Leaving Summit County was hard for Eric Turner, but he knew he needed help.
After his first year in the mountains, his wife joined him in the High Country, and the two were making a life for themselves. But Turner said his alcohol addiction had started to get out of control.
Years into talking to a therapist about his PTSD, Turner said he had finally started discussing his alcohol problems with a counselor. Eventually, they began discussing inpatient treatment — an option that meant leaving the county.
Get top headlines and KUNC reporting directly to your mailbox each week when you subscribe to In The NoCo.
Inpatient treatment involves checking into a rehab facility and staying there for the duration of the treatment — often weeks at a time. Turner attended two inpatient treatment programs in Denver, then another program tailored for first responders and veterans in California.
“That was extremely difficult for both of us — especially for my wife,” Turner said. “She had to take over all the responsibilities at home. … We were able to do phone calls a couple times a week, but other than that, the communication was pretty much cut off.”
While the behavioral health landscape in Summit County has grown more robust in recent years, there are still gaps in resources that force people to seek treatment outside the county. There continues to be a lack of services and providers in certain areas of care, including inpatient services, intensive outpatient services, psychiatric-level providers, bilingual providers and Medicaid providers, according to the Summit County Public Health Department’s 2022 health assessment.
Ruby Hornback, a clinical case manager for the Summit County Sheriff’s Office who works to connect those incarcerated in the local jail with substance-use treatment, said some of the resources that would be most helpful remain a pipe dream.
“Sober living would be the No. 1 thing that would be most helpful for a lot of people around here, I believe,” Hornback said. “The other thing we don’t have access to is inpatient residential treatment, and there’s also no intensive outpatient treatment for men in this community.”
Many providers also don’t accept Medicaid, Hornback said, putting higher-level services out of reach for those who have fewer resources. So when it comes time to connect a client with resources, she said the lack of available local options for certain types of treatment can be disappointing.
Those with deep ties to Summit County can feel “disempowered” when they have to choose between staying in the community or seeking help elsewhere, Hornback said. Even if people know there are resources like sober living, shelters or inpatient treatment in places like Denver, Grand Junction and Colorado Spring — she said many people still don’t want to leave.
“There is a really big resistance to leave this mountain lifestyle because they all came here for a reason — and some of them grew up here as well and don’t want to leave, either,” Hornback said. “It’s really unfortunate that those folks who do have such a big community connection to Summit County don’t want to leave but aren’t able to find a way to really be successful here.”
‘A very long journey’
Even as the party culture in mountain towns can encourage drug and alcohol use, Summit County residents report difficulty accessing care.
Summit County Commissioner Tamara Pogue described the prevalence of substance-use disorders among locals as somewhat of an “endemic” that the county has only just started to make progress on in recent years.
“Summit County has long struggled with substance use disorders,” Pogue said. “Residents often turn to substances as a coping mechanism, and that leads to us having very high rates of substance-use disorder.”
Behavioral health — a term encompassing both mental health and substance-use disorder, and recognizing their interconnected nature — has been identified in public health reports as a top priority for improving overall health and wellbeing in Summit County.
More than a quarter of local respondents to a health survey reported that they or a loved one did not receive the mental health care they needed in the past 12 months, according to a Summit County health plan published in 2022. Nearly 1 in 10 respondents said they or a loved one did not receive the substance-use disorder treatment they needed.
There are many barriers to accessing care in Summit County — stigma being perhaps the biggest hurdle for many. Still, just a few years ago, the behavioral health landscape in the county looked very different.
The Strong Future ballot measure that Summit County voters passed in 2018 created a dedicated stream of funds to help bring behavioral health providers to the area. The county also severed ties in 2021 with Mind Springs, its community mental health center, over concerns about quality of care. An audit later found “life-threatening” errors among a sample of Mind Springs outpatient clients.
“We all know this has been a very long journey for Summit County,” Pogue said. “We have had providers in the past who have not provided the level of service our residents have a right to expect.”
The Strong Future ballot measure created a mill levy on properties in Summit County, raising millions of dollars a year, about $2 million of which is dedicated to behavioral health services annually, Pogue said. To date, the Strong Future fund has raised almost $15 million for behavioral health since 2018, according to county government records.
But barriers to finding treatment persist. The mountain resort region that includes Summit County has some of the highest rates of residents without health insurance — creating additional hurdles to accessing care. In 2023, the region’s uninsured rate stood at 12.5%, more than double the state average of 4.6%, according to the Colorado Health Institute.
“Since Strong Future passed and Building Hope was established, we’ve been really able to move the needle on access to care,” Pogue said. “There are a lot of new services that didn’t exist five years ago, but we still have gaps in our care.”
Building hope in the community
In the past decade, more than 80 people in Summit County have died by suicide. Building Hope — now the backbone of much of the county’s mental health support — was founded in 2016 after a rash of local suicides.
Among those was Patti Casey, a longtime Breckenridge resident with deep community ties who had kept her lifelong struggle with depression and alcoholism a secret. To honor her, Casey’s family advocated for better mental health care and set up a memorial fund that provided the initial support for Building Hope.
“What came out of her death and the others was that there was not a coordinated system of mental health happening in Summit,” Building Hope Executive Director Kellyn Ender said.
Substance use factors heavily into suicide, which is the eighth leading cause of death in Colorado, according to the Centers for Disease Control and Prevention. The Centennial State has among the highest rates of suicide deaths in the country.
Almost one-third of people who died by suicide in between 2016 and 2020 had a problem with alcohol, and about one-quarter had a problem with a substance other than alcohol, according to a report issued by the Colorado Department of Public Health.
Even more consumed substances around the time of their death, the state report found. Toxicology reports indicate that about 38% of people who died by suicide had alcohol in their systems, while 22% had consumed marijuana. Opioids were present in about 17% of suicide decedents, and benzodiazepines — such as Valium and Xanax — were present in about 14%, the report states.
“It is very rare that (coroners) see a suicide happen without some kind of substance on board,” Ender said. “Whether that means substance use was an issue or it gave liquid courage for the moment, it’s certain that substance use, mental health and suicide are very much enmeshed.”
In the years since Building Hope was founded, local suicide deaths, which once reached double digits almost annually, have dropped significantly, according to data from the Summit County Coroner’s Office.
From 2019 and 2023, suicides in Summit County declined by almost one-third compared to the previous five-year period, an analysis of the data revealed.
Behind the scenes, Building Hope has worked to entice providers to come to the community, offering scholarships for clinical training and networking opportunities that help create bonds between providers, government and nonprofits, Ender said.
The insurance landscape for mental health especially is “extremely difficult,” but Building Hope has worked with providers to increase the types of insurance that are accepted locally, she added.
While Ender acknowledged that continued work is needed around behavioral health, especially substance use, she said that there are more therapists and community resources in Summit County now than there were just a few years ago.
Through its mental health scholarship program, Building Hope has made counseling available for any local resident who needs it, providing 12 free sessions for those who lack insurance or aren’t covered by insurance, she said.
“Anyone who wants therapy should be able to get it without having finances be a barrier,” Ender said. “If you live or work in Summit and you need help finding therapy, we can help you out.”
‘Readiness to change’
The road to overcoming a substance-use disorder is different for everyone. That’s why public health officials and those recovering from addiction say having a wide suite of services available to the community is important to allow people to choose their own path.
Over the past few years, Summit County has focused on creating a “robust system” of outpatient care, Pogue said. Strong Future funds have supported Building Hope, mental health and substance-use navigation services at the Family & Intercultural Resource Center, withdrawal management — or detox — through Recovery Resources, school-based behavioral health services and more, she said.
“We want to ensure whatever treatment really resonates to a given person that they have that methodology or modality available to them,” Pogue said.
Medication-assisted treatment is one resource that is now available to help those with substance-use disorders that weren’t available just a few years ago, Pogue said. Medication-assisted treatment uses medications to manage withdrawal symptoms in combination with counseling to treat addiction.
While residents had to drive to Denver to receive medication-assisted treatment in the past, the Front Range Clinic and Summit Community Care Clinic now offer treatments such as buprenorphine and naltrexone to treat opioid addiction at locations in Summit County.
But especially on the substance-use side of behavioral health, there remains a lot of work to be done.
“There is both a lot being done and a long way to go,” Pogue said. “And I think there is still a lot of work to help folks know what services are available, and if you’re in a crisis, it’s really hard to learn what is available.”
Michelle Marzo, a 30-year Summit County resident who runs a private counseling practice in Frisco, believes all clinicians need to be cross-trained in addiction. Therapy is often people’s most direct contact with the behavioral health system, and people tend to build a sense of trust with their therapist, Marzo said.
Because of how widespread substances are in society — and in the apres ski culture especially — therapists who don’t do a substance-use evaluation with their clients could be overlooking the underlying causes of the mental health conditions a person is exhibiting, she said.
For example, a client who drinks three Red Bull energy drinks and smokes a pack of cigarettes a day may present signs of anxiety or another mental health issue, but unless a therapist is looking at substance use, they’re not addressing the root cause, Marzo said. Understanding a person’s substance use at least allows a therapist to talk about managing it with their client, she said.
“When it is so ingrained in our culture that there’s nothing wrong with it, people really have to sometimes be ready, and it’s all about readiness to change with substance abuse,” Marzo said. “But we as providers can at least screen for it and put that idea in their mind through their counseling.”
With an abundance of therapists in the community, there are many more options for people to access care in Summit County today than there were five years ago, Pogue said. But amid a housing crisis, it is cost-prohibitive to bring sober living or inpatient rehab facilities to the county, she said.
Still, Summit County continues to work on behavioral health. Last year, the Summit County government designated Eagle Valley Behavioral Health as its community health center. The county’s partnership with the wholly owned subsidiary of Vail Health is expected to further expand the availability of mental health services locally and reduce barriers to accessing help.
In 2025, Vail Health plans to open the Precourt Healing Center, a 28-bed inpatient behavioral health facility in Edwards that will provide care for adults and adolescents experiencing acute psychiatric crises.
While still outside of Summit County, Pogue called the Precourt Healing Center and partnership with Eagle Valley Behavioral Health a “really big deal” for local residents.
Behavioral health infrastructure in Summit County has ramped up in recent years, but there are still needs going unmet.
Last year, the Summit County government allocated $2.5 million in Strong Future funds for behavioral health but received $5.3 million in requests from community organizations focused on mental health and substance use, Pogue said. She said the demand shows that the county needs to redouble its efforts to access local, state and federal funds for behavioral health.
“I think this both speaks to the success of the model, as well as the need that we aren’t able to meet,” Pogue said. “There just aren’t enough dollars to plug all the holes we need to plug for our residents and what they need.”
