The Pitkin County Jail as seen on Thursday, July 27, 2023, in Aspen.
Austin Colbert/The Aspen Times

More than half of the average daily population in Pitkin County’s jail has a serious mental health issue, according to a 2022 report by Justice Planners.

The high incidence of mental health issues among incarcerated populations is no coincidence; the lack of support for people struggling with mental health often results in entanglement with the criminal justice system.

The criminal legal system and mental health are deeply intertwined and can be tied to the rise and fall in the use of mental asylums, according to Mental Health Colorado President and CEO Vincent Atchity.

“We went through a phase as a nation where we recognized that warehousing people in giant asylums was not productive of good health outcomes,” Atchity said, noting mental health treatment facilities did not replace the asylums. “Our jail and prison populations have grown as a consequence, as has our homeless population, but there are people who are ill and can’t survive in our economy without supportive housing.”

The nebulous path to finding appropriate resources and the high cost of care can make it difficult to get the support one needs, especially before their mental health reaches a breaking point met with institutionalization or incarceration.

“We have a group of parents that come to us with their stories and their advocacy. And they are famously being told in many instances by people (to) wait until (their loved ones) do something egregious enough that the police will come and take them away and arrest them so that you’re not worried about where they are or their safety and they may get some access to care,” Atchity said.

In some cases, jail is the only way to access mental health services due to the prohibitive cost of accessing mental health care, according to Atchity.

“Jails and prisons are the number one largest psychiatric facilities in every state in the country,” he said.

The lack of an accessible pathway to care can result in people ending up in crisis — they might lose their homes, turn to hard substances, or act compulsively in a way that ends up with law enforcement becoming involved, Atchity said.

During the pre-trial period, people who are charged with a crime are held in jails, establishing a connection to the jail regardless of conviction status.

According to Interim Detentions Divisions Chief Dan Fellin, Pitkin County law enforcement aims to divert people from jails by connecting people with alternative resources when responding to calls.

“We haven’t ever really had that hard-line, hard-nosed approach,” he said. “Everybody around here, all the agencies … we all see the need to help people versus taking everybody to jail.”

For calls involving substance use or mental health, law enforcement partners with the Pitkin Area Co-Responder Team (PACT). The program pairs mental health professionals with law enforcement officers with the objective of decriminalizing mental illness and improving access to resources for people struggling with mental health or substance use.

“Our goal is to, when possible, keep people out of jail and out of the hospital and keep them within the least restrictive disposition,” Pitkin County Public Health Planning and Programs Manager Jenny Lyons said. “Whenever possible, the team is going to do their utmost to resolve things on scene. A huge area of focus is just helping people stay safe and connecting them to resources without unnecessary transportation elsewhere.”

Of the 173 active calls where a PACT clinician responded on-scene in 2022, only six individuals were transported to jail, according to PACT’s annual report. Of those incidents, 113 were resolved on scene; in other cases, individuals were transported to emergency departments or put in touch with other community resources.

For people with serious mental health or substance use issues, being isolated from their community and cut off from systems of support can exacerbate those issues. 

PACT aims to connect people with resources so they can remain in their communities while receiving support, rather than introducing additional stressors associated with being transported somewhere else, according to Lyons.

Acknowledging that being in jail is a punishment in itself, Fellin said the county jail offers mental health services to inmates with the goal of reducing recidivism and providing inmates with the support they need.

“People with mental health issues can deteriorate in jail, which is why I think it’s a big deal for us to be offering all the services that we can and as much help as we can provide to people when they’re inside and then continuing that care once they’re outside,” Fellin said.

The jail contracts with Turn Key Health Clinics to provide mental health services to inmates.

For inmates who have already received diagnoses prior to their incarceration, Turn Key facilitates continuity of care, including access to medication and follow-up appointments with medical providers, according to Turn Key Director of Psychiatry and Mental Health Services Dr. Jawaun Lewis.

During the intake process, inmates complete a medical screening, as well as a mental health screening. If the patient is determined through the intake process to need mental health support, Turn Key will provide support for starting or continuing relevant medications. Turn Key itself does not diagnose patients; they only treat symptoms, Lewis said.

If people come into jail without a diagnosis, Turn Key will refer patients to an outpatient provider for a diagnosis. In those cases, an assigned case manager or therapist works with the individual to set up an outpatient appointment for a diagnosis.

After release from jail, case managers continue to work with individuals for a set period of time. Funding for case management, mental-health treatment, and other mental health services is provided by Colorado’s jail-based behavioral services program.

According to Atchity, incarcerated individuals are the only people in the United States with a constitutional right to healthcare.

“You should not need to get arrested in order to access care for your mental health or your substance use condition,” Atchity said. “That care ought to be accessible to you in your state of liberty in the community.”

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Larimer County is nearing completion on construction of its new behavioral health facility, Longview Behavioral Health Center, which will provide acute mental health care for patients in an underserved area, according to Larimer County Behavioral Health Director Laurie Stolen.

Nick Sok with Merit Electric works on wiring for in one of the patient rooms Thursday at the new Larimer County Behavioral Health Facility under construction. (Jenny Sparks/Loveland Reporter-Herald)

The structure, situated on a 40-acre lot at the northwest corner of Trilby and Taft Hill roads almost directly between Fort Collins and Loveland, is prepared for a Sept. 22 ribbon cutting ceremony and will begin accepting patients on Dec. 4.

The product of a mental health initiative led by the county and funded by a voter-approved sales tax of .25%, which was passed in 2018, Stolen said that the facility is a rarity in the country.

Operated by SummitStone Health Partners and working in close collaboration with area hospitals and outpatient behavioral health providers, the facility will serve as a seamless way to help locals navigate some of the most frightening and difficult moments of their lives, provide short or medium term stabilization, and then continue to help clients receive the help they need in an outpatient setting, Stolen said.

Part of the funding from the sales tax includes a fund that can be used to help those without the means to cover their treatment.

Designed to be a one-stop shop that can treat a variety of mental health crises ranging from substance abuse disorders to suicidal ideation to psychotic episodes, the building houses its own pharmacy, suites of therapy rooms, a full withdrawal management, or detox, wing, a full-service kitchen and a docking bay for drop-offs by ambulances and law enforcement.

The last feature is crucial, Stolen said, as the entire purpose of the facility is to encourage first responders to bring residents who might be in the midst of a behavioral health crisis, whether that be a suicide attempt, a psychotic episode, or something similar, to the new facility rather than the hospital or the jail, neither of which might be the best place for them to recover and receive proper treatment.

“We want to incentivize them to use this building, and not the jail, not the emergency room, so we allowed them to kind of lay out the inside part of the building here with a transportation lounge area, their own bathrooms so they don’t have to take off their utility belts and such,” Stolen said.

There are of course more ways to enter the building as a client than via ambulance or police cruiser.

Laurie Stolen, director of Behavioral Health Services for Larimer County, center, and senior project engineer Wes Schlegel, left, stand at the main entrance of the new Larimer County Behavioral Health Facility on Thursday. (Jenny Sparks/Loveland Reporter-Herald)

A stunning two-story entryway and lobby make up the center of the building, where patients who might not be at a stage in their mental health crisis to need an ambulance can enter and admit themselves, and where family and friends can visit. The pharmacy is located there, and while it is intended at first to serve only patients at Longview, Stolen said it could potentially become a retail pharmacy, serving anyone nearby if the location is convenient for them.

The structure emphasizes natural light, with floor-to-ceiling windows throughout the facility. In one area that is too far from any external walls to effectively light the area with windows, is a “light well,” essentially a small courtyard with an open ceiling, enclosed with glass. It allows light to shine into what would otherwise be a dimly lit, gray area; clients, staff and visitors can even step out into the light well, weather permitting, to feel the sun.

The building was intentionally made to be welcoming and beautiful, and actively sought to avoid a clinical, institutional feel like a psychiatric hospital or a prison, Stolen said.

But as project engineer Wes Schlegel explains, there is a careful balancing act between beauty and safety. Many of Longview’s clients are not the most predictable, and some are there in the first place because they want to hurt themselves.

A large staircase to the right of the entryway into the lobby will soon have what Stolen described as a transparent glass frame with inserted leaves that will cover the entire upper entryway. Beautiful, she explained, but also effective at keeping clients from trying to jump off of the staircase.

Bathroom door handles, showers, bed frames, and any other conceivable residential items are “non-ligature,” essentially incapable of having anything tied to it. Towel hooks flick down if more than a few pounds of pressure is put on them. Door handles are situated within the door itself. Mirrors are made of highly reflective stainless steel instead of glass to prevent shattering and reduce the chance that a client might get a sharp object with which to hurt themselves or others.

Other clients might try to barricade themselves in rooms or smash their way out of one of the building’s many windows,  Stolen and Schlegel said. Residential doors are dual hinged, so if a client attempts to barricade themselves inside a room, a key can be turned and the door swings out rather than in. All the windows are made as a single unit, double paned with a shatterproof glass similar to that of a car windshield.

Stolen debated bolting chairs to the floor to reduce the odds of a client trying to use one to break through a window or otherwise cause damage, but because that seemed to contradict her belief that the facility should be as welcoming as possible, the facility bought chairs light enough to move across a floor but far too heavy to lift and throw.

The end result of all the thought and work, Stolen said, is a facility that is inviting, safe and above all, specialized to treat a variety of behavioral health crises.

“That’s the beauty of having everything all in one building,” Stolen said while standing in the crisis stabilization wing of the facility. “They really have the ability to transition and move people within the same building. And they can stay in the same bed and get different levels of care.

“So if there’s someone who’s on the withdrawal management level, and they’re also floridly psychotic and they’ve got depression, they can be treated with all of the meds and all of the specialties from this side without leaving that bed. Because all the services are available in one building. That’s what makes it kind of unique.”

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