From left: Colorado Public Radio reporter John Daley, Colorado Sun reporter Jennifer Brown, MindSite News editor Rob Waters, Democratic Senator Michael Bennet, Republican challenger Joe O’Dea, and CBS 4 political reporter and moderator Shaun Boyd.

In a sign of the elevated importance mental health issues have assumed among voters and policymakers, Colorado Democratic Senator Michael Bennet and his Republican challenger, Joe O’Dea, took part October 18 in the first-ever Senate candidates’ forum focused solely on mental health.

During the event, co-sponsored by MindSite News, the candidates clashed sharply on spending but agreed on the need to address the youth mental health crisis, to create parity for mental health care and to expand the mental health workforce. The forum, held on the campus of the University of Colorado Anschutz Medical Center, can be viewed in its entirety on the YouTube page of MindSite News.

Following the forum, a clinical director and a policy leader from Children’s Hospital Colorado spoke with the forum’s media panelists about some of the issues facing children and families in Colorado.

The forum was co-sponsored by Inseparable, Healthier Colorado and Children’s Hospital Colorado.

Below are some excerpts from the candidate’s discussion and from the two hospital experts. The excerpts have been lightly edited for clarity.

Democratic incumbent Senator Michael Bennet:

We’re facing an epidemic of mental health in Colorado and across this country, as a result of an economy that for 50 years has worked incredibly well for the top 10% of Americans but almost for nobody else; the opioid epidemic on top of that; COVID on top of that, the effect of social media, on top of that.

What we need is parity. We need to treat mental health as seriously as we do physical health. That means integrating physical health and mental health. It means making sure we go to where people are, like their schools like their workplaces to make sure that we’re really integrating mental health into people’s lives. And that that’s the work that we’re trying to do together in a bipartisan way on the Finance Committee. I’m grateful that we passed the American Rescue Plan because Colorado is now going to have $600 million to spend in rural areas and across the state making sure that we’re attracting and retaining and training the mental health folks that we desperately need.

And then we passed $12 billion in the bipartisan gun bill to address mental health. That is, I think, the largest expenditure on mental health ever in the history of our country to support community health and behavioral health centers.

Republican candidate Joe O’Dea:

The issue of mental health is deeply personal to me. At 14 years old, our daughter lost a very close friend to suicide. Our niece, just four years ago lost a fiancé to suicide on Christmas Day. I don’t know a family that hasn’t been affected by mental health. My heart breaks for the young people of the country who are going through their struggles. We’re failing our kids, and we have to do better.

What’s happening in America is not working. Partisanship is poisoning our country. My opponent votes with Joe Biden 98% of the time, it’s not working. Inflation: 40-year high, it’s not working. Crime is at an all-time high, not working. Homelessness in Colorado is rampant, it’s not working. And this we had this list. Mental health, especially for our kids, it’s not working.

Last year Children’s Hospital declared a youth mental health state of emergency. Teen suicide in Colorado has increased 58% In three years, making it the number one cause in adolescent deaths. It’s a staggering number. And since Children’s Hospital declared the emergency, there has been a 23% increase in mental health visits to the ER, that’s 103% increase above the first quarter of 2019, which was before the pandemic. What will things look like in 2028? Well, if we put a massive, massive, massive focus on these issues, and we reprioritize our values, we can turn the ship around. We lead. We do what’s right by our kids. This debate is long past due, but it’s about priorities.

Jessica Hawks, child and adolescent psychologist, clinical director of Pediatric Mental Health Institute Children’s Hospital Colorado: 

It’s important to take a step back and realize that we were actually in a mental health crisis for our youth, even before the pandemic. We’re fortunate in that we’re now in a place where we have a national platform to be able to really talk about these issues.

We have an incredible mental health shortage. If you look at any outpatient clinic right now, for youth mental health, it is common that you’re waiting six plus months to get an appointment. I think that speaks to how few mental health providers we have for the number of youth that need the care.

One of the biggest problems is that we aren’t getting reimbursed sufficient amounts in mental health to be able to cover the costs. And that’s why a lot of different facilities closed down, because the reimbursements they’re getting don’t cover the services that need to be offered for the kids.

If you look at community mental health providers, a lot of them won’t even take private insurance because it is so much paperwork and the reimbursement is also not great. Even middle-class folks with private insurance have a really difficult time finding mental health care because a lot of mental health providers just simply won’t take insurance.

If you look in primary care settings across the state and across the country, our pediatricians are being inundated with the mental health crisis. More appointments are addressing mental health than any other health concern right now. And that is not necessarily what pediatricians went into the field to do. There’s a lot of different things that we need to do to be able to address that.

One is we need to be able to integrate more mental health providers into primary care settings, be able to partner with our pediatricians and be able to support them, so they can focus on what they do best. And our mental health providers can focus on what they do best.

We need more money to be able to open back up residential beds. But it’s really the whole continuum of care that needs to be funded better. We need to be starting early with prevention and early intervention, so that we don’t need to have all of it invested towards residential care. We need more therapeutic foster care homes. We need more residential beds. We need places for these children that come to our emergency departments in a mental health crisis.

Zack Zaslow, interim vice president of population health and advocacy at Children’s Hospital Colorado:

Over the last 10 to 15 years, Colorado has lost over 2000 pediatric residential beds. We have about 300 remaining. When we at Children’s Hospital Colorado have a patient who has been in our inpatient unit, and they’ve gotten better and are ready to step down to a less acute setting but are not ready to go home yet – we don’t have that supply of those stepped-down post-acute care facilities anymore.

That supply crunch is creating problems. Kids end up waiting in our inpatient unit for weeks, months, sometimes over a year. They’re without their families and friends, they’re not getting the education that is required. Often, they’re getting worse because they’re in a restrictive setting; they should be closer to home. We need those residential beds.

It’s not just residential; it’s therapeutic treatment, foster care. It’s respite care for families, so that parents can feel comfortable coming and picking up their child from the emergency department or inpatient unit, and taking them back home, and feeling like they have the resources and skills to keep that kid safe. We just don’t have those in-home, or community supports and services right now. So kids are ending up in the most acute setting, the most expensive setting, which is not what they need.

If you go to your primary care doctor’s office, you’re not going to spend the whole time with your doctor. You’re going to have your blood pressure taken by a medical assistant or nurse practitioner. We don’t have that same complementary workforce on the mental health side. And that’s what we’re going to need. In every county in Colorado, we need to make use of the workforce that we have, to get kids and families the support that they need.

We need teachers, coaches, parents, folks that can do that Mental Health First Aid class to be able to spot those initial concerns, and then refer a child to a therapist to a primary care provider or a school counselor. We need to use that frontline workforce that we have already.

Most primary care providers didn’t train in mental health, they trained in family medicine or pediatrics. We have a program here at Children’s Colorado that allows for primary care providers in the state to do a tele-consult with one of our child and adolescent psychiatrists within 45 minutes. But if they have a patient in their office, who’s struggling with mental health challenges – as over 50% of their patients now are – they can quickly get on the phone with us and do a tele-health consult. Rather than saying, ‘This is above my paygrade, you got to go to the emergency room.’

There was federal legislation in 2018 called the Families First Prevention Services Act, which intended to move kids and other people out of institutional settings back into home and community-based settings. We at Children’s Hospital Colorado supported that bill. We don’t want children to be in an institutional, restrictive setting any longer than they need to be.

But the reality is Colorado has only done half that bargain. We’ve closed some of those institutional settings, we have not stood up the complimentary home- and community-based services in order to take care of those kids in their home or closer to their community. We’ve got to make good on that part of the bargain.

Rob Waters

Rob Waters, the founding editor of MindSite News, is an award-winning health and mental health journalist and contributing writer to Health Affairs. Waters has worked as a staff reporter or editor at Bloomberg...