Finding peace in the holidays

Growing mental healthcare options can help locals year round

By Katherine Nettles

The holidays can be a challenging time for many people, especially living in a geographically remote mountain community. But for anyone who could use some extra support this time of year, there is a growing network of mental healthcare options for a variety of needs and income levels in the Gunnison Valley. In fact, the newest is right here in the heart of Crested Butte on Elk Avenue—the Axis Health System. 

Axis Health System merged with the former Center for Mental Health in 2021, which resulted in a new location at 412 Elk Avenue, and the merger is part of a bigger picture to provide holistic healthcare. Services began at the new location in September, and the care is ideal for those who have Medicaid or lower incomes. 

Sarah Kramer, who works at Axis as a licensed clinical social worker, therapist and clinical supervisor and who also serves on the board for Crested Butte State of Mind (CBSoM), characterizes the change as part of an incremental healthcare continuum.

Kramer explains that there are now more options than ever before to meet people’s mental healthcare needs, style preferences and resources. 

The Axis model: an integrated system

“We are a year and a half into having a new name,” says Kramer. “People may remember us as the Center for Mental Health, before we merged with Axis. The advantages of that merger are that Axis really thrives in what we call integrated care. So, doctors, dentists and many types of providers are eventually all working in the same spaces.” 

She says the 2000s brought a lot of funding to this model, and there is now more emphasis on community wellness centers in place of stand-alone mental health centers. “We are going to build on what those in the southwestern region have been working on,” says Kramer. That will begin with Axis making dental care available to Medicaid patients coming soon, most likely in Gunnison, since Medicaid patients currently have to travel out of Gunnison County to obtain dental services. Since there are several established primary care providers in the valley, Axis is not looking at offering that at this point. 

“In rural areas, our primary caregivers already do a lot of low-level mental health care. This partnership and the work we’re doing in the community is asking where are the holes that need to be filled and not getting in anyone’s way,” she says.

Seasonal challenges

Kramer addresses the double-edged sword of holiday stress for some people within our community, for many different reasons.

“Holidays mean a lot of things to different people. For some it means a lot of excitement and celebration. But for some that comes with a lot of expectations or demands of what it should be, and that creates a lot to fulfill. And what’s unique to Crested Butte is that a lot of us here have a chosen tribe rather than a family around us. You might be here and feel very connected to the community, but on certain calendar days emotions surface about our family of origin,” says Kramer. 

“Also, the economy here is very tourist driven, and the holidays happen during our busiest tourist weeks. So, a lot of locals aren’t going to take those days to travel home or even to connect with their tribe here. This is when we are busy and saving up for the other times of year when we have more time for ourselves. You might also be cut off from your family for any number of reasons.” 

Kramer says there are other factors, too. “If you suffer from depression, anxiety or other mood disorders, we’re entering the darkest times of the year and that can be the most difficult for people that struggle with mood. If you’re feeling more shuttered it might be harder to get outside and enjoy the things you enjoy, or it might be harder to motivate to go out and be connected with people.

“Depression and anxiety can tell us things that aren’t true, like ‘people don’t want to see me or connect,’ or ‘they are too busy for me,’ or ‘I won’t be any fun anyway.’ It can be hard to sort through that without support. …and it’s helpful for everyone to take moments to celebrate in any way you need to, to capstone your year,” says Kramer.

“The old story about needing help, is that this is a bad person who is not trying hard enough and making poor choices.  As brain science evolves, we can really see that our internal systems are very connected, and that utilizing treatment approaches like psychotherapy or medication makes sense. It’s validating that these approaches make sense.” 

Sorting the local options: Medicaid, insurance and CBSOM

For anyone embarking on a new journey for mental health care in the valley, there are several options for people at various incomes, health insurance coverage (or not insured) and urgency levels.  

“CBSoM has this beautiful grassroots name in the valley and they can help screen and direct people based on their needs and preferences,” says Kramer. 

As a common starting point for people, CBSoM connects providers and patients through referrals, scholarships and collaboration. 

For those on Medicaid, Axis has its new Elk Avenue location and a walk-in location in Gunnison. 

Axis also accepts insurance and self-pay. “We are able to offer a sliding scale of fees based on income,” says Kramer, ranging from $15–$35 for those under 200% of the national federal poverty level. She admits they are not the most affordable option for some higher incomes or higher insurance deductibles, but that is where the larger network comes in. For those paying out of pocket, Kramer estimates that most providers in the valley are between $80–$150 per hour.  

 For those who have insurance but find their coverage doesn’t make care attainable, CBSoM provides scholarships. CBSoM executive director Meghan Dougherty describes how it works.  

“Our Therapy Scholarship Program launched in April 2020 providing access to short-term, affordable, and quality mental health care in the Gunnison Valley. CBSoM scholarships help those who are uninsured or underinsured connect to our growing network of 40 local licensed therapists and two telehealth organizations for up to 10 sessions of individual counseling for free. We are helping remove barriers that include inability to pay for therapeutic intervention, challenges with locating and determining appropriate care, wait-time for care, and the daunting process of navigating the mental health care system. We have provided over 3,500 individual therapy sessions to those most in need,” she says.

Dougherty noted that the demand for this service remains high, and CBSoM helps an average of 10 people per month in getting care this way. The goal is to increase awareness and reduce the stigma associated with seeking support. “We consistently hear ‘if it wasn’t for the therapy scholarship, I would not have been able to access care,’” says Dougherty. “We are seeing the most common barrier to accessing mental health to be financial hardship and insurance not covering mental health services, in addition to challenges with navigating the system especially for those reaching out for help for the first time.” 

Gunnison Valley Health (GVH) launched a behavioral health team in the last few years, which also offers outpatient care and accepts insurance or self-pay. 

“GVH is benefitting from really being embedded in the whole healthcare team and that wrap-around healthcare model,” says Kramer. “They are specializing in a really small but essential set of services for the community.” GVH has also taken over jail-based and emergency services contracts for mental healthcare in the valley. 

For more urgent needs, Axis’s Gunnison location has walk-in hours which can work well for someone who needs to get same-day help. The GVH Emergency Room and both state and local mobile crisis lines are available 24/7 for people who may need support or who have a mental health emergency.

Kramer says the state crisis lines are important to keep local mobile crisis teams from being overwhelmed, so callers should be aware they might not get someone local right away. “They are trying to figure out how serious it is and whether to activate the local crisis team, or help you make a plan for how to get through the next couple days, etc. If it is serious, they will activate GVH to respond in person, immediately. GVH has done a phenomenal job with their response time. It’s a really good thing they’re doing.” Kramer says in crisis, it’s good to know you might have someone show up at your door. “But you might feel frustrated by the triage system. I tell people they can call dispatch and say ‘I need to talk to whoever is on call.’ But they are also trying not to flood the local team if it’s something that can be helped on the phone.”

Care for all seasons

“A beautiful thing about COVID is it really normalized therapy for folks,” says Kramer. “Our community has always been a place that the state recognizes has a lower providers per capita rate. So the more care that opens up, the better.”

Care is not only for the holidays, of course. “One of the common themes that comes through my door is the injured person who can’t do what they normally would to cope,” says Kramer. “And with age comes a diminished ability to take part in activities you love. So it’s about finding new ways to activate internal coping, or discover what your body can do. There’s a push in how to collaborate between providers to care for the whole person. If we’re going to maximize someone’s quality of life, it makes sense that therapists and doctors should be working together.” 

Kramer says this approach can do two things: destigmatize mental healthcare as overall wellness, but also confuse people as to what care is available. “When you had ‘mental health’ on the door people could recognize that,” she points out.

She says that because Axis services in Gunnison County are really focused on outpatient services, people usually have some idea of what they want when they make an appointment. A specially trained administrative patient experience specialist helps guide new clients to get enrolled.

“It can feel intimidating because we don’t always know what help we want, but it’s designed to be a collaborative process so the person can consider their options,” says Kramer.

Kramer says localized care is generally well regarded among her clients, even in a small town. “I think people who walk through the door appreciate knowing you’re really from here, that you live in and participate in this community. And for people who want more privacy than that there are a lot of other options that don’t require going through a door on Elk Avenue…In rural counseling you do get really good at not recognizing people unless they want to be recognized.”

Dougherty echoes the need to focus on helping each other and collaborating among providers. 

“CB State of Mind is part of a collaborative effort in our community truly moving the needle on positive behavioral health outcomes for anyone in need,” says Dougherty. “We are working together to address a variety of needs from prevention to treatment, to recovery across the life span. As I reflect on the past year, I am thankful for CBSoM’s growing partnerships continuing to spark conversations and normalizing talking about mental health up and down the valley.  We hear ‘thank you for what are you are doing’ on a daily basis from people who would not have been able to access support otherwise, and this is what keeps me going.  You are not alone!”