are eye-popping.
Regina Huerter, director of the Office of Crime Prevention and Control, said a four-year review of city records found that the 300 most frequent users of city services spend more than 14,000 nights in jail and go to detox more than 2,000 times each year. They are in and out of the courts and emergency rooms constantly.
The cost per person is estimated at $38,000 a year, or $11 million for just 300 desperately ill individuals.
“And that population is just a drop in the bucket,” Huerter said.
The key to reducing those numbers, Mares said, is to focus on prevention and early intervention strategies.
“Better attention to behavioral health issues upstream” would cut the numbers of people who end up homeless, in jail or frequenting emergency rooms, Mares said. “This is not just focusing on crises. It’s to develop comprehensive strategies for that population.”
Mares said early indicators of behavioral health problems can be identified in school children who act out and constantly disrupt classrooms.
Mental illness among children is often overlooked, but new data show the problem is serious and widespread.
The recent Kids Count in Colorado report from the Colorado Children’s Campaign found that 60 percent of high school students in the state reported poor mental health on one or more days in the previous 30 days. About a quarter of high school and middle school students reported feelings of sadness or hopelessness lasting two weeks or more and interfering with their normal activities. And 15 percent of high school students reported seriously considering suicide in the past year.
Among adults, Mares said that behavioral health problems often can be identified in people involved in what are considered minor nuisance offenses, such as disturbing the peace, urinating in public or vagrancy.
“Several efforts are going on now in the city around these areas,” he said, but the mayor believes “there has to be a better way, a better overall strategy.”
Mares has been meeting with leaders across the spectrum of the community from Denver Public Schools administrators and sheriff’s deputies to emergency room personnel and leaders of the foundation community.
His goal is to find resources to better fund and expand early intervention programs for school children, coordinate programs to get access to treatment for people when they first exhibit troubling behaviors and to build a stronger network of services for individuals and their families when signs of mental illness emerge.
Another initiative is to expand the training of people in the community to recognize signs of mental illness and to intervene appropriately. This is where strategic partnerships are important, Mares said, citing the Mental Health First Aid Colorado program, which is a project Jeannie Ritter has championed.
“We are doing mental health first aid training programs for people working in the libraries,” Ritter said. “RTD has worked with us to create a great video for RTD operators.
“These are people who day-in, day-out are dealing with people who need help. They have asked for our help and they need to know what to do.”
Mares also is charged with addressing the behavioral health needs of city workers whose jobs often require them to confront some of the most traumatic and unsettling problems in the community.
Mares estimates the city workforce at around 12,000, which includes workers in the police and fire departments, the sheriff’s office and across the career services spectrum.
“For many of them, the amount of stress they experience every day is incredible,” he said. “I am there to look at these things through a different lens.”
The city has had a longstanding employee assistance program, but it is only effective if employees actually seek help there. Mares said too often the stigma of mental illness and the tough-guy culture of entrenched organizations keeps workers from getting the services they need.
He told the story of a CEO of a large corporation who revealed her own struggle with mental illness to a large meeting of employees at the company.
Afterwards, “her email was full of messages from employees saying: ‘I don’t fear for my job anymore.’ ‘I now know I can deal with this openly.’
“This is very doable here,” Mares said. “The fact that a mayor of a major city has taken this step says ‘this is not an in-the-closet issue anymore.’ ”
“This is a really bold move for the mayor,” she said. “Nobody in a public leadership role wants his budget to be bigger than that of the last guy. But he went ahead and created a cabinet-level position and it’s backed up not just by panic and hand-wringing, but by real evidence.”
Fighting the stigma
Advocates for normalizing behavioral health programs in the community say this is Denver’s moment. Emulating effective public acceptance campaigns is a key initiative for the behavioral health community.
“I’ve attended programs at the Carter Center and I’ve met Rosalyn Carter, and this is what we’re talking about nationally,” Ritter said. “I attended a panel of representatives from the gay rights movement, the breast cancer movement and communities of color to talk about, ‘What was the strategy?’ ”
Mares recalled the 1970s when women were ashamed to admit they had breast cancer. “Now, hundreds of thousands of people take to the streets every year wearing pink.”
Under his leadership, Mental Health America of Colorado began developing an intensive media and public education campaign around reducing the stigma of mental illness.
“Think about it,” Mares said, “the percentage of people who are in the LGBT community is around, what, 10 to 15 percent? Let’s say it’s even 20 to 30 percent. Compare that to the 80 percent of the population who experience mental illness at some time in their lives.
“We really need to get people to realize they’re not alone. It’s time to start breaking down those barriers.
“We need to move the dial on mental illness.”