In a state where the mental health safety net is plagued by a lack of financial transparency, competition, and the inability or unwillingness to serve the neediest patients, local leaders say one mental health center and its top executive stand out as worse than the rest.
“(Expletive) Mind Springs, for one thing,” says Sheriff Jaime FitzSimons, when asked about the threats to mental health in Summit County. “And that (expletive) snake oil saleswoman who runs it, for another.”
Mind Springs Health, led by CEO Sharon Raggio, is the private nonprofit responsible for providing behavioral health safety-net services in Summit and nine other Western Slope counties: Eagle, Garfield, Grand, Jackson, Mesa, Moffat, Pitkin, Rio Blanco, and Routt. It is one of 17 regional “community mental health centers” statewide that long have been responsible for inpatient hospitalization, intensive outpatient treatment, outpatient psychiatric care, counseling, and other forms of treatment for Coloradans on Medicaid or who are indigent, underinsured, or in crisis.
A recent Colorado News Collaborative investigation found that many of those mental health treatment centers fail to serve the most vulnerable Coloradans, aided by a system that creates a financial incentive to take on fewer ill people and charge higher costs, while also protecting them from competition.
Communities served by Mind Springs are among the most frustrated. Nowhere is that disappointment expressed so bitterly and publicly than in Summit County.
In 2018 voters passed a tax measure to fund mental health care, even though it meant they are essentially having to pay twice for similar services. Since then, local officials have worked with the state to end three of Mind Springs’ contracts. And now they are going a step further by severing ties altogether and joining nearby Eagle County’s new community mental health center because leaders in both say the state cannot — or will not — fix problems with Mind Springs.
The split marks the first of its kind in the 50-year history of Colorado’s mental health safety net system, and is prompting other Mind Springs’ communities to eye ways to take control of their own care.
Raggio, in a series of interviews over several months, has not addressed specific reasons for public discontent, telling the Colorado News Collaborative, “I don’t believe in litigating issues in the media.”
“It makes me sad that anybody would feel that they got less than adequate services from our organization,” she says. “It makes me sad that people have such negative things to say.”
The new mom
Travis Bickford doesn’t want to hear it. Raggio’s words will not bring back what he says Mind Springs — from its clinics to its hospital to its services in the county jail — took from his family.
His wife, Jackie Bickford, 31, had a history of depression and alcohol addiction when she sought treatment at the Mind Springs office near their home in Breckenridge in 2016. She was experiencing severe postpartum depression after the birth of their son, Trent, a few months earlier. The clinic prescribed medication that her husband says seemed to make her more depressed and “turn her into a zombie.”
“The doctors there just handed that … out like it was candy. They would chastise her for overusing the medicine, but then keep refilling her prescription.”
Because she was talking about ending her life, he and his father-in-law had her committed to the Mind Springs-owned West Springs psychiatric hospital in Grand Junction. He says his wife returned home after about 10 days “far worse” than when she went in: “Constant crying, depression, abusing medicine, drinking vodka.”
He was at work one day in April 2016 when a nurse called their home for a wellness check. Police responding to the nurse’s concern found Bickford drunk and semi-conscious with her infant son nearby, and arrested her on suspicion of child abuse and neglect.
Her family made the tough decision not to bail her out, assuming she — and Trent — would be safer if she were in jail where Mind Springs had a contract to provide mental health services. She threatened to kill herself if he was removed from her care, so the jail clothed her in a smock that kept her from hurting herself and put her on a 24/7 suicide watch.
Within a day, Bickford persuaded a Mind Springs clinician to clear her to move off suicide watch and into a regular cell among the jail’s general population. Four days later, she killed herself.
Her family unsuccessfully sued the sheriff’s department, one of its officers, and the Mind Springs’ clinician who had evaluated her. During a deposition, the family’s lawyer asked the clinician whether, in retrospect, she wished she had not cleared Bickford to be taken off of suicide watch.
“No,” she answered.
“Why is that?” the lawyer asked.
“Because I did what was presented to me during her evaluation. She was not suicidal at the time,” she said.
The clinician called Bickford’s suicide an “impulsive decision,” even though records show she had been suicidal for weeks and even the day leading up to it. She also said Bickford’s husband told her his wife had improved in the hospital and was not suicidal.
Travis Bickford winces when reading the testimony.
“It’s hard enough that I lost my wife, that Trent lost his mom because we were desperate to get Jackie help and these … people didn’t do their jobs,” he says. “But to sit here knowing this woman blatantly lied to justify her wrongdoing, to have no recourse after we made it perfectly clear Jackie was suicidal and tried like hell to make them help her, well, that takes crazy to a whole new level.”
The clinician, through a Mind Springs spokesman, declined to comment or provide any written notes of the conversation with Travis Bickford.
Trent Bickford, now 6 and with no recollection of his mother, walks into the room and sees his father crying during an interview. He climbs on the kitchen counter and grabs a paper towel to wipe away the tears.
“It’s ok,” he tells his dad. “I know.”
“Please don’t call Mind Springs”
FitzSimons became sheriff shortly after Bickford’s death and inherited the legal aftermath — and county residents’ deep distrust of their community mental health center.
“When we’d come across people experiencing crises, they’d half the time say, ‘Oh my God, please don’t call Mind Springs. I won’t talk to them. They’re horrible,’” says FitzSimons, whose jail — like many others — is full of people with untreated behavioral health conditions.
He and other Summit County officials grew especially impatient with Mind Springs’ mobile crisis response unit. The state-funded program is supposed to dispatch a mental health specialist at any hour to help stabilize people so they don’t end up in more expensive emergency rooms. Assistant County Manager Sarah Vaine inquired about the program when noticing the number of ER visits wasn’t dropping, only to be told by a Mind Springs supervisor in Summit County that the organization was urging clients to go to the ER because it didn’t want to risk the safety of its mobile response team members.
Mind Springs’ spokeswoman, in response, wrote, “There is a delicate balance between a crisis worker’s personal safety, and responding appropriately to a crisis in someone’s home.”
Officials and private mental health care providers in five other counties within Mind Springs’ service area also describe their local mobile crisis response units as unresponsive.
Raul De Villegas-Decker, a clinical psychologist in Grand Junction, where Mind Springs is headquartered, says the unit there would call the primary care practice where he worked asking what it could do for someone in crisis.
“It was almost laughable — not the call you would expect from the very people who are paid to know how to handle crises,” he says.
Even Mind Springs’ own staff members say they have problems getting the units to show up.
“There’s typically nothing mobile at all about our mobile crisis team. It’s just basically a call center. And when you call, they act almost like you’re inconveniencing them,” says a Mind Springs clinician who asked not to be identified for fear of being fired. “Here you have someone who is literally at the lowest point of their life, and they’re reaching out or having someone else reaching out for them, and what are we offering them? Nothing, which is terrifying.”
Raggio says her organization responds appropriately to crises as needed, but declined to discuss any particular incident raised in this story.
Raggio, who made $312,331 in 2019, cites a lack of state and federal funding and a maze of red tape as challenges for Mind Springs. But more often than not the former licensed professional counselor keeps returning to her own history leading Mind Springs from the verge of bankruptcy with “three days’ cash on hand” in 2008 to building a psychiatric hospital in 2018 and women’s recovery center in 2020. In almost all her interviews, she mentions the multiple business innovation awards the organization has won from industry groups.
“We’ve done a lot of good things,” she added. “I know there are naysayers and that makes me sad. I think we all want the same things and can achieve more working together.”
“A black hole”
Mind Springs’ critics, county officials, former clients, even its own employees say that it’s not just mobile crisis units that seem to be MIA.
How much tax money the center receives for its programs, what it spends in each county, how many people it employs in each are questions the center can’t or won’t answer.
“Mind Springs is a black hole,” says Summit County Commissioner Tamara Pogue.
“We don’t know where the money goes or how it is being spent,” adds Beth Melton, a Routt County commissioner. “It seems to me that we should have an understanding of what services are being provided in the community.”
Mesa County Commissioner Janet Rowland, who has a background in mental health care, also has questions about how Mind Springs is using state and federal tax dollars. She says Raggio keeps giving different explanations for barriers to care. “I’ve heard money’s an issue. I’ve at other times heard capacity or staff or state rules and regulations are the issue. We haven’t gotten to a real answer about what’s getting in the way.”
Raggio, who refers to herself as “an open book,” repeatedly has said her organization does not keep its electronic records in a way it could figure out how much it spends per county.
“That’s a lie,” Sarah Vaine, Summit’s assistant county manager says.
In response to CoLab’s initial investigation published earlier this month, Mind Springs’ spokeswoman contradicted Raggio, saying her colleagues do in fact keep records by county and would make them available for review. As of this writing, she has not provided them.
Alex Wolfe, a 22-year-old Summit County resident, has spent years cycling in and out of treatment for borderline personality disorder. In 2018, he did a stint in Mind Springs’ psychiatric hospital from which he and his mother say he was released on the condition that he attend a certain kind of therapy group offered only at 5:30 p.m. each Wednesday.
“I went in at that time. They said come back next Wednesday. I went in again. They said there’s no such group,” he says.
Trust in Mind Springs’ home county of Mesa also is low. In two Mesa County surveys, one to residents and one to health care providers, respondents warned people to stay away from the center.
One provider wrote, “The saying is, you might as well commit suicide than go to Mind Springs because they will drive you to it.”
The Colorado News Collaborative interviewed more than 100 people about Mind Springs. The only praise came from someone who works in its hospital and from three self-identified clients who appeared in one of the organization’s marketing videos. CoLab could not locate any of the clients who provided those positive testimonials.
Prominent Summit County businesswoman Patti Casey took her life by suicide in January 2016. By that year’s end, so had 12 other county residents, a pattern that prompted Casey’s family to launch a mental health care nonprofit in her memory.
Building Hope quickly drew widespread support for its mission of reducing mental health stigma, increasing access to treatment for Spanish — and English — speakers, and addressing other local behavioral health challenges. Community members rallied around that mission and proposed a mill levy to pay for mental health services Mind Springs wasn’t providing.
In less than three years, Building Hope has used about $2 million in revenues to help more than 1,800 county residents who either don’t have insurance or have a deductible they can’t afford to pay for up to 12 therapy sessions.
“People who have been (harmed) so badly by the system just needed to have their health honored the way we do for other people who are sick,” says Jennifer McAtamney, Building Hope’s executive director.
Vaine, Summit’s assistant county manager, last year kicked Mind Springs’ detox program out of a county-owned building, then ended Mind Springs’ contract for that service and worked to prod the state to fund a different nonprofit to run it.
Likewise, FitzSimons has ended Mind Springs’ jail and mobile crisis response contracts and replaced them with programs of his choosing. “At first, we didn’t know we could say no to Mind Springs,” FitzSimons says. “But now I’ve got sheriffs all over the state calling to learn how to break from community mental health centers that aren’t getting the job done.”
Following Summit’s lead, Eagle County in 2017 passed its own mental health tax — on marijuana sales. Responding to what County Manager Jeff Shroll says are the same problems other counties have experienced with Mind Springs, his county then went a step further by forming its own community mental health center, called Eagle Valley Behavioral Health. The new nonprofit is a subsidiary of Vail Hospital, which will likely build a psychiatric hospital as well as a shorter-term overnight facility to stabilize people in crisis. It will include a team of clinicians co-responding to crises with law enforcement, a detox program and all the other safety net services expected by the state.
Leaders in Summit County are now working with those in Eagle County and with state behavioral health administrators to fully split from Mind Springs and join the new center.
The creation of the state’s 18th community mental health center — the first new one in several decades — challenges the status quo of Colorado’s mental health safety net system. The new center will not be joining the Colorado Behavioral Healthcare Council, the powerful trade group that represents all other centers throughout the state in contract negotiations and has lobbied against proposals requiring competitive bidding for mental health contracts and more transparency and accountability among the centers. Its creation also will take tens of millions of state and federal tax dollars annually out of Mind Springs’ pocket.
Meanwhile, other counties are also taking action. Mesa County has been researching ways to possibly end some of Mind Springs’ contracts there. Routt County has been changing some of its contracts with Mind Springs from a flat fee to an hourly rate so, as Melton tells it, “we actually pay for services that they’ve actually provided.”
In six months of interviews, no one — except for Sheriff FitzSimons — called to dismantle Colorado’s community mental health centers. But, as the state prepares to launch a new cabinet-level department overseeing mental health care this summer, Melton and officials from counties across the state have been asking for laws and policies to make the centers more transparent and accountable.
Colorado’s Office of Behavioral Health Director Robert Werthwein has been outspoken about the need for those changes. “Let’s just say, and I’m trying to be diplomatic, that a lot of work needs to be done,” he said of Mind Springs in particular. He will not be there to help make reforms because his department announced earlier this month that he will be resigning in February.
Susan Greene can be reached at [email protected]
This investigation is part of the “On Edge” series about Colorado’s mental health by the Colorado News Collaborative. “On Edge” reporting is supported by the Carter Center’s Rosalynn Carter Fellowship for Mental Health Reporting as well as by the Benjamin von Sternenfels Rosenthal Grant for Mental Health Investigative Journalism. To learn more about the Colorado News Collaborative, visit colabnews.co
Updated 6 p.m. Dec. 22, 2021 This story has been corrected to report that Eagle County passed its mental health tax in 2017, not 2018. That was before, not after, Summit County, which passed its tax in 2018.