Financial costs, stigma create barriers
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This graphic provided by the Colorado Health Institute shows reasons why Coloradans do not seek mental health assistance.
This graphic provided by the Colorado Health Institute shows reasons why Coloradans do not seek mental health assistance.

(Editor’s note: This article is the second in a three-part series examining mental health problems and available services in the Gunnison Valley.)


Gunnison’s Sarah Smith believes she’s struggled with anxiety much of her life. But it wasn’t until she had a mental health crisis two years ago that she realized she needed help.

Smith — whose name has been changed for the purpose of this article — was diagnosed with general anxiety disorder and attention deficit disorder. To hear her describe her condition, it’s not difficult to understand why she is exhausted at the end of the day, or how it interrupts everyday functions.

“It feels like my brain runs a million miles a minute all day long, and I feel like my brain is too big for my head,” Smith said. “I feel like I have an elephant on my chest and … I’ll make things a big deal that other people would not see as a big deal. I can’t get in the car without being afraid of getting a flat tire or hitting a deer.”

But while Smith is on a path of recovery — she’s in therapy, on medication and said she’s healthier than she’s been in a long time — her care is not without burdens.

Smith’s co-pay for each therapy session is $25, and she spends about $60 monthly for medication. Although she works for a large employer in the Gunnison Valley and has insurance to cover some of her costs, she admits her care takes a bite out of her budget.

Smith also deals with the social stigma of having a mental illness. She has yet to tell her parents about her condition because she’s concerned they would tell her to be “stronger.” Many of her friends and coworkers know, but sometimes she receives an errant comment about her condition.

“I think the big thing I struggle with is people not understanding,” Smith said. “The thing I hate is when people say to me, ‘Just relax.’ If I was able to ‘just relax,’ I would be saving myself a whole lot of money.”

A report by the Colorado Health Institute shows that Gunnison County is one area of the state where mental health is reported to be among the worst. The report indicates that economics and the inability for a community to talk about mental health — due to the stigma associated with it — are two of the greatest obstacles in people receiving care.

While Smith is a success story — she’s viewed as intelligent, successful and highly functioning now — mental health experts believe many go without seeking help due to the fear of the expense and the social appearance.

“What we’re still lacking is the ability to access people who won’t walk in the door due to cost, stigma, schedules, prior experience or even a friend’s experience,” said Kimberly Behounek, regional director for Center for Mental Health (CMH).


How much will it cost?

Making a living in the Gunnison Valley is notoriously difficult. It has long been reported that wages fail to keep pace with housing costs, fueling an affordable housing crisis in the county. Some families have difficulty with the cost and availability of childcare, while others are working multiple jobs just to make ends meet.

Insurance may cover some counseling sessions — typically three to eight — but many times the short stint of therapy isn’t enough to sustain improvement.

“Sometimes the frequency that people need isn’t what they can afford, so they do less,” said Behounek.

CMH is the only facility in Gunnison County which will take Medicaid clients. It also has a sliding scale for uninsured patients. They must provide income verification documents, and after six months conditions are reevaluated.

Yet for some, Behounek said, that may not be enough.

“Some pay as little as $10 a session — but even that may be cost prohibitive for some,” she said.

Locally, private counselors may not take insurance and typically charge $100-120 an hour. Meeting each week could cost a family almost $500 monthly.

Since sometimes mental health issues may impact more than one family member due to both genetic and environmental factors, Gunnison High School (GHS) counselor Jessica Vogan said difficult choices are made.

“It would be like you have a broken arm, but your child has to have their appendix out, so you choose to not get your arm fixed,” Vogan said.

Vogan — a trained mental health professional — knows first-hand the financial burden placed upon families when there is a mental health need. Many of the youth she counsels, she said, may not have access to other resources. That leaves her as the sole source of counseling for some.

“We can’t overstep our professional bounds and provide formal counseling,” said Vogan. “But I also know that I see that kid every single day and so, is it OK for me to do 10-minute check-ins every day or 20-minute check-ins every week because I know I’m more consistent than the therapist the family can’t afford and they go to once every two weeks? It’s challenging.”

Both CMH and GHS offer some financial assistance to those in need. CMH has set up the Zudwig Fund. Donations are accepted through CMH and can be earmarked for a specific need, such as helping to pay for someone’s counseling, or to fund a capital project such as the new mental health clinic being established in Crested Butte.

Meanwhile, GHS has the Second Wind fund which will pay for eight sessions for an uninsured student. However, the fund is restricted to students who have indicated they are suicidal.


What will people think?

Perhaps even greater than financial concerns is that surrounding perception associated with mental health needs.

In a joint venture with Gunnison Valley Health, CMH is establishing a mental health clinic in Crested Butte. But recently, Behounek said, the title of the new clinic was questioned. Concern was raised about patients seen walking into a mental health center.

Instead, Behounek was asked if the new facility could be called a wellness center.

Licensed Professional Counselor Laurie Boscaro has a private practice in Gunnison, and hangs a small shingle in front of the entrance to her office on Main Street. She readily acknowledges how stigma can prevent a patient from seeking treatment.

Boscaro noted that seldom do people have an issue going to a doctor to address back pain. However, she said, few people are as open about the counseling they receive to deal with anxiety that keeps them awake at night.

“We have a ways to go as a society in terms of how we talk about mental health,” Boscaro said. “Not talking about mental health allows people to feel isolated, when in reality they are surrounded by people with similar struggles.”

Boscaro said one in four people will experience a mental health issue at some point in their lives.

“The stigma that currently surrounds mental health creates barriers for people seeking treatment,” she continued. “People often resist admitting that they are struggling for fear of what others will think of them. I look forward to the day when going to counseling is viewed no differently than going to physical therapy, as both have a focus on living your best life.”

Behounek agreed with Boscaro’s assessment and hope for the future of mental health. She said one of the greatest aids to improving mental health in an area is the attitude of the community.

“We need a compassionate and understanding community that recognizes the diverse needs an individual has,” said Behounek.


(Chris Rourke can be contacted at 970.641.1414 or at