Mental Health Colorado president and CEO Andrew Romanoff talks about Mental Health Awareness month
May 11, 2018
SUMMIT COUNTY — According to the National Alliance on Mental Illness, approximately 1 in 5 American adults experiences mental illness, yet only 41 percent of adults with a mental health condition receive treatment in any given year.
That trend is true in Colorado, where outward appearances don't always tell the whole story. The state leads the nation in many physical health indicators, such as having the lowest obesity rate in the country and some of the lowest rates of diabetes, cardiac disease and cancer. However, Colorado also has one of the highest suicide rates in the nation, and the nonprofit Mental Health America ranks Colorado 43rd among all states when it comes to rate of mental illness and access to mental health care.
Organizations such as Mental Health Colorado are trying to change the narrative by having Coloradans look after their mental health as carefully as we do our physical health. Mental Health Colorado president and CEO Andrew Romanoff — the veteran Democratic politician who was once Colorado House speaker — spoke to the Summit Daily News about the state of mental health in Colorado.
SUMMIT DAILY NEWS: How did you go from Colorado politics to advocating for mental health care?
ANDREW ROMANOFF: I like to say that I left politics because of illness; the voters got sick of me. I got termed out of the Colorado House and ran for office again and didn't win. But my path to Mental Health Colorado actually began more painfully because of a suicide in my family. My first cousin, who was like my little sister, committed suicide in our backyard on New Year's Day a few years ago. We had no clue something was wrong; there were no warning signs, no diagnosed mental illness. I worked on these issues in the state House for many years, and mental illness touches all of our families, but this time it really hit hard with mine. For a while, I wondered if I could time travel back and try to stop it from happening, but that didn't work. Then this job came along, and I thought, "Maybe if I can't bring her back, I can spare other families from this experience."
SDN: And how does an organization like Mental Health Colorado help Colorado families?
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AR: Mental Health Colorado has been around for 65 years, and a big goal of the organization is to change public perception of mental illness. We go around the state giving presentations to make people more comfortable seeking help, to tell them that mental illness is treatable. That's half of what we do. The other half is public policy.
SDN: Why do you think mental health care is such a problem in Colorado, especially in rural communities?
AR: It's a double whammy. First, mental health professionals are far and few between. Insurance reimbursement rates, especially for Medicaid, are not high enough to incentivize mental health professionals to work here. Secondly, there's a cultural issue that stigmatizes mental health conditions. If you live in a town where everyone knows your name, you try to hide it. You don't want people recognizing your truck in front of a therapist's office. You don't want people to think you're crazy.
SDN: How can we start turning things around for mental health care in this state?
AR: I can think of a few solutions. For one thing, promote integration of mental health care with physical health care. It helps with stigma if you treat the two like they're both equally important. For example, when it comes to kids, research shows that a lot of kids get more positive mental health care results if mental health professionals are available at school, where they are, instead of having to reach out to an adult outside of school.
It's also important to engage families in conversation and try to integrate mental health care into their lives instead of segregating it or criminalizing it. We recently helped get Senate Bill 270 passed, which expands treatment and housing to people with severe mental health emergencies instead of using jails.
Another way to improve mental health care outcomes is to provide more incentives for mental health professionals to work in underserved areas. The country is experiencing a shortage of mental health professionals, especially those accepting Medicaid, in part because reimbursement is often low and the paperwork is burdensome. So one way to increase provider numbers out here is to convince insurers to increase their reimbursement rates, but it's very difficult to convince insurers on that, or to follow set policies regarding mental health provider networks.
SDN: How do we go about addressing the provider shortage?
AR: In the short term, one way to compensate for the provider shortage is to promote new technology to make mental health care more accessible, like telehealth. Most places have the ability to virtually "see" a therapist even if one isn't available nearby. We also got a bill passed to create a one-stop-shopping portal for people to find a mental health care provider, which will help people navigate a system that is far too complicated. We've also been working on trying to reduce the digits for the Colorado Crisis Services hotline from nine digits — 844-493-8255 — to three, like 911. They already have a text line, which has proven popular among young people. Texting to 38255 can connect a person having trouble to someone who can help.
But long term, the most significant way to expand mental health care access is to strengthen the enforcement of insurance laws. About 20 years ago, Colorado passed a parity law requiring insurance companies treat mental and physical health the same, so they can't do things like cover six counseling sessions and then tell the patient they're on their own after that.
Routine access laws also require that insurers have a robust network of providers across the state and have a provider available for an appointment within seven days. The problem is folks don't have any idea that these laws exist and don't know when the insurance company is breaking the law by holding back on services. Fighting insurance companies is also exhausting, and so rather than deal with that and the high premiums, people just don't seek help.
My organization has been trying to work with state legislators and the insurance industry to find a way to overcome these problems. Whether it be by increasing reimbursement rates or getting the Division of Insurance to enforce existing laws, we need to find a solution that keeps this from dragging on.
But most importantly, we're trying to encourage people to get screened. At our website, you can get an informal mental health screening. It has 11 screening tools where you'll find quizzes and questionnaires that can tell you if you're experiencing symptoms of depression or anxiety or some other common mental health conditions.
Sometimes, like with my family, there are no warning signs of a mental health crisis. However, if we get people encouraged to seek help themselves, to make it seem as universal as getting weighed or getting your blood pressure checked, we can really start improving many lives here in Summit and the rest of Colorado.