We’ll probably never know why our suicide rate is three times the national average, but we can certainly put our heads together to figure out a responsible and effective way to address it. For starters, there is no inpatient treatment available for mental health issues in Aspen, or even Glenwood Springs. The closest place an Aspenite can go for acute suicidal ideation inpatient treatment is Grand Junction, which is a two-and-a-half hour drive away. That’s a big part of the problem.
People are asking why the expansion that’s adding 152,000 square feet to the hospital does not include any new services for mental health treatment. I called Ginny Dyche, director of community relations for Aspen Valley Hospital, to find out what treatment they can provide people who are suicidal. She told me that if a person comes into the ER they are evaluated both medically and for risk of suicide. But they don’t even have a psychiatrist on staff, so AVH is in no way equipped to provide treatment to someone who is suicidal.
If the ER staff determines the patient is at any risk of suicide at all, one of two things happen. They either call the Aspen Hope Center or Mind Springs, which AVH contracts with to provide these services, or the process begins to find placement somewhere in the state that has an inpatient facility and a bed available. That can be anywhere from Grand Junction to Boulder or Colorado Springs.
As for why the AVH expansion isn’t adding this badly needed service for the community, Dyche said it’s just not economically feasible. Even though this valley has a statistically high suicide rate, it’s still a small number of people each year. To staff an inpatient mental health unit requires doctors, nurses, therapists and mental health techs, and there simply wouldn’t be enough patients to support it.
I then called Michelle Muething, executive director of the Hope Center, to find out exactly how they’re able to treat suicidal patients without an inpatient psych unit. Muething has a graduate degree in clinical psychology and has been a crisis clinician for more than 20 years. She said the lack of an inpatient psych unit in the valley isn’t relevant.
“I don’t think the lack of hospitalization has a bearing,” Meuthing said. “We replaced the need for inpatient hospitalization. We bring the hospital to the person.”
She’s talking about the Hope Center’s Virtual Intensive Outpatient Program (VIOP), which she says creates a human safety net around the person in need. If a patient meets the criteria for inpatient services, but Meuthing doesn’t think that will help the person, she can put them in the VIOP if they agree.
“You need love, support, therapy, med assessment and to be surrounded by people who know and love you,” she said. “We create a human safety net around that person, and it becomes a substitute for inpatient hospitalization. In almost four years, 77 people have gone through that program and all are alive and well today. I can count on one hand how many people I’ve encountered who genuinely didn’t want to wake up the next morning.”
As part of the program, the person has at least five points of contact per day. Each morning they’re required to call the center at an assigned wake-up time for a morning check-in. They see a clinician, therapist and case manager every day, and they have to call to check-in again at bedtime.
“They can call at any other time day and night, but the safety system is really with their family and friends,” Meuthing said. “If they don’t call (within 10 minutes of their assigned times) we send a safety person or law enforcement to find them.”
Meuthing emphasized that friends and family of the patient play a crucial role in their treatment. She said as soon as you feel that someone you care about is suicidal, you should call the Hope Center immediately and let them help guide you on how to get the person into the program. She told of one man who brought his girlfriend to the center, who adamantly denied she was suicidal. In frustration, the man handed Meuthing his phone so she could read the text messages from just a few hours before, where the woman threatened to commit suicide.
“Therapists are not magicians, we can’t cure anybody’s problem in one hour,” she said. “Our job is to put that safety plan in place, because the more people in it the tighter that net becomes and the less likely they are to fall through the holes. When people are in such depths of depression, they truly don’t know what to do, what steps to take to get them off the path they’re on. That’s why the support system is so important.”
Due to the patient’s tendency to lie to the therapist, Meuthing said it’s critical to have at least one person attached to the hip of the suicidal person at the beginning of the process so the patient can’t deny the suicidal ideation. That person is the first member of the safety net. Other friends and family members soon join the net and help them through the process.
“They’re living life through the lens of a depressive fog,” she said. “They’re so overwhelmed. You have to understand what it’s like to live in the murkiness of depression — it’s hard to see how to put one foot in front of the other. The support system becomes the crucial lifeline.”
It sounds like a great program that has helped a lot of people, and I’m thrilled that the Hope Center is here to provide services to those who ask. But we do need an inpatient pysch facility in this valley. As we’ve all seen with soul-crushing frequency, there are still way too many people in this valley who fall through the cracks. Some transplanted locals may not have support systems here. Others would never dare to admit to a friend they felt such a level of depression for fear they may be shipped off to Grand Junction or Denver, where they may not know a single soul.
If those far away cities are the closest places for Aspenites to seek treatment, then the people of Vail, Rifle, Glenwood Springs and all the other surrounding mountain towns are in the same boat. If family and friends are so important for the treatment process, isn’t it critical that those people be able to get to the treatment facility to participate? What if all the hospitals in the area joined forces to create a co-op of sorts in the form of a centrally located place (Glenwood Springs?) people could turn to for inpatient help? If such a facility could provide treatment for a large portion of the Western Slope, would it then be economically feasible?
I don’t have the answers. I just know that, even though only a small percentage of people who are suicidal genuinely don’t want to wake up the next morning, they’re important, loved, and will leave an excruciating hole in our community if they kill themselves. They’re the ones most likely to do it, and this valley has got to figure out a way to provide intensive inpatient therapy that will keep people safe while still close to their homes, friends and families. Intensive outpatient treatment is a great option, but one size clearly does not fit all in the world of mental healthcare.
Doug Allen would like to talk to one of the 77 people who’s participated in the Hope Center’s VIOP. You can remain completely anonymous. Reach him via email at Doug.Allen75@yahoo.com , or follow him on Twitter @Doug__Allen (two underscores).