FORT LUPTON, Colo. -- Suicide rates, overdoses and substance abuse all are on the rise since the onset of the coronavirus pandemic, according to a new Government Accountability Office report.

Colorado's community health centers have seen a dramatic increase in patients in need of care.

Jonathan Muther, vice president of medical services for Salud Family Health Centers, which operates 13 clinics serving both rural and metropolitan residents, said before COVID-19, nearly one in five patients presented symptoms of mental illness or substance-use disorder. Since the pandemic, one in three present symptoms, but most cannot access care.

"Even before the pandemic, more than half of the individuals with an identified need did not receive access to care," Muther recounted. "And that gap has only widened since the pandemic."

Last week, Muther told members of the U.S. Senate Committee on Health, Education, Labor and Pensions his team has responded to the increased need in part by expanding telehealth efforts. But he argued more needs to be done to remove barriers that prevent people from getting care, including lack of adequate health coverage, not knowing where to get help, social stigma, and a lack of non-English-speaking staff.

Changes in how federally qualified health centers are reimbursed would give more providers the flexibility to meet people in need of care where they are.

Muther pointed to Salud's integrated approach to care, where people get mental-health screenings whenever they check in with their primary-care provider, vision specialist or dentist.

"We structurally embed a behavioral-health visit in the context of the medical visit, whether that's in person or via telehealth," Muther explained. "We have behavioral-health providers that just do a proactive outreach to individuals in order to recognize a mental-health concern as early as possible and be able to do something about it."

Adults are most likely to reveal symptoms, which can include increased anxiety or depression, but also physical manifestations such as chronic head or stomach aches, to their doctor.

Muther added getting more mental-health professionals into schools can help reach children. Clinics have also successfully reached patients who don't get regular checkups through targeted outreach.

Research shows two in 10 Iowa youth report they have considered suicide, and to confront the crisis, doctors and social scientists are using federal grant money to expand mental health services to rural Iowa children.

Child care and mental health experts at the University of Iowa are using a $2.5 million federal grant to reach out, especially to rural schools, which often lack services.

Dr. Tom Scholz, professor of pediatrics at the University of Iowa and director of the division of child and community health, said the trend was well on its way before the pandemic, which only made things worse. He stressed making up for lost time is critical.

"The sooner we can get at those kids, the sooner we can make the diagnosis, the sooner we can initiate therapies, the better those kids are going to do in school and with interactions with their family," Scholz outlined. "And as a foundation as they launch into their post school activities, into adulthood."

Doctors will partner with schools and a dozen community health centers scattered around rural Iowa to serve more young people who need mental health care.

Scholz pointed out the grant will help provide more online psychiatric visits for children, and researchers are working with local health centers to serve as many youths as possible in person. It's help that might otherwise be unavailable, because many kids are far from urban centers.

"It would have required them traveling to Des Moines, Iowa City, maybe Omaha," Scholz explained. "But we're able to provide services in the communities nearer to where they live."

The new grant allows University of Iowa psychiatrists to continue and broaden the work they have been doing. Last year alone, mental health specialists worked with community health centers in rural Iowa to provide nearly 2,000 online psychiatry visits for children who need help.

A report has found Connecticut could do more to strengthen its youth behavioral health system.

Connecticut and the U.S. are facing an increasing child mental health crisis, which was brewing long before the pandemic made it worse. A 2022 report showed suicide was the leading cause of death for Connecticut teens age 15 to 19, but Connecticut is making strides to provide an adept youth behavioral health system.

Jason Lang, chief program officer for the Child Health and Development Institute, described one of the report's recommendations.

"The current reimbursement rates for many behavioral health services have not kept up with inflation over the last decade," Lang pointed out. "There's a large gap in terms of funding that's available to the providers, that in turn is limiting their ability to attract behavioral health clinicians and staff."

Almost half the population in the U.S. lives in a mental health workforce shortage area. KFF data showed Connecticut has 47 health care professional shortage areas, leaving more than 1.6 million people without access to coverage.

Other report recommendations included creating a central support to provide training for workers and keep up on employment trends.

In addition to the behavioral health industry taking action, Lang noted the General Assembly could take its own actions, too. Some of these include Senate Bill 2, which was passed this year. The bill created the Office of the Behavioral Health Advocate to help people in the state get mental health care.

"Some of the other things the Legislature could do are make an immediate investment in recruiting and particularly retaining the clinicians that are working in community mental health right now," Lang suggested. "Because I think if we don't do anything to support and retain them, we're going to continue to lose them to those other jobs."

Getting people to enter back into this workforce could be a problem. A report found 56% of public health workers are experiencing symptoms of post-traumatic stress disorder, brought on by the mental health crisis growing during the pandemic and in the years since.

No Indiana county has enough mental-health professionals to meet the local needs according to the Rural Health Information Hub. Add to that an overall mistrust of the healthcare system by many people of color, and there's an unmet need that one Indianapolis nonprofit hopes to help fill.

Nonprofit community center Flanner House has opened a facility geared for the mental-health needs of Black Hoosiers.

Morningstar Afrocentric Wellness Center Director Bwana Clements said he and Flanner House Executive Director Brandon Cosby envisioned opening the center after seeing that young Black men seemed unresponsive to traditional therapeutic models.

"Wouldn't it be nice if we had an agency to prevent the challenges and difficulties of having to retell your story, over and over, to people who may or may not understand it?" Clements asked.

He said the center offers individual, couples and family counseling, as well as bereavement therapy for young people who have suffered a loss due to violence or trauma.

The American Psychiatric Association has found that, with Black patients, physicians are 23% more verbally dominant and engaged in 33% less patient-centered communication than with white patients.

The Substance Abuse and Mental Health Services Administration points to reasons why Black Americans and other minority groups don't always seek help for mental health. There's still a stigma around getting this type of care, but lack of access and insurance costs also are factors.

Clements said the center was intentionally designed for people to feel at home.

"There's something about being able to walk into a space, seeing people that look like yourself, and knowing that they understand without you having to explain," he added.

Clements said anyone is welcome at the Wellness Center, no matter their race or sexual orientation. The American Psychiatric Association says other common barriers to seeking help include concerns about privacy, lack of knowledge about available treatments, and denial of mental-health problems.


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