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UCHealth dedicates more than $100 million for behavioral health care

Clinical care at UCHealth

Sept. 4, 2019, marks an important date in advancing health care in Colorado.

UCHealth announced a significant investment that will bolster behavioral health care for patients across the state. With an infusion of $100 million and an additional $25 million in matching funds, UCHealth will ensure that behavioral health therapists and psychiatrists are an integral part of the patient care experience. By building out its intensive outpatient, preventive and telehealth services, the health system will be able to better serve more individuals in Colorado, the Rocky Mountain region and beyond.

Please read UCHealth’s press release here.

This dramatic expansion of behavioral health care by UCHealth complements the efforts of CU Anschutz and Children’s Hospital Colorado to address mental health needs. Last fall, Children’s teamed with the CU School of Medicine’s Department of Psychiatry to launch Partners for Children’s Mental Health (PCMH), a statewide network of individuals, organizations and agencies committed to helping kids get the right mental health, at the right time, within their own community.

Taken in combination with the efforts of so many units of the university – including the Department of Psychiatry, the National Mental Health Innovation Center, the Helen and Arthur E. Johnson Depression Center – the CU Anschutz Medical Campus is making progress toward reducing the harmful stigma that too-often keeps those in need of quality mental health care from seeking it.

“Together with our clinical partners, we will accelerate the pace of change in behavioral health care, and bring high-quality, integrated care to more of the millions of patients cared for each year.” – Don Elliman, Chancellor of CU Anschutz

“Our faculty have the expertise and resources to make a transformative impact on people’s lives,” said CU Anschutz Chancellor Don Elliman. “Together with our clinical partners, we will accelerate the pace of change in behavioral health care, and bring high-quality, integrated care to more of the millions of patients cared for each year.”

Dr. Neill Epperson, professor and chair of the Department of Psychiatry at the CU School of Medicine, said 20% to 40% of primary care patients have a behavioral health need.

“Attending to our patients’ behavioral health needs in a timely manner is critical to their overall health and well-being. This comprehensive approach to mental health and substance abuse treatment has the potential to improve the lives of hundreds of thousands of Coloradans,” Dr. Epperson said. “By embedding services within primary care locations, we can treat these needs in a cost-efficient manner while still providing an expert psychiatrist for patients who need a specialist.”

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The importance of the mental side of healing

Bruce Gordon

Bruce Gordon has always been an athlete. Climbing mountains, endurance swimming and biking came naturally to him.

But he also had a lingering concern that had always weighed on him: a family history of heart attacks. And in November 2017, that genetic propensity caught up to him. While he was at the airport heading for his departure gate, Gordon suffered a major heart attack that required multiple resuscitations and triple bypass surgery at UCHealth University of Colorado Hospital to save his life.

After surgery and the physical recovery that followed, Gordon entered unfamiliar territory. He struggled with anxiety and a feeling of fragility, and he was ultimately afraid he was going to have another heart attack. It became clear that he needed to seek mental health support.

“The anxiety was paralyzing,” he says. “I remember my daughter coming up to me and touching me on the shoulder, and I jumped. I couldn’t believe it. It was like I was having PTSD.”

What many people don’t realize, says C. Neill Epperson, MD, chair of the Department of Psychiatry at the University of Colorado School of Medicine, is that “Having a severe or life-threatening medical problem like a heart attack can have a direct, negative effect on brain health – from functionality, to how you feel, to how you think about your health moving forward.

“When you’ve experienced a traumatic event or a life threatening health condition, you can feel terrified and helpless in the moment, and that feeling of extreme fear doesn’t automatically go away just because the event is over,” Epperson explains. “Memories of the event are indelibly encoded in the brain. However, things we may have seen, smelled, heard or thought during the event can also become linked to it in such a manner that they provoke a similar terror when re-experienced, even in a safe context. We can become anxious, irritable and jumpy. As Mr. Gordon discovered during his recovery, trauma-informed, cognitive behavioral therapies change the brain so that these memories – potential triggers for anxiety and worry – are no longer as powerful.”

“You have to address the mental side of healing,” says Gordon, who worked with a sports psychologist to help him navigate this essential aspect of his recovery. “Even if you reach a point when you’re feeling good physically, if you’re pushing down the pain or the trauma of the mental side, it’s going to manifest itself in a negative way. You can’t be afraid to face it – to let your emotion come out, to cry. Talking to someone professionally is super important.”

Learn more about Dr. Epperson’s insights into the relationship between mental health and physical health in the video below.

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Book focuses on ‘the how’ of implementing integrated healthcare

Integrated care handbook
The evidence-based handbook “Integrated Behavioral Health in Primary Care” is available through Springer Publishing and Amazon.

For decades, mental health was largely divorced from physical health. While this perspective has changed, primary care physicians continue the challenging task of revising their practices to encompass mental and behavioral healthcare.

They are turning to an emerging approach to primary care practice called integrated behavioral healthcare — an area in which the University of Colorado Anschutz Medical Campus is leading. This patient-centric model focuses on care that treats the whole person; it relies on the idea that the mind and body are not separable. In other words, patients’ primary care and behavioral healthcare providers work together to deliver the best care.

CU Anschutz’s very own, Larry Green, MD, and  Stephanie Gold, MD, co-edited a handbook to help guide this process, “Integrated Behavioral Health in Primary Care: Your Patients Are Waiting.”

Leadership for transforming care

This evidence-based handbook is intended to give practical, firsthand advice from real-world practices that can be applied by large and small, rural and urban, and public and private primary care practices around the world. It is broken down into chapters that focus on “the how” of what it takes to implement integrated care.

Larry Green, MD
Larry Green, MD, professor in the Department of Family Medicine

“This handbook can be used as a walkthrough for practice transformation,” said Gold, an assistant professor in the Department of Family Medicine in the University of Colorado School of Medicine. “It is a ‘how to guide’ on integrating behavioral health into primary care clinics. It provides much-needed guidance and support in how to approach to care delivery.”

Each chapter includes extra resources including articles and websites that can assist in implementation.

Collaborating to create change

Gold and Green, MD, a professor in the Department of Family Medicine, were contacted by Springer, publisher of the handbook, to edit the piece and organize other expert opinion.

“The book is grounded in lessons learned from pioneers in integrated care,” Gold said of her collaborators.

The intended audience stretches far beyond physicians; it is for anyone involved in primary care, including practice administrators and practice facilitators. The content is general enough to be applicable to practices across the world, save some policy information specific to the United States.

Stephanie Gold, MD
Stephanie Gold, MD, assistant professor in the Department of Family Medicine

“This can be used in any community,” said Green. “It’s a practical guide to help healthcare providers know what it takes to get this implementation work done.”

Progressing despite barriers

“There has been a persistent failure of providing proper healthcare for people with mental, emotional, and behavioral problems,” Green added. “Primary care practices everywhere cannot escape this. Patients are waiting for this kind of care. We just need to get on with it. We know how; let’s work together and do it.”

Integrated Behavioral Health in Primary Care is available now through Springer Publishing and Amazon.

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Help is only a phone call away with Real Help hotline

In life, there are highs and lows. Some are big and small. If you reach a point where you’re feeling overwhelmed by the stress in your life – whether it’s related to finances, relationships or any other issue – there’s help through the Real Help hotline.

The Real Help hotline provides all CU employees with access to professional counselors, who offer assistance finding wellness and behavioral health resources or immediate counseling over the phone. Whether callers are experiencing a serious crisis or just need recommendations for when life gets too stressful, Real Help is here. Due to the hotline’s extensive footprint, counselors can assist callers with safety, emergency financial and legal resources. It’s free, confidential and available 24/7.

The best part: The CU Health Plan’s hotline affiliation means counselors can direct callers to services and behavioral health providers covered by CU’s health plans. They can recommend CU Health Plan wellness programs that may help employees deal with situations including the Employee Assistance Programs (EAP), Move, Silver Sneakers and many others. Any CU employee, regardless of health coverage, can receive assistance and referrals to the appropriate care.

“The Real Help hotline is an initial step toward providing members of the CU community with integrated resources and access to multi-level mental health care,” said Gena Trujillo, Assistant Vice President and Operations Officer at CU Health Plan Administration.

 

Not sure when to call? Here are the top five reasons people called in April 2019:

1. Anxiety
2. “Major Life Stressors”
3. Mood Concern(s)
4. Safety concerns/ suicidal ideation
5. Family Issues

 

Calls are not limited to your personal needs. If you have concerns about others, Real Help is there – 8% of calls are people calling in concern about others, most often a dependent. Dependents of CU Health Plan members can also use the service.

“Everything with this service was designed from the start to be convenient and accessible for every employee. While our crisis clinicians and triage specialists are not benefits counselors, they can direct employees to local resources and referrals, and provide in-the-month, crisis-focused mental health support 24-7,” said Josh Larson, MA, LPC, Rocky Mountain Crisis Partner’s Clinical Operations and Quality Assurance Specialist.

If you, a co-worker or a family member needs assistance, the number to call is (833) 533-CHAT (2428).

 

Guest contributor: Kayle Lingo, University of Colorado.

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Rep. Crow tabs mental health crisis as a top concern

Matt Vogl and Rep. Jason Crow

On a tour of CU Anschutz Medical Campus facilities and programs, U.S. Rep. Jason Crow learned how the campus in the heart of his district is expanding mental health resources and innovation. The emphasis is well-timed, considering the need for new treatments and improved patient access has never been greater.

Referencing the recent shooting at the STEM School in Highlands Ranch, the newly-elected congressman said Colorado’s mental health crisis, particularly among youth and adolescents, is one of the “top three issues” voiced by his constituents. Crow said he was told during a recent visit to Children’s Hospital Colorado that the hospital has seen, in just four years, a six-fold increase in psychiatric ward admissions for attempted suicide in the 8 to 18 age group.

Mental health crisis

“In Colorado, we have a great quality of life, lots of sunshine and a good economy, but we have a tremendous problem with mental health … How do we start getting our arms around it?” Crow asked during the May 28 tour. He represents the 6th Congressional District, which includes all of Aurora and much of the metro-Denver area.

C. Neill Epperson
C. Neill Epperson, MD, chair of the Department of Psychiatry, gives Rep. Jason Crow an overview of CU Anschutz mental health programs, research and initiatives.

C. Neill Epperson, MD, chair of the School of Medicine’s Department of Psychiatry, and Matt Mishkind, PhD, deputy director of the Helen and Arthur E. Johnson Depression Center (JDC), and Heather Mulvihill, MS, MA, LPC, board chair of the JDC, gave Crow an overview of the campus’s shared vision and growing emphasis on mental health.

Epperson explained the clinical care and research taking place within the schools and colleges, as well as mental health services offered for students, while Mishkind described the community oriented programs and innovations offered through the JDC and the Steven A. Cohen Military Family Clinic.

‘Tip of the iceberg’

Crow also met with Matt Vogl, executive director of the National Mental Health Innovation Center (NMHIC), and School of Medicine Dean John J. Reilly, Jr., MD.

Epperson noted that while CU Anschutz is increasing mental health resources, research and care – including lifespan programs in the Department of Psychiatry, new telehealth technologies and integrated-care approaches – “we’re just hitting the tip of the iceberg.”

She said the effort requires teamwork, including the many advances offered at a leading-edge academic medical campus such as CU Anschutz, but also assistance from local, state and federal government as well as philanthropy.

Major problem: roadblocks to care

A major problem, Epperson said, are Colorado’s low insurance reimbursement rates to mental health providers, leaving people who can’t afford out-of-pocket costs unable to access needed care. “We need more advocacy for parity,” she said. “We really don’t have networks that are adequate to meet the needs of people in Colorado.”

Mishkind explained the JDC’s many services to the Colorado community, including an evaluation around computer-assisted therapies that allow providers to work with more than one patient at a time. Mulvihill added, “We also work to get upstream of a crisis, so we talk to families, teachers and others about how to manage stress earlier on, and how to help kids before things reach a crisis point.”

Mental health counselors in schools

In addition to Colorado’s need for better financial incentives to providers, which translate to expanded patient access to care, the group discussed how societal shifts have contributed to the mental health crisis. Today’s schools, for instance, often lack curriculums and extra-curricular activities that help students develop social and emotional intelligence and resiliency skills.

U.S. Rep. Jason Crow
U.S. Rep. Jason Crow explains that Colorado’s mental health crisis, particularly among adolescents, is one of the “top three issues” voiced by his constituents.

Crow noted that a current federal program offers 100 qualifying schools a grant of $2 million per year over five years to hire more mental health counselors. “I’d like to do something similar, but do it with the development of a life skills and mental health curriculum where we have somebody there who sees what is happening before (the grant starts) and then five years later, so we see the impact,” he said.

Developing reliable outcome measures

Reilly noted that research into mental health generally requires long observation periods to assess whether, for example, high school students who received life-skills services end up as healthier and more resilient adults. He added that academic medical centers should take the lead in developing reliable and interpretable outcome measures.

At the NMHIC, Vogl explained the many ways the center is developing concepts and programs for real-world implementation. “Everything we do is in support of the community, nonprofits and other groups that are trying to solve mental health problems that they haven’t previously been able to solve,” he said.

‘A lot happening’

NMHIC is on the leading edge of testing new ways and tools, such as virtual-reality devices, to make mental health services more accessible to everyone. As one example, the center is working with Pixar Animation Studios to create social and emotional learning tools for children.

Crow’s interest in mental health was heartening to the group, which foresees improved mental health services on the horizon.

“There is a lot happening,” Epperson said, “so this is a really good time to join with us as we’re investing more resources to enhance mental health in Colorado.”

Photos by Matt Kaskavitch, Office of Communications.

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Mental Health Month 2019: Marcus Institute for Brain Health

Born out of the D-Day invasion, the motto of the US Army Rangers is “Rangers lead the way.”

But even the toughest among us sometimes need help.

In 2006, Nathan was a Ranger whose platoon had a suicide vest detonate nearby. After the incident, Nathan began experiencing some problems. “After that I started noticing some kind of weird things going on,” Nathan says. “I was having a lot of problems with headaches. I started noticing a lot of balance issues as I go throughout my day. Towards the end of my day I would have a really hard time even putting one foot in front of the other. I started figuring out that I really needed to start getting some help.”   

Nathan turned to the Marcus Institute for Brain Health (MIBH) here at CU Anschutz, which leads the way in providing innovative veteran mental health services to help our vets heal from the “invisible wounds” of traumatic brain injuries and psychological health changes.

He was able to find both an interdisciplinary expertise and an individualized approach at MIBH, where the traditional clinical approach, which includes neurology and physical therapy, is merged with integrative therapies, such as yoga and canine therapy.

No one patient or person is the same, so the focus at MIBH is about comprehensive, personalized treatments to complex problems with an emphasis on sharing information to help elevate care.

May is Mental Health Month. Hear how the Marcus Institute for Brain Health helped Nathan heal and become better prepared for being a dad in the video below.

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Cohen Clinic celebrates one-year anniversary with 5K run

Run and One Cohen Clinic run

The Steven A. Cohen Military Clinic celebrated its one-year anniversary on April 13 with a 5K run, part of a national event to raise awareness about the problem of veteran suicide. The Cohen Clinic opened in March 2018 and is located in Greenwood Village, about 15 minutes from the University of Colorado Anschutz Medical Campus.

“We chose the ‘Run as One’ event because we care about addressing the issue of veteran suicide, and we want to raise awareness about the issue of suicide within the community,” said Gillian Kaag, director of the Cohen Clinic. Additionally, at the one-year celebration, the Colorado Veterans Project presented the Cohen Clinic with a $10,000 donation, which will be used to expand access to care for veterans and their families.

Cohen Clinic one-year anniversary
The Cohen Clinic celebrated its one-year anniversary with a fun run through the Highlands neighborhood of northwest Denver.

“This donation will support the clinic’s priority on working to remove barriers to care so that veterans and their families can get the critical care they need,” Kaag said.

Medal of Honor recipient and Cohen Veterans Network ambassador Kyle White attended the celebration as the special guest of honor.

Providing low- to no-cost care

Working in relation to the core services offered by the Helen and Arthur E. Johnson Depression Center at CU Anschutz, the Cohen Clinic provides confidential, compassionate and personalized mental health care to post-9/11 veterans, National Guard and Reserves and their family members at low to no cost.

The Cohen Clinic represents a $9.8 million partnership between the University of Colorado Anschutz Medical Campus and the Cohen Veterans Network, a nonprofit philanthropic organization. Steven A. Cohen, a philanthropist and successful hedge fund manager, created the Cohen Veterans Network in 2016 to establish 25 clinics by 2020 across the United States in areas with a high population of veterans. In Colorado alone, there are currently 60,000 post-9/11 veterans who reside in the state.

There are currently 11 clinics open, with 14 set to open by the end of 2019.

“It is exciting to be connected to the local community and the broader mission of bringing access of low-cost, high-quality mental health care to veterans and their family members,” said Holli Keyser, communications and marketing manager for the Cohen Clinic.

A year of accomplishment

The Cohen Clinic has served 240 clients over the past year, with 57 percent being veterans and 33 percent being family members. The clinic is focused on removing barriers to mental health care, offering transportation to appointments, childcare in the clinic and financial assistance through the Cohen Veterans Fund.

Additionally, the Cohen Clinic offers telehealth appointments — face-to-face counseling online, which allows veterans and their families to get the critical care they need, particularly in rural or underserved areas across Colorado.

“Our team is dedicated to the mission to save lives, save families and save the futures of post-9/11 veterans and their families,” Kaag said.

Providing outreach to the local community has also contributed to the Cohen Clinic’s success, including building a network of more than 100 referral partner organizations that provide services to veterans and family members.

“We have a robust outreach team to support the veteran community and ensure that organizations know we are a trusted resource for military families in Colorado,” Keyser said.

Whole mental health

The Cohen Clinic provides services for behavior health challenges such as depression, anxiety, post-traumatic stress disorder, sleep problems, anger, grief and loss and transition issues.

However, the Cohen Clinic not only focuses on evidence-based mental health treatments and prevention, but also provides education and training, family support, case management as well as helping clients transition into civilian life.

“Military families can connect with our clinic at multiple places of health, and we offer trusted help and resources for the community locally and throughout the state,” Keyser said.

The design of the clinic also contributes to providing whole mental health care, helping clients and their families feel at home when they visit. Original artwork created by local veterans hang on the walls, and the quiet environment provides a soothing feeling from the moment someone enters the clinic.

“We have an intentional design of the clinic: a calming environment and relaxing therapy rooms for our adult clients, children and teens,” Keyser said.

For more information about the services offered at the Cohen Clinic, please visit its website. 

Guest contributor: Story by Katherine Phillips

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Using our expertise to fight the opioid crisis

Vicodin

The opioid epidemic is devastating communities, families and individuals across Colorado and the country. On average 130 Americans die every day from opioid overdose; it was responsible for 560 deaths in Colorado 2017. And for every death, there are many more people struggling with opioid addiction.

To address the expansive scale of the crisis, the CU Anschutz Medical Campus is marshaling its resources across the spectrum of health fields. Here are some examples.

Coordinating Colorado’s opioid response
CU Anschutz is the home of the Colorado Consortium for Prescription Drug Abuse Prevention, which coordinates Colorado’s statewide response to the opioid epidemic. Operated out of the Skaggs School of Pharmacy and Pharmaceutical Sciences under the direction of Professor Robert Valuck, the consortium’s members include faculty from each of our schools and colleges, in addition to representatives from state agencies, law enforcement and community coalitions. The consortium consults with state lawmakers about legislation, coordinates public awareness campaigns, and helps train doctors on safe prescribing practices and members of the community on how to reverse overdoses. It also supports public awareness campaigns and medicine takeback programs.

Since its establishment in 2013, this pioneering collaboration has leveraged state and institutional investments to attract more than $30 million to address drug abuse. Its innovative approach has been cited in analysis of successful responses to the opioid epidemic.

Educating health professionals
To address the shortage of health professionals equipped to deal with the opioid epidemic, CU Anschutz offers a number of trainings, certificates and degrees. The Colorado School of Public Health launched both a certificate and an MPH concentration in Population Mental Health and Well-Being, addressing mental health and substance use from a population perspective. Both programs are set to begin in Fall 2019.

CU Anschutz physicians developed a one-click tool, launched at UCHealth University of Colorado Hospital in 2017, that allows busy emergency room staff to instantly see how many prescriptions a patient has filled at other locations.

Cognizant of the fact that dentists write about 12 percent of opioid prescriptions, the School of Dental Medicine offers continuing education programs to educate practicing dentists on newly developed guidelines for prescribing pain medications and best practices for discussing pain and opioids with patients.

Online continuing education courses for health professionals in opioid stewardship and preventing prescription drug abuse are operated by the Center for Health, Work and Environment in the Colorado School of Public Health. Seminars on campus have included an opioid education day, hosted by the Physical Therapy Program last fall, addressing improved approaches to pain management; a training on the signs of opioid overdose; and an International Overdose Awareness Day event that included a hands-on demonstration of how to obtain and administer Naloxone, or Narcan, a drug that reverses opioid overdoses.

Research to better understand the science of addiction
Inside our labs, researchers are seeking to answer questions at the heart of the epidemic. One study revealed how emergency department physicians underestimated how often they prescribed opioids. Another used health data to predict who would use opioids after hospitalization. Other studies – too numerous for an inclusive list – have ranged from prescription of opioids by veterinarians to opioid use and misuse following treatment for head and neck cancer to the varying rates of opioid prescriptions at veterans hospitals.

Developing clinical solutions
One way CU Anschutz is helping deliver quality care to address opioid addiction is illustrated in the story of Nicholas Antonio. Nicholas’s experience as a survivor of the Columbine school shooting 20 years ago led to significant post-traumatic stress disorder, and he turned to opioids to cope. After a downward spiral that included jail time, he finally found the help he needed at the Sheridan Health Services clinic, operated by the CU College of Nursing. There he received medication-assisted treatment (MAT), a whole-patient approach that combines FDA-approved medications with counseling and behavioral therapies. The approach not only worked for Nicholas; it has proven so effective in treating opioid addiction that governments at all levels are expanding access to it. State funding enabled CU Nursing to extend MAT training in Pueblo and Routt counties, and a federal grant to the School of Medicine expanded access across 24 additional rural Colorado counties.

Meanwhile, CU Anschutz physicians developed a one-click tool, launched at UCHealth University of Colorado Hospital in 2017, that allows busy emergency room staff to instantly see how many prescriptions a patient has filled at other locations. Should abuse be suspected, doctors can adjust their treatment plan accordingly. Then, depending on their addiction severity, patients can be referred for inpatient treatment at the Center for Dependency, Addiction and Rehabilitation (CeDAR) and/or to outpatient community programs such as the Sheridan Clinic’s MAT that combine medication-based approaches with behavioral treatments to help patients maintain sobriety.

Where to next?
The epidemic continues to rage on, but there are some reasons for hope. Since 2014, the number of opioid prescriptions written by Colorado physicians has dropped by more than 200,000 (from 4 million to 3.8 million). And they’ve dropped even more dramatically at Colorado emergency rooms that participated in a pilot program to reduce opioid use – including University of Colorado Hospital’s ER, which has trimmed its opioid prescription from 20 percent to 8 percent of patients in the past three years.

Now the consortium and other state entities are devising a plan to take the opioid-reduction strategies from the ER program to the rest of the hospital. The idea is to bring together specialty doctors’ groups and get them working on guidelines tailored to the nuances of each specialty that will result in fewer opioid prescriptions.

These are just some of the broad-based efforts CU Anschutz is undertaking to combat the opioid epidemic. With a mission of improving the well-being of the communities it serves, CU Anschutz is responding to the seriousness and the complexity of the crisis broadly, and in concert with many other institutions. There is no single fix, but by attacking it from all sides we are making progress.

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20 years after Columbine, symposium focuses on prevention

Frank DeAngelis, former Columbine principal

For Frank DeAngelis, the “beloved 13” are never far away. They are with the retired Columbine High School principal when he speaks about school safety across the country, while he works as a consultant for safety and emergency management in Jefferson County, and the moment he wakes up in the morning.

“I refuse to become helpless and hopeless … each morning I recite the names of my beloved 13 and they give me the reason to do what I do,” DeAngelis said. “They gave me the reason to walk back into Columbine High School for 15 years after the tragedy.”

Deborah Prothrow-Stith
Deborah Prothrow-Stith, dean of the Charles Drew University of Medicine and Science, talked about cultural, political and historical aspects of adolescent violence in her keynote address.

Although the Columbine shooting of 20 years ago represents one of the darkest days in Colorado history, a day-long symposium at the CU Anschutz Medical Campus on April 16 struck a hopeful and problem-solving tone. “Uniting to Prevent School Violence – 20 Years Since Columbine” drew more than 200 attendees and featured national experts on school violence, local politicians and leaders in law enforcement and mental and behavioral health.

Word clouds and real-time polls

The event was hosted by the CU Center for Bioethics and Humanities, the Center for the Study and Prevention of Violence at CU Boulder, and the Colorado School of Public Health and its program for Injury Prevention, Education and Research (PIPER). The interactive program allowed audience members to use their smartphones to participate in polls, ask questions and even create word clouds (when asked to enter the first word that came to mind when thinking about U.S. school violence, “gun” and “preventable” emerged as the top choices).

In his introductory remarks, Matthew Wynia, MD, MPH, FACP, director of the Center for Bioethics and Humanities, said the tragedy of April 20, 1999, affected the entire country and rippled across the world. He said it forced Colorado to take a leadership role in helping others to learn how to prevent school violence.

‘Honor the legacy’

“Today our hope is to honor and respect the legacy of the tragedy at Columbine by coming together to learn and provide a forum for our state to help move forward the agenda to prevent such future incidents,” Wynia said.

Crowd shot of Uniting to Prevent Violence symposium
The “Uniting to Prevent School Violence” symposium drew more than 200 people to an Education 2 South auditorium on April 16.

The opening session featured keynote speaker Deborah Prothrow-Stith, MD, dean of the Charles Drew University of Medicine and Science and national expert on adolescent violence, and Colorado Lt. Gov. Dianne Primavera.

It was DeAngelis’ vivid recollections of that horrific day and its aftermath that evoked emotions from attendees.

The principal was in his office about to renew the contract of a first-year teacher when his secretary broke in with reports of gunfire. When he stepped into the hallway, “my worst nightmare became a reality because I encountered a gunman 75 yards away,” DeAngelis said.

The principal, the gunman and the key

He saw a group of girls walking into the same hallway, having just come from the locker rooms next to the gym. He ran toward the them and the gunman, urgently ushering the girls back down the hall toward the gym. “As the girls were screaming and the shots were ringing louder I reached in my pocket where I had a set of about 35 keys on a key ring,” he said. “The first key I pull out I stick in the door and it opens on the first try.”

PANEL DISCUSSION

The afternoon session began with a moving Art from Ashes poetry reading, an introduction from Attorney General of Colorado, Philip Weiser, JD, and former attorney general, Cynthia Coffman, JD, followed by a stakeholder discussion about the future direction for Colorado and our country.

In the panel discussion, Christine Harms, MS, director of Colorado School Safety Center, Department of Public Safety, highlighted the high teen suicide rate in Colorado and stated that it is a community issue, not just a school issue.

Susan Payne, founding director of Safe2Tell, stressed the importance of breaking down silos and creating a collaborative system of support at every school, including law enforcement and community members, as the majority of reports to Safe2Tell occur after school hours. All panelists agreed that the best way to put the research presented in the morning sessions into practice is to have young people be a part of the solution.

To this day, DeAngelis regularly receives photos from those girls – now women in their late 30s – showing off their growing families, their smiling children. “They say, ‘Mr. D, we’re so glad you found that key.’ … I’m not sure if I found that key. Someone found it for me.”

As mass shootings continue on a regular basis, DeAngelis and the thousands more who’ve been directly affected search for ways to prevent future senseless acts. The retired educator, who received a master’s degree from CU, noted that “so many lessons have been learned” over the 20 years, including improved response systems, crisis care and understanding of recovery for PTSD.

Back in 1999, he said, fire drills were the only emergency exercises held in school. “So that’s an important lesson learned – that we’re training for that day when something could happen at your school, at your church, at your mental facility.”

Much to learn from victims

Prothrow-Stith was among a group of leaders in the late 1970s who, alarmed by statistics that homicide was the leading cause of death for young black men and the second leading cause of death for all U.S. adolescents, set stage for addressing violence as a public health problem.

She said survivors of acts of mass violence are some of the best champions of solutions to the problem. “There’s a lot to learn from them, and the politicians listen to them when they don’t listen to the data.”

Prothrow-Stith offered several slides, including a study showing that states with stronger firearm laws have lower rates of suicide and homicide. Another study showed that motor vehicle fatalities have steadily dropped over the decades, corresponding to increased funding for automotive safety programs. Meanwhile, U.S. firearm fatalities continue to rise while safety-related funding remains low.

In 2015, for example, 33,800 Americans died in car accidents, and Congress approved $830 million for safety research. Meanwhile, 33,636 people died from gunshots that year while just $5 million was OK’d for gun safety research. “It seems we could have more of an impact if we had more collaborative, concerted funding focused on prevention (of firearm violence),” she said.

The matter of guns

Prothrow-Stith noted that there are almost twice as many suicides each year in the U.S. than homicides. “What we’re learning about guns and their participation in both homicide and suicide suggest that there are things we can do,” she said. “If I were to say where I’m probably the most frustrated it’s in our lack of ability … to address gun ownership in the U.S.”

She pointed out that New Zealand, where recent shootings at two mosques killed 50 people, has already banned semi-automatic weapons and assault rifles. In contrast, she noted, the U.S. has pro-violence cultural messaging that dates back centuries and it’s not changing. “I don’t know that we’ve released our children of the marketing of violence,” she said. “Now we’re marketing this thing called violence to girls as well.”

‘Colorado stands as a model for other states to look to when it comes to school safety.’ – Lt. Gov. Dianne Primavera

She admitted to reaching a point of being “almost withdrawn from this issue” when not even the devastating Sandy Hook Elementary School massacre in 2012 was enough to spur Congress to act. But the strong activist responses by students after last year’s Parkland, Fla., shooting, and the subsequent passage of a Florida gun bill, has renewed her optimism.

Making headway

“When we think about hurt children hurting other children we really have to think about what we give as cultural messages, and of course we need to make the hurt go away,” Prothrow-Stith said. “But if we can share strategies for healing and handling the hurt better and healthier, rather than fighting or hurting oneself, I think we could make a dent in this.”

Primavera said Colorado has done much to improve school safety since Columbine, including:

  • Opening one of the largest School Safety Resource Centers in the nation, where more than 46,000 people have been trained on threat assessments, suicide prevention and child sexual abuse prevention.
  • Launch of the state’s Safe2Tell tip-line program, which has become a model for recognizing threats and responding quickly.
  • In 2013, the state passed universal background checks, resulting in “thousands” of people with criminal records being denied access to firearms.
  • In 2018, the Colorado Legislature approved $60 million in school safety grants.
  • Last week Gov. Jared Polis signed the Lifesaving Extreme Risk Protection Order into law. The legislation allows family members and law enforcement officers to request a court order to temporarily remove firearms from someone who is deemed a danger to themselves or others. Her mention about the new law drew a burst of applause from the audience.

“Colorado stands as a model for other states to look to when it comes to school safety,” Primavera said.

Emotions welled in the auditorium when DeAngelis read off the names of the 12 students and one teacher killed 20 years ago. He said his intent is to celebrate their lives. “As we go through the next four days, that’s what I want you to do. We’ll always remember the 13,” he said. “Columbine represents hope.”

Contributors: Sidebar story by Kiley Kudrna, photos by Matt Kaskavitch, Office of Communications

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Can technology provide solutions to mental health crisis?

Speaking to a rapt audience of almost 5,000 in Denver, Matt Vogl covered more territory than what is usual in a brief TEDx talk. He went from an unflinching account of what led him to the brink of suicide 15 years ago to his desire to disrupt and innovate in the nation’s “snarled” mental health system to promising virtual-reality treatments for prisoners in Alaska and beyond.

Vogl, executive director of the National Mental Health Innovation Center (NMHIC) at the University of Colorado Anschutz Medical Campus, was among the featured speakers at TEDx Mile High “Reset” on Saturday at the Bellco Theater. Listed in the program as a “mental health technologist,” Vogl wowed the crowd, which frequently broke in with spirited applause and gave him a standing ovation after his 15-minute presentation.

Matt Vogl at TEDx Mile High
Matt Vogl, who once worked as a standup comedian, told the TEDx Mile High crowd, “The best part of the comedy life was it provided the perfect cover for my misery.”

Vogl recounted the highs of his standup comedian career, saying, “Even when it sucked, the comedy life was amazing: I was getting paid to make people laugh. And best of all, it provided the perfect cover for my misery. … I was really funny, and I was really miserable.”

‘My rock bottom’

He recalled a night of smash shows at the Comedy Works in Denver, then going home and researching ways to kill himself. “Eventually, it got so bad that I wrote a note and picked a date. And then I bought a gun.” He said a neighbor randomly intervened and saved his life that day.

“It’s crazy how close I came, but what’s even crazier is that almost dying by suicide wasn’t my rock bottom,” he said. “My rock bottom came when I tried to access care in our snarled mental health system.” He illustrated the U.S.’s broken care system by showing a photo of highway gridlock. Access to care is abysmal, misdiagnoses are common and medications often make the patient feel worse. Vogl said he bottomed out when a therapist fell asleep in the middle of a session — and had the nerve to ask for a copay.

Currently in the United States, 80 percent of people with a mental illness don’t receive adequate care, Vogl said. But building more clinics and hiring more providers won’t solve the crisis, he said. “We cannot clinic our way out of our mental health access problem.”

Access to mental health care

His goal as co-founder of the NMHIC, established 2-1/2 years ago, is to test news ways to make mental health services of all kinds more accessible to everyone — when they need it and even before they need it. The center brings together behavioral health experts and community resources to produce new strategies that advance care in Colorado and across the nation.

Vogl, who has type 2 bipolar disorder, is fueled by a passion for mental behavioral services, and he’s increasingly intrigued by ways technology can be part of the solution.

An example is a collaboration the NMHIC has forged with prisons in the northernmost state — at the request of the Alaska Department of Corrections. The department was struggling with mental health issues among many inmates, often exacerbated by Alaska’s extremely long and dark winters.

Demos of virtual reality
The National Mental Health Innovation Center’s booth in the lobby at Bellco Theater was popular with attendees who enjoyed demonstrations of the center’s virtual reality technology.

Vogl and a couple NMHIC colleagues introduced some of the inmates to VR technology. One inmate, behind bars for nearly 40 years, was transported to a sunny mountainside, leaving him in tears and saying, “I forgot what free felt like.”

Pilot program in Alaska prisons

The NMHIC launched a pilot program in three Alaska prisons to help inmates meditate. The plan is to integrate meaningful, personalized content for their virtual exposures. “A native inmate could meditate in the Inuit village where he grew up, or even participate in traditional ceremonies,” Vogl said. “We believe that over time this program can help us lower the use of sedating medications and solitary confinement.”

VR also shows promise in helping people overcome phobias, he said. For prisoners, this could help them transition to life on the outside — a prospect so frightening that it fuels a 70 percent recidivism rate.

VIRTUAL REALITY A HIT AT TEDx

The National Mental Health Innovation Center had a booth at the Bellco Theater lobby where the throngs of TEDx attendees could try virtual reality for themselves. More than 500 people participated in the demos, enjoying a relaxing tai chi experience, as well as being exposed to some of the meditation scenarios that are being piloted in Alaska prisons.

“We’re working with a New York-based startup firm to pilot test a series of VR experiences that enables inmates to learn critical skills to thrive on the outside. Things like resolving domestic conflict, or dealing with a job interview where the interviewer is grilling you about your time in prison,” he said. “Very often prisoners have some of the worst access to mental health services. So, if a solution works for them, there’s a good chance it will work for the rest of us — and it is.”

Technology isn’t the enemy

He showed a slide of his two sons, Mark and Sam, and said bipolar has a genetic component. He noted that people with untreated bipolar disorder have a 30 percent higher suicide rate than the general population, and “that scares me.” Prevention, early intervention and quick access to great care can lower those rates, Vogl said, motivating him to turn his fear into solutions.

“Technology isn’t the enemy of mental health. It’s a scalable solution,” he said. “I know because we’re seeing it work. In this life we can make life better — for me, for Mark and Sam, for inmates in Alaska and for everyone else caught in that bumper-to-bumper traffic.”

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