Colorado’s LGBTQ+ youth are living with high rates of depression, stress and thoughts of self-harm, but finding treatment in Northern Colorado can be a challenge.
This has been the experience of 15-year-old Maddie Maes. Her mental health has been up and down for most of her life.
“And then in eighth grade, it got so bad. It was so terrible,” Maes said, sitting on the couch with her mom, Kristin Vera, at home in Fort Collins.
Maes said she was sad and anxious all the time. She struggled to talk with strangers and lost friends.
“Her mood was so extraordinarily low. And of course, I was worried about self-harm, suicide and also, it's just hard to see your kid being miserable,” Vera said.
Maes’ new therapist, who she started seeing during the pandemic, wasn’t the right fit. It was around this time that Maes told her family she was transgender, something she had begun to question as early as third grade.
“And so I do think that they're related, the gender identity struggle and the depression struggle,” Vera said. “Because feeling like something is just not right is, I think, how Maddie felt. Like something wasn't right, but she couldn't name what it was.”
'It felt like such an emergency'
The family was in a common situation: having a hard time finding appropriate, affordable care for their child in crisis. Kids who identify as LGBTQ+ like Maddie struggle at much higher rates than other youth demographics. According to the 2021 Healthy Kids Colorado Survey, which polls high school students, 74% of transgender respondents experienced persistent sadness and hopelessness. That year, over half seriously considered suicide.
“I felt consumed by it,” Vera said. “It felt like such an emergency to find help for my kid.”
She searched therapists covered by her insurance but many weren’t accepting new clients or were only offering telehealth. Vera worried about having to go to Denver or Boulder for care. She worried about being able to afford out-of-pocket expenses.
Federal and state laws require health insurance companies to offer comparable coverage for behavioral and physical health services. Still, many Coloradans find themselves unable to easily access mental health services.
Under Colorado’s time and distance rules, insurance carriers must ensure that members can get behavioral health care within seven calendar days and within a specified number of miles. While the state’s Division of Insurance receives few complaints related to an inability to find care quickly and close-by, it says that's more likely due to lack of awareness.
Colorado lawmakers and the Division of Insurance have taken steps in recent years to expand and strengthen enforcement of laws related to insurance coverage for behavioral health care.
For example, the Colorado Option, a standardized health benefit plan established last year, requires behavioral health providers to be culturally competent and reflect the diversity of enrollees.
But in practice, many families experience the panic of trying to help their kid in crisis without a clear path forward. According to a recent analysis by the Colorado Health Institute, 42% of LGBTQ+ Coloradans reported needing mental health help and not getting it, compared to 15% of heterosexual, cisgender residents.
“And there aren't that many (therapists) who specialize in kids like my kid,” Vera said. "I just remember the anxiety of being in that space of feeling like someone has got to help us. But who? Where are they?”
'The need is huge'
Eventually, Maes’ family found The Rainbow Circles, a nonprofit practice based in Fort Collins primarily serving LGBTQ+ kids and adults.
The offices are cozy, lit by lamps and decorated with plants, rainbow carpets, a feelings wheel and framed poetry from a transgender writer. Dr. M Watson Saltis and their colleague Kate Peters point out the gender affirming clothing closet and community art wall.
“We wanted it to feel not like a stifled therapy office,” Saltis said. “It does actually feel like a living room.”
The Rainbow Circles is trying to remove a major barrier to care: cost. Around 40% of their clients come from low income families. The practice accepts Health First Colorado, the state’s medicaid program as well as some private insurance. Remaining costs are covered by grants, fundraising and out-of-pockets payments on a sliding scale.
When the practice first opened in January of last year, Saltis was the sole licensed clinician– Peters was still an intern. Since then, the Rainbow Circles has expanded: they have more than tripled their office space and expect to employ 13 clinicians by September.
“The need is huge,” Saltis said. “I don't know any other queer, nonbinary registered play therapists in Northern Colorado, in Fort Collins. I think maybe there's a couple, but it's such a small area who also takes insurance. My personal wait list used to be like two years long.”
Colorado doesn’t track the gender identity or sexual orientation of licensed mental health professionals, but according to the American Psychological Association (APA), most psychologists in the U.S. are white women.
Less is known about gender and sexual orientation. In a 2021 APA survey, however, 11% of respondents identified as gay or bisexual while the number of nonbinary or transgender psychologists was too small to report. Nine percent of respondents reported working with gender non-conforming populations frequently, while 33% felt knowledgeable in how to work with these clients. Both numbers have risen since 2015, the previous survey year.
In 2021, the APA published guidelines on working with clients of various sexual orientations. But LGBTQ+ curriculum is not a specific accreditation requirement for most doctoral degrees in psychology.
“For psychologists, we see diversity as a construct,” APA’s Chief Education Officer Dr. Cathi Grus said. "Gender identity and sexual orientation is just one aspect so it would be a challenge for all psychologists to be competent across all aspects.”
Grus noted that theAPA’s code of ethics directs psychologists to work within the boundaries of their education and experience, and requires additional training to remain competent, particularly if a technique or population is new to them.
Kate Peters' experience, as a clinician and a person in therapy, is that sufficient training is not widespread.
“I think it's seen as an add on,” Peters said. “Like, it's seen as like, ‘This is a population that I probably won't have to work with or that it's not super important for me to know about. Like this is just so small that I'm never going to encounter it.'”
While there is no consensus on how much training is needed, an effort is underway to get more information out there.
'People care about you'
In 2021, the Denver-based nonprofit Envision:You surveyed hundreds of LGBTQ+ Coloradans about their behavioral health concerns. The vast majority said they would use a resource that helped identify LGBTQ+ affirming providers and that current resources were hard to trust or out-of-date. Respondents talked about having to educate providers about their identities and providers failing to use their correct name and pronouns.
Envision:You is working on a wellness app set to launch next year that will help users find vetted mental health providers who specialize in working with Colorado’s LGBTQ+ population.
Steven Haden, the co-founder of Envision:You, is a therapist himself and has the lived experience that can be crucial to connecting with patients.
“In my own journey, having reached a point where I was suicidal, where I had lost hope for a better day when the resources that were available to me were not affirming. As a young gay man, I felt lost,” Haden said.
He points to an alarming statistic. Lesbian, gay and bisexual youth are more than four times as likely to attempt suicide than their heterosexual peers.
“The suicide rates. It's just heartbreaking,” Haden said. “What I want young LGBTQ folks to know both in Colorado and around the country is that people care about you. There’s resources and support out there…And I can say with a lot of confidence that a better day is ahead for you.”
Maddie Maes, who spent the summer working at a local hardware store and building a computer from scratch, feels better now than she did at this time last year. She still lives with depression, but it is no longer constant. Therapy has been helping her navigate her ups and downs and work through tough situations – like tricky friendships, for example.
“Even if, like, my problem doesn't get fixed in a day or, like, a month, it's still really good to talk about it. I feel like even if I'm not, like, completely better, I do feel better,” Maes said.
Last week, Maes started as a ninth grader at Poudre High School in Fort Collins. Her mom says her daughter is ready for a bigger experience. Maes is thinking about joining the robotics club. Her first day, she said, was pretty cool and she met a lot of people.
KUNC is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity, and newsrooms in select states across the country.
Correction: A previous version of this story cited the launch date of the wellness app from Envision:You as later this year. The story has been updated to reflect the new launch date of next year and also to correct the misspelling of Steven Haden's last name.
