This is the second 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.


STORY BY McKenna Harford, Lance Maggart and Bryce Martin

After a long day under the browbeating heat of the Iraqi desert sun, CarrieAnn Grayson retired to her tent for some rest.

She was a first lieutenant in the U.S. Army signals corps and executive officer of her company, which was stationed at a field base in a remote part of Iraq. It was shortly after the United States began its invasion of the war-torn country in 2003.

As she was about to get some much-deserved sleep, Grayson noticed a figure enter her tent.

She recognized the face of the enlisted soldier. The man had already prompted red flags in her mind through prior events, such as making sexual comments and innuendo to other women in her camp. She grew cautious.

The exchange between them was swift.

The soldier approached and cornered her in the tent. She believed he was about to sexually assault her.

What happened next was a natural reaction to such a threat, especially from somebody in the military. In an attempt to protect herself, Grayson grabbed her M4 carbine rifle and threatened the soldier. She warned him not to take another step.

The man then slunk out of her tent and back into the night.

But the ordeal wasn’t over for Grayson. She would pay the price for suggesting that man, a fellow member of the U.S. Army, had attempted to commit a crime against her, an officer.

Grayson was removed from her command post and escorted to a secluded location. Her weapon was taken away from her and she was sent out of country, to Germany, not long after.

She had initially asked her commander how the situation could have been handled differently. The answer sent shivers down her spine.

“You should have allowed the assault to occur and reported it after,” she incredulously recalled the commander’s response.

Almost immediately after Grayson left Iraq for Germany, she began experiencing unusual symptoms. She fell into a deep state of despair. She felt anti-social, had constant nightmares and episodes where her emotions were easily triggered. Ultimately, she overdosed on prescription pain medication, which was for leg injuries she sustained during the invasion.

It would be years before she discovered that she was struggling with post-traumatic stress disorder, or PTSD, a diagnosis she believed was hid from her for years by the U.S. Army. It’s now a very common condition for soldiers and veterans.

The attempted sexual assault and the ensuing relocation contributed to, if not single-handedly caused, Grayson’s mental illness.

She’s since been through the gamut of treatment for PTSD, including counseling sessions and medication. Because it is so emotionally taxing for Grayson to review the incidents that caused her PTSD, she can be somewhat reluctant to meet new providers and begin the painful process of reliving her experiences anew.

She has found that counselors in Grand County that she had connected with eventually closed their practice or moved onto new roles or positions over time.

“Until I feel like I have a crisis, I often don’t go in,” she admitted of her reluctance for continued mental health care. “Those of us with PTSD don’t tend towards preventative maintenance, which is horrible. But with counseling, we don’t want to talk about the trauma.”

CarrieAnn Grayson smiles as her dog jumps around in the fresh snow at Snow Mountain Ranch-YMCA of the Rockies. Grayson, a military veteran, was diagnosed with post-traumatic stress disorder following an attempted sexual assault while she served with the U.S. Army. | Photo by Lance Maggart

WATCH | Above: CarrieAnn Grayson shares her story in front of an audience in San Antonio, Texas, as part of PBS's The Telling Project, a three-act play organized by playwright Jonathan Wei, where veterans and their families are given a voice to share their experiences.

Grayson’s claim that providers often leave Grand County is fundamental to understanding the county’s infrastructural issues with mental health care.

Between 2017 and 2019, 16 mental health providers left the county.

Mike and Mary Haas, who offered psychology and counseling services in Granby, retired in 2018. Another provider in Winter Park switched career paths and closed her practice, Creative Connectivity Counseling, which consisted of her and a partner. The partner ended up moving to Steamboat Springs following the closure of the practice. Others retired, closed or relocated elsewhere.

“There’s a lot of different factors that go into why people move,” said Sue Johnson, one of two behavioral health navigators in the county.

She added that community mental health centers, such as Mind Springs, often see high turnover because new providers and recent graduates use the centers as a springboard to gain experience before moving on.

The transient nature of the community was something Johnson highlighted as a contributing factor for the exodus.

“A lot of people come up here and find that it’s great for skiing and riding and there’s beautiful summers, but the in-between seasons can be tough. Or it’s socially isolating.

“It’s tough being in a small community and it’s not for everyone.”

Even the mental health profession is not immune to the seasonal nature of Grand County.

According to data from the County Health Ranking website, a collaborative program between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, Grand County had 28 mental health care providers between 2017 and 2018, making for a mental health care provider ratio of one provider for every 550 residents.

Grand County had been ranked 30th in the state of Colorado, out of 64 total counties, six of which did not report data, for number of mental health care providers per capita.

That number has since dropped significantly, however.

Now only 12 mental health providers exist within the county, which puts the ratio closer to one provider for every 1,280 residents. The county now has a ranking of 46th in the state for its number of providers, just above Clear Creek, Lake and Park counties, among others.

The issue of retention is exacerbated by a nationwide problem with mental health provider recruitment as facilities are understaffed throughout the United States.

Mental health providers in small communities like Grand County also face unique challenges, such as running into clients outside of sessions. This can make it difficult for them to be part of the community while still following the stringent ethics that providers maintain, including confidentiality.

“It’s hard for those providers to be out and about in the community because you never know who you’re going to run into,” said Jen Fanning, executive director of the Grand County Rural Health Network, a nonprofit organization that connect citizens with health resources. “I think that’s part of the reason it’s been so hard for some of our providers to stay.”

Ultimately, this dynamic can be harmful to the provider’s ability to offer services.

As someone who has worked with all of the mental health providers in Grand County, Fanning had no one to turn to when she was experiencing postpartum depression after the birth of one of her children.

“As a health and human services provider, I can’t get anybody to see me because I work with them,” she said. “When I need care, what do I have?”

It’s different when having to be so open and vulnerable with somebody in the way that promotes healing, she explained.

The Kaiser Family Foundation, a nonprofit that focuses on health policy, estimates that only 26 percent of the national need for mental health care professionals is met.

“We definitely have a huge service need that’s reflected across the country and the state,” Johnson said. And it’s echoed on a more local level.

“Capacity is difficult for us. We have open access hours; I typically have two open slots for intake on Monday mornings. Almost every week they get filled and we have to turn people away and say come back next week.” - Ellen Cowman, Mind Springs

The shortage also affects Middle Park Health’s ability to offer mental health care.

Jason Bryan, vice president of human resources and administration for Middle Park Health, said the hospital currently believes the best approach to mental health care is to partner with the existing resources in the community and to support what’s already working.

“If we can partner with individuals, such as Mind Springs, and be a partner together then that’s where I think we can be the most effective,” Bryan said. “They have the subject matter experts and the respect of the community in that regard.”

Instead, Middle Park Health want to focus on the medical side for patients and “if we can collaborate and be effective together, then that’s where I think we could stand to be stronger,” he said.

Currently, the hospital has not come to any conclusions on how mental health care might be included in planned future expansions.

Bryan explained that, because of the nationwide shortage of mental health care providers, it makes more sense for the hospital to partner with the existing providers.

But that doesn’t address the current need for more providers to increase patient capacity.

Local efforts, however, are being made to attempt to fill the gaps.

One, the behavioral health navigator program, helps expand the capacity of medical providers to address mental health by offering a version of integrated care. Navigators see patients during their primary care visits at Middle Park Health and other medical clinics across the county.

In an attempt to address recruitment concerns, Grand County’s largest mental health provider, Mind Springs Health in Granby, offers employees the chance to apply for student loan reimbursements to help with debt incurred during their training.

The nonprofit is also bolstering its internship program so people who are still in school or training can be prepared to go right into the workforce upon getting their credentials.

“One of our strategies is to grow our own, really give somebody a solid internship experience and then hope they stay on and stay with us,” said Kathy Capps, operations manager for Mind Springs Health, which has 13 locations in 10 northwestern Colorado counties.

With a lack of mental health care facilities and systems, further pressure is put onto existing local providers.

The county has no psychiatric hospital nor a mental health respite care facility. There is no local psychiatrist within the county’s borders. Local providers are compelled to care for patients in a system that is geographically dispersed, understaffed and overworked. All too often it is law enforcement that serves as the first responders when citizens experience a mental health crisis.

The effects of such a deficient mental health care infrastructure are felt substantially.

“For me (the challenge) is capacity,” said Ellen Cowman, clinical supervisor at Mind Springs in Granby. “Capacity is difficult for us. We have open access hours; I typically have two open slots for intake on Monday mornings. Almost every week they get filled and we have to turn people away and say come back next week.”

But not if they’re in a severe crisis, such as being suicidal. At that point, an on-call crisis counselor would be called to assist.

Considering Grand County’s continued population growth, the problem with capacity worsens each year.

The logistical reality, according to Makena Line, program coordinator at Mind Springs, is that those seeking mental health treatment might not be able to get in as quickly as they’d like.

According to Mind Springs, there were 728 unique individuals who sought care through their office in 2018. The most common mental health issues they encounter at their Granby location are depression, anxiety and PTSD.

CarrieAnn Grayson’s cut-to-the-chase demeanor belies the traumas of her past. She is shorter than most, with a big personality that is playful yet pulls no punches. She has a lively and easygoing smile while her eyes are sharp, piercing almost, reminiscent of a seasoned teacher peering at a troublesome yet cherished student.

For nearly two decades, the Grand County resident has lived with the daily realities of PTSD, which, as a former U.S. Army captain, she was officially diagnosed with while still in the military.

The outspoken Texas native has since encountered misconceptions and myths, supporters and detractors and a mental health infrastructure that has not always served her needs.

Her journey over the last decade has taken her from San Antonio, Texas, to Colorado’s high country. She has experienced marked improvements and difficult setbacks, all while advocating loudly and forcefully for veterans and anyone else suffering from PTSD.

She has sought to embrace her diagnosis while also creating a life that is not defined by it.

“No one told me I had it, it was just a note in my medical chart,” Grayson said. “When I was getting out of the military I was going through a medical board and it came up as one of my diagnoses. That is how I found out I have PTSD.”

Grayson believes the military deliberately withheld her diagnosis as part of a larger effort to label soldiers with PTSD as having borderline personality disorder to reduce disability payments. Veterans with a borderline personality disorder diagnosis are not eligible to receive compensation from the military while veterans with PTSD diagnosis are.

CarrieAnn Grayson was a first lieutenant in the U.S. Army signals corps and executive officer of her company, which was stationed at a field base in a remote part of Iraq. She reached the rank of captain before her discharge in 2008.

She was eventually medically discharged from the Army in 2008, not because of her PTSD but for exertional compartment syndrome, which is a type of exercise-induced muscle and nerve condition. The syndrome was officially designated by the military as a combat-related injury since it was a result of her official duties.

But it is her PTSD that most impacts her life, from how she interacts with others to her job opportunities and recreational options.

“It seems like we are always in fight or flight mode,” Grayson said. “We are always overanalyzing things. You have a sense of impending doom.”

She has developed various strategies for dealing with her diagnosis and the more acute episodes she sometimes experiences. A crisis, however, can set her back an entire day.

“If something happens at noon, I am done, my brain is done,” she explained. “But if it happens at the end of the day, I can go home, reflect about it and sleep. I don’t wake up completely refreshed but it doesn’t affect me as much.”

An unfortunate side-effect from PTSD is the way it causes sufferers to seemingly act indifferent to the feelings of others.

“With PTSD you lack empathy,” Grayson acknowledged. “You become numb to other people’s feelings.”

She believes the problem to be because those with PTSD are wrestling with so many emotions of their own, they don’t have enough empathy to give to others.

An intense desire for control is also a common feature accompanying her disorder.

“We are constantly trying to control our own lives and the things around us to make up for the incident that happened that caused the PTSD,” she explained. “Because, in that moment, we had no control.”

Grayson’s PTSD has also made it more difficult for her to maintain healthy adult friendships and gainful employment.

She worked as a technology teacher in Texas, before moving to Colorado. Since putting down stakes in Grand County, Grayson has worked and volunteered at several positions in education, veteran services and recreation.

One of the biggest problems Grayson encounters, however, is the way specific events can precipitate crises, which can lead to a spiraling mental health condition. That’s what happened to her in late 2017.

“I had a mental health crisis,” Grayson remembered. “I was suicidal.”

When she sought care during the episode at Middle Park Health-Granby, she said she felt her crisis was not taken seriously after telling hospital staff that she was unsure if the Veterans Administration would cover the costs of her care.

“I said I don’t know if the VA is going to pay for this, and they said, ‘Yeah, we don’t know either,’” Grayson explained.

DEFINING OUR TERMS: What we mean by 'providers'

Grand County saw a drastic reduction in the number of mental health care providers since 2017. But what exactly do we mean by “provider?”

A mental health provider is any health care professional that treats patients for mental health, be it preventative or otherwise.

Primary care physicians, however, the doctor you’d see for a routine physical or if you get injured, are not included when we say “provider.”

While they do tackle questions from patients about mental health — Sue Johnson said around 70 percent of primary care visits include some sort of mental health question — that’s not their main role.

A mental health provider includes therapists, counselors, social workers and psychiatrists, the people who specialize in dealing with mental health issues. They are most often licensed professionals.

Middle Park Health, the county’s largest medical provider, focuses little on mental health, with the exception of its emergency department and primary care physicians.

Instead, what is offered for mental health care in Grand County comes from two sources: Mind Springs and private providers.

The staff at Mind Springs, a nonprofit organization headquartered in Grand Junction, includes two full-time therapists and two additional therapists who provide services one day a week.

Using telehealth options, Mind Springs is able to spread the knowledge and abilities of their staff to any of their offices, which helps provide Grand County with psychiatry, translation and additional counseling services, though not through a typical in-person setting.

Local residents are able to take advantage of the new Mind Springs acute treatment unit in Frisco, a small in-patient facility for people experiencing mental or emotional distress but not to the level of needing to be held at a psychiatric hospital.

In addition to Mind Springs, Grand County only has nine private providers, just two of which explicitly accept Medicaid. Mind Springs, which contracts with local governments on the western slope, accepts both Medicaid and Medicare.

Of the nine private providers, four are located in the Granby area, including two offices at the Inn at SilverCreek. One provider is located in Winter Park, one in Fraser and another in Tabernash. Three of the providers specialize in Christian counseling.

A quote from Buddha is written on a whiteboard inside the conference room at Mind Springs Health in Granby. | Photo by Bryce Martin

Aside from a lack of providers, accessing mental health care in Grand County can already be a complicated process on its own.

When, where and how each individual moves through the mental health system varies depending upon the needs of the client and the type of mental health issue being addressed.

“People have an idea of what mental health treatment might look like, be it therapy for six weeks or two years of intensive psychotherapy,” Capps said.

But not everyone has to have that, she indicated, as treatment is very individualized.

“Someone could have two appointments and feel well enough to go back out and live their lives,” she suggested. “We do a ton of skill building and education. We don’t necessarily need to do deep trauma work all the time.”

For anyone looking to access care through Mind Springs, versus one of Grand County’s private providers, the process usually begins with a call to the Granby office.

Mind Springs offers walk-in services to clients from only 8:30 a.m. to 10:30 a.m. on Mondays, with very limited slots available. Outside those two hours, anyone who wants treatment and are not in a crisis must schedule appointments well ahead of time, at least two to three weeks in advance, according to staff.

After Mind Springs staff meets with a client to review their condition and current state, they develop treatment plans and options. The process could include development of a safety plan or scheduling of follow-up appointments. A local behavioral health navigator can also be called upon to assist clients with navigating the process or to help address certain hurdles that clients are encountering when seeking treatment.

Individuals experiencing a mental health crisis, however, such as a nervous breakdown, psychotic break or thoughts of suicide or harming others, move through a different path to access care.

When in crisis, a person reaches Mind Springs through one of several routes, including going to the emergency room, calling Mind Springs’s crisis line or walking into Mind Springs’s office directly. Mind Springs is also sometimes called upon by local law enforcement to deal with subjects in crisis.

Once a provider from Mind Springs arrives to assist with a subject, they assess their mental state and the overall situation.

If the situation allows, Mind Springs will attempt to treat a client through what they call a “safety plan route” to determine if they represent an imminent threat to themselves or others. If they don’t, a client will be taken home and follow-up appointments with providers and check-up calls are made.

If they believe a client will cause harm to themselves or others, the person can be put on a mental health hold, or M1 hold.

While on an M1 hold, the individual can legally be detained and transported, either by law enforcement or a contracted transport service, to a mental health hospital. In the same situation, mental health professionals also have the ability to offer patients the option of voluntary placement, through which they voluntarily agree to go to a psychiatric hospital via their own means of transportation.

Just like for patients seeking care, a significant barrier for organizations trying to expand or continue providing care is financial. Funding for new programs, facilities and positions can be hard to come by for mental health providers.

The reason is partly because state and local funding is limited and fluctuates often, while funding that is available through grants is highly competitive.

“Funding is typically so specific and it’s never long-term,” Fanning said. “It’s constantly these organizations, nonprofits, government entities and providers trying to figure out that puzzle. How do we make sure that this program that we’re hearing is really important and valuable doesn’t go away even though that funding stream is changing?”

Grand County funds mental health through the sheriff’s office, EMS and public health and human services, as well as through grants for health nonprofits in the county like the Rural Health Network. There is no county mental health department, except for limited resources through Grand County Health and Human Services.

The county hasn’t funded Mind Springs in a few years. Instead, Mind Springs is contracted by the Colorado Office of Behavioral Health to provide crisis services to the northwest region of Colorado.

Other funding for providers comes from health insurance reimbursements, which are not always reliable since not all insurances provide the same level of reimbursement. It can also fluctuate based on changes to insurance requirements and products.

According to Kim Long, health coverage guide for the Grand County Rural Health Network, Medicaid requires a lot of paperwork, which many offices don’t have the capacity to do. It also has some of the lowest levels of reimbursement.

“(Providers) benefit more from cash pay and/or from commercial plans,” Long said.

At the state level, Mind Springs is part of a lobbying group that fights for funding and legislation to support mental health care. The Grand County Board of Commissioners is also a member of such groups that have asked for more support for local mental health.

Unlike other communities, the county commissioners said they have not had conversations about proposing a tax increase to fund mental health resources, like Summit County did in 2018.

“The answer would be no because we’re not hearing from our taxpayers that they would support that kind of a measure,” County Commissioner Merrit Linke said.

Instead, the commissioners are hoping to work with surrounding counties, such as Summit, Routt and Moffat, to address issues with transportation to mental health facilities, which is currently a major barrier to care.

When someone experiences a mental crisis they usually have to rely upon the sheriff’s office to transport them to a facility, usually West Springs Hospital, a psychiatric hospital in Grand Junction owned and operated by Mind Springs. It is the only psychiatric facility between Denver and Salt Lake City, Utah.

This mode of transport requires the person to be handcuffed, per the sheriff’s office’s protocol to ensure the safety of the person and the officers.

“That isn’t always the most user-friendly for the person that’s having the problem, so that’s partly why we’re looking at alternative means of transport,” Linke said.

Having to make the nearly four-hour drive to West Springs also strains the sheriff’s office’s resources, so Linke said the commissioners have begun having conversations with neighboring counties to try to create a regional solution.

Funding is also running short for the much-used behavioral health navigator program.

“... the biggest part, relating to mental health, is providers. We just simply don’t have enough.” -Jen Fanning, Grand County Rural Health Network

The program takes advantage of the conversations already happening to educate patients on the available resources and provide them with coping tools. Sometimes they also provide treatment. According to Johnson, around 70 percent of primary care visits include mental health needs.

“For people that maybe would never think about seeing a counselor, it’s a little bit easier when their primary care doctor or nurse practitioner says, ‘Hey, you’re having some depression, I’d like you to talk to Sue,’” Johnson explained. “It makes it feel less stigmatizing and it’s also a lot more convenient.”

Unfortunately, the behavioral health navigator program was funded by a three-year grant from the Denver Foundation that ends December 2019, so the program’s partners are scrambling to find alternative funding.

“Right now, we’re working on sustainability ideas to keep the program going,” Johnson confirmed. “It’s definitely been highly utilized. We’re never not busy.”

Support groups are another resource found in the county to help expand capacity. But those, too, have barriers.

There are presently 10 local groups that address a variety of issues, including grief and substance use. However, there are gaps in what the groups cover.

Martha Baird, 63, of Tabernash relied on a depression support group when she lived in Seattle, but hasn’t been able to find one in Grand County. The group gave her a chance to talk to people who could relate, as well as hear others’ experiences with medications and treatments.

“I have been missing good connections,” she said. “I think (a support group) is what I’m missing right now.”

Baird previously considered starting her own group, but found it was more time and work than she could commit. She also noted that the geographical distance in the county, as well as the seasonal population, would make a group difficult to maintain.

There’s also a liability concern with support groups for organizations and individuals since sensitive topics are discussed, as Fanning explained. She recommended peer-support training for anyone interested in starting up a group, along with recognition that peer support is an informal resource.

“You want to make sure that the space in support groups is safe and healing,” Fanning said, adding that the liability and lengthy training for best practices in a community like Grand County is a barrier. “But the biggest part, relating to mental health, is providers. We just simply don’t have enough.”


In the next installment of our four-part series, we take a close look at mental health and potentials barriers to care from the perspective of local law enforcement, the judicial system and health care professionals.

Are you having a mental health crisis? Get help today.

Call the National Suicide Prevention Hotline, 24/7: 1-800-273-8255

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