New emergency program provides mental health care across Colorado

The COVID-19 pandemic's effects run deep - far beyond the virus's immediate infections. From loss of livelihoods to drastic decreases in social connection, people across the country are suffering ongoing emotional strain. And that has psychological health researchers, like Colorado State University's Deborah Essert, worried.

Essert is the director of the Psychological Services Center, operated through the psychology department in the College of Natural Sciences, which serves members of the greater Fort Collins community.

As the state moved to a stay-at-home order in the spring, I saw the need for it from a community medical health perspective. At the same time, my heart ached knowing how much the isolation, increased stress, and economic upheaval would negatively impact the emotional well-being and physical safety of so many in Colorado."

Deborah Essert, Psychological Health Researcher, Colorado State University.

So she, along with Brad Conner, who directs the addiction counseling master's program in the department, have created an initiative to provide an emergency expansion of mental health care across the state, with a focus on suicide prevention during the pandemic.

The program is being supported by a grant of almost $800,000 from the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA).

The state of Colorado already had the seventh highest number of deaths by suicide in the country before the pandemic. For example, in 2017, the latest year for which CDC data is available, more people in Colorado died by suicide than from diabetes or drug overdoses.

The pandemic threatens to make that worse.

"When we are faced with an unknown threat, it is easy to become myopic," Essert says. She feels that with so much attention on the virus itself, the mental health impacts of the pandemic have been neglected.

"This is why the Federal Aviation Administration requires two crew members in the cockpit at all times - while one is focusing on a new immediate problem, the other can keep the plane in the air," she explains. "When we went to stay-at-home orders for COVID-19, as a mental health provider, I felt locked out of the cockpit."

With the new statewide suicide prevention program, she hopes she and the team can help more people stay aloft in this turbulent time.

Stopping the spread of the novel coronavirus has, understandably, been a top priority, as the death toll continues to increase. But, notes, Essert, "many of the safety measures taken to slow the spread of COVID-19 and their repercussions are associated with higher suicidality - including isolation, strained family relationships, financial insecurity, and marital distress," she says.

"And when you take increased feelings of loneliness, fear, and confusion, add to it the possibility of using substances to cope with the sudden uptick in sustained stress, and then drastically reduce and complicate access to mental and behavioral health care, it is like a perfect storm for increased mental health symptoms and suicidality."

The new emergency program will focus, in particular, on communities and individuals at highest risk, including rural and agricultural areas, the uninsured, and people with substance-use disorders.

Others in the community who might be assumed to be well-situated to get help they might need are also going unnoticed. Frontline health care workers, particularly in the middle of a pandemic, often don't have their mental health needs recognized, Essert notes, which is why support for this group also will be a focus in the new program.

Also at considerable risk are those experiencing domestic violence and their children, as increased isolation is associated with a greater threat to physical safety and suicidality.

This group that was "nearly invisible and voiceless before the pandemic now has even fewer eyes on them, which means less access to support," Essert says. "For some of the most vulnerable and desperate in our community, the motto that families are 'safer at home' is horribly untrue."

While the pandemic has added strain to most everyone's lives, Essert has seen from their work at the Psychological Services Center that it has pushed many people who were already struggling to manage daily life into much higher risk for self-harm.

"Part of the aim of this project is to bring to light that, for some, there are dangers more powerful, and more proximal, than the threat posed by COVID-19," Essert says. "For some, the more imminent danger is the one waiting for them at home, or the threat they pose to themselves when they are home alone."

The new SAMHSA grant will enable Essert and Conner and their team (which also includes Lorann Stallones, a professor in the psychology department and director of the Colorado Injury Control Research Center, Paula Yuma, an assistant professor of social work in the College of Health and Human Sciences, and Heather Schatten of Brown University) to immediately begin training more providers throughout the state in evidence-based practices put forth by the U.S. Centers for Disease Control and Prevention.

"We aim to reduce suicidality by reducing risk factors and promoting protective factors within the individual - and in the systems around them," Essert explains.

The project, which is a collaboration among the psychology department's Counseling Psychology and Masters in Addiction Counseling programs, the School of Social Work, and the Colorado School of Public Health, will partner with agencies in the area and across the state, including the University of Colorado Health system, Crossroads Safehouse, La Familia, Sandstone Care, and the 17th Judicial District Diversion Program.

This is just the beginning of their new network. They plan to add more groups and agencies in the near future (with a priority to those who serve rural communities, underserved groups, and people experiencing domestic violence).

In fact, when they put out a call for partners earlier this year, Essert says, "the response and support from across the state was actually overwhelming. It seems everyone feels the need to strengthen the links around mental health right now."

At the CSU-based Psychological Services Center, the grant will allow the team to deploy an Integrated Suicide Treatment Team that will be able to see at least 60 new clients.

The grant officially began at the end of July, and Essert, Conner, and the group have been hiring and training additional staff. "We plan to be offering services and training to the community by September," she says.

And that can't come too soon.

"We are all being stretched to understand and manage a new normal," Essert says. "While that can bring about some solidarity and resilience, it can also leave us feeling depleted and susceptible to feelings of depression, anxiety, and other emotional struggles."

Soon there will be more life-saving resources for people to turn to across the state.