CASTLE ROCK — Douglas County Commissioner Lora Thomas will never forget the night she got the call.
Two dead. A 15-year-old boy suffering from mental illness had killed his mother before turning the gun on himself. The two had argued earlier in the evening about taking his medication.
The mother was raising four children by herself because her husband had committed suicide years earlier. One son was away at college, two sisters who were also in the home at the time of the shooting, ran upstairs to hide. One of them jumped from a second-floor window to escape. She is now paralyzed.
Tatiana Klamo had a gun in the home for security reasons. She had taken it out of the safe the night before because she had heard noises.
Her son found the gun and chased his mother through the house, eventually shooting her multiple times.
Thomas was Douglas County Coroner at the time, and Douglas County led the state in death by suicide, 57 in 2014.
Thomas said it was clear what the problem was, and rather than advocating to ban guns, Douglas County officials decided to make improvements to its mental health program.
“After all this happened, the county manager said, “You know what? This is Douglas County, we are better than this,” Thomas said through tears. “We need to solve this.”
Thomas left Douglas County government for two years but returned in January 2017 after being elected to the Board of County Commissioners.
In the meantime, Barbara Drake, Deputy County Manager for Douglas County, was enlisted to find an answer. When Drake came to Douglas County in 2009, she already had decades of experience in mental health.
She holds a Master’s Degree in social work and spent 25 years in the department of human services for El Paso County. When she left El Paso in 2009, she was the Director of Human Services, overseeing more than 400 employees.
Drake led the startup of the Douglas County Mental Health Initiative (DCMHI) by examining what programs were available at the time to Douglas County residents and identifying the gaps.
DCMHI is comprised of 37 community partners including law enforcement, emergency medical experts, fire fighters, judicial services, human services, public and private health care, hospitals, schools, churches, nonprofits, etc.
“It took us about a year and a half to identify everything,” Drake said. “We brought community partners together, and we mapped how everybody helped people access mental health services. That allowed us to identify where people fell off the radar, where they fell through the cracks.”
Most often, Drake said, people lose track when they are passed from one organization to another.
“We tried to look at what do we need in Douglas County to better serve our residents?” Drake said. “You can never say you can avoid all tragedy, but we felt like we could do a lot better than what was happening.”
One concern for officials was they did not want to grow government by giving direct services, but they did feel they could facilitate those services.
“We are a very conservative county. We believe that government needs to be really tiny,” Thomas said with a laugh. “So we are keeping all of our private sector partners who are doing the work, and all Barbara has done is create an umbrella over it. We’re pushing everything still to the private sector.”
To manage that workload, in 2016, the county did create a new position, the “Mental Health Initiative Coordinator.”
“We didn’t want to settle with the system working the way it was,” Drake said. “We are headed to becoming a county with more than 500,000 people, and we didn’t want to wake up one morning and go ‘oops we don’t have a system in place to deal with a half million people that need these kinds of services.’ “
Drake was referring to the fact that Douglas County is somewhat isolated from many mental health services because of its positioning between the much more populous counties of Arapahoe, Jefferson and El Paso, all separated by miles of rural highway.
Residents must drive to Arapaho County to get crisis services, detox, counseling and other needs.
“For many years we were just seen as a smaller county that didn’t have some of these needs, so we got attached to a larger county,” Drake said. “We wanted a say about what is going to work in our county. We don’t want system organizations to come in and say, ‘Here is what we are going to give you.’ “
COMMUNITY RESPONSE TEAM
To this point, the first point of contact for most mental health calls was usually a law enforcement officer responding to a 911 call. The officer had one of three choices to make on scene — leave the scene without doing anything, place the person on a 72-hour mental health hold at a local hospital or arrest them for something.
Drake’s group wanted better, and by May of 2017, the county rolled out implementation of its first strategy — the Community Response Team (CRT).
After looking at past 911 calls and determining when the most calls came in for mental health issues, things such as high-profile suicides, welfare checks, domestic disturbance calls, the CRT paired a police officer with a mental health clinician Monday-Thursday from 10 a.m. to 8 p.m. to take the calls that were mental health related, whether those be through 911 or other referrals.
That team now works with first responders to make better decisions about what to do on scene.
“Previously if you wanted to take someone to a mental health facility, you had to take them to a hospital first to get them screened to make sure they were OK medically,” Drake said. “We set up protocols with fire to come out and screen them on scene so our CRT could take someone directly to a psychiatric facility and bypass the hospital.”
Drake said the CRT was developed with three goals in mind:
- Not take people to jail whose primary issue was a mental health issue.
- Not take people who don’t need it to the emergency room, often to sit for nine or 10 hours because they are not priority.
- To get people the appropriate mental health services.
In January, they added a second CRT that works Tuesday-Friday from 10 a.m. to 8 p.m. Having CRTs to respond specifically to mental health calls allows police and fire personnel to be released to take other calls.
In all, since the program rolled out one year ago, CRTs have had 944 contacts, 384 of which were 911 calls, 166 were officer, fire or community referrals, 381 were follow-ups and 13 were uncategorized calls.
“We have a much grander vision to create a whole network around the CRT so they have appropriate places to take people that are convenient, and so they don’t have a lot of barriers in place to take people there,” Thomas said.
A case management piece, unique to Douglas County, facilitates follow-up visits and makes sure those contacted by the CRT are getting the services they need.
Most response team models don’t include a case manager, but it’s become a vital part of Douglas County’s efforts.
“The important thing we are learning,” Drake said, “is you have to follow up with these individuals. You have to follow up to make sure they are connected with some kind of outpatient services.”
Those needing services now get them more efficiently and in many cases at a reduced cost because Douglas County has also worked with private sector services to accept the CRT process.
Fire fighters and other first responders can prescreen at the site for medical issues and clinicians can offer mental evaluations so the patient doesn’t have to repeat the process when transported to private facilities.
Additionally, having that case manager also helps prevent repeat calls for emergency personnel.
“It makes all the difference in the world,” Drake said. “Because this is about building trust and building relationships with people, so that if they have a crisis they call the case manager or the community response team instead of picking up the phone and dialing 911.”
The piece that glues everything together, Thomas and Drake said, is a universal medical release CRT officials get signed at the scene. The release allows service providers to communicate with each other without violating the federal Health Insurance Portability and Accountability Act.
“This allows the case manager to keep track of them so they don’t fall in a crack,” Thomas said. “Keep them in their therapy, keep them engaged in the solution. And that is the absolute key. It’s the communication it’s the relationship building. It’s organizations and individuals being able to step outside of boundaries and barriers to figure out how to work with each other.”
The truth is in the numbers Thomas and Drake said.
- 132 people have been diverted from the emergency room.
- 54 people have been diverted from jail.
- Patrol officers were released back into service 548 times because CRT arrived.
- Fire fighters were released back into service 115 times, and fire vehicles 62 times, because CRT arrived.
- 64 patients were treated at the scene.
- Of the 911 calls, 56.7 percent were treated at the scene, 11 percent were taken directly to in-patient psychiatric care or detox.
- Services have been provided to ages 8 to 87 years old.
Most importantly for the two women, however, is the decrease in suicides, something that Thomas has been passionate about since leaving the Colorado State Patrol (CSP) after 26 years in law enforcement.
Her first eye opener came after she left the CSP, Thomas said. She spent seven years with the Colorado Department of Health and Environment researching homicides and suicides for a national reporting system. She said she was shocked when she learned Colorado averaged 1,000 suicides and 200 homicides a year.
Then, as a fiscal conservative, she ran for Douglas County Coroner to reduce the budget of the office, but while in that role from 2011 to 2015, she experienced suicide at a level she had never seen.
“I was struck by sitting across the table or standing in kitchens with parents who had lost their children,” Thomas said through more tears. “They were left broken hearted all you can do is cry with them and say this is not your fault. We have to learn how to do a better job as a society in keeping an eye out for each other.”
Early in her term as coroner, she started the non-profit “A Night With a Coroner,” which raises money to combat teen suicide.
She ran for county commissioner in 2016, where she has taken an active interest in the CRT program and advocates for its work, saying there is no doubt in her mind it is working.
The numbers seem to be validating her beliefs. In 2017, suicides in Douglas County were down to 44, after hovering around 60 for the past few years.
“I can’t say absolutely this team is why,” Thomas said. “But if you see the statistics how many suicidal subjects they responded to, how could you not but think there are people alive today because of this team.”
The plans are not complete the two women said.
A community education and anti-stigma campaign is in the works, Douglas County is partnering with other metro-area health departments for a “Let’s Talk” campaign, and they are hosting forums about mental health.
“We have to make people realize they can reach out and ask for help that sometimes is more difficult in a county like Douglas County where there is a high level of educated people,” Drake said. “People who are expected to be able to handle things on their own. They have to know if you feel like something is happening with someone not be afraid to reach out and ask for help to engage someone.”