Health Policy Solutions

By Katie Kerwin McCrimmon

The pseudo therapist is the ultimate manly man: part Ron Burgundy, part Dr. Phil, and part Burt Reynolds.

Meet Dr. Rich Mahogany, the hilarious, irreverent online doc who uses dark humor to combat the deadly serious topic of male depression and suicide. Dr. M, as his creators affectionately call him, teaches breathing exercises complete with the F-word so you can deal with your SOB boss and that “105-year-old lady doing 7 in the fast lane.” His idea of yoga is the seventh-inning stretch.  He cleans his desk with a leaf blower, counts a long spell on the toilet as meditation and graduated from Porksausage University. So of course, his therapeutic recipe for guacamole includes bacon.

Welcome to Man Therapy (www.mantherapy.org), the Colorado creation that is going global.

Launched in July by an unlikely trio — Colorado’s Office of Suicide Prevention at the Colorado Department of Public Health and Environment; the Denver advertising firm, Cactus Communications; and the Carson J. Spencer Foundation, a Colorado suicide prevention nonprofit — Man Therapy is heading Down Under.

Beyond Blue, Australia’s leading organization that fights depression, is adapting Man Therapy and plans to launch a national public education campaign this summer. At first, Australian mental health experts were leery of using the word therapy in the name of their site because of the stigma men attach to the concept.

Dr. Mahogany does a trust fall with himself to demonstrate group therapy. Denver stage actor, John Arp, plays the irreverent fake doc. (Photo courtesy of www.mantherapy.org.)

But Joe Conrad, founder and CEO of Cactus, helped convince them that smashing that stigma was central to their concept.

“We’re not apologizing. We’re presenting it in a new light.”

As the Man Therapy creators explained in a PowerPoint presentation to a national conference of suicide experts:

“Men think therapy is for women and sissies. So they don’t seek the help that they need, when they need it. Let’s show them that therapy and honest talk can be masculine by providing them the therapist they need. A therapist who is a no-nonsense man’s man.  A therapist who will tell it like it is. A therapist like Dr. Rich Mahogany.

“He’s part doctor, part football coach, part drinking buddy and 100 percent action hero.”

Before signing on, Beyond Blue did a study with Australian men and found they loved Dr. M’s wacky attitude. So they decided to stick with the name Man Therapy and are creating a fake Aussie colleague dubbed Dr. Byron Ironwood who supposedly studied in Vienna once upon a time with Mahogany.

The Aussie un-therapist therapist will dole out advice mirroring the U.S. website. Mental health experts in Canada and the United Kingdom also are planning to join the movement and likely will use Dr. Mahogany for their campaigns, said Jarrod Hindman, director of Colorado’s Office of Suicide Prevention.

Along with winning a raft of health and advertising awards, Conrad said he’s been humbled by the impact Man Therapy started having right out of the chutes.

On July 8, the day the site launched, the New York Times ran a story about Man Therapy.  The site received more than 5,000 hits. That night, a message to Dr. Mahogany landed in Conrad’s inbox. It was from a 28-year-old combat veteran in Baton Rouge, La., who had been struggling with depression.

Apparently the man’s therapist had seen the site and told him to check it out.

“He took time to write about what an incredible experience it was for him. He said he got a lot out of it and had already emailed the link to combat vets in his support group,” Conrad recalled.

“He has a young family and said the site already helped him think differently and want to continue in therapy. We didn’t create the site for vets or people outside of Colorado,” Conrad said.

But, Man Therapy is clearly resonating with veterans, cops and other guy’s guys around the U.S. and the world.

“We’ve seen it continue to pick up speed,” Conrad said.

For instance, he just shipped a box of materials to a supervisor with the Boston Police Department. And he received an email from the head of the Connecticut National Guard.

“They were finding the campaign really helpful. They had just lost three guys to suicide in the last six months,” Conrad said.

So far, Conrad says Man Therapy has generated over 225,000 unique visitors with an average of about 572 per day. Men, therapists or women concerned about men in their lives poke around on average for several minutes, an eternity in the online world. More than 50,000 visitors have taken the “18-point head inspection,” which generates advice and recommendations. Ninety percent of those who took the self-assessment reported that they were likely or very likely to use the advice.

The campaign also features billboards, bus shelter ads, drink coasters to distribute in bars and, of course, award-winning videos intended to go viral.

Funding for the $400,000 project came from the Anschutz Family Foundation. Now those funds are gone and the partners are applying for new grants and keeping the project alive through pro-bono work, professional kudos and word of mouth.

“I’ve never been closer to a campaign. It’s our baby,” Conrad said.

Some mental health professionals were skeptical at first because they thought the campaign was too edgy.

But that was precisely the point of it. Conrad and his team tried to come at the campaign from an entirely new vantage point.

“We were trying to create something for men. That’s what drove us, no predetermined idea of what would work,” he said.

Added Hindman: “We’ve created a venue for men to dip their toes in the water for mental health support and treatment. It’s a place where men can safely and anonymously learn some things, try some tips or tools. And if you need professional help, you’ve got to man up and get it.”

The need for help in Colorado and around the country is more urgent than ever. And targeting men in their middle years has proved prescient.

The U.S. Centers for Disease Control and Prevention released a report earlier this month showing that suicides among middle-aged people rose dramatically from 1999 to 2010 both in the U.S. and in Colorado.

The suicide rate among people ages 35 to 64 increased across the U.S. by 28 percent during that period. Colorado consistently has had one of the highest suicide rates in the country and during that period saw an increase in the rate of suicides among people ages 35 to 64 from 25 to 41 percent.

Initially Man Therapy targeted men ages 25 to 54, but they are now expanding to reach men up to 64 years old.

Man Therapy’s veneer is humor. Check out the yoga video to see Dr. M’s 1970s Rocky-era shiny “yoga shorts.”

“Competitive Therapy” the way a man would do it. (Photo courtesy of www.mantherapy.org.)

Try taking the self-assessment and you’ll see questions like this: “Did you know koalas sleep 18 hours a day? Lazy little bastards. Tell me about your sleep habits.”

There’s a section of the site called Gentlemental Health 101. Dr. M does a trust fall with himself in the Group Therapy section. There’s “One-on-None,” DIY therapy. And of course, there’s a section on “Competitive Therapy” where you’ll get to see Dr. M naked and learn about “exercise, camaraderie, sweating, winning and/or hoisting championship trophies.”

Beneath the spoofs, however, there’s real advice, an omnipresent red phone with links to suicide help lines and ways to connect with other men or real therapists.

“We want depression to be a health issue. It’s been separated out as a mental health issue. Obviously one’s brain is part of one’s body. We should screen for it, just like they check your heart…just like asking about smoking or the number of drinks you have,” Hindman said.

The serious intent of the campaign is to reach men before they’re in crisis.

“There’s a huge void,” said Conrad. “Guys really bottle up their feelings. Unlike women, they don’t have networks of support. They tend to swallow their emotions. We tapped into something that’s universal.

“The strategy was not to wait for someone to hit a crisis, to catch things before they become a crisis. It’s much more of an early-intervention, prevention campaign,” Conrad said.

“We still have only scratched the surface with the potential impact.”

By Michael Lott-Manier

Colorado’s 69^th General Assembly convened in January in the shadow of heartbreaking tragedies in Aurora and in Newtown, Conn. Gov. John Hickenlooper and legislators from both parties expressed the desire to respond to a perceived connection between these atrocious crimes and serious mental illness.

Mental Health America of Colorado (MHAC), as it has done for 60 years, met with legislators and lobbyists to educate them about mental health. We reminded them that the vast majority (96 percent) of violent crimes are not committed by individuals with mental health conditions, that connecting violence and mental health in public policy further stigmatizes an already marginalized group of people, and that the best way to prevent violence in all its forms is to focus on the fundamentals of health and education.

The political expediency of taking action in response to tragic violence could have resulted in policies that would have worsened the stigma around mental health, negatively affecting many of the 1.5 million Coloradans who have a behavioral health condition. Motivated as always by the knowledge that mental illnesses and addictions are diagnosable and treatable health conditions, and that recovery is possible, MHAC and our partners chose to seize the opportunity created by renewed public attention to the issue of mental health. Together we moved the conversation toward policy changes that could help individuals with serious behavioral health problems and their families get the help they need, when they need it.

Evan Silverman of Denver testified before lawmakers about mental health issues. Silverman described the fear and isolation of being placed on an involuntary hold. He’s doing well now and shook Gov. John Hickenlooper’s hand during the bill signing.

After 120 days of intense debates, emotional advocacy, and legal fine-tuning, we are proud to say that 2013 truly was the Year of Mental Health at the Colorado state capitol.

In addition to other health care reforms (Medicaid expansion, improved parity for behavioral health coverage) two historic pieces of behavioral health legislation moved forward this year. One deals with Colorado’s civil commitment laws — statutes long overdue for a 21^st century update. The other is a bill that includes over $20 million in funding to create a statewide behavioral health crisis response system. The governor signed both bills into law at the Jefferson Center for Mental Health on May 16.

Updating commitment laws

Colorado’s current laws governing how law enforcement and medical professionals can commit someone against his or her will for mental health or addiction treatment were passed in the 1970s. Back then a diagnosis-driven mindset led to three separate commitment statutes for alcohol, drug and mental health treatment.  We advocate for a person-centered approach that recognizes the widespread issue of co-occurring mental health and substance use disorders. Colorado House Bill 13-1296 establishes a task force comprised of experts from the worlds of medicine, law enforcement, behavioral health advocacy and individuals who have lived experience with involuntary commitment to integrate these statutes into one new and improved law.

The group created by HB 13-1296 will also need to approve a legal definition of “danger” as it is used in statutes as meaning “substantial risk” of harm to self or others. There is currently no statutory definition of dangerousness due to mental illness in Colorado. Many people have expressed concerns about defining a term that has been variously interpreted by medical professionals and lawyers for decades. This task force is charged with creating a system that respects and balances individual civil rights, the concerns of family members, and the needs of law enforcement and medical professionals. Part of that system will be a just and standardized definition of danger to self or others.

Historic funding for crisis response

One of MHAC’s founding goals is to reduce the need for involuntary treatment. That is why we fought hard for funds to create a statewide behavioral health crisis response system that will offer evidence-based alternatives to hospitalization. We are very grateful for the support of Gov. Hickenlooper and members of the legislature’s Joint Budget Committee in securing over $20 million for this historic effort. Senate Bill 13-266 lays out guiding principles, crafted by MHAC and our partners at Metro Crisis Services and the Colorado Behavioral Healthcare Council, for a crisis system that will improve overall public services in our state.

Hickenlooper and behavioral health leaders from across Colorado attend the signing of HB 13-1296 and SB 13-266 at the Jefferson Center for Mental Health on May 16.

Calling 911 and/or going to the emergency room has become the de facto behavioral health crisis system for most Coloradans. This situation drains costly public resources while failing to improve public health and safety. SB 13-266 sets up a competitive bidding process for funding to establish regional crisis treatment centers across the state, form mobile crisis response teams and create a 24-hour statewide behavioral health crisis hotline. MHAC and our partners made sure that innovative, state of the art ideas — expanded peer-to-peer services, trauma informed care, public stigma reduction efforts — were also included in this historic bill.

It goes without saying that our work is just beginning. This legislative session has empowered Colorado’s behavioral health community to take bold steps to transform how we deal with this vital and long-ignored area of health care. With profound gratitude to the governor and the legislature, we are thrilled to be a part of the historic changes set in motion this year.

Michael Lott-Manier is the public policy and advocacy coordinator at Mental Health America of Colorado.

By Katie Kerwin McCrimmon

In an ambitious new health agenda, Gov. John Hickenlooper is pledging to cut the number of uninsured people in Colorado by 520,000, prevent 150,000 Coloradans from becoming obese and reduce Medicaid costs by $280 million.

Hickenlooper this week released a report called The State of Health as part of his commitment to make Colorado the healthiest state in the nation.

“We want to make sure that from the Eastern Plains to the San Juans, from rural communities to urban communities, that at any income, age, gender or ethnicity that everybody has the chance to live the healthiest life they possibly can,” Hickenlooper said Monday when he unveiled the new report.

To emphasize his health theme, the governor and some of his top aides pedaled over from the Capitol on B-cycle bikes. The governor’s bike fittingly was sponsored by LiveWell Colorado, a statewide nonprofit committed to reducing obesity and promoting healthier communities in Colorado.

The report centers on four key areas of focus: wellness and prevention, expanding health access and coverage, improving health systems and boosting value while cutting costs.

“We need to make sure that all Coloradans have the access to care at the right time and the right place.

Among the specific goals, Hickenlooper plans to:

• Prevent 92,000 people from misusing prescription drugs
• Improve oral health by ensuring that 7,500 children visit a dentist before age 1.
• Integrate physical and behavioral health systems
• Engage at least half of state employees in health risk assessments and encourage prevention and wellness programs

With respect to covering more of the uninsured, Hickenlooper said he plans to focus intently on cutting costs while expanding care.

“We’re going to expand coverage and I guarantee you we’re going to improve quality, but we also have to focus now on controlling costs,” Hickenlooper said.

“If we’re going to do this, it’s going to require all hands on deck.”

By Katie Kerwin McCrimmon

Colorado is the only state in the country where three separate laws govern the actions of police, emergency doctors, mental health and substance abuse experts  when patients appear to be a danger to themselves or others and need to be held against their will for 72 hours.

A new law winding its way through the legislature, HB 13-1296,  for the first time defines key terms related to involuntary holds including “danger to self or others” and what it means to be “gravely disabled” because of a mental health crisis.

Originally intended to meld and clarify the three disparate involuntary commitment laws, the bill instead creates a task force of health and law enforcement experts who will spend the summer studying how best to streamline Colorado’s laws relating to emergency holds. The task force is expected to produce draft legislation for 2014.

To help prevent another tragedy like last July’s theater massacre in Aurora, Gov. John Hickenlooper in December announced an $18 million plan to improve Colorado’s mental health systems by creating better crisis systems and clarifying the state’s civil commitment laws.

Reggie Bicha, executive director of the Colorado Department of Human Services, says Colorado is the only state in the country with three statutes that govern involuntary commitment.

“We believe individuals who are struggling with mental health (challenges) should receive services on a voluntary basis whenever possible. We are absolutely committed to reducing the use of involuntary commitment,” Reggie Bicha, executive director of Colorado’s Department of Human Services testified before the House health committee that unanimously moved the bill forward on Tuesday.

“That said, there are times when we must use the system,” Bicha said.

Colorado’s current system of having three separate laws — one related to mental health, one to alcohol abuse and the third to drug use — is out of date and confusing for workers coping with emergencies on the ground, Bicha said.

Furthermore, behavioral health experts now know that people struggling with mental health challenges often self-medicate with alcohol and drugs.  Or the reverse can be true. Substance abuse can increase the chances of psychosis later in life. Since substance use disorders can be intimately tied to mental health disorders, experts say it makes sense to meld laws related to involuntary commitment.

During an earlier briefing for lawmakers on involuntary commitments, experts from Mental Health America of Colorado said that in the 2011 fiscal year, 28,700 individuals were placed on emergency mental health holds or were certified for commitment. Of those:

• 20,819 were placed on at least one 72-hour hold
• About 3,800 were certified for at least one short- or long-term commitment.
• 3,942 individuals committed themselves voluntarily
• Ages ranged from under 5 to over 60
• Two-thirds were Anglo while about half were female and half were male
• 58 percent of all holds and certifications were the result of danger to self while only 3.5 percent related to danger to others.
• About 16 percent related to grave disability. Data to categorize the remaining holds is missing.

Data about mental health and substance abuse challenges in jails and prisons is also startling.

Arapahoe County Sheriff Grayson Robinson says as many as one in four of the inmates in his jail on any given day are dealing with a mental health challenge.

Arapahoe County Sheriff Grayson Robinson told lawmakers what they already know. “The jails of our country have become the mental health institutions of our country because we no longer have the capacity to care for these people.”

Data from his facility has found that nearly one in four of about 2,000 people in the Arapahoe County jail on any given day is suffering from a significant mental health issue while 85 percent or more say they were under the influence of alcohol or drugs while engaged in the criminal behavior that led to incarceration.

Robinson said he strongly supports improving the state’s mental health systems and better clarifying involuntary holds.

“This is clearly an important bill to mental health. It’s also a public safety matter.”

Robinson said law enforcement officials are often the first to confront people struggling with mental health challenges and substance abuse.

“Sometimes it’s confusing about which option to take,” Robinson said of Colorado’s three disparate statutes.

Also testifying on behalf of the bill were patients and parents of children who have struggled with mental health crises.

Evan Silverman of Denver shared with lawmakers how two psychotic breaks in the 1990s led to involuntary commitments. Silverman also spoke last week during the session sponsored by Mental Health America of Colorado. (Read more: Attacks from left and right undermine gun bill on mental health.)

Evan Silverman of Denver said he experienced his first bout of severe depression and paranoia in college. Three psychotic breaks followed in the 1999s. Silverman, who received a diagnosis of schizophrenia, is now doing well and works at Tattered Cover Book Store. But he says that he fears he might not have asked for help if he knew his name could end up on a police list of potentially dangerous patients.

He began by describing his peers in kindergarten:

“There were five of us in the advanced reading group. Three of those children ended up at Harvard and one at the University of Texas, followed by medical school at Stanford. I was not one of them. I am the only one who has been involuntarily committed.”

The first time he was committed, Silverman recalled the torture of being unable to sleep and counting every second for two days and two nights. He described seeing flies trapped between two panes of glass. Some were alive and some were dead. He empathized with the ones that were alive but could not escape.

“My doctor said he had never seen anyone so depressed,” Silverman recalled.

He recovered, then had a second psychotic break during which his father had to take him to the hospital. During that commitment, because Silverman’s regular psychiatrist was out of town for an extended vacation, he was taken to a different hospital where he had to endure confinement in an isolation room for 13 days.

Ultimately, Silverman was diagnosed with schizophrenia. He believes the emergency holds may have saved his life. But, he said he could have been hospitalized for a much shorter period of time during his second commitment had he received better care.

Silverman is now doing well, working at the Tattered Cover Book Store and is advocating for people with mental illnesses as a board member for Mental Health America of Colorado.

Sometimes parents know that their children need help, but can’t get it.

“This is an important bill for our communities. This is an important bill for our families,” said Rep. Tracy Kraft-Tharp, a co-sponsor of the bill along with Rep. Beth McCann. “People in our society have worked with families who may have an adult or adolescent child who is having a mental health crisis. They are at a loss as to what to do and they need help.”

Among those who wished his family had gotten help before a tragedy was Ron Liggett.

“My son has been in the news for murdering his mother,” Liggett told lawmakers.

His son, Ari Liggett, 24, has been accused of poisoning his mother, Beverly Liggett, then dismembering her body.

“We spent 20 years with the mental health system and know all its strengths and failures,” Liggett said. “I am representing myself and perhaps other families dealing with violent children.”

Liggett said he gets numerous calls from other distraught parents.

“We have a lot of young men that are very frustrated and angry and will be expressing it,” he said.

Citing the Boston explosions this week, Liggett said our society must focus equally on the potential dangers of both terrorism and threats related to mental health.

“We need to think of resources differently,’’ he said. “The ripple effect of what one mentally ill person can do to a neighborhood and a family is huge. There’s no end to this.”

By Katie Kerwin McCrimmon

As Adam Lanza fired 154 shots from a rifle, mowing down 20 first graders and six educators at Sandy Hook Elementary School, a group of gun control advocates and law enforcement officers happened to be meeting in Colorado to craft legislation to curb gun violence here.

Rep. Rhonda Fields, D-Aurora, who lost her son to a 2005 shooting, and Rep. Beth McCann, D-Denver, a former prosecutor and Denver manager of safety, both attended the Dec. 15 meeting. The news from Newtown, Conn., was fresh and shocking. Heartbreaking updates came in spurts on phones. No one knew at first why Lanza had aimed his violence at first-graders or that he had also killed his mother with her own gun. But it was clear immediately that a massacre of defenseless young children would dramatically alter the debate about guns in Colorado and the U.S., just like the Aurora theater shootings months earlier.

After the November elections, Colorado Democrats knew they would control both houses of the legislature and the governor’s office. Still, they wanted at least one of their gun-control measures to garner bipartisan support. Republicans here were unlikely to support universal background checks or restrictions on high-capacity magazines. So, Democrats honed in on a measure to keep guns out of the hands of people suffering from mental illnesses, hoping to attract support from conservatives.

Rep. Beth McCann is trying to win bipartisan support for a gun bill tied to mental health. While she doesn’t want to stigmatize people suffering from mental illnesses, she wants to protect the public.

Even the NRA endorses a national database of people with mental illnesses. The group frequently touts its slogan: “Guns don’t kill people. People do.” The inaccurate implication is that gun violence stems almost entirely from people with mental illnesses. Days after Newtown, NRA leader Wayne LaPierre decried “an unknown number of genuine monsters, people that are so deranged, so evil, so possessed by voices and driven by demons, that no sane person can every possibly comprehend them.”

In Colorado, McCann planned to sponsor a measure that zeroed in on keeping guns out of the hands of people experiencing mental illness. (Click here to read more.) By requiring mental health workers to report potentially violent patients, she hopes to keep guns away from people like accused Aurora-theater shooter, James Holmes.

“I’m looking at how to make our communities safer,” McCann said.

For instance, in the Aurora case, court records show Holmes had confessed to his psychiatrist that he was having homicidal thoughts more than a month before his attack. The psychiatrist reported those concerns to campus police, but Holmes was still able to stockpile guns, ammunition and sophisticated bomb-making equipment in advance of his July rampage.

While McCann is concerned about protecting the rights of people with mental illnesses, she’s also trying to safeguard the public. She planned to introduce her bill last month. But as drafts circulated around the Capitol, McCann took heat from all sides. Now she says the bill probably will call for a study instead of requiring mental health workers to report concerns about potentially dangerous patients to police. She may introduce it by Friday.

“I’m working with Republicans to see if we can come up with some mutually agreeable language,” McCann said Wednesday.

As a bipartisan group of U.S. Senators is coming together this week to allow the first debate on a major gun control bill in Congress since 1993, McCann is leading her own challenging behind-the-scenes negotiations to introduce the last piece of Colorado’s package of gun reforms that advocates were discussing back in December. Gov. John Hickenlooper has already signed measures for universal background checks and limits on high-capacity ammunition clips.

Now only the mental health questions remain on the table.

“It’s very challenging. It’s hard to figure out who’s going to make the decision about when someone is so dangerous that they should not be able to buy a gun. How do you predict that?” McCann said.

Guns seizure laws in Connecticut, Indiana provide models

As McCann has fought for a bill on guns and mental health, it turns out that forces on both the left and right colluded to undermine the effort. Gun-rights advocates in Colorado disagreed sharply with the NRA and didn’t want any lists of gun owners whether they had suffered mental illnesses or not. Civil libertarians objected to a lack of due process that could allow seizures of guns from innocent people. And advocates for people experiencing mental illnesses worried that the proposed bill would further stigmatize people in need of care and could frighten them away from seeking treatment.

Ironically, one of the most promising models for how to thwart gun violence among people experiencing mental health crises has been on the books since 1999 in Adam Lanza’s home state of Connecticut. That law allows police to obtain a warrant and seize guns from people who might be a danger to themselves or others. Indiana also has a gun seizure law. Passed in 2005 after a fatal shooting of a police officer by a man experiencing paranoia, it allows police to seize firearms without a warrant if a person appears to be mentally unstable and potentially violent. People who have had guns seized are then entitled to a hearing to determine if they can have them back.

While the laws could provide models for Colorado, they have been used very little in Connecticut and Indiana. (Read more about the Indiana law. Read more about the Connecticut law.)

And rather than preventing mass shootings like Newtown, Aurora or Columbine, the laws have been most likely to prevent suicides and potential murder-suicides.

Small fraction of violence linked to mental illness

Dr. Paul Appelbaum of Columbia, says that only a small percentage of violence is linked to mental illness. Laws reducing access to guns in general may be more effective than targeting people with mental illnesses.

National experts on guns and mental illness say Colorado may be better off taking a slower approach on new legislation to prevent gun violence related to mental illness. In New York, mental health advocates believe that the legislation Gov. Andrew Cuomo rushed into law in January could harm people with mental illnesses without curbing violence.

“The amount of attention that’s been devoted to mental illness since the Newtown shootings seems to me to be vastly disproportionate to the actual impact of mental illness on gun violence,” said Dr. Paul Appelbaum, a professor of psychiatry, medicine and law at Columbia University.

“The best data we have suggests that in this country somewhere between 3 and 5 percent of violence is attributable to mental illness,” Appelbaum said. “You could spend a lot of time and effort trying to identify everybody with a mental illness who might be dangerous and restricting their access to weapons and you’d be left with 95 to 97 percent of the violence we have now.

“Preventing (dangerous people) from having access to guns is a good thing. But the focus in my view ought to be on reducing access to guns as opposed to focusing on people with mental illness.”

Appelbaum is one of many New York mental health professionals who worries that the portion of the new New York gun law that requires mandatory reporting of potentially dangerous patients will do much more harm than good.

“It’s highly unlikely to have much of an effect on rates of violence,” Appelbaum said. “And it’s likely to be counterproductive in the long run. This is truly an unprecedented intrusion on the confidentiality of the therapist-patient relationship. It’s likely to deter people from seeking treatment.”

Fears that government lists could stop people from seeking help

One such patient who says mandatory reporting could have deterred him from asking for help during a psychotic break is Evan Silverman of Denver.

Evan Silverman of Denver said he experienced his first bout of severe depression and paranoia in college. Three psychotic breaks followed in the 1999s. Silverman, who received a diagnosis of schizophrenia, is now doing well and works at Tattered Cover Book Store. But he says that he fears he might not have asked for help if he knew his name could end up on a police list of potentially dangerous patients.

Silverman was a top student as a child then experienced his first bout of severe depression and paranoid delusions in college.

“I thought my neighbor was going to kill me,” Silverman said. His dad flew to Oregon to help him and Silverman graduated from college and went to work at Tattered Cover. Then he experienced two psychotic breaks in the 1990s that culminated with a long-term hospitalization.

As the psychosis set a second time, Silverman knew something was wrong and called his dad to meet him at a restaurant. As his dad arrived, Silverman raced out the door, convinced that someone from the FBI was tracking him.

“I knew in the deepest part of my soul that my dad would act in my best interest and that I needed his help,” Silverman recalled during a session on mental illness with Colorado lawmakers.

Silverman’s father drove him to the ER, where Silverman recalls trying to escape. He was committed and endured 13 excruciating days in isolation, convinced that doctors were trying to poison him, unable to eat and suffering delusions.

“One of my delusions while in the hospital was that to be free all I had to do was go to Tijuana (Mexico). Tijuana is always a somewhat dangerous place and especially for someone experiencing a psychotic break,” Silverman said. “I have heard it stated that people with serious and persistent mental illness are 11 times more likely than the general population to be victims of violent crime.

“If I had thought that by going to the hospital my confidentiality would be breached or my name would be added to a database of people who are considered potentially dangerous, I might have made the choice to not call my dad at all and actually headed to Mexico. I could have died,” said Silverman, now 38.

Initially diagnosed with bipolar disorder, Silverman ultimately received a diagnosis of schizophrenia. He is doing much better now, considers his medications critical to his health and continues to work at Tattered Cover.

Appelbaum of Columbia believes patients with severe mental illness who are most likely to hurt themselves or others also would be most likely to fear that if they’re honest with their mental health provider, that person would then betray longstanding patient privacy and report them to police. Many could fear having their names on government lists where they could remain for years.

“This is truly a sea change in how we’ve dealt with the privacy of the treatment relationship. We’re now turning (therapists) into agents of the state, charged with trying to identify people who may create a serious risk of harm to themselves or to other people.

“Part of the answer is what many people don’t want to hear. Guns that can kill large numbers of people ought not to be as available as they are today.”

Appelbaum thinks focusing on people with mental illness is a diversion from the truly dangerous people.

“Only a small number are mentally ill. Most murders are committed by people who are angry, drunk or using violence in the commission of another crime,” he said. “Identifying those people and depriving them of access to weapons is much more likely to be effective than this dragnet approach that we’ve taken toward people with mental illness, the vast majority of whom won’t hurt themselves or other people.”

‘People become mentally ill. And they recover.’

Another complication of keeping guns away from people experiencing mental health problems is that crises come and go. Sometimes people have mental illnesses and gun access can be dangerous. Sometimes they get better.

Deborah Azreal is a research scientist at the Harvard School of Public Health’s Injury Control Research Center.

She says that people with mental illnesses are at low risk in general for violence, but the biggest threat is suicide.

“Limiting access to firearms among people who are at risk of suicide — when they are actually at risk of suicide — is a laudable goal and isn’t being addressed much in the wake of Newtown,” Azrael said.

Rather than focusing on the purchase of new weapons, changing behaviors around access to existing weapons could be also prove effective, she said.

For instance, the slogan “Friends don’t let friends drive drunk” has helped stigmatize drunk driving. Azrael says there could be great potential in mounting a similar campaign to routinely lock up guns and prevent access to them during periods of stress.

Azrael’s fellow researchers at Harvard often talk about the “11^th Commandment of gun safety”: if you or someone you know is going through hard times — loss of a job, struggle with alcohol or drugs, divorce or a legal problem — it’s critical to limit the person’s access to guns during that period of vulnerability.

Azrael said there are interesting models around the country where places like gun ranges, pawnshops or gun stores allow the temporary surrender of guns.

“Responsible gun owners and responsible people need to be aware of that risk and willing to intervene,” she said. “It’s important to acknowledge that there are hundreds of millions of guns out there and that is going to limit the impact (of new gun laws.)”

Azrael also thinks the Connecticut law —allowing for temporary gun seizure when a person appears to be dangerous — holds promise.

“It’s ironic. It could have been used had someone called in the case of the Lanzas. I’m not pointing fingers at anyone, but one issue with mental health and firearms is that mental health isn’t a stable condition. People become mentally ill and they recover.

“We know that suicidal crises don’t last,” Azrael said. “If you can interrupt a process of (suicidal thoughts) you have a real chance of saving a life.”

Access to guns during periods of instability can be dangerous.

“The real issue with people who are unstable and have guns is that they are much more likely (to become violent) when they’re in possession of a gun already,” Azrael said. “There are 300 million Americans and we all have real risks of going through periods of mental illness.’’

“By all means, fix the mental health systems. The benefits are likely to be enormous in all sorts of ways,” Azrael said.

Appelbaum of Columbia is also a supporter of gun seizure laws. In Indiana, a person who has had a gun seized gets a hearing within 14 days.

“But in that critical period when some guy is beating his wife and threatening to blow her head off or belligerent and threatening people in a bar, he doesn’t have a weapon,” Appelbaum said.

In essence, there’s a critical cooling-off period.

Why mental health gun bill concerned advocates on left and right

In Colorado, gun-rights advocates, civil libertarians and advocates for the mentally ill all had reservations about the proposed bill related to guns and mental health.

Dudley Brown, executive director of Rocky Mountain Gun Owners, thought NRA leaders were crazy to endorse databases of people with mental illnesses.

“What’s scary about this is that a lot of soldiers come home from Iraq and Afghanistan and they’re going to need to talk to a counselor,” Brown said.  “If all of a sudden, the threat of talking to a counselor means they may not have the ability to possess a firearm for hunting or self-defense or a job, they’re not going to talk to a counselor.

“It’s no surprise that many people in the military possess firearms,” Brown said. “They want to go duck hunting with their son every year or they’re police officers or want guns for self-defense or target shooting.”

Brown said some studies show nearly half of Americans will have some sort of mental health challenge in their lifetimes.

“So, in other words, you can strip half of America’s rights to keep and bear arms. This is not a little tiny change in the law. It’s massive and it’s rife for potential lawsuits,” Brown said.

Dave Kopel, a libertarian with the Independence Institute, wants dangerous people off the streets, but worries about taking guns away from innocent people.

Dave Kopel is research director at the libertarian think tank, the Independence Institute. He’s also a policy analyst with the Cato Institute and a constitutional law professor at the University of Denver. He applauds the idea of a study on how to better keep guns out of the hands of people who are mentally ill.

“Mental health is a complex issue. It’s important to get all the experts in the room. Rep. McCann, to her credit, did not just have this drafted in the (Democratic) caucus. It was circulated to some Republicans and they raised concerns,” Kopel said.

“We need to take one step back,” Kopel said. “The issue is less about somebody like James Holmes buying a gun — which we don’t want him to do — but that James Holmes is walking the streets.

“You want a guy like him civilly committed and off the streets period,” Kopel said. “We need to strengthen our civil commitment laws and provide substantial funding for that. That is something that’s expensive in the short run, but will save lives and pay for itself in reduced prison costs. If you can commit a guy for three years and cure him, that’s better than a life sentence for 50 years or going through a capital trial.”

Kopel believes the big problem with ordering mental health workers to report potentially dangerous patients, then banning them from buying guns is that it takes away due process rights.

“A social worker or nurse says this person shouldn’t have a gun. That immediately imposes a gun ban on the person and turns them into a felon,” Kopel said. From his libertarian approach, he says, “you don’t take anybody’s rights away just based on someone’s accusations.”

In the Holmes case, Kopel believes that when the psychiatrist warned police about her client’s suicidal fantasies, he should have been placed on a 72-hour hold.

“If the person is taking steps (toward violence) you definitely want to move fast,” Kopel said. “I’m just concerned about due process. I want the guns taken away from the people from whom they should be taken. And I want it done with a fair process so we don’t turn innocent people into criminals.”

Many advocates for people with mental illnesses want fewer guns in general, but worry that measures that specifically target people experience mental illness could be misguided.

Michael Lott-Manier is public policy and advocacy coordinator for Mental Health America of Colorado. The group helped advise McCann, but didn’t take a formal position on her bill.

“Our goal is to get people treatment when they need it and to encourage wellness,” Lott-Manier said.  “When someone commits an act of violence whether it’s suicide with a firearm or one of these rampage killings, we want to prevent these atrocities from happening. But we want to go about it in a way that doesn’t keep people from seeking treatment.

“We want to help them when they need it,’’ he said. “Recovery is always possible even from serious mental illness.”

When there’s a highly publicized case like Newtown or Aurora and there are allegations of serious mental illness, Lott-Manier points out that system failures are complex.

“We didn’t just fail on guns. The failure happened a long time before any of these people got guns. There was a failure to address a pretty serious mental illness.”

Lott-Manier said lack of treatment can lead to violent outbursts. And when it comes to gun deaths, many more Coloradans commit suicide than use a gun to kill someone else, especially in an extremely rare rampage-style killing.

“We don’t want to say that any new gun laws are bad,” he said. “But we should all help people get the treatment they need.”

Lott-Manier says evidence and data about violence are quite clear.

“The way to prevent gun violence is to prevent violence and trauma in early childhood,” he said. “Those are the things that really matter to our community.”

By Katie Kerwin McCrimmon

Colorado is flunking when it comes to children’s health and it’s time to mount an aggressive turnaround campaign.

That was one of the key lessons from the release last week of the annual Colorado Health Report Card.

“We’re not growing our own healthy children. Our child obesity rate remains in the middle of the pack,” said Anne Warhover, president and CEO of the Colorado Health Foundation, which releases the report card each spring. “That’s where the foundation is really going to emphasize more and more of our work in trying to prevent childhood obesity. It leads to so much cost in our system.”

Ellen Robinson is Colorado’s new health and wellness director.

Warhover also announced that the foundation is funding a new position in Gov. John Hickenlooper’s office: a state director of health and wellness. In an era when Mayor Michael Bloomberg of New York has become the de facto U.S. Surgeon General by combating everything from smoking to sugar-laden drinks and assault weapons, leadership from politicians can be vital in driving improvements in health. Hickenlooper often repeats the mantra that he wants Colorado to be the healthiest state in the nation. Now Ellen Robinson, whose family started Denver’s Robinson Dairy in 1885, will become the state’s new health and wellness director.

Her work will be challenging.

For years, Coloradans have been congratulating themselves because the state is the leanest in the nation. But, in fact, Colorado’s adult obesity rate has doubled in fewer than 20 years while child obesity rates continue to climb at one of the fastest clips in the nation.

Source: 2012 Colorado Health Report Card. (Click on image to enlarge.)

Overall, when it comes to nurturing healthy children, the state declined from a C- in 2011 down to a D+ in 2012, where the state had hovered the previous two years.  Pregnant moms and newborns fare only slightly better with consistently poor C grades, while adolescents, adults and seniors get Bs.

For this year’s report, study authors posed the question “What if Colorado were number 1?” Analysts at the Colorado Health Institute teamed with the Colorado Health Foundation and found that being No. 1 in 38 key health indicators would not only boost the physical and mental health of Coloradans, but would also save taxpayers and businesses hundreds of millions of dollars annually while helping to revive the economy.

Kelly Brough, president and CEO of the Denver Metro Chamber of Commerce, said people in the business community now understand that improving health in Colorado is central to hiking profits.

“The first step toward fixing a problem is acknowledging you have one,” said Brough. “To not be No. 1 in all of these indicators is shocking. The economic imperative for us to do this is critical.”

Brough said the Chamber recently identified three pillars upon which business success will rest: dramatic improvements in health, education and infrastructure.

Brough said that prospective employers have long lists they’re checking and that Colorado’s health status is as vital as the state’s tax policies.

“We’re the leanest. We exercise the most and we’re the smartest,” Brough said. “I sell this all day long.

“But these aren’t stupid people. They see our growth rate (in child and adult obesity). While the South may be staying ahead of us, we’re coming on fast. These CEOs are smart enough to look at the generation we’re raising and those numbers are not at all encouraging,” Brough said.

She highlighted some of the potential savings identified in this year’s Health Report Card if Colorado could climb to No. 1:

• $230 million a year if Colorado could cut its obesity rate in half, back to 1996 levels. (Currently, Colorado ranks No. 1 in its low rate of adult obesity, but one in five Colorado adults is obese. The state ranks 23^rd in the nation for child obesity with 14.2 percent of children now obese. The percentages swell much more when analysts include adults and children who are overweight, but not yet considered obese.)
• $184 million a year if Colorado ranked 1^st, not 27^th on teen pregnancy and 3,000 fewer teens got pregnant each year.
• $121 million a year if the state did a better job of treating depression.

Brough said Colorado must tap its popularity with fit, young people and work much harder to give children who grow up in Colorado better opportunities.

“Colorado is the top attraction for 25- to 34-year-olds. Why care? They also come very well educated to our state. We have jobs and our quality of life really matters to them: our sunshine, our mountains, our outdoor lifestyles. We’re hardworking and smart and we get up earlier on weekends than weekdays.”

Employers look for fit, smart employees who cost less because they stay well, fill fewer prescriptions and have much lower rates of heart disease, cancer and diabetes, three of the most expensive illnesses.

“They want a workforce that is healthy,” she said. “But it’s not enough to be among states with good health. We need to lead the world.”

If Colorado continues to rear unhealthy children, the state will soon become unattractive to both prospective employers and bright young people who want to move here.

“We are losing our competitive position,” she said. “Why do we care (about health)? Because it costs so damn much not to care.”

Source: 2012 Colorado Health Report Card. (Click on image to enlarge.)

Warhover challenged health advocates and business leaders to each tackle a single indicator and fight for first place in the nation.

“What if we were No. 1 instead of 36^th (on children who have insurance)? An additional 78,000 kids would need to be insured. That’s not a lot of kids. We can do that. We could get to be No. 1 in normal weight (newborns) if 2,100 babies were born in a given year at a healthy weight,” Warhover said.

“It’s not that aspirational,” added Michele Lueck, president and CEO of the Colorado Health Institute, whose researchers analyzed the health data for the report card.

Lueck cited some examples. Currently only 77 percent of Colorado kids get preventive dental visits. Hawaii does much better with nearly 87 percent of kids getting dental care.

To beat Hawaii, Colorado would need to get dental visits for 116,000 more kids a year.

“It seems like we can get to this,” Lueck said and joked that perhaps the business or health groups that sponsor and succeed on that indicator should score a trip to Hawaii.

“It seems doable. We can be No. 1 in things other than football,” Lueck said.

In addition to capturing bragging rights, the cost savings would be substantial.

“Mental health is one of the most striking,” said Lueck. “The cost savings would be over $120 million annually if we did a better job with mental health, not eliminating it, just getting the No. 1 ranking.”

While the 2012 Colorado Health Report Card posts bleak grades overall, Shepard Nevel, vice president for policy and evaluation for the Colorado Health Foundation, sees the cup (of water, not soda) very much half full.

“These are goals that we as a state can achieve,” he said.

It’s very doable to make sure that 2,100 additional babies each year are born at healthy birth weights or that an additional 23,400 children have access to regular health care at a “medical home.”

Reversing the child obesity epidemic will be the first order of business as the Health Foundation moves forward.

“Child obesity has such a significant and enduring impact on health, the economy, our health care systems and education,” Nevel said.

“These are significant, but very achievable goals.”

By Michael Lott Manier

In the wake of the heartbreaking tragedies in Aurora and Newtown, the debate over gun control has taken center stage in Colorado. The legislature is now set to consider an expansion of the ways in which individuals who have received treatment for mental health conditions or substance use disorders (collectively known as behavioral health) can be prohibited from purchasing or possessing firearms.

The rampage killings that reignited the gun control debate have been inextricably linked in the public consciousness with the issue of mental health. Politicians and gun-rights advocates have focused on the message that the way to keep our communities safe is to keep guns out of the hands of “the mentally ill” or “the wrong people.” Certainly there are commonsense ways to protect our communities from gun violence that focus on behavioral health. In fact, limiting access to guns among individuals who have been committed to a facility for mental health treatment is already part of Colorado law.

Source: Colorado Department of Public Health and Environment. (Click on image to enlarge.)

What the gun control debate in Colorado and across the U.S. has ignored, however, is that the most significant intersection of behavioral health and gun violence is not mass shootings nor violence against others. It is suicide.

Suicide, whether or not it is committed with a firearm, is an urgent public health issue in Colorado. In 2011 at least 910 Coloradans died from suicide, making it the seventh leading cause of death. Among Coloradans ages 10 to 34, suicide was the second leading cause of death — more than homicide, influenza and pneumonia, diabetes, leukemia, lymphoma and heart disease combined. Only motor vehicle crashes kill more young people than suicide in Colorado.

One of the reasons for the consistently high suicide rate in Colorado is the use of firearms. Homicides by firearm have been trending downward in the United States thanks in large part to advances in emergency medicine. If someone is shot by another person during the commission of a crime in the U.S. and receives emergency care in time, he or she has about an 80 percent chance of survival. The chances are reversed when it comes to suicide. If someone uses a gun to kill him or herself, the fatality rate is 85 percent.

Nationally, two-thirds of all firearms deaths each year are suicides. In Colorado, the numbers are more acute. From 2004 to 2011, 4,362 people died as a result of firearm wounds in Colorado. More than three quarters of those deaths — 3,315 — were suicides. At least half of all suicides in Colorado are committed with a firearm. As is the case everywhere, the overwhelming majority of those killed are male. More white non-Hispanic men commit suicide with a firearm in Colorado than almost any other state.

Source: Colorado Department of Public Health and Environment. (Click on image to enlarge.)

These grim statistics stand in sharp contrast to the numbers associated with violence against others. People with a mental health diagnosis who do not have a co-occurring substance use disorder are no more likely than the general population to commit an act of violence against another person.  Only 4 percent of violent crimes against others are committed by someone with a diagnosis of serious mental illness.  The same risk factors that make someone without a diagnosable mental illness more likely to commit a violent crime also affect people with a mental health diagnosis — and at almost exactly the same rates. The strongest predictors of violence against others are substance abuse, a history of trauma and low socioeconomic status. There is overwhelming evidence that managing those three risk factors greatly reduces violent crime. In contrast, there is no evidence showing that a lower rate of mental illness in a population is associated with a lower rate of violent crimes against others. 

While the focus of politicians and gun-rights advocates may be on the danger posed to the public by people with mental illness, the most common intersection of violent crimes against others and behavioral health is actually the victimization of people with an untreated condition. Men and women with a serious mental illness who may or may not have a substance use problem are 11 times more likely to be the victim of a violent crime than the general population. 

Source: Colorado Department of Public Health and Environment. (Click on image to enlarge.)

Just as with other health conditions, social determinants of health — employment, income, education — strongly affect an individual’s chances of having a serious behavioral health condition. People with an untreated behavioral health condition who are low-income and whose social supports are weak, are far more likely to be the victims of sexual assault, domestic violence and homicide than people who do not have an untreated condition. The trauma of those crimes also increases the victim’s risk of suicide.

As Coloradans continue to debate firearms, violence and behavioral health in our society, we need to remind everyone of the essential facts. We need commonsense gun violence prevention laws, but we also need to address the behavioral health needs of our most vulnerable citizens. Colorado is moving in the right direction as it restores some of the funding for behavioral health services that were cut dramatically during the recession, and we must advocate vigorously for each and every additional dollar.

Funding, however, is not enough. It is time to bring suicide in general, and especially the role of firearms in suicide, out of the closet and into the light of day. More than three-quarters of all firearm deaths in Colorado are suicides. These violent deaths are almost always the fatal symptom of an untreated behavioral health condition. When that is the case, they are 100 percent preventable. If saving the most lives is our top priority, if we want to rescue the most families from the tragedy of losing a loved one to gun violence, then our focus must include preventing suicide.

Michael Lott-Manier is the public policy and advocacy coordinator at Mental Health America of Colorado.

By Kevin Vaughan and Burt Hubbard

I-News Network

During the 12-year span between the mass shootings at Columbine and Aurora, Coloradans used guns to kill themselves about four times more frequently than they used them to kill each other, an I-News analysis of death certificates found.

The analysis, which covered the years 2000 through 2011, also found that white residents disproportionately committed suicides with guns while minorities were disproportionately victims of homicide shootings.

In the wake of the July 20 attack at the Century Aurora 16, which left 12 people dead and more than 50 injured, state legislators introduced a flurry of measures, including proposals to prohibit the sale of high-capacity magazines, impose universal background checks, and ban people with concealed weapons permits from carrying guns on college campuses. The bills have sparked sometimes-emotional debate and prompted large protests as gun rights activists and supporters of the proposals beseeched lawmakers and Gov. John Hickenlooper.

Earlier this week, a plane circling central Denver towed a banner that read: “Hick: Don’t Take Our Guns.”

But people on both sides of the debate said that the reality of Colorado’s firearms deaths – that more than three-quarters of them are suicides – means that the proposals may do little to put much of a dent in the overall loss of life involving guns.

“I think that really goes much more to the issue of responsible ownership – that if you know you’ve got someone in your home who is struggling with depression, or something like that, you really ought to take active steps to either not have one or make sure if you do it is locked up,” said Tom Mauser, who has worked to pass gun control measures in the nearly 14 years since his son, Daniel, was killed at Columbine High.

“These are not suicide reduction bills, and no responsible person would claim they are,” said David Kopel, a law professor at the University of Denver and research director at the Independence Institute who has testified against some of the gun proposals. “They are, at their best, and their ideals, crime reduction bills.”

I-News analyzed data from the Colorado Department of Public Health and Environment on deaths from firearms between 2000 and 2011, the latest year available. The information comes from death certificates. It found:

• Suicides accounted for 76 percent of the 6,258 deaths from guns over the 12 years, while homicides comprised 20 percent. The rest were either accidental, legal shootings by law enforcement officers, or unexplained. Nationally, about 60 percent of gun deaths are suicides.
• Gun suicides were disproportionately committed by white residents, while homicide victims were predominately minority. White residents, who make up 70 percent of the state’s population, accounted for 88 percent of the gun suicides. On the other hand, 58 percent of homicide victims were minorities, who comprise 30 percent of the state’s residents. Blacks were victims in 21 percent of the homicides, but only make up 4 percent of Colorado’s population. Latinos were victims in 34 percent of homicides, while comprising 21 percent of the state’s population.
• Gun death victims were overwhelmingly male. They accounted for 85 percent of all deaths involving guns and 87 percent of suicides using guns.
• Those over age 70 had the highest rate of overall deaths from guns, 18 for every 100,000 residents of that age group. They were almost exclusively suicides. The 21-to-30 age group had the highest rate of homicides, about 5 for every 100,000.

I-News also calculated gun death rates by county and found wide geographic disparities.

Based on the number of overall gun deaths during the 12 years, the highest rates were in Montrose, Mesa, Fremont and Pueblo counties among medium- and large-sized counties – those with populations of more than 40,000.

The lowest rates were in Eagle, Douglas, Weld and Boulder counties. Denver and El Paso counties had the highest number of overall deaths involving guns, 831 and 804 respectively, but their rates per 100,000 residents ranked them in the middle among the counties.

Denver did have the highest number of residents killed in homicides, 342 over the 12 years or 5 per every 100,000 people, followed by Pueblo and Adams counties. El Paso County had the highest overall death toll from gun suicides, 596 over the 12 years, but Mesa had the highest rate of residents killing themselves with guns among larger counties, 15.6 per 100,000 residents.

Lanny Berman, a psychologist who is executive director of the American Association of Suicidology, said that the issue of guns and suicide is complex – and confusing. Overall in the United States, the percentage of suicides committed with guns has fallen in recent years even as the overall number of suicides hasn’t changed much.

“I’d like to think that it’s come down because there’s been a lot of public education and work in that area,” Berman said. “That said, hanging deaths have increased, and we can’t figure out how to engage restricted access to ropes and other forms of ligature. I can argue safe storage of a firearm, and convince some people that’s wise, but belts, and guitar straps and anything else one might use to hang themselves with, I have no argument.”

People whose suicide attempts are unsuccessful don’t necessarily go on to kill themselves, Berman said.

“The people who have been rescued off the Golden Gate Bridge – a very small portion of them go on to die by suicide,” he said. “If you can intervene – in this case by restricting access – people change their mind, good things happen, they get into treatment, time changes a lot of things. Who knows what, but things happen and people don’t necessarily stay suicidal. That’s just what we know about being suicidal, it waxes and wanes and is highly responsive to the moment. So change the moment and you’re going to save lives.”

Mauser, who said he backed the measures introduced this year because he believed they represented reasonable efforts to keep guns out of the hands of people who shouldn’t have them, also lamented the reality that when a gun is involved the odds of surviving a suicide attempt are small.

“You’re more likely to survive some of the other things,” Mauser said. “You’re not going to survive a gunshot to the head.”

Kopel, who said as a “card-carrying Roman Catholic” he was opposed to suicide, also expressed little hope that legislation could do much about the majority of gun deaths.

“The vast majority of gun deaths are suicides, and of those, they are hugely skewed to males and hugely skewed to older populations,” he said. “I think it’s highly unrealistic to think that any form of gun control is going to reduce suicide in this group.”

I-News is the public service journalism arm of Rocky Mountain PBS. Contact I-News or learn more at inewsnetwork.org

Contact Kevin Vaughan at kvaughan@inewsnetwork.org or 303-446-4936. Contact Burt Hubbard at bhubbard@inewsnetwork.org or 303-446-4931.

By Katie Kerwin McCrimmon

Colorado lawmakers plan to introduce legislation by next week to make it harder for people with mental illnesses to buy guns.

The legislation, which does not yet have a bill number, marks the last of several measures that Democrats are sponsoring this year to try and curb gun violence in the wake of the Aurora theater shootings and the massacre at Sandy Hook Elementary School.

The other bills include measures to limit magazines to 15 rounds, require background checks on all gun transactions, limit guns on campuses and require gun buyers to pay for their own background checks.

Rep. Beth McCann, D-Denver, is the House sponsor for the gun measure related to the mentally ill.

Rep. Beth McCann, D-Denver, wants mental health providers to do more to safeguard the public from patients who should not have guns.

“The goal of the bill is to try to give mental health professionals another tool so that if they believe someone is dangerous either to themselves or to someone else, they can actually report that to CBI (the Colorado Bureau of Investigation) and have a flag put on that person’s instant check so they wouldn’t be able to purchase a gun,” McCann said.

New York passed a similar measure earlier this year. Currently in Colorado, mental health workers can put people who are a danger to themselves or others in a mental health facility for 72 hours. But only in rare cases are those holds reported to law enforcement officials.

California requires notification to law enforcement when anyone faces involuntary commitment and those people are barred from buying guns for five years.

The Colorado measure could include a similar measure to the California bill or it may simply require that people be evaluated for gun ownership if they have been placed in a mental health facility on an involuntary hold.

McCann, a former prosecutor and former Denver Manager of Safety, said people who are mentally unstable should not have access to weapons.

“Currently (in Colorado) there’s no provision for a mental health professional to have any input,” McCann said.

It’s possible that Aurora theater shooting suspect, James Holmes, for example, could have been prevented from buying weapons, McCann said.

“He was seeing a mental health professional. Had she had the ability to say, ‘this person shouldn’t have a gun,’ who knows? He purchased his guns from licensed dealers. If there had been a red flag, he wouldn’t have been able to do that. It would have put up another barrier,” McCann said.

She personally witnessed crime scenes while working for the Denver District Attorney’s office and said she saw some extremely disturbing homicides that would not have happened without easy access to guns. Rep. Rhonda Fields, D-Aurora, whose son was shot and killed before he was able to testify against a gang member and who recently faced death threats from a gun enthusiast, will co-sponsor the bill, McCann said.

Some advocates for people suffering mental illnesses opposed the New York measure, fearing that people having violent impulses would avoid seeing a mental health provider or would not be entirely truthful with their therapists or psychiatrists if they knew the professional was required to report potentially violent behavior.

McCann has been meeting with advocates for people coping with mental illness here in Colorado. She said she is inclined to lean toward protecting the public, but may consider altering mandatory reporting requirements in order to encourage patients with mental illness to continue seeking care.

Advocates for people suffering from mental illness are “concerned about their ability to predict violence and…interfering with the patient-therapist relationship,” McCann said.

“We’re trying to see if there’s a way we can do a bill that would be acceptable to mental health professionals,” she said. “I don’t want to do a bill that’s not going to work.”

Mental Health America of Colorado has not yet taken a position on the bill, said Michael Lott-Manier, the group’s public policy and advocacy coordinator.

He warned, however, against preventing people from seeking mental health care.

“If people fear that they will be viewed differently than everyone else and have this mark upon their names, they are less likely to seek help,” Lott-Manier said.

“We believe gun violence is a public health issue and that it should be treated like one. Any legislative agenda that focuses solely on mental illness as a risk for gun violence will be ineffective,” he said.

For example, , Lott-Manier said 76 percent of 4,362 people in Colorado whose death was linked to a gun between 2004 and 2012 killed themselves.

As Colorado policymakers work to prevent gun violence, they must also focus on the suicide, not just mass shootings or homicides.

“We support a comprehensive package of commonsense gun violence prevention measures,” Lott-Manier said.

Gov. John Hickenlooper’s proposal to increase spending on mental health issues by $18.5 million includes a statewide crisis hotline and walk-in centers that would open around the state. These options could give people who are suicidal a safe way to seek help.

“Mental health is a part of every single human,” Lott-Manier said. “Everybody has mental health concerns. One in four people may have a diagnosis and seek treatment. But each of us needs to take care of (our mental health).

“When it comes to guns and death, the biggest issue is suicide, a fatal symptom of untreated behavioral health conditions,” Lott-Manier said.

While Colorado lawmakers and mental health advocates debate the merits of mandatory reporting, New York Gov. Andrew Cuomo pushed through a comprehensive package requiring mental health professionals to report concerns.

Law enforcement officials there are required to confiscate any firearms owned by a patient who is deemed to be potentially dangerous. Therapists in New York will not be sanctioned for failure to report potentially violent patients if the mental health providers “acted in good faith.” Colorado’s measure is expected to have a similar clause to protect providers.

“People who have mental health issues should not have guns,” Cuomo said. “They could hurt themselves. They could hurt other people.”

By Diane Carman

The debate over what’s to blame for gun violence – easy access to guns or lack of access to mental health care – ensued in earnest Tuesday night, with intense partisans from both sides in the audience erupting in applause frequently throughout a forum in Denver.

It’s unlikely that many minds were changed by the time the 90-minute standoff ended in what appeared to be a draw. But the debate highlighted the heated controversy that is being played out across the country as states and the federal government consider gun control bills and mental health care measures in the wake of the slaughter of 20 children and six adults in December at an elementary school in Newtown, Conn.

“The real thread that runs through mass murder in this country is not the particular type of gun or magazine that’s used but mental illness,” said David Kopel, research director at the Independence Institute and adjunct professor at the University of Denver’s Sturm College of Law.

David Kopel

He said “overwhelmingly” mass murders are committed by young men suffering from schizophrenia who are “dangerously mentally ill.”

States with weak involuntary civil commitment laws experience higher rates of violence, he said. “This is something that is long overdue to start addressing.”

Weld County District Attorney Ken Buck agreed. “We need to deal with the twisted minds who commit these crimes and not the twisted metal that is used,” he said.

After six years of advocating for more resources for mental health care, John Morse, president of the Colorado Senate and a former police officer, said, “I’m happy to have this new-found support. I just hope it’s real and that we’re actually going to get some resources” for mental health care.

“But the rest of the world is just as mentally ill as we are here,” he said, “and they don’t have the level of gun violence that we have because we do make it so easy to get guns. We have to address this both ways.”

State Rep. Rhonda Fields, D-Aurora, said she was pleased to hear the governor call for more funding for mental health care in his state of the state address, but cautioned that “it’s real important that we don’t demonize people who have a mental illness.”

An estimated one in four people suffers from mental illness, she said. “That’s a lot of folks. And people that work with people with mental illness are concerned about what we’re doing as it relates to trying to associate these mass murders with mental illness.”

Buck agreed. “There are only a small, small fraction of folks with mental health problems that commit these massacres,” he said. “It’s only a small, small fraction of people who own magazines over 20 rounds that commit any kind of crime. In fact, I would suggest that number is even smaller.”

Buck also said he thinks background checks to ensure that felons, persons under restraining orders and the mentally ill don’t buy guns are “insane.

“Criminals don’t buy guns in stores,” he said.

Gov. John Hickenlooper, who moderated the discussion, challenged that point.

“Criminals are often stupid,” he said. “Maybe the system of background checks doesn’t catch all the crooks, but it does catch the dumb ones.”

Tom Deland, president of the Colorado Association of Chiefs of Police, said, “It makes sense to whatever level we can to keep guns out of the hands of people who shouldn’t have them.”

U.S. Rep. Doug Lamborn, R-Colorado Springs, said that it’s clear background checks don’t work because the alleged shooters in Aurora and Tucson passed background checks as they assembled their arsenals, and the Sandy Hook School shooter avoided the system by killing his mother and stealing weapons from her home.

Fields sharply disagreed, pointing out that in Colorado “in one month alone close to 1,000 people were denied access to guns” because they were identified in background checks as convicted felons, mentally ill or under restraining orders in domestic violence situations. “We know that background checks do work.”

Citing polls showing 80 percent support for more comprehensive background checks, Fields said the “voters are saying … they are a reasonable approach to addressing gun violence.”

For his part, Hickenlooper, has called on leaders to do more to prevent gun violence. He has said he supports limiting gun magazines to 15 rounds and charging gun buyers for their background checks. But he has not declared whether he’ll support all the gun control measures now under consideration in the Legislature. On Tuesday evening, he tried to straddle the divide between the two sides represented by the participants.

“We are in a different place in the West,” he said. “Our heritage of guns is rich …. Over a third of Coloradans own at least one gun and two of the worst shootings in history took place in Colorado.”

The same challenge is being faced by Congress and other states, he said, “how do we respect the rights of law-abiding citizens to own their firearms while at the same time maintaining the safety of our communities.

“Because of the horrific nature of those shootings it puts Colorado at the front of the debate.”

An estimated 1,000 people attended the event at the Seawell Ballroom, which was sponsored by the Counterterrorism Education Learning Lab.