This is the first installment in a four-part, in-depth series by Sky-Hi News about mental health in Grand County. Throughout this series, which will be in print and on our website every Friday throughout April, you will meet several local people who struggle with mental health issues, both personally and professionally. We share their stories and how they connect to the systemic issues facing local mental health. Their stories are woven together through all four parts, giving mental health in Grand County a visible face while examining the issues and what’s being done to address them.
PART ONE
STORY BY McKenna Harford, Lance Maggart and Bryce Martin
Vanessa Benjamin-Rus had been watching a movie on her laptop and writing in her journal on a relatively uneventful Sunday evening in Grand Lake. She got up from her bed and walked a few steps into her bathroom.
Her mind suddenly foggy, she noticed scratches covering her arms and thighs. A bit of blood pooled at the ends of some of the scratches. She thought perhaps one of her many animals climbed into bed with her and, for some reason, caused the scratches.
She called out to her husband for help. He woke from his sleep and quickly bolted to her side.
She doesn’t remember what happened next, only that she suddenly came alert while in her dining room.
Her mind began to race. She began to scrutinize the scene inside her home. Her husband, Carl Rus, was standing nearby and noticeably shaken. She noticed a cut on his lip and tried to help him.
“Get away!” Rus yelled.
Did I do this? She wondered.
“It was an alter,” Rus muttered.
The word clicked in Benjamin-Rus’s mind. Yes, she had done this. But, it wasn’t exactly her. One of her other personalities had intruded into Benjamin-Rus’s mind that night, Feb. 26, 2012. The personality, who was called Shawn, had apparently cut her body and attacked her husband.
Her consciousness had been pushed deep into herself and allowed for an alter, or alternate personality, to take control of her body and mind.
It was another incident that the two were all too familiar with, caused by her struggle with dissociative identity disorder.
While her specific disease is rare, her issues with Grand County’s mental health system and the local stigma are common.
People struggling with mental health issues are your friend, your neighbor, your employee and, in many cases, yourself.
Benjamin-Rus and her husband both suffer from mental health issues. On the exterior, they seem to be ordinary people, just going about their daily lives. But they are quietly facing a struggle within.
Their struggles in Grand County include a small and overworked field of providers to treat them, a monopolized mental health infrastructure to heal them, law enforcement and a legal system that doesn’t quite know how to handle them, and a stigma that often dissuades people from simply accepting them.
The crux of the local problem is a rising need for mental health care that is met with dwindling resources.
In 2017, the county’s largest mental health provider, Mind Springs Health in Granby, saw 653 patients, which was a 22 percent increase from the previous year. The patient count rose again in 2018, to 728.
Currently, the average wait time to see a counselor at Mind Springs is two to three weeks and newly implemented walk-in hours at the Granby office are so popular that people are frequently turned away.
An increased need for treatment is compounded by another statistic, that the number of suicides in the county is two-and-a-half times more than the national average. That figure, while similar in resort areas across the state, serves to illustrate the issue of people not finding the preventative mental health care they might need.
But as demand for help has increased, the number of mental health care providers in the county has dropped, from 28 in 2017 to currently 12, none of which provide services in a language other than English and not all of them accept all health insurances.
Eleven percent of the county’s population stated that they experienced eight or more days of poor mental health in the past 30 days, according to Mental Health Colorado, the state’s leading advocate for prevention and treatment of mental health and substance use disorders. While that’s lower than the state average of 11.8 percent, the issue of mental health is complex in Grand County as the full picture of the local struggle is not entirely quantifiable.
It is hard to know the exact parameters of the issue in Grand County because mental health is consistently unreported, according to Jen Fanning, executive director of the Grand County Rural Health Network, a nonprofit organization that connect citizens with health resources. Many people have not sought help or are undiagnosed because of a variety of barriers to care, including a societal stigma surrounding mental health.
People also move to the county specifically to isolate themselves, which can further hinder the overall understanding of mental health in the community.
“A lot of people come up here specifically to isolate and or feel isolated,” Fanning said. “Not all, certainly not all or even the majority, but it’s possible to do. Or to be transient and move constantly, this is one of those places that happens and it’s not noticeable because we have that seasonal level of work.”
The struggle, nonetheless, is real and ever-present.
What is known is that Grand County has quite a few populations that are disproportionately affected by mental health struggles, including veterans, first responders, people with traumatic brain injuries and the elderly.
For example, the Center for Disease Control estimates that 20 percent of people over 55 experience some kind of mental health concern. This age range accounts for over one-third of the county’s population.
Grand County also has a larger than average population of veterans, which account for about 8 percent of residents, and one study estimates they experience mental health concerns at a rate of almost one in four.
A number of issues the community is facing can also contribute to poor mental health, including the higher cost of living, unstable work, a lack of affordable housing and a lack of services, such as transportation and childcare. Fanning explained these issues exacerbate stress and make it difficult for individuals to take care of themselves, physically and mentally.
“… There’s all this data that that level of stress makes you unhealthy overall because it just elevates everything,” she said. “In my opinion, (stress) is the very basis of our issues in our community, so if we could provide that support and reduce that stigma for the people who truly need it then people would be healthier.”
“In my opinion, (stress) is the very basis of our issues in our community...”
For groups that often face discrimination, such as people of color, the LGBTQ community and people with low-income, the effect on their mental health is even more acute, Fanning said.
In Grand County, the issues facing the community are particularly salient for the almost 50 percent of residents that live below the self-sufficiency standard, which calculates how much income a family must earn to meet basic needs without public or private assistance.
According to the Substance Abuse and Mental Health Services Administration, the relationship between poverty and mental health is complex because it’s unclear if poverty increases the likelihood of experiencing mental illness or if those experiencing mental illness are more likely to experience poverty.
Regardless of the underlying causes, Grand County officials are seeing an increase in people reporting mental health concerns or seeking help, which is weighing on already overworked providers.
“I think we have some great resources available but it is that capacity piece of how quickly can we get somebody in,” said Makena Line, program coordinator at Mind Springs. “We have wonderful staff, but they’re people, too, and they can’t work all the time.”
While mental health concerns have always been common in the emergency rooms at Middle Park Health, the number of such visits has been steadily ticking up, according to Dr. Michelle Lupica, director of the emergency department and trauma services at Middle Park Health-Granby.
“We have wonderful staff, but they’re people, too, and they can’t work all the time.”
And it’s not just medical providers that have noticed the prevalence. Law enforcement now deals with calls regarding mental health concerns on a daily basis, according to the Grand County Sheriff’s Office.
“That is one of our crises right now: we have a lot of those calls so we have to make sure we have the right tools to help these people without making mental health a criminal issue,” Grand County Sheriff Brett Schroetlin said.
Whether the increasing pervasiveness of mental health concerns is because of more people feeling comfortable seeking help or because more people are experiencing mental health issues than before, Grand County doesn’t have the resources to address the growing need.
It could also be because of the county’s growing population in the last few years, going from 12,455 in 2000 to now more than 15,000, according to U.S. Census data.
Fanning explained it’s important to have enough resources to respond to people in a timely manner when they finally do take the first step to seek care.
“When people are ready to see (a provider), you’ve got to maximize that energy,” she said. “You have to have that level of readiness.”
When Martha Baird, 63, of Tabernash moved to Grand County three years ago, she had already been diagnosed with depression and was on medication, so she wasn’t expecting to have any trouble.
Baird reached out to a physician who connected her with a behavioral health navigator to help her find a local therapist.
“He said, ‘You have to find somebody who takes your insurance,’” Baird explained. “Well there were two choices. That’s a big deal, taking my insurance.”
One of Baird’s choices was unable to take new patients and the other wasn’t a good fit, so she’s now relying on her primary care physician for mental health care.
Kim Long, health coverage guide for the Grand County Rural Health Network, said the complexities of health insurance make it really difficult to know where to go and what will be covered.
“It’s a game to find out where it’s going to be taken, to what extent and the guarantee of the copays and coinsurance doesn’t reach very far,” Long said.
Other financial barriers to care include transportation, housing and childcare, which can not only cause stress and contribute to poor mental health, but also get in the way of seeking care for a variety of reasons.
“As far as people who take insurance, in Kremmling and Grand Lake there are no mental health providers and if you don’t have a vehicle and you’re in Grand Lake or Kremmling, it’s really tough,” said Sue Johnson, one of two local behavioral health navigators.
Aside from financial concerns, social stigma and a general misunderstanding of mental health plays a large role in keeping people from seeking help when they need it.
Mental health is often treated differently than physical health because of the misconception that those struggling can control their mental illness. However, just like a physical condition, such as diabetes, who experiences mental illness and what causes it are not within an individual’s control.
“We go to a doctor to stay healthy and when we’re sick, so why wouldn’t we go to a trained therapist to get tools to help overcome anxiety or depression,” Fanning said. “If you’re diagnosed with diabetes, I don’t care what age you’re at, you have to learn tools on how to manage that and you have to make choices every single day. It’s the same thing with mental health.”
In hindsight, Baird recognizes that she has likely suffered from depression since she was a child, but it wasn’t until her first appointment with a psychologist, when medication was suggested, that she realized what she was experiencing was more than just sadness.
Now, she thinks about her depression differently.
“It’s an illness, so you can think about it that way, that I’m sick,” she said. “It’s a chronic illness that I have. It’s difficult to really understand it unless you’re part of it.”
This misconception feeds into stigmatization by perpetuating the idea that mental illness is something that an individual can simply get over or move on from, a kind of “pull yourself up by the bootstraps” mentality, which can be harmful.
“That’s one of my all-time least favorite sayings and it’s actually physically impossible,” Johnson laughed. “It’s a frustrating phrase to hear when you’re suffering from a mental health issue because it’s not that simple. It’s not a matter of will or effort. (...) It creates more of that self-stigma for that person where they feel even worse about themselves.”
Mind Springs reported that its most common mental health issues observed in patients at its Granby office, through 2017 and 2018, were anxiety, depression, substance abuse and post-traumatic stress disorder.
Anxiety and depression are the most common mental health issues nationally, according to research from Mental Health America, the nation’s leading community-based nonprofit dedicated to addressing mental illness, with three out of our people experiencing one or both at some point in their lives.
“This isn’t something that should be looked at as bad; it’s normal,” Fanning commented.
Because of the frequency of mental health issues, and a lack of local care, the county identified mental health as the top priority in its Public Health Improvement Plan for 2018. The plan is a five-year guiding document that identifies health priorities, provides health data and gives actionable suggestions for the Grand County Public Health office and other local health organizations.
The priorities in the plan are decided by calculating the unmet need in the community. One top priority was to create a community-wide behavioral health strategic plan that sustains existing programs and expands resources.
Some of the actionable steps identified in the plan include hosting community meetings, research and implementation of in-person integrated and private care, advocacy to policy makers and education of the community. Conversations on how to roll out those steps are ongoing.
Mental health was also the top priority for the 2013 public health plan.
Mental health is a daily priority for Vanessa Benjamin-Rus.
When you meet her, you immediately notice her cropped, red-colored hair. She’s a bit taller than average and carries herself with what can be perceived as confidence.
She’ll greet you with a smile, more often than not, or a gentle handshake. She’ll enjoy a laugh and good-spirited conversation.
But that mild demeanor, that toothy smile, is often merely a façade she wears.
It makes sense when considering her struggles.
At any time, one of Benjamin-Rus’s other personalities can take over her body. She calls them simply “alters.” When it happens, the Vanessa everybody knows fades to the background, leaving her alters to control what she says and does. She loses time and wakes up with no memory of what happened.
The 44-year-old was diagnosed with dissociative identity disorder in 2010, but it had developed throughout her adolescence.
Dissociative identity disorder, or DID, is a rare condition in which two or more distinct identities, or personality states, are present in — and alternately take control of — an individual, according to Psychology Today. The person also experiences memory loss that is too extensive to be explained by ordinary forgetfulness.
It was formerly known as multiple personality disorder, but changed in 1994 to better reflect an understanding of the condition.
DID is one of the most controversial and complex psychological disorders that can afflict a human. It’s usually different from person to person and carries with it a frightening range of symptoms.
For Benjamin-Rus, the worst symptom is when one of her alters attempts to self-harm.
And that’s happened several times in her life.
“I was doused with meds, put in what they call quiet rooms. Straight jackets were considered a form of restraint.”
Before moving to Colorado, Benjamin-Rus had been to several in-patient psychiatric facilities.
“I was doused with meds, put in what they call quiet rooms,” she recalled. “Straight jackets were considered a form of restraint.”
Finding a diagnosis wasn’t easy. Doctors bounced around from a diagnosis of schizo-effectiveness to bipolar disorder— pretty much everything, she said, because the symptoms weren’t initially seen head-on.
It wasn’t until she moved to Grand County, about nine years ago, when she received her actual diagnosis.
Right now, she utilizes the mental health services offered by Mind Springs in Granby. She has been a patient since its rebranding away from Colorado West in 2013.
Her current therapist there, she says, is helpful. “She’s amazing with my alters and me, and my husband, Carl. She’s definitely meant to do what she does.”
Benjamin-Rus has a total of eight alters. Two others, which are considered malevolent, have put her in the emergency room and caused her to self harm.
She says she’s never abused drugs or alcohol: “I’ve been straight-edge my whole life.” But she has been rushed to the emergency room several times in Grand County after an overdose of prescription medication, which she ironically uses to treat her mental illness.
Her cocktail of medication has been changed since her first hospitalization at age 15. Since then, she’s tried 52 different medications.
There is no cure for DID and treatment is sometimes a wash. All she can do is manage her symptoms the best way possible — through medication, talk therapy and peer support.
But it’s not always enough; anything can trigger an episode.
Symptoms aren’t always present before an alter takes over, but Benjamin-Rus typically feels overwhelming anxiety. Her body begins to tremble. When an alter appears, it feels like Benjamin-Rus is in a daydream. She wakes up with no memory due to what is called dissociative amnesia.
Benjamin-Rus’s alternate personalities include a five-year-old boy named Gabriel, a six-year-old girl named Nessa, a 12-year-old called Pikachu, 18-year-old Shawn, a 24-year-old named Mina, a 43-year-old girl named Glaceon, two men in their 50s and 60s who rarely come around, and two “demon” alters, which don’t really have a name.
Not many people have witnessed her alters save for her husband, emergency personnel and her therapists and doctors. The only way she can communicate with them is through notes left during episodes. She said she believes the alters cannot communicate with each other, as far as Rus has explained from his experiences with them.
It’s always up to her husband, Carl Rus, to explain what happened when her dominant personality, Vanessa, fades away.
Rus, however, suffers from his own mental health issues.
Benjamin-Rus married Carl Rus in 2011. There’s a bit of an age difference, Benjamin-Rus being 44 and Rus being 31, but it works, they said.
Her husband is the primary person to deal with the alters.
“I don’t know what he sees, what he endures, but I know it hurts,” she admitted. “It takes a toll.”
Rus said he simply learns to deal the best way he can. He is foremost a consoler for when his wife is in a crisis.
“I’ve been in therapy since I was 10. I'm usually good without it — because of the experiences I've gained,” he admitted.
Rus has been diagnosed with Type 1 bipolar disorder and severe PTSD. He is medicated for his bipolar disease, but there is no treatment, aside from therapy, for PTSD.
“You just learn to deal with things the best way you can,” he said.
The couple’s marriage seems to work, however.
“We know how to work with one another,” Rus affirmed.
But that’s not always the case with people on the outside.
Hollywood has portrayed DID many times in films and TV shows, often using hyperbole to achieve a blockbuster flourish. The common misrepresentation of the disease adds to the stigma for those actually suffering, convincing people that that is what DID truly looks like.
“People are basing things on stereotypes,” Rus said. “It’s what they see in movies or on the news — that being coupled with immediate assumptions and judgmental behavior.”
In addition to the problematic lack of resources in the county, one of the biggest detriments to local mental health, according to Benjamin-Rus, is its stigma.
“It’s not easy living with this,” she admitted, indicating that she has had trouble keeping friends, employment and dealing with local people who clearly don’t understand the condition.
Benjamin-Rus said there is a lot of gossip in Grand County, but those people who have said off-handed things about her have never come up and spoken with her.
“It can be depressing,” she said, and even sometimes sends her into a rage.
She holds certain that some people don’t believe her illness, and that it’s faked. The only thing she can do for those people is hope they become educated and informed.
“If you feel the need to think I’m crazy or faking it or delusional, to fill the void that is your ignorance, go ahead,” she said firmly. “Be glad you don’t have it. Be glad you don’t have to worry about it.”
Fanning said the stigma surrounding mental health is huge.
“It’s one of those things that we, as a county, as a region, as a state, and, I dare say, as a nation, have been working on for the past several years is how do we reduce that stigma,” she said. “Three-quarters of people will experience anxiety or depression at some point in their life, so why is it stigmatized?”
She acknowledged that people generally keep quiet about their mental health. That, coupled with a lack of capacity to see people, creates a sizable issue.
Benjamin-Rus said the public’s perception of mental health definitely needs to change.
“I just don’t want people to be afraid of me,” she said.
While Benjamin-Rus said it is difficult to find employers in Grand County that acknowledge and work with her diagnosis, Rus said he is satisfied with his employer.
Rus works as a local custodian. His boss, he says, is flexible and treats him very well.
When there’s a crisis with his wife, he is able to quickly go to her side.
But he, too, admitted there seems to be more bad than good employers in the county.
“It's easier to target someone who seems vulnerable,” Benjamin-Rus said. “People like to make examples out of them.”
But they’re “regular” people, the two exclaimed. They’re not sure what mental illness is supposed to act like or talk like to meet people’s misguided stereotypes.
What they do know is that they have a family, a home, a car, they dress normal and do the everyday things other people do. They have bills, chores and responsibilities. They have their ups and their downs.
“We may have a difficult time,” Rus said, “but don't be afraid of us.”
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In the next installment of our four-part series, we examine the infrastructural deficiencies that have come to define mental health care in Grand County and the effects that has on those struggling with mental illness in the community.
Are you having a mental health crisis? Get help today.
Call the National Suicide Prevention Hotline, 24/7: 1-800-273-8255