This is the fourth and final 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 FOUR
STORY BY McKenna Harford, Lance Maggart and Bryce Martin
As vacationers enjoyed the warm summer weather and bright Rocky Mountain sunshine late last July, Reg Rhodes was suffering.
The 47-year-old Grand Lake resident had a history of chronic clinical depression. His outlook on life wasn’t improving.
When he didn’t show up to work one day, as his close friend and boss Joe Kelley recalled, the team at Power World in Granby grew nervous. That wasn’t like him, according to Kelley.
“We knew something was wrong when he didn’t show up,” he said.
Rhodes’s long experience with depression was well known by those who knew him, especially by Kelley. Though, just days earlier, Rhodes was in good spirits, excitedly showing Kelley some unknown bicycle trails around the county and buying pizza for everybody at work. He was simply in a “really good mood.”
On July 29, 2018, it was made apparent why Rhodes hadn’t shown up to work. He had taken his own life.
He was found during a welfare check inside his Grand Lake home, with his beloved canine companion, named Wrangler, still by his side.
“I don’t know how to describe it, nor did I know what to do that day,” Kelley admitted.
It was a sudden jolt to Kelley and the Power World family, where Rhodes was a master mechanic. Dealing with the loss of a friend was difficult. Kelley said he experienced a cycle of continual grief then anger.
No one at Power World realized, at the time, that Rhodes’s suddenly happy demeanor could have been an indication of his future suicide. They were just relieved that their good friend was experiencing some sort of contentment or relief from his anguish.
In hindsight, Kelley said he believes that his seemingly improved mental state was because Rhodes had decided on a plan to finally end his suffering.
“He didn’t see his own value,” Kelley remembered. “He thought of himself as worthless.”
The amount of suicides each year in Grand County has been trending upwards for the past decade. Data from the Colorado Department of Public Health and Environment shows the county had the highest suicide rate of all major resort communities in Colorado, when considering suicide deaths from 2004 to 2017. The actual number of suicide deaths may seem relatively small, due to the county’s smaller overall population, but the deaths are not insignificant. Each suicide death has a profound impact on the county’s suicide rate.
Grand County’s suicide rate in 2018 was close to 40 deaths per 100,000 citizens; nearly three times the national average of 14 per 100,000 citizens.
From 2007 through 2018, there were a total of 35 suicides in the county. Last year, the county had six instances in which an individual ended his or her life.
Looking at trends in the county shows that men die by suicide at a far higher rate than women. Since 2011, a total of 24 men have taken their lives compared to six women and one transgender woman. Their ages spanned from the young teens to late 70s.
An examination of resort communities in the Rocky Mountain west also shows higher-than-average suicide rates.
Routt County, home to the Steamboat ski resort, had a suicide rate, from 2004 to 2017, of 20.9 suicides per 100,000 people. To the south, Summit County had a rate of 15.9 and, further west, Eagle County — with the lowest suicide rate among resort communities — had a rate of 12.1.
Resort communities not along the I-70 mountain corridor had slightly lower suicide rates. In San Miguel County, where Telluride ski resort is located, the rate was 18 per 100,000, from 2004 to 2017. East of the Continental Divide, Boulder County, where Eldora ski resort is located, had a rate of 17.
Like other resort markets in the state, one of the unique aspects to suicide statistics in Grand County is related to a phenomenon sometimes referred to as suicide tourism.
Suicide tourism is the practice of traveling to a location away from home to commit suicide, often occurring at famous landmarks, such as the Golden Gate Bridge, or in beautiful outdoor environments like Grand County.
Since 2007, one-fifth of the county’s suicides have been completed by non-residents.
Grand County Coroner Brenda Bock recalled this phenomenon when she came upon a note, years ago, left by a person who had taken their own life inside the county. The note indicated that they had come to “beautiful Colorado because it was closer to God.”
Based upon her investigations, Bock confirmed that many individuals who come to Grand County to complete suicide want to die in a place of beauty.
Aside from its picturesque setting, determining why there is a higher-than-average suicide rate in Grand County is difficult as suicide can occur for a myriad of reasons.
There are, however, at least ways to explain how the area is more susceptible.
Scholars and public health professionals have pointed to numerous contributing factors, from troubled local economies to the isolation that can sometimes accompany the rural settings of the west. Other factors include the prevalence of veterans, who die by suicide at a rate roughly twice as often as the general public, and the relatively high amount of firearm ownership.
There is one surprising factor, however, that is believed to correlate closely with suicide: elevation.
A study published March 2018 in the “Harvard Review of Psychiatry” titled “Living High and Feeling Low: Altitude, Suicide and Depression,” authored by doctors Brent Kious, Douglas Kondo and Perry Renshaw, found that higher elevation may be linked to increased rates of suicide.
The researchers analyzed 12 studies, most of which reported that high-altitude areas in the United States had increased rates of depression and suicide.
Suicide rates increased dramatically at altitudes between about 2,000 and 3,000 feet, according to the study. On average, and adjusted for population distribution, suicide rates were found to be 17.7 at high altitude, 11.9 at middle and 4.8 at low altitude for every 100,000 people.
The average altitude of Grand County’s six major towns is 8,165 feet.
Studies from other countries, though not all, have also reported increased suicide rates at higher altitudes.
The study’s researchers suggested the reason higher altitude leads to greater suicide rates might be tied to chronic hypobaric hypoxia, which is low blood oxygen levels related to atmospheric pressure. That, according to the study, could negatively alter serotonin metabolism — which, in basic terms, contributes to feelings of well-being and happiness —and brain bioenergetics.
“Could I have done more to help?”
That’s one of the many questions that some people weigh in their mind after the loss of loved ones to suicide.
The actions of one individual, often struggling with a mental health disorder, can have radical, earth-shattering and lifelong consequences for those left behind. The aftermath of suicide is often underscored by an array of conflicting emotions and personal turmoil.
Kasy Allen was distraught after her 17-year-old nephew, Caleb, took his own life in 2017.
Caleb was brawny and strong growing up. He was fairly thin and lanky with light brown, often shaggy, hair. Allen, 37, called him goofy, in an endearing sense, and said he liked to make people laugh.
This was despite coming from a troubled home life with parents that had substance abuse problems, according to Allen.
In eighth grade, Caleb lived with Allen and her family in Hot Sulphur Springs for several months while he attended East Grand Middle School.
He was a member of the school’s wrestling squad and did quite well, according to his aunt.
“He had a lot of friends and a few that would be considered close,” she indicated.
She was unsure if any of those friends knew about his tough life growing up.
Caleb was not formally diagnosed with any mental health disorders, according to Allen, and did not take any medication for his depression at the time of his suicide. While in Grand County, however, Caleb attended weekly therapy sessions.
“We did see a change in him while he was with us,” Allen recalled.
After his stay, he returned to live with his mother in the Colorado Springs area. Allen said she believes Caleb continued to struggle with issues related to depression and poor mental health after returning home.
It was in 2017 when he gained his independence, moving into a home with some friends who lived in Colorado Springs. At the time, Caleb was attending Mitchell High School and was nurturing dreams of one day becoming a gym teacher.
In September, just a month after starting his junior year of high school, Caleb was found dead inside his bedroom. He had killed himself.
There was a one-page letter left behind.
He did not believe anyone would care if he ended his life, according to the letter.
He was in a state of despair, Allen believes, as he had recently gone through a break-up with a girlfriend. His true motive, however, will never be known.
It was an earth-shattering moment for Allen when she learned about Caleb’s tragic fate. She had considered herself a sort of motherly figure for the boy during his stay with her family. She loved him deeply.
"Caleb took his own life because he was so damn sad he couldn’t deal with it anymore."
About six months later, a second person close to Allen died by suicide.
She had known Hunter Henderson since childhood. He had attended Middle Park High School while living in Grand County several years ago.
“Physically, he was the Jolly Green Giant,” Allen remembered fondly. “He was always bigger than everyone else, but very kind and thoughtful. He liked to laugh and make people laugh. He was over 6 feet tall and just a big lover.”
Henderson was very sociable and had a large circle of friends, including very close lifelong friends.
But he could hide his own pain well, according to Allen, even though he was good at making other people laugh.
“It seemed that he always struggled with being sad,” Allen said. “Many of those close enough to him knew he had attempted suicide multiple times in his life.”
Henderson struggled financially and lost his belongings a few times, funneling his pain into a heroin addiction.
He was 37 and living in Orlando, Florida, at the time of his death.
The two deaths happening within six months of each other was especially tough for Allen.
“I watched everyone else move on, but I got stuck,” she admitted. “It just got to the point where I was depressed.”
Allen eventually saw a therapist and was diagnosed with post-traumatic stress disorder.
She began seeking help wherever she could find it. She ultimately attended grief-counseling sessions with a local Christian-based counseling group.
“(The program) is very well organized and put together, but it just wasn’t for me,” she said. “Everyone has their own way of healing.”
The quality of that program, however, inspired her initial development of a secular grief-counseling group that she’s currently working to help establish locally.
Allen created a group on social media specifically for those impacted by suicide in Grand County. In early March, Suicide Survivors Loss & Support-Grand County, CO went live on Facebook.
The private group, admittance for which is by request only, is meant to serve as a safe space where people can recount their stories to those who have experienced the same type of loss from suicide. They can also seek support and use the group as a resource to find treatment options.
Allen acknowledged that she does not have the extensive knowledge and expertise necessary to effectively shepherd the development of the group into a fully-fledged grief counseling organization. There are issues related to confidentiality, how to conduct group sessions, scheduling questions and how to handle individuals experiencing crises as outstanding hurdles to the group’s development.
People can still use the group as a supportive resource.
“I want to help someone who is going through something like I was,” Allen said. “To just be there and hopefully help them feel better. Caleb took his own life because he was so damn sad he couldn’t deal with it anymore.”
Such a group, she said, would have been helpful after the loss of Caleb and Henderson.
But the losses engendered within her a feeling of importance to live in the moment.
“I am moving forward in life, being a mom again,” she said. “I am focusing on making my kids happy and husband happy and not focusing so much on the deaths that happened, but on the joy of life.
“We are only here for so long; we have to enjoy that.”
Barbara Watts wouldn’t have won any Mother of the Year awards, according to her daughter, Robin Watts-Trainor.
That was something she was forced to confront after her mother’s suicide.
For Watts-Trainor, a longtime Granby resident and former town trustee, her mother’s suicide early last year had a different impact, one that she said she’s still trying to process.
“Things were getting so bad towards the end that it was almost a relief,” she admitted. “But I feel guilty about it; I have a lot of guilt with that.”
Watts-Trainor, 55, is an ebullient community fixture who is quick to make a quip or sarcastic remark. She’s usually seen with a smile on her face. But she didn’t stifle her emotion when it came to discussing Watts. Her words were sharp and conveyed the deep-settled pain of growing up with her mother, who struggled with severe mental illness. Their relationship had been strained, to say the least.
Watts was just days away from her 74th birthday when she completed suicide. She had lived in a small apartment at a senior living complex in Arvada. Roughly average in height, standing at about 5-foot-7, she was a very attractive woman, according to her daughter.
“She took very good care of herself physically and always dressed very nice,” Watts-Trainor said. “She wanted people to think she was better than she was. She was incredibly vain.”
She said her mother had an unyielding desire to be the center of attention in all circumstances and could become obstinate if not. In her free time she enjoyed crafting and fancied herself something of a decorator, which her daughter said was part of her heavy emphasis on appearances.
Watts was diagnosed with both bipolar and borderline personality disorder. During her life, she was prescribed medication for her diagnoses on numerous occasions, but Watts-Trainor said she did not know whether or not she actually took the medication. It was part of her refusal to accept that she had mental health issues.
“She was all about status,” Watts-Trainor said. “She was always comparing herself to those around her.”
Watts quit attending school in middle school and was married for the first time when she was just 13 years old. She later attended cosmetology school and even operated her own beauty shop in Buena Vista for a period.
While she enjoyed being the center of attention, Watts-Trainor said she was not a particularly social person.
“She would meet somebody and it would be like a zero-to-60 relationship,” Watts-Trainor said, “… then that person would do something to (upset her) and she would totally cut off contact.”
By the time of her death, Watts had few significant social contacts. She kept in touch with her brother in Texas, but was often at odds with her neighbors in the senior living community in Arvada.
Watts-Trainor, an only child, said she attended 11 different schools in 12 years while growing up. The traditional role of a mother, as a protector and caregiver, shifted to Watts-Trainor. She spent much of her childhood caring for Watts.
By early high school, she had already started referring to her mother as Barbara instead of “mom.”
“I was the adult in the relationship,” she explained. “That’s just how it was.”
Trainor said her mother struggled with an addiction to prescription opioids, which she believed was fundamental to her lifelong mental health issues. Watts had attempted suicide on several occasions previously in her life.
Her mother was found dead in her Arvada apartment a few days after taking her own life. She had lived isolated and alone, for the most part.
After her mother’s suicide, Watts-Trainor sought counseling from a local therapist.
“I felt guilty because I felt relieved,” she admitted. “I am angry at her for being a lousy mother and dragging me through all the things she did. I didn’t even want to mourn her.”
Watts-Trainor’s eventual feelings of grief were complex. But, through therapy, she was able to work through some of the confused emotions.
“(The therapist) said to me, ‘You are not mourning your mother, you are mourning the fact that the person who gave birth to you was never a mother,’” she explained.
The uneasy, complicated relationship with her mother and the feelings that arose following her death ultimately led Watts-Trainor to discover the benefits of therapy.
She used her mother’s story, and her own subsequent mixed emotions, to stress the importance of seeking professional help when experiencing any form of mental illnesses.
Her mother, she said, had not legitimately sought help in her lifetime.
“My mom didn’t really think anything was wrong with her,” she affirmed. “I don’t think she was ever really honest with doctors or therapists, so they couldn’t help her deal with her issues.”
Watts-Trainor said she is a firm believer that everybody needs a therapist at some point in life.
“From the young mothers who have postpartum depression to cops and first responders, there are a lot of fallacies,” she said. “(People think), ‘If I were smarter, stronger, if I had more money or if I was a good enough Christian, I wouldn’t need it.’ But it is OK to need to talk to somebody.”
While suicide and mental health are closely connected, not every person who attempts or completes suicide has a mental health disorder or diagnosis.
“Having a mental health condition, if it is untreated or unsupported, can put you at higher risk for suicide,” explained Sarah Brummett, director of the Colorado State Office of Suicide Prevention, part of the state health department. “On the other side, we know that a big percentage of people who die by suicide do not have a diagnosed mental health condition.”
Just 30 percent of individuals who die by suicide are receiving some form of mental health treatment at the time of their death, she noted.
But the question is why people opt to end their lives.
“That is the million-dollar question,” as Brummett put it.
A broad answer is pain and a loss of hope that things will improve. When that is paired with a loss of hope and access to lethal means, it is a dangerous combination, she said.
Feelings of suicide are treatable, though. Recovery is actually more probable than not, Brummett said.
While millions of Americans experience thoughts of suicide each year, it’s a relatively small percentage that makes an actual attempt. Of those who attempt, over 90 percent will live.
“There are millions of stories of hope and recovery,” Brummett indicated.
The biggest step individuals can take when looking to combat suicidal thoughts or feelings is to first acknowledge the existence of such thoughts. Then, reach out to seek support, either to a crisis hotline or to a trusted friend, family member or care provider.
Changes in personality and demeanor, sleeping patterns, eating habits, substance use and abuse and even increased agitation are potential warning signs of suicide. Talk about suicide or feeling like a burden are “big” red flags, she said.
When those signs are noticed, it’s important to put aside any uneasiness and ask about the person’s feelings.
“Ask those difficult questions,” she said. “Asking those questions gives someone the opportunity to say, ‘Yeah, this is tough.’”
Those conversations can save lives, she professed.
Joe Kelley didn’t know how to help his friend, who ultimately took his own life.
“I don’t know enough about (mental health care) to say what Reg would have needed,” Kelley said. “But I certainly want to be involved in creating more awareness.”
A LONG ROAD TO IMPROVED HEALTH CARE
Despite a drop in the amount of local mental health providers and other barriers to care, Grand County is not without its resources for those in need of help.
One of the newest resources available, a result of conversations after a 2012 public needs survey, is the behavioral health navigator program.
The program, helmed by navigators Sue Johnson and Kaitey Davidson, has had a positive response since it was implemented in 2016. It’s a partnership between Mind Springs Health, Middle Park Health, the Grand County Rural Health Network and Grand County Public Health Department, the four of which applied for the grant to fund the program.
It did, however, take a few years since it was first discussed in 2012 to secure funding, which ultimately came from a three-year grant provided by the Denver Foundation.
The program is designed to assist people through the local mental health system and to get help.
Referrals to the program come mainly from primary care offices around the county.
“The navigators have a lot more flexibility to often see someone that same day or very quickly after they’re referred to our program,” said Johnson, who has lived in Grand County for the last 16 years.
“We can serve as a therapeutic source until someone’s able to get in with a long-term provider,” she explained.
The navigators are there to feel out a person’s personality, to assess their needs and capabilities in order to offer the best referral for external behavioral care.
“A lot of times your doctor’s office may give you several cards or a list of therapists — and it becomes overwhelming, especially if you’re experiencing anxiety or depression,” she said. “This takes a little bit of the guesswork out.”
The program also helps people get in to see more advanced level care, chiefly psychiatrists, which Grand County does not have locally. There are psychiatric services available through Mind Springs, but, in Grand County, that’s only via televideo. Though, people can see a psychiatrist face-to-face if they’re willing to drive outside the area. The navigators will also refer people to psychiatrists outside of the Mind Springs network.
The goal of the program isn’t to take away from existing mental health resources, but to fill in the local gaps. It’s Grand County’s version of integrated care, according to Johnson, which many primary care practices along the Front Range are moving towards, in part because it helps get services to patients quickly and conveniently.
Many of the practices have primary care providers along with therapists and psychiatric services, all in one office. That’s now becoming a bit more of a reality for the county through the navigator program.
“These primary care doctors now have a resource to rely on for mental health,” she explained.
The providers that do exist in Grand County want to help and their efforts are not futile. They have a heavy weight on their shoulders, with strains from an increased amount of people seeking mental health treatment from a system with fewer providers. But that should never deter people from seeking help.
For those who aren’t sure how to take the first step, initially acknowledging and talking about their struggles is crucial to weaken any associated stigma.
Coupled with that is further education about mental health, what it really looks like and realizing that it can affect anybody at anytime. People with struggles need help — that’s just a fact — regardless of who they are. Hiding it or refusing to deal with it can manifest itself in worse ways in the long term.
Being open and honest about mental health makes it easier for people to seek help and acknowledge the actual significant amount of people who are suffering — people that wouldn’t ordinarily come forward.
Legislative work on mental health
By Bryce Martin
At the state level, mental health has become somewhat of a buzzword.
Many legislators understand and acknowledge the mental health crisis affecting areas across the state, but what’s most important is if and how they’re working to implement real solutions.
“This session, we are focusing on providing mental health treatment for some of our most vulnerable populations,” said Rep. KC Becker, D-Boulder, who represents Grand County.
As Colorado has one of the highest rates of youth suicide in the country, there are two bills this session that focus on providing treatment, training and resources to more quickly notice and address the signs of depression and potential suicide in youth, she explained.
“We should do all we can to support mental health counseling and services in our schools,” she said.
Of notable importance is House Bill 19-1120, which looks at ways to prevent youth suicide including allowing minors, ages 12 and up, to seek psychotherapy services without needing the consent of parents. Another focused on youth is HB19-1017, which would create a trial program to place social workers in each grade, from kindergarten through fifth grade, who would follow students through to their elementary graduation.
In addition to policies designed to help Colorado’s youth, bills are being developed to address the mental health of first responders, expanding access to mental health facilities and improving care “across the board through comprehensive health policy reforms,” Becker indicated.
One such bill is HB19-1160, which would establish a three-year mental health facility pilot program to provide residential care, treatment and services to people with either a mental or physical health diagnosis.
Expanding access to and increasing funding for mental health screenings and treatment capacity is a way to address mental health issues, according to Becker.
“I think the bills we have outlined this session are making a dent in that effort, but there is more work to do,” she said.
It’s not a sole person’s responsibility to improve local mental health care. Expanding its infrastructure will take countless entities, time and money. It’s certainly not something that can happen overnight or probably even in the next few years. Fixing the barriers in Grand County will first require small steps.
Some of those fixes are in the works, beginning with local discussions to identify the problems and create reasonable and actionable plans to address them.
A major initial step is to continue supporting existing programs that are effective, such as the behavioral health navigator program, which is set to lose funding at the end of the year.
Jen Fanning, executive director of the Grand County Rural Health Network, said her organization, along with community partners, are looking for funding to sustain the program, including asking for contributions from the county and hospital, as well as applying for grants.
“There are some things that we’ve just gotten going in the past couple of years and they’re proving to work, so we want to sustain them,” Fanning said.
Similar conversations are occurring around the transportation of a person during a mental health crisis, a large barrier to care.
Mind Springs currently contracts with Citadel, a secure chauffeur service, and the Grand County Sheriff’s Office for transporting people in a crisis. However, the grant funding Citadel’s contract runs out this year.
Going back to rely solely on the sheriff’s office for transports isn’t ideal for anyone involved. Instead, officials are working together to see if other funding can be secured or if another option is available.
Suggestions at a recent gathering of stakeholders ranged from training volunteers to sit with people in crisis in the emergency room while they wait for transportation to creating a regional contract with a transportation service in conjunction with surrounding counties.
In order to continue building on the work being done, Fanning is also working with stakeholders and community members to create an updated mental health strategic plan, which will provide an outline and goals for the next five years.
A committee working on the plan sent out a public survey that asked respondents to rank their top five mental health priorities, from a list of 20 or more ideas that included creating trainings, expanding capacity and implementing programs.
The responses will be presented to the county’s Health and Human Resources Coalition to take action on the top priorities identified.
CarrieAnn Grayson, a Grand County resident and military veteran who has post-traumatic stress disorder, says she wants to see more local, public conversations about mental health in the community.
“It just takes one person putting their experiences out there to start that dialog,” she said. “It will let other people know they are not alone.”
Something that would be helpful, she said, would be having an Americans with Disabilities Act, or ADA, coordinator, which is an individual designated to coordinate and implement ADA compliance activities.
Federal guidelines under the ADA protect people with mental illness through anti-discrimination rules, requirements for job accommodations and more.
“I think it would be really beneficial if the county had an advocate for people with disabilities, to include mental illnesses,” Grayson said. “Someone who can help them navigate the challenges they are having, but not just the physical barriers.”
Grayson said she believes the public broadly stigmatizes mental illnesses and that stigma extends to everyone who experiences illnesses without tangible symbols.
“I think people with any type of mental illness are categorized into one lump sum. Whether you have PTSD or whatever, there is a stigma on all of them together because there is no visual representation of their illness,” she explained.
A specific aspect to her own mental health care is having a service dog. She’s usually spotted with her large, black poodle named Guinness, which she’s had for six years.
“She is by far the most effective form of treatment,” Grayson noted. “She has tasks that are related to helping me, like blocking, cover and something they call DPT, or deep pressure therapy.”
What most of Grand County’s mental health professionals, government leaders, law enforcement, health care workers and those experiencing mental health illnesses agree on, however, is to take that first step to addressing the issues: to start talking about it.
It’s all about bringing the issues out of the shadows.
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Are you having a mental health crisis? Get help today.
Call the National Suicide Prevention Hotline, 24/7: 1-800-273-8255