Nancy VanDeMark has worked in the mental health and substance use field for more than 30 years, most recently as director of the Office of Behavioral Health in the Colorado Department of Human Services. She previously worked as a consultant, an executive-level administrator of a substance use treatment organization and a research director. Her work has focused on improving mental health and substance use services for individuals with the most complicated needs.
Ascent: You've been working to improve mental health and substance use services for individuals for your entire career—in government, the private sector and academia. What are the top three changes you've seen in the past five years in this arena?
VanDeMark: One thing is the increased attention and resources moving toward treatment of substance use disorder. That’s noteworthy. Until recent years, substance use disorders and people in recovery have been relatively hidden. It took the courage of high-profile people who have publicly acknowledged their substance use history, and of their family members, sharing their tragic story of loss, that has humanized the faces of people with substance use issues. The stigma, while still apparent, has begun to become less apparent in certain circumstances.
Another is the wider acknowledgement of the role of adverse childhood events as risk factors for later physical and mental health conditions. Although the first studies that Kaiser did on ACEs were completed in the ‘90s, it seems like in the last five years the general public has begun to understand that the environment of early childhood can create changes in the brain. This helps people better understand that mental health and substance use conditions are not moral weaknesses but have similar paths of development as physical health concerns. As a result, we’re helping people to acknowledge that they’re not morally weak but instead have health problems—just like any other health problem.
Finally, the trend of treating substance use and mental health as health conditions has enabled access to services through primary care. This trend has set the stage for more equitable coverage by requiring companies to provide mental health and substance use services equally with health conditions. We still have a way to go, but we’ve made quite a bit of progress on that front as well.
Ascent: What is the top challenge Coloradans face in terms of access to services, and what is Mental Health Colorado's role in addressing that challenge?
VanDeMark: We work on three levels: to promote mental health, to end stigma and to ensure access to mental health and substance use services. What we know is that stigma continues to prevent many people from accessing care. The Colorado Health Access Survey (by the Colorado Health Institute) found that almost a quarter of people needing mental health treatment don’t seek it because they’re afraid someone might find out they have a problem. This rate doubles when you look at the percentage of people who need substance use treatment but don’t get it; it’s right around 44%. So even though we’ve seen growth in availability of mental health and substance use services in primary care sites, many people still feel uncomfortable about talking to a professional about their problems.
Access is also a problem, and it’s a particular concern in the rural and frontier parts of the state. This is largely because of a lack of available psychiatric beds on the Western Slope and the lack of outpatient mental health and substance use treatment across the state. Behavioral health workforce challenges are acute for our rural and frontier areas as well. The stigma can also differ across the state. The culture of independence, self-sufficiency and self-determination creates strength in our rural communities but also inhibits people from seeking mental health care.
We are seeing increases in public awareness of the need for substance use services and increases in support for measures that expand mental health and substance use treatment. We have a lot of opportunity in health care to get ahead of some of the physical health costs by fully funding mental health and substance use services. These problems, if left untreated, will create large liabilities for the state in the future. Our governor created an Office of Saving People Money as one of his signature initiatives, and clearly, increasing our focus on mental health and substance use will help the state do just that over the long haul.
Colorado ranks among the top 10 states in suicide; it’s the number one cause of death for young people. We have a particular need to ensure people access to mental health and substance use services. People are dying as a result of untreated substance use and mental health disorders in our state and across the nation.
Ascent: As a leader of a non-profit advocacy organization, what is the single most important message the community needs to hear about treatment and prevention of mental health and substance use disorders?
VanDeMark: It’s a simple message: There is effective prevention and treatment for mental health and substance use conditions. If you believe that someone is struggling with a mental health condition or at risk for suicide, it is important to talk with them and encourage them to seek help, whether it’s through Colorado Crisis Services (1-844-493-8255 or text "talk" to 38255), their primary care provider or by contacting a mental health or substance use counselor.